CDC HAN: CDC Expands Guidance for Zika Virus Transmission in Miami-Dade, Florida

Message Details

Date Sent: 08/22/2016 08:35 AM EDT
Sender: Michigan Health Alert Network
Subject: CDC HAN: CDC Expands Guidance for Zika Virus Transmission in Miami-Dade, Florida

Message:

Summary
CDC has previously issued travel, testing, and other guidance for local mosquito-borne Zika virus transmission (active Zika virus transmission) for a one-square-mile area in the Wynwood area of‎ Miami that the Florida Department of Health (FL DOH) identified. The guidance for those who live in or traveled to this area any time after June 15, 2016, remains in effect.
FL DOH continues to investigate active Zika virus transmission in South Florida. Investigation has revealed a new area of active transmission in a 1.5-square-mile section of Miami Beach. In addition, FL DOH has identified multiple other individual instances of mosquito-borne Zika virus infection and an increase in travel-related cases. 
Because the incubation period for Zika infection is up to two weeks, a high proportion of infected people have no symptoms, and the diagnosis and investigation of cases takes several weeks, coupled with these individual instances of mosquito-borne Zika virus infection and increase in travel-related cases, it is possible that other neighborhoods in Miami-Dade County have active Zika virus transmission that is not yet apparent.
For the identified area of active transmission in Miami Beach, CDC advises that the recommendations outlined below be followed. Based on the earliest time of symptom onset and a maximal two-week incubation period for Zika virus, this guidance applies to pregnant women, women of reproductive age, and their partners who live in or traveled to Miami Beach after July 14, 2016. 
For all other areas of Miami-Dade County, while further investigations are underway, CDC advises strict adherence to precautions to prevent mosquito bites. Consistent with the August 3 recommendation of the Florida Governor, pregnant women in these areas should be assessed for potential exposure to Zika virus and, when indicated, obtain laboratory testing.  Pregnant women and partners of pregnant women who are concerned about potential Zika virus exposure may also consider postponing nonessential travel to all parts of Miami-Dade County. 
This is an ongoing investigation, and FL DOH and CDC are working together to rapidly learn more about the extent of active Zika virus transmission in Miami-Dade County. CDC will update these recommendations as more information becomes available. 
Recommendations

1. Pregnant women should avoid travel to the designated area of Miami Beach (http://www.cdc.gov/zika/intheus/florida-update.html), in addition to the designate)d area of Wynwood, both located in Miami-Dade County, because active Zika virus transmission has been confirmed in both of these areas.
2. Pregnant women and their partners living in or traveling to the designated areas should be aware of active Zika virus transmission and should follow steps to prevent mosquito bites (http://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html). Healthcare providers caring for pregnant women and their partners should visit CDC Zika website (http://www.cdc.gov/zika/) frequently for the most up-to-date recommendations.
3. Women and men who live in or who have traveled to the designated area of Miami Beach since July 14, 2016, should be aware of active Zika virus transmission, and those who have a pregnant sex partner should consistently and correctly use condoms or other barriers to prevent infection during sex or not have sex for the duration of the pregnancy. The same recommendation applies for women and men who live in or who have traveled to the designated area in Wynwood since June 15, 2016. 
4. Pregnant women and partners of pregnant women who are concerned about potential Zika virus exposure may also consider postponing nonessential travel to all parts of Miami-Dade County. 
5. All pregnant women in the United States should be assessed for possible Zika virus exposure and signs or symptoms consistent with Zika virus disease at each prenatal care visit. Women with ongoing risk of possible Zika virus exposure include those who live in or frequently travel to the designated areas of Miami Beach and Wynwood due to the possibility of active Zika virus transmission.  Women with limited risk of Zika virus exposure include those who traveled to the designated areas of Miami Beach and Wynwood or had sex without using condoms or other barrier methods to prevent infection by a partner who lives in or traveled to the designated areas of Miami Beach and Wynwood. Each prenatal evaluation should include an assessment of signs and symptoms of Zika virus disease (acute onset of fever, rash, arthralgia, conjunctivitis), travel history, and sexual exposure to determine whether Zika virus testing is indicated. Limitations of laboratory tests used to diagnose Zika virus infection should also be discussed with pregnant women and their partners.
6. Pregnant women with possible exposure to Zika virus and signs or symptoms consistent with Zika virus disease should be tested for Zika virus infection based on time of evaluation relative to symptom onset in accordance with CDC guidance (http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e).
7. Pregnant women with ongoing risk of possible Zika virus exposure and who do not report symptoms of Zika virus disease should be tested in the first and second trimesters of pregnancy in accordance with CDC guidance (http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e).
8. Pregnant women with limited risk of possible Zika virus exposure and who do not report symptoms should consult with their healthcare providers to obtain testing for Zika virus infection based on the elapsed interval since their last possible exposure in accordance with CDC guidance (http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e).
9. Women with Zika virus disease should wait at least eight weeks after symptom onset to attempt conception, and men with Zika virus disease should wait at least six months after symptom onset.
10.  Women and men with ongoing risk of possible Zika virus exposure who do not have signs or symptoms consistent with Zika virus disease and are considering pregnancy should consult their healthcare provider. Due to the ongoing risk of possible Zika virus exposure, healthcare providers should discuss the risks of Zika, emphasize ways to prevent Zika virus infection, and provide information about safe and effective contraceptive methods. As part of their pregnancy planning and counseling with their healthcare providers, some women and their partners living either of the two designated areas (Miami Beach and Wynwood) might consider if now is the right time to get pregnant due to the possibility of exposure to Zika virus during pregnancy or the periconceptional period.
11. Women and men with limited risk of possible Zika virus exposure and who do not report signs or symptoms consistent with Zika virus disease should wait at least eight weeks after last possible exposure to attempt conception.

For More Information

• Interim Guidance for Health Care Providers Caring for Pregnant Women:
  MMWR:  http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_w
  Summary:  http://www.cdc.gov/zika/hc-providers/pregnant-woman.html
• Fact Sheet with Testing Algorithms:http://www.cdc.gov/zika/pdfs/testing_algorithm.pdf
• Interim Guidance for Prevention of Sexual Transmission of Zika Virus: http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e2.htm?s_cid=mm6529e2_w
• Updated information on active transmission of Zika virus from the Florida Department of Health: http://www.floridahealth.gov/newsroom/index.html

--This message is being sent to the following statewide MIHAN roles: Communicable Disease / Infection Prevention | Epidemiology | HAN Coordinator | Health Officer | Healthcare | Laboratory | Physician / Medical Director --