Newyork-Presbyterian/Queens

NewYork-Presbyterian/Queens Information Bulletin

February 10, 2016 # 16-42 TO: Office of the President Operations Group Administrative Directors and Department Heads Clinical Chairmen/Directors Attending & Voluntary Staff Nurse Managers Nurse Practitioners Physician Assistants Administrative Support Staff for above Graduate Medical Staff Women’s Auxiliary Officers Volunteer Services

SUBJECT: UPDATE: Zika Virus Outbreak

On Monday, February 1, 2016, the World Health Organization (WHO) declared the Zika virus outbreak a global public health emergency of international concern, due to its possible link to birth defects. Testing Guidelines have now changed. In addition, the list of countries and territories with active Zika virus transmission and the Guidelines for Pregnant Women have been updated. There are also new Guidelines for prevention of sexual transmission.

For more information, see Zika Virus Clinical Bulletin #3 below.

Approved by Willa Brody Director, External Affairs Zika Virus: Clinical Bulletin #3 February 8, 2016

On Monday, February 1, 2016, the World Health Organization (WHO) declared the Zika virus outbreak a global public health emergency of international concern, due to its possible link to birth defects. Testing guidelines have now changed.

UPDATED List of Countries and Territories with Active Zika Virus Transmission Active Zika virus transmission has been documented throughout much of Central and South America and the Caribbean. There is also transmission in a few areas in Oceania/Pacific Islands and Africa. The most up-to-date list of affected areas can be found on the CDC website.

UPDATED Guidelines for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure On 2/5/16, the CDC published updated guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure. These guidelines include the following recommendations:  Serologic testing for Zika virus should now be offered to asymptomatic pregnant women who traveled to an area with ongoing Zika virus transmission. The results of these tests may help to inform subsequent evaluation and management during pregnancy. (See Figure below). Testing is available through and recommended by New York State Department of Health. (See “Testing for Zika Virus Infection” below.)

 Pregnant women who have a clinical illness consistent with Zika virus disease during or within 2 weeks of travel to areas with ongoing Zika virus transmission should be tested for Zika virus infection.

 Recommendations for pregnant women residing in areas with ongoing Zika virus transmission are also provided in the updated guidelines.

NEW Guidelines for Prevention of Sexual Transmission of Zika Virus On February 2, 2016, health officials reported a case of Zika virus infection in Texas that appears to have been sexually transmitted by a man who had recently returned from Venezuela infected with Zika virus. New guidelines for prevention of sexual transmission of Zika virus were published by the CDC on February 5, 2016. Additional recommendations will be provided as more information becomes available. The interim guidelines include the following recommendations  Men and their pregnant partners: Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (vaginal, anal, oral) for the duration of pregnancy.

 Men and their nonpregnant sex partners: Men who reside in or have traveled to an area of active Zika virus transmission who are concerned about sexual transmission of Zika virus might consider abstaining from sexual activity or using condoms consistently and correctly during sex.

 Testing of men for the purpose of assessing the risk of sexual transmission is not recommended.

NEW Guidelines for Testing for Zika Virus Infection  Testing for Zika virus infection is currently recommended for (1) symptomatic persons who traveled to an affected area within 2 weeks of symptom onset and (2) pregnant women, regardless of the presence or absence of symptoms, who traveled to an affected area while pregnant.  Testing is currently available only through the Department of Health (DOH) and testing must be approved by the DOH prior to submitting specimens for testing.

 If you have a patient for whom testing appears to be indicated, contact NYCDOH (866-692-3641) to obtain approval for testing and for additional information about specimen collection.  Additional information and algorithms for collecting and submitting specimens from NYP Ambulatory Care Network, Columbia Doctors, and Weill Cornell Physician Organization sites are in development and will be made available soon.

Figure (from CDC Guidelines)

References 1. Oduyebo T. Update: interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure – United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1-6 http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_e 2. Oster AM. Interim guidelines for prevention of sexual transmission of Zika virus – United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1-2 http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_e

Additional Resources:  NYP Infonet Zika Virus Webpage: https://infonet.nyp.org/EPI/Pages/ZikaVirus.aspx  CDC Zika Virus Webpage: http://www.cdc.gov/zika/index.html  Department of Infection Prevention & Control: o NYP/AH: 212-932-5219 o NYP/CU and NYP/MSCH: 212-305-7025 o NYP/WC: 212-746-1754 o NYP/WD: 914-997-4377 o NYP/LM: 212-312-5976