Zika
If you suspect Zika virus infection or have questions about diagnosis, testing, or Zika affected areas, please call Maricopa County Department of Public Health (MCDPH) at 602-506-6767 within 24 hours Monday-Friday, 8 a.m. to 5 p.m. On weekends and after hours, call 602-747-7111.
To date, all cases in Maricopa County have been travel-associated. Areas that have had locally-acquired transmission include Africa, Asia, Mexico, Central and South America, and the Caribbean. Approximately 1 in 5 people infected with Zika virus will become ill (see patient Screening Criteria below). Incubation period is 3-14 days.
Zika virus infection during pregnancy can cause birth defects such as microcephaly. It is believed that approximately 1 in 10 Zika infections during pregnancy leads to birth defects. CDC has issued an advisory for pregnant women to avoid travel to Zika affected areas.
Depending on the patient's travel history, other arboviral infections might be included in the differential, including chikungunya and dengue. Chikungunya and dengue often circulate in the same areas as Zika and are clinically indistinguishable. Please test for all three. Note: most major commercial laboratories are capable of testing for Zika virus infection.
Go to latest ADHS Testing Algorithms for Zika virus
Go to MCDPH Provider Toolkit on Zika Virus (printable guidance docs and handouts)
-
Office of Epidemiology & Data Services
Physical Address
4041 N Central Avenue
Phoenix, AZ 85012
Phone:
602-506-6767
Fax:
602-372-8935
- Appropriate travel/border commuter history (see list of affected areas Opens a New Window. ) during pregnancy or the 6 weeks prior to last menstrual period, 8 weeks prior to conception, or unprotected sexual contact with someone who traveled or lived in an area with ongoing Zika virus transmission regardless of symptoms; OR
- For patients without a known exposure history (see above) and clinical suspicion of Zika, the following screening criteria should be considered: Maculopapular rash AND at least two of the following: acute onset of fever, arthralgia, or conjunctivitis
*IgM test results in pregnant women exposed to Zika virus more than 12 weeks prior must be interpreted with caution and cannot rule out Zika virus infection. CDC recommends PCR testing of asymptomatic pregnant women once per trimester. Ongoing monitoring of pregnant mother and fetus for signs of microcephaly, intracranial calcifications, and small size for gestational age are recommended. Please consult with MCDPH to determine if testing at birth is recommended by calling 602-506-6767 Monday-Friday, 8 a.m. to 5 p.m. On weekends and after hours, call 602-747-7111.
Diagnostics
Refer to Arizona Department of Health Services Zika testing algorithm (PDF) Opens a New Window. for complete testing guidelines and recommendations for follow-up testing.
Most major commercial laboratories are capable of testing for Zika virus infection. Please check with your laboratory provider for testing availability and specimen shipping recommendations.
If your laboratory provider is unable to test for Zika and the patient meets screening criteria, testing can be arranged through MCDPH by calling 602-506-6767 Monday-Friday, 8 a.m. to 5 p.m. Testing availability is dependent on laboratory resources, and all testing through the Arizona State Public Health Laboratory must be approved by MCDPH prior to submitting specimens.
Treatment
NOTE: Rule out dengue before prescribing NSAIDS.
Prevention and Counseling
- Women planning to become pregnant who live in or travel to a Zika-affected area should see a healthcare provider to discuss Zika prevention and avoiding unnecessary travel.
- Advise males with travel to Zika-affected areas who have a pregnant sex partner to use condoms Opens a New Window. or to abstain from sex for 3 months or the duration of the pregnancy, whichever is longer.
- Advise females with travel to Zika-affected areas who have a pregnant sex partner to use condoms or to abstain from sex for 8 weeks or the duration of the pregnancy, whichever is longer.
- It is extremely important to communicate that Zika is sexually transmissible regardless of gender.
- Counsel patients to delay attempts at conception Opens a New Window. for the recommended time period below until the couples' risk of Zika is minimal.
- Female partner traveled to an area with local Zika transmission – 8 weeks after last possible exposure or after symptoms start.
- Male partner traveled to an area with local Zika transmission - 3 months after last possible exposure or after symptoms start.
- It is extremely important that patients with possible recent Zika exposure avoid mosquito bites during the first three weeks post-travel or onset date to avoid transmission of the virus to mosquitoes locally. Please educate patients and families about mosquito bite prevention.
Please refer to the following websites for more detailed information:
- MCDPH Provider Toolkit on Zika Virus Opens a New Window. (printable guidance docs and handouts)
- ADHS Arboviral Handbook Opens a New Window.
- Opens a New Window. ADHS Zika Testing Algorithms Opens a New Window.
- Center for Disease Control and Prevention Zika webpage Opens a New Window.
- Areas with Risk of Zika, CDC Opens a New Window.
- Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2017 Opens a New Window.
- Update: Interim Guidance for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection - United States, October 2017 Opens a New Window.
- CDC Zika Registry Information Opens a New Window.
Screening Criteria
- Appropriate travel/border commuter history (see map of affected areas Opens a New Window. ) or had unprotected sexual contact with someone who traveled or lived in an area with ongoing Zika virus transmission; PLUS
- At least two of the following: acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis; OR
- For patients without a known exposure history (see above) and clinical suspicion of Zika, the following screening criteria should be considered: Maculopapular rash AND at least two of the following: acute onset of fever, arthralgia, or conjunctivitis
Diagnostics
Refer to Arizona Department of Health Services Zika testing algorithm (PDF) Opens a New Window. for complete testing guidelines and recommendations for follow-up testing.
Most major commercial laboratories are capable of testing for Zika virus infection. Please check with your laboratory provider for testing availability and specimen shipping recommendations.
If your laboratory provider is unable to test for Zika and the patient meets screening criteria, testing can be arranged through MCDPH by calling 602-506-6767 Monday-Friday, 8 a.m. to 5 p.m. Testing availability is dependent on laboratory resources, and all testing through the Arizona State Public Health Laboratory must be approved by MCDPH prior to submitting specimens.
NOTE: Remember to consider simultaneous testing for chikungunya and dengue.
Treatment
No specific antiviral therapy is available for Zika virus disease. Treatment is supportive and may include rest, fluids and analgesics and antipyretics.
NOTE: Rule out dengue before prescribing NSAIDS.
Prevention and Counseling
- Women planning to become pregnant who live in or travel to a Zika-affected area should see a healthcare provider to discuss Zika prevention and avoiding unnecessary travel.
- Advise males with travel to Zika-affected areas who have a pregnant sex partner to use condoms Opens a New Window. or to abstain from sex for 3 months or the duration of the pregnancy, whichever is longer.
- Advise females with travel to Zika-affected areas who have a pregnant sex partner to use condoms or to abstain from sex for 8 weeks or the duration of the pregnancy, whichever is longer.
- It is extremely important to communicate that Zika is sexually transmissible regardless of gender.
- Counsel patients to delay attempts at conception for the recommended time period below until the couples' risk of Zika is minimal.
- Female partner traveled to an area with local Zika transmission – 8 weeks after last possible exposure or after symptoms start.
- Male partner traveled to an area with local Zika transmission – 3 months after last possible exposure or after symptoms start.
- It is extremely important that patients with possible recent Zika exposure avoid mosquito bites during the first three weeks post-travel or onset date to avoid transmission of the virus to mosquitoes locally. Please educate patients and families about mosquito bite prevention.
Resources
Please refer to the following websites for more detailed information:
- MCDPH Zika Virus Provider Toolkit (printables and handouts) Opens a New Window.
- ADHS Arboviral Handbook Opens a New Window.
- Opens a New Opens a New Window. ADHS Zika Testing Algorithms Opens a New Window.
- Center for Disease Control and Prevention Zika webpage Opens a New Window.
- Areas with Risk of Zika, CDC
- Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2017
- Update: Interim Guidance for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection - United States, October 2017
- CDC Zika Registry Information Opens a New Window.
Screening Criteria
- Born to a mother with laboratory evidence of Zika or an unspecified flavivirus;
OR; - Born to a mother without laboratory evidence of Zika or an unspecified flavivirus* (negative test results or never tested) who had appropriate exposure history Opens a New Window.
PLUS- microcephaly;
- intracranial calcifications;
- brain or eye abnormalities present on ultrasound; OR
- other abnormalities consistent with congenital Zika syndrome with no other known etiologies
*IgM test results in pregnant women exposed to Zika virus more than 12 weeks prior must be interpreted with caution and cannot rule out Zika virus infection. CDC recommends PCR testing once per trimester of asymptomatic pregnant women who have continued ongoing exposure to Zika virus. Ongoing monitoring of pregnant mother and fetus for signs of microcephaly, intracranial calcifications, and small size for gestational age are recommended. Please consult with MCDPH to determine if testing at birth is recommended by calling 602-506-6767 Monday-Friday, 8 a.m. to 5 p.m. on weekends and after hours call 602-747-7111.
Diagnostics
Refer to Arizona Department of Health Services Zika testing algorithm (PDF) Opens a New Window.
for complete testing guidelines and recommendations for follow-up testing.
Most major commercial laboratories are capable of testing for Zika virus infection. Please check with your laboratory provider for testing availability and specimen shipping recommendations.
If your laboratory provider is unable to test for Zika and the patient meets screening criteria, testing can be arranged through MCDPH by calling 602-506-6767 Monday-Friday, 8 a.m. to 5 p.m. Testing availability is dependent on laboratory resources, and all testing through the Arizona State Public Health Laboratory must be approved by MCDPH prior to submitting specimens.
Healthcare providers should consult with MCDPH for collection and submission guidelines on fetal or infant specimens. If infant testing is deemed appropriate per screening criteria, test the following:
- Collect infant urine AND serum and submit for testing by PCR and IgM at a public health laboratory or commercial laboratory within 2 days of birth
Additional considerations:
- placenta can also be tested by PCR and IHC
- CSF can also be tested if collected for other diagnostic studies
- Tissue from fetal loss or stillbirth can be tested by PCR and IHC for women with laboratory evidence of Zika virus infection
*Infants with evidence of Zika virus infection should be assessed for long-term sequelae.
Treatment & Follow-Up Care
The prognosis for infants with congenital Zika virus infection is currently unknown.CDC’s infant guidance Opens a New Window. includes recommendations for testing infants for congenital Zika infection and clinical management recommendations for infants with evidence of Zika virus infection, both with and without apparent birth defects, to ensure careful screening and monitoring of infant development. For infants with congenital Zika virus infection, care is focused on diagnosing and managing conditions that are present, monitoring the child’s development over time, and addressing problems as they arise. Read more on CDC website. See Caring For Infants At-Risk for Zika Opens a New Window. guide.
Resources
Please refer to the following websites for more detailed information:
- MCDPH Provider Toolkit on Zika Virus (printable guidance docs and handouts)
- Resources for Healthcare Providers Caring for Infants Affected by Zika Opens a New Window.
- Congenital Zika Syndrome & Other Birth Defects Opens a New Window.
- Opens a New Window. ADHS Zika Testing Algorithms Opens a New Window.
- Center for Disease Control and Prevention Zika webpage Opens a New Window.
- Areas with Risk of Zika, CDC
- Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2017 Opens a New Window.
- Update: Interim Guidance for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection - United States, October 2017 Opens a New Window. Opens a New Window.
- CDC Zika Registry Information Opens a New Window.
Webinar
Zika Update for Healthcare Providers, Maricopa County Opens a New Window. (webinar by Dr. Rebecca Sunenshine, Medical Director of the Disease Control Division 2/2017)
Provider Toolkit
Printable fact sheets for use by providers and commercial testing labs for Zika virus.
Zika Fast Facts Opens a New Window. (PDF)
Caring for Infants with Zika Exposure Opens a New Window. (PDF)
Detecting and Preventing Zika Virus Opens a New Window. (PDF)
Zika Info for Pregnant Women and Moms-to-Be Opens a New Window. | En Español Opens a New Window. (PDF)
What You Should Know About the Zika Virus (English) Opens a New Window. (PDF) (general audience handout)
Links
ADHS Zika Information for Healthcare Providers
CDC Zika Training for Healthcare Providers