May 4, 2016
Thank you for your continued efforts to help your patients understand the Zika virus risks and how they can prevent all mosquito-borne infections. At this juncture, clinicians that provide care to pregnant women, women of reproductive age, and special needs infants are at the forefront of the Zika virus response. I also understand that the diagnosis and management of Zika for your patients could be very complex. Protecting pregnant women from Zika virus infection and its potential adverse health effects is a top priority for the Virginia Department of Health (VDH) and can only be accomplished with your assistance.
Information regarding Zika virus evolves rapidly, and this letter provides some critical updates for your clinical practice. The following are key points for your awareness:
- Mosquito season in Virginia began May 1; please continue to educate your patients regarding mosquito bite prevention.
- Public health testing criteria have been expanded to identify possible locally acquired cases
- Zika virus RT-PCR testing is now available commercially through Focus Diagnostics,
- Regularly check the VDH Zika website and the Centers for Disease Control and Prevention (CDC) Zika website for the most up-to-date information.
Cases in Virginia
All suspected Zika virus disease cases must be reported to the local health department. As of April 27, 2016, VDH has reported to the CDC 13 cases of Zika virus disease in Virginia residents (2 in Northwest Region, 5 in Northern Region, 1 in Eastern Region, 3 in Central Region, and 2 in Southwest Region).
Zika Virus Laboratory Testing
In Virginia, the Division of Consolidated Laboratory Services (DCLS) is now testing for Zika virus using the CDC-developed Zika IgM antibody capture ELISA (Zika MAC-ELISA) and Trioplex Real-time RT-PCR Assay under Emergency Use Authorization by the Food and Drug Administration (FDA). Depending on the timing, the Trioplex RT-PCR Assay can be conducted on urine or serum; if urine is submitted, it must be paired with a serum specimen. (Please see DCLS Testing Instructions for detail.) On April 28, 2016, the FDA issued an Emergency Use Authorization (EUA) to authorize the emergency use of Focus Diagnostics, Inc.’s, Zika Virus RNA Qualitative Real-Time RT-PCR test for Zika virus in human serum specimens.
VDH Public health testing criteria for Zika virus have been expanded in order to increase surveillance efforts aimed at identifying possible locally acquired (via mosquito transmission) cases. Zika virus lab testing conducted at DCLS requires review and prior approval by public health officials before testing will be performed. Health care providers should continue to utilize the public health testing algorithm and may contact their local health department to discuss criteria for Zika virus testing, for assistance in specimen collection and submission, and for general guidance on interpreting test results. As Chikungunya virus infection and dengue virus infection can have early symptoms resembling those of Zika virus infection, and co-infection with these viruses is possible, in addition to testing for Zika virus, testing should be considered for Chikungunya and Dengue.
The following resources are available on the VDH Zika website to assist you in decision making regarding diagnosis, testing, specimen collection and handling, and interpretation of complex laboratory results:
- NEW public health testing recommendations: VDH Zika testing algorithm
- DCLS laboratory testing instructions
- CDC Testing fact sheets for health care providers, patients, and pregnant women for the Zika IgM MAC-ELISA and the Trioplex RT-PCR
- Test interpretation: common Zika virus lab test scenarios
- VDH Quick Reference Table for evaluating Chikungunya, Dengue and Zika virus
Educational Tools to Provide Guidance to Your Patients
The VDH “Zika Virus Disease Checklist for Clinicians” includes many links to patient resources/handouts. Thank you for considering the following actions when interacting with your patients regarding the prevention, testing, and management of Zika virus disease. Links to available patient handouts/educational resources are provided for each recommended action:
- Educate all patients on ways to prevent exposure to Zika virus by encouraging them to:
- Provide specific guidance for pregnant women:
- Prevent exposure to Zika virus, through mosquito contact and sexual transmission
- For pregnant women who are tested for Zika virus, introduce the US Zika Pregnancy Registry. For your pregnant patients with positive or inconclusive lab results, public health will be in touch with you regarding the collection of data at periodic intervals during pregnancy and through the baby’s first year of
- Provide guidance to women of reproductive age and their sexual partners: CDC provides time frames to consider regarding pregnancy planning as it relates to Zika
- For patients that are suspected or confirmed to have Zika virus:
- Please ensure the patient understands the importance of taking responsibility to avoid mosquito bites and eliminating mosquito habitats where they
- Please remind the patient that the local health department may contact them to ask permission to conduct mosquito surveillance activities around their home.
- Please remind the patient to defer blood donation for 4 weeks as per FDA
Coordination of Care for Infants Born with Birth Defects
If an infant has been diagnosed with a birth defect, such as those associated with Zika virus exposure, these infants and their families are eligible to receive care coordination and child development services through the VDH’s Children and Youth with Special Health Care Needs (CYSHCN) programs.
- Care Connection for Children is a network of six regional centers that provide care coordination, medical insurance evaluation, family-to-family support, and other related
- Child Development Centers are located across five regions and provide diagnostic assessment, care planning, follow-up care coordination, and referral to those children and youth suspected of having development disorders associated with sensory or physical
Please visit the VDH Zika Virus Disease Information website and the CDC Zika Virus website for more information. Please contact your local health department for disease reporting, testing guidance, help with test interpretation, and other questions you may have regarding Zika virus.
Marissa J. Levine, MD, MPH, FAAFP
State Health Commissioner