Health Alert
FIRST TRAVEL-RELATED ZIKA VIRUS CASE CONFIRMED IN DELAWARE

Delaware Division of Public Health (DPH) received confirmation today from the Centers for Disease Control and Prevention (CDC) of our first, laboratory-confirmed, travel-related case. The individual is an adult female and she is not considered infectious. As expected, the illness was mild and she has already recovered. Pregnancy is not an issue.

SUMMARY

As the Zika Virus outbreak continues to evolve, DPH will provide updated guidance from the CDC to the healthcare community.

Most people infected with Zika do not develop symptoms. About one in five people infected with the virus develop the disease. Zika is generally a mild illness currently widespread in Central and South America and the Caribbean. Anyone who lives or travels in the impacted areas could be infected regardless of whether they show symptoms. The most serious threat linked to Zika is serious birth defects. Microcephaly and other poor pregnancy outcomes are now being linked to the virus.

BACKGROUND

Zika is generally transmitted through bites of infected Aedes mosquitoes. The mosquito that most commonly transmits Zika (Aedes aegypti), as well as dengue and chikungunya, is very rare in Delaware. However, in Delaware we do have another Aedes species of concern for possible transmission of Zika, the Asian tiger mosquito, Aedes albopictus. Local Zika transmission via a mosquito is possible once mosquito season starts but it depends on a variety of factors.

The most significant threat linked to Zika is serious birth defects. While it generally presents as a mild illness, there have been reports of serious birth defects to infants whose mother contracted the virus while pregnant. Microcephalya condition in which a baby’s head is smaller than expected when compared to babies of the same sex and age, and other poor pregnancy outcomes in babies of mothers are now being explicitly linked to the virus, per a new CDC announcement today.

As a result, the Division of Public Health (DPH) is focusing its messaging and awareness on preventing exposure to pregnant women and their male partners.

RECOMMENDATIONS/REPORTING

Precautions for pregnant women or women who may get pregnant:

• If you are pregnant, postpone travel to the countries where Zika virus transmission is ongoing.
• If your male sexual partner has traveled to or lives in an area with active Zika virus transmission, condoms should be used for the duration of the pregnancy. Discuss your male partner’s potential exposures and history of Zika-like illness with your doctor.
• If you are trying to become pregnant, talk to your doctor before you travel about your plans to become pregnant and the risk of Zika virus.
• If you are pregnant or may become pregnant and must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip.
• If you are not pregnant, but your male partner lives in or has traveled to a country with Zika, consider using condoms.

SCREENING AND REPORTING POTENTIAL ILLNESSES

All women who traveled to an area with ongoing Zika virus transmission during pregnancy should be evaluated specifically for Zika virus infection and tested in accordance with CDC’s latest guidance. See CDC links below.

Health care providers should ask all their patients about recent travel. Because of the similar geographic distribution and clinical presentation of Zika, dengue, and chikungunya virus infection, patients with symptoms consistent with Zika virus should also be evaluated for dengue and chikungunya virus infection, in accordance with existing guidelines.

To screen patients for travel-related infectious diseases, healthcare providers can use the updated DPH screening tool at:
http://www.dhss.delaware.gov/dhss/dph/php/files/emergingandtravelrelatedinfdiseasescreeningtool.pdf

PATIENT TESTING

According to CDC, testing should be prioritized for:

• Pregnant women with travel to affected areas – regardless of presence of symptoms
• Travelers to affected areas exhibiting symptoms

Contact DPH Office of Infectious Disease Epidemiology at 888-295-5156 or 302-744-4990 for assistance with specimen collection and coordination of testing.

ADDITIONAL INFORMATION

• UPDATED: Interim Guidelines for Pregnant and Reproductive Age Women: http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_e
• NEW: Interim Guidelines for Prevention of Sexual Transmission of Zika Virus: http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_e
• NEW:: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses: http://www.cdc.gov/mmwr/volumes/65/wr/mm6506e1er.htm?s_cid=mm6506e1er_e
• For further information on Zika: http://www.cdc.gov/zika/
• Educational flyer for pregnant women in English: http://www.dhss.delaware.gov/dhss/dph/files/zikaflyerforpregnantwomen.pdf
• Educational flyer for pregnant women in Spanish: http://www.dhss.delaware.gov/dhss/dph/files/zikaflyerforpregnantwomensp.pdf
• DPH special bulletin on Zika: http://www.dhss.delaware.gov/dhss/dph/files/dphbulletin1602zika.pdf
• Zika information in Spanish: http://www.cdc.gov/spanish/mediosdecomunicacion/comunicados/d_recomendaciones_viajeros_virus_del_zika_011516.html
• For DPH clinical guidance on travel-related screening: http://www.dhss.delaware.gov/dhss/dph/php/files/emergingandtravelrelatedinfdiseasescreeningtool.pdf
• For the latest Centers for Disease Control and Prevention (CDC) list of impacted countries, visit: http://wwwnc.cdc.gov/travel/notices
• Department of Natural Resources and Environmental Control mosquito control: http://www.dnrec.delaware.gov/fw/mosquito/Pages/MC-Diseases.aspx

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