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CDC Issues Zika Advisory For Pregnant Women In Brownsville Texas

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Distributed via the CDC Health Alert Network
December 14, 2016, 16:15 ET (4:15 PM ET) 
CDCHAN-00399

CDC Guidance for Travel and Testing of Pregnant Women and Women of Reproductive Age for Zika Virus Infection Related to the Investigation for Local Mosquito-borne Zika Virus Transmission in Brownsville, Cameron County, Texas

Summary
On November 28, 2016, the Texas Department of State Health Services (TDSHS) reported the first case of locally acquired mosquito-borne Zika virus infection in the city of Brownsville, Cameron County, Texas. On December 9, 2016, four additional cases in people living in proximity to the first case were reported. TDSHS continues to investigate Zika virus transmission in Brownsville.

Currently only five cases are known to have been locally acquired in the Brownsville area, and there is not yet any evidence of widespread, sustained local transmission. However, temperatures in the region are still conducive to mosquito-borne transmission, and therefore the risk of continued local transmission of Zika virus cannot be ruled out. CDC, TDSHS, and local authorities continue to investigate the cases in Brownsville and will share up-to-date information and recommendations as the situation develops. The active, ongoing surveillance and response underway in Texas will provide more information over time that may allow for more precise and focused assessment of risk. The exact level and location of risk of Zika virus infection in Brownsville is unknown; pregnant women in the area are at some risk for Zika virus infection.

For these reasons, CDC is designating the city of Brownsville as a Zika cautionary (yellow) area for testing and travel guidance, as recommended in the CDC Interim Zika Response Plan (https://www.cdc.gov/zika/pdfs/zika-draft-interim-conus-plan.pdf).  Based on the earliest time of symptom onset for cases of locally acquired Zika virus infection in Brownsville and a maximum 2-week incubation period for Zika virus, this guidance applies to pregnant women, women of reproductive age, and their sexual partners who live in or traveled to Brownsville on or after October 29, 2016. Because many people with Zika virus infection will not have symptoms or will have only mild symptoms, additional people may be infected.

Brownsville is located in Cameron County, Texas, which shares a border with Mexico (https://www.cdc.gov/zika/intheus/texas-update.html). Many people travel regularly across the United States-Mexico border to temporarily live, work, attend school, socialize, and seek medical care. Areas of active Zika virus transmission have also been reported in Mexico near the United States-Mexico border, and CDC issued a Travel Notice for Mexico (https://wwwnc.cdc.gov/travel/notices/alert/zika-virus-mexico) on December 10, 2015, recommending that pregnant women should not travel to any area of Mexico below 6,500 feet.

This is an ongoing investigation, and TDSHS, Cameron County Health Department, Brownsville Health Department, and CDC are working together to rapidly learn more about the extent of Zika virus transmission in Brownsville. CDC will update these recommendations as more information becomes available.

Recommendations for Brownsville, Texas (yellow area)

Travel Recommendations for Pregnant Women
Pregnant women who live in other areas should consider postponing travel to Brownsville. Areas of mosquito-borne transmission can arise and resolve over time. Travelers, and in particular, pregnant women, are urged to monitor the CDC website to ensure they have access to the most up-to-date information and recommendations (https://www.cdc.gov/zika/).

Prevention Recommendations for Pregnant Women

  1. Pregnant women and their partners who live in or travel to Brownsville should be aware of local Zika virus transmission and should strictly follow steps to prevent mosquito bites. (https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html).
  2. Pregnant women and their partners who live in or travel to Brownsville should consistently and correctly use condoms to prevent Zika virus infection during sex (vaginal, anal, or oral) or should not have sex during the pregnancy.

Testing Recommendations for Pregnant Women

  1. Pregnant women with an epidemiologic link to Brownsville on or after October 29, 2016, should be tested for Zika virus infection in accordance with CDC guidance. An epidemiologic link means that they live in, traveled to, or had sex without using a condom with someone who lives in or traveled to Brownsville on or after this date (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e).
    1. Pregnant women with symptoms of Zika virus disease should be tested according to CDC guidance, which is based on the time of evaluation relative to symptom onset.
    2. Pregnant women with ongoing risks for exposure (who live in or frequently travel [for example, daily, weekly]) to Brownsville and who are without symptoms of Zika virus disease should consult with their healthcare provider to obtain testing for Zika virus infection in both the first and second trimesters of pregnancy.
    3. Pregnant women who are asymptomatic but who have had limited risks for exposure (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) should also be tested for Zika virus infection. Laboratory testing for these women should be performed based on the time of clinical evaluation relative to last possible exposure in accordance with CDC guidance (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm).
  2. Healthcare providers should contact their state, local, or territorial health department to coordinate testing and interpret results. Healthcare providers should discuss the limitations of laboratory tests used to diagnose Zika virus infection with pregnant women and their partners, including the possibility of false positive results related to prior exposure to other flaviviruses (for example, dengue).

Women and Their Partners Who are Planning to Conceive in the Near Future

  1. Women who have limited risk (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) of possible exposure may consider waiting at least 8 weeks from symptom onset (if symptomatic) or last possible exposure (if asymptomatic) to attempt conception.
  2. Men who have limited risk (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) of possible exposure may consider waiting at least 6 months from symptom onset (if symptomatic) or last possible exposure (if asymptomatic) to attempt conception.
  3. People living in Brownsville should be counseled on the possible risk for Zika virus infection during the periconceptional period. Women and men should discuss their reproductive life plans with their healthcare provider in the context of potential and ongoing Zika virus exposure. Women and men with ongoing risks for exposure and who are diagnosed with Zika virus disease should wait at least 8 weeks and at least 6 months, respectively, after symptom onset before attempting conception.
  4. Some couples in which one or both partners have had a possible Zika virus exposure might choose to wait longer or shorter than the recommended period to conceive, depending on individual circumstances (for example, age, fertility, details of possible exposure) and risk tolerance. Limited data exist on the persistence of Zika virus RNA in body fluids, and the risk for adverse pregnancy outcomes associated with maternal Zika virus infection around the time of conception is currently not known.
  5. Women and their partners who are attempting conception and live in or travel to Brownsville should be aware of Zika virus transmission and should strictly follow steps to prevent mosquito bites. (https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html).

Background
Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus). Zika virus can also be sexually transmitted. Zika virus infection during pregnancy is a cause of microcephaly and severe fetal brain defects and has been associated with other adverse pregnancy outcomes. Most people infected with Zika virus will not have symptoms; infants with microcephaly and other birth defects have been born to women with Zika virus infection who did not report symptoms.

For pregnant women who report clinical illness consistent with Zika virus disease (symptomatic pregnant women), CDC's testing recommendations are the same for those with ongoing risk and those with limited risk for possible Zika virus exposure. Symptomatic pregnant women who are evaluated less than 2 weeks after symptom onset should receive serum and urine Zika virus RNA nucleic acid test (NAT) testing. Symptomatic pregnant women who are evaluated 2 to 12 weeks after symptom onset should first receive a Zika virus immunoglobulin (Ig) M antibody test; if the IgM antibody test result is positive or equivocal (unclear), serum and urine RNA NAT testing should be performed. If the RNA NAT result is negative, a positive or equivocal (unclear) Zika virus IgM antibody test result should be followed by plaque reduction neutralization testing (PRNT). Interpretation of serologic results has been described (https://www.cdc.gov/mmwr/volumes/65/wr/mm6521e1.htm).   

Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women with ongoing risk for possible exposure who are evaluated less than 2 weeks after last possible exposure, RNA NAT testing should be performed. If the RNA NAT result is negative, a Zika virus IgM antibody test should be performed 2 to 12 weeks after the exposure. Asymptomatic pregnant women with limited risk for possible exposure who are first evaluated 2 to 12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal (unclear), serum and urine RNA NAT should be performed. Asymptomatic pregnant women with ongoing risk for possible exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate RNA NAT testing should be performed when IgM antibody test results are positive or equivocal (unclear).

Further information on the interpretation of laboratory test results and clinical management of pregnant women with laboratory evidence of possible Zika virus infection are available below.

For More Information

 

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

 
 

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Admin Grand Master

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MEDIA STATEMENT
 
For Immediate Release
Wednesday, December 14, 2016      
 
(404) 639-3286
 
CDC Issues Zika Virus Guidance for Brownsville, Texas
 
CDC has issued Zika-related travel and testing guidance for Brownsville, Cameron County, Texas, following reports from Texas public health officials of five cases spread locally by mosquitoes. This information suggests that there may be a risk of continued spread of Zika virus and therefore pregnant women are at some risk for Zika virus infection. CDC is designating the city of Brownsville as a Zika cautionary area (yellow area). Texas Department of State Health Services (TDSHS), Cameron County Health Department, Brownsville Health Department and CDC are working together to rapidly learn more about the extent of Zika virus transmission in Brownsville.
 
Local spread of Zika virus by mosquitoes has also been reported in Mexico along the United States-Mexico border and CDC has had a travel notice for Zika virus in Mexico since December 10, 2015. Because many people with Zika virus infection will not have symptoms or will have only mild symptoms, additional people may be infected. In addition, active Zika virus spread may not be apparent yet, given that the incubation period for Zika virus infection can be as long as two weeks and the diagnosis and investigation of cases can take several weeks.
 
As of this time, only five cases are known to have been spread locally in the Brownsville area and there is not yet any evidence of widespread, sustained local spread of Zika. Still, temperatures in the region are conducive to mosquito-borne spread, and the risk of continued local spread cannot be ruled out. For these reasons, CDC is designating testing and travel recommendations for the city of Brownsville.
 
“We are working closely with Texas to gather and analyze new information every day. With the new information that there has been local spread of Zika for at least several weeks, we conclude that pregnant women should avoid the Brownsville area – and make every effort to prevent mosquito bites if they live or work there,” said CDC Director Tom Frieden, M.D., M.P.H. “Together with Texas officials we are working to protect pregnant women from the potentially devastating effects of this virus.”  
   
CDC recommendations are summarized below; specific guidance is at:https://emergency.cdc.gov/han/han00399.asp.
  
·         Pregnant women who live in other areas should consider postponing travel to Brownsville.
 
·         Pregnant women and their partners who live in or travel to Brownsville should be aware of local spread of Zika virus and should strictly follow steps to prevent mosquito bites.
 
·         Women and men who live in or travel to Brownsville who are pregnant or have a pregnant sex partner should consistently and correctly use condoms to prevent Zika virus infection during sex (vaginal, anal or oral) or should not have sex during the pregnancy.
 
·         Pregnant women who live in, traveled to or had sex without a condom with someone who lives in or traveled to Brownsville on or after October 29, 2016, should be tested for Zika virus infection in accordance with CDC guidance.
 
·         Women who have limited risk (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) of possible exposure may consider waiting at least eight weeks from symptom onset (if they had symptoms) or last possible exposure (if they did not have symptoms) to attempt getting pregnant.
 
·         Men who have limited risk (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) for exposure may consider waiting at least six months from symptom onset (if they had symptoms) or last possible exposure (if they did not have symptoms) to attempt conception.
 
·         People living in Brownsville should be counseled on the possible risk for Zika virus infection before getting pregnant and through early pregnancy. Women and men should discuss their reproductive life plans with their healthcare provider in the context of potential and ongoing Zika virus exposure. Women and men with ongoing risks for exposure and who are diagnosed with Zika virus disease should wait at least eight weeks and at least six months, respectively, after symptom onset before attempting conception.
 
·         Some couples in which one or both partners have had a possible Zika virus exposure might choose to wait longer or shorter than the recommended period to conceive, depending on individual circumstances (for example, age, fertility, details of possible exposure) and risk tolerance. Limited data exist on the persistence of Zika virus RNA in body fluids, and the risk for adverse pregnancy outcomes associated with maternal Zika virus infection around the time of conception is currently not known.
 
·         Women and men attempting conception living in or traveling to Brownsville should be aware of Zika virus transmission and should strictly follow steps to prevent mosquito bites.
 
CDC continues to encourage everyone living in areas with Aedes aegypti and Aedes albopictus mosquitoes, especially pregnant women and women planning to become pregnant, to protect themselves from mosquito bites.  Apply Environmental Protection Agency (EPA)-approved insect repellent with one of the following active ingredients DEET, picaridin, IR3535, oil of lemon eucalyptus or para-menthane-diol, or 2-undecanone, following product label instructions, to uncovered skin; wear long-sleeved shirts and long pants; use or repair screens on windows and doors; use air conditioning when available; and remove standing water where mosquitoes can lay eggs.
For more information about Zika: http://www.cdc.gov/zika/.
 
###
 
 
CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation.  Whether these threats are chronic or acute, manmade or natural, human error or deliberate attack, global or domestic, CDC is the U.S. health protection agency.
 
Admin Grand Master

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Advice for people living in or traveling to Brownsville, Texas

 

On December 14, 2016, CDC issued guidance related to Zika for people living in or traveling to Brownsville, Cameron County, TX. On November 28, the Texas Department of State Health Services reported the state’s first case of local mosquito-borne Zika virus infection in Brownsville. Additional cases of mosquito-borne Zika have been identified in the area, suggesting that there is a risk of continued spread of Zika virus in Brownsville. As a result, CDC has designated Brownsville as a Zika cautionary area (yellow area).

CDC designates areas for Zika virus transmission prevention in the continental United States and Hawaii as red or yellow.

Guidance for Zika cautionary areas (Yellow areas)

Zika cautionary area (yellow area): A geographic area where local spread of Zika virus has been identified, but there is not yet any evidence of widespread, sustained local spread. Although the specific level of risk in yellow areas is unknown, there is still a risk to pregnant women. Brownsville, TX, is currently designated as a yellow area.

Travel

  • Pregnant women who live in other areas should consider postponing travel to Brownsville, TX.

Prevention

  • Pregnant women, women trying to get pregnant, and their partners who live in or travel to Brownsville should be aware of local Zika virus transmission and should strictly follow steps to prevent mosquito bites.
  • Pregnant women and their partners who live in or travel to Brownsville should use condoms every time they have sex or not have sex during the pregnancy.

Testing and Diagnosis

  • Pregnant women who live in, traveled to, or had sex without a condom with someone who lives in or traveled to Brownsville on or after October 29, 2016, should be tested for Zika virus.
    • Pregnant women with symptoms of Zika should be tested for Zika virus.
    • Pregnant women without Zika symptoms with ongoing risks for exposure (they live in or frequently travel [daily or weekly]) to Brownsville should talk to their healthcare provider to obtain routine testing for Zika virus in both the first and second trimesters.
    • Pregnant women without Zika symptoms who had limited travel to Brownsville or who had sex without a condom with a person who lives in or traveled to Brownsville should be tested for Zika virus.

Pregnancy Planning

  • Women who had limited travel to Brownsville or had sex without a condom with a person who lives in or traveled to Brownsville may consider waiting at least 8 weeks after symptoms started or last possible exposure before trying to get pregnant.
  • Men who had limited travel to Brownsville or had sex without a condom with a person who lives in or traveled to Brownsville may consider waiting at least 6 months after symptoms started or last possible exposure before trying to get their partner pregnant.
  • People living in Brownsville should talk to their healthcare provider about the possible risk for Zika infection and about their pregnancy plans.
  • Women who live in or frequently travel to Brownsville who are diagnosed with Zika should wait at least 8 weeks after symptoms started before trying to get pregnant.
  • Men who live in or frequently travel to Brownsville who are diagnosed with Zika should wait at least 6 months after symptoms started before trying to get their partner pregnant.
  • Given the limited data available about the persistence at the time of conception, some couples with a partner with possible Zika virus exposure may choose to wait longer or shorter than the recommended period to try to get pregnant.

Zika cautionary area in Brownsville, TX

Map of Brownsville, Texas where a locally-transmitted case of Zika was reported

Brownsville, TX. Yellow shows areas where pregnant women should consider postponing travel.

 
 
 
  • Page last reviewed: December 14, 2016
  • Page last updated: December 14, 2016

 

https://www.cdc.gov/zika/intheus/texas-update.html

Admin Grand Master

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Public Health Officials Outline Zika Testing Guidance

News Release
Dec. 14, 2016

As state and local health departments investigate five locally transmitted cases of Zika virus disease in a small area of Brownsville, the U.S. Centers for Disease Control and Prevention has issued updated guidance for pregnant women living in and traveling to Brownsville.

 

While the risk of exposure in Brownsville is thought to be low, in accordance with the CDC guidance, the Texas Department of State Health Services recommends all pregnant Brownsville residents and those who travel there on or after Oct. 29 be tested for Zika. Residents and frequent travelers, who visit Brownsville on a daily or weekly basis, should get routine Zika testing once during the first trimester of pregnancy and once during the second trimester. Pregnant women with limited travel should discuss it with their doctor and be tested based on when the travel occurred. Because of the risk of sexual transmission, the same recommendations apply to women who have sex without a condom with a partner who is a Brownsville resident or traveler.

 

Health care providers can find more detailed testing guidance in the CDC health alert. DSHS is also emphasizing its previous guidance to test pregnant women who have Zika symptoms or who travel to Mexico or other areas where mosquitoes are spreading Zika.

 

“Right now, we’re aware that local transmission has occurred in a small area of Brownsville,” said Dr. John Hellerstedt, DSHS commissioner. “However, we want to cast a wide net with testing to develop a clearer picture of what is happening with Zika in the area and provide pregnant women with more information about their health.”

 

Health officials continue to recommend pregnant women avoid travel across the border to Mexico, given the ongoing local transmission of Zika there. DSHS also continues to urge everyone strictly follow personal precautions against Zika, including the use of mosquito repellent and wearing long sleeves and pants. DSHS particularly urges the use of these precautions in higher risk areas along the border and during any travel to areas with active Zika transmission.

 

Zika virus is transmitted to people primarily through the bite of an infected mosquito, though it can also spread by sexual contact. The four most common symptoms are fever, itchy rash, joint pain and eye redness. While symptoms are usually minor, Zika can also cause severe birth defects, including microcephaly, and other poor birth outcomes in some women infected during pregnancy. More guidance for clinicians, recommendations for the public and updated case counts are available at TexasZika.org.

 

-30-

(News Media Contact: Chris Van Deusen, DSHS Press Officer, 512-776-7753)

DSHS Press Office on Twitter

 

http://www.dshs.texas.gov/news/releases/2016/20161214.aspx

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