CDC unveils Zika guidance for infants, expands travel advisory

In the latest quickly evolving Zika virus developments, the US Centers for Disease Control and Prevention (CDC) today released interim guidance to help doctors evaluate and test babies born with possible infections and added two more destinations to its travel advisory—US Virgin Islands and the Dominican Republic.

Also, the CDC signaled that Zika virus infection is now a nationally notifiable condition, according to today's new guidance and information covered during a CDC clinician's call.

When to test newborns

The CDC released its interim Zika guidance targeting babies born in the United States in an early online edition of Morbidity and Mortality Weekly Report (MMWR).

CDC experts addressed the document and other recently released guidance at a CDC Clinician Outreach and Community Activity (COCA) call today, during which officials said the agency is also developing specific guidance for the care of pregnant women in Zika transmission countries and territories.

Today's document walks clinicians through what types of samples to collect and what type of tests to order. Congenital Zika virus infection is defined as the presence of Zika virus RNA or antigen in any of the samples collected.

Illinois health officials recently reported two imported Zika infections in pregnant women, a potential risk for birth defects, and US clinicians are likely to see more such cases, since the number of travel-linked cases is expected to grow, along with the threat of local spread in parts of the continental United States.

Zika testing is recommended for both the baby and the mother for babies born with microcephaly (small heads) or intracranial calcification to moms who may have been exposed to the virus. Ophthalmologic testing within 1 month is recommended for babies with possible infections due to reports of eye problems. Infants with positive or inconclusive tests should be evaluated for long-term complications, including a hearing test at 6 months, even if the initial hearing test was normal, the CDC said.

For babies without microcephaly born to mothers who might have been exposed to Zika virus during pregnancy, further workup depends on the mother's Zika test results. If tests are negative, routine monitor is recommended, but positive or inconclusive results should trigger testing of the baby.

Since there are no treatments or vaccines against Zika virus, treatment of congenital Zika virus infection is supportive, with a focus on the baby's medical and neurodevelopment issues. The guidance recommends that health providers encourage mothers to breastfeed their babies, even in areas where the virus is circulating, because the benefits outweigh any Zika-linked risks. Viral RNA has been detected in breast milk, but no far no illnesses have been traced to breastfeeding.

Travel advisory list grows by 2

The CDC today added the US Virgin Islands and the Dominican Republic to its travel advisory for pregnant women or those planning on becoming pregnant, the second time the CDC has expanded the list since it first posted the level 2 notice on Jan 15.

The US Virgin Islands appeared today on the Pan American Health Organization (PAHO) list of locations in the Americas reporting local spread, raising the number to 22. It is the second US territory in the Caribbean to report local Zika virus spread, following Puerto Rico on Dec 31.

Health officials announced the case on Jan 22, involving a 42-year-old woman on the island of St Croix who had not traveled before she got sick, according to an Associated Press (AP) report.

The Dominican Republic announced its first cases a few days ago, and PAHO added the country to its list yesterday.

Addition to notifiable disease list

Because of the seriousness of the Zika virus threat to pregnant women and in response to the largest reported Zika virus outbreak to date, the CDC and the Council of State and Territorial Epidemiologists (CSTE) have worked together to confirm that Zika virus disease is now a notifiable condition in the United States, Ben Haynes, a spokesman for the CDC confirmed.

In an e-mail update to its members, the CSTE said the CDC in a Jan 15 health advisory asked state health departments to report lab-confirmed infections to the CDC, and to assist with notification. The CDC has assigned event code 11726 to Zika virus disease for reporting purposes.

The CSTE said it received word on Jan 21 that on an expedited basis the Office of Management and Budget has cleared the CDC to receive the case notifications.

See also:

Jan 26 MMWR interim guidance on infants

CDC COCA call information

Jan 22 AP story

CDC travel notice page

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