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)

  1. Pregnant Women
  2. Men & Non-Pregnant Women
  3. Infants
  4. Handouts & Training

Screening Criteria 

1. Appropriate travel/border commuter history (see list of affected areas) during pregnancy or the 6 weeks prior to last menstrual period or unprotected sexual contact with someone who traveled or lived in an area with ongoing Zika virus transmission regardless of symptoms; OR

2. 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.
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Diagnostics


Refer to Arizona Department of Health Services Zika testing algorithm (PDF) 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.
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When collecting specimens for testing of a pregnant woman at either a commercial or public health laboratory, count the number of days since onset of symptoms or last known exposure to determine which tests are appropriate.
    • Within 2 weeks of symptom onset or last known exposure - collect urine AND serum for PCR testing
    • Between 2 and 12 weeks of symptom onset or last known exposure - collect serum for IgM testing
    • Beyond 12 weeks - NO lab testing is recommended; serial ultrasounds and prenatal care monitoring are advised for pregnant women
NOTE: when in doubt, order both tests and remember to test for chikungunya and dengue, if warranted.

If Zika exposure to a pregnant woman is continuous or repeated, the Centers for Disease Control and Prevention (CDC) recommends PCR testing once per trimester. There is no recommended lab testing after 12 weeks following onset/exposure; serial ultrasounds and prenatal care monitoring are advised for pregnant women. 

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

    • Counsel all pregnant women to avoid nonessential travel to areas with local Zika transmission, which includes Mexico.
    • Pregnant women or 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 baseline IgM testing.
    • Advise those who travel to Zika-affected areas who have a pregnant sex partner to use condoms or to abstain from sex for 6 months or the duration of the pregnancy, whichever is longer.
    • 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:
    • Within 2 weeks of symptom onset or last known exposure - collect urine AND serum for PCR testing
    • Between 2 and 12 weeks of symptom onset or last known exposure - collect serum for IgM testing
    • Beyond 12 weeks - NO lab testing is recommended; serial ultrasounds and prenatal care monitoring are advised for pregnant women
    NOTE: when in doubt, order both tests and remember to test for chikungunya and dengue, if warranted