Zika

Zika Virus

Zika virus is spread by the bite of an infected mosquito. The virus is actively circulating in more than 60 countries, including the United States, but has yet to land in Arizona. While 80 percent of those infected have mild or no symptoms, Zika can cause severe birth defects including microcephaly.

Preventing mosquito bites, both at home and while traveling, is the best way to protect yourself and your family from Zika virus and other mosquito-borne disease. Check out affected areas and current CDC travel alerts. Click on any of the boxes above to learn more about Zika virus or to access additional information, including Zika FAQs, Laboratory Resources, Data,  Additional Resources & Downloads,  or to learn about any other Mosquito-Borne Diseases.

Signs & Symptoms

If a person is bitten by a mosquito infected with Zika, they usually develop symptoms within 2–7 days after the bite. However, only about 1 in every 5 people infected will develop any signs or symptoms.

People that do have symptoms can experience rash, fever, joint pain, and red eyes (conjunctivitis).

The most likely way to acquire Zika virus infection is through the bite of an infected mosquito. Other types of transmission, including perinatal, in utero, sexual contact, and possible transfusion-related transmission events have also been reported.

The mosquitoes that can transmit Zika virus – Aedes aegypti – are present in Arizona. Zika virus has not been identified in mosquitoes within Arizona, and there is no evidence that local transmission of disease is occurring. For more information about where these mosquitoes are found, please see the Arizona mosquito activity report.

Zika & Pregnancy

If you are pregnant

  • Do not travel to areas with local Zika transmission
  • If you must travel or you live in areas with local Zika transmission (including Mexico):
    • Take steps to prevent mosquito bites by:
      • wearing EPA-registered insect repellents (DEET is safe during pregnancy),
      • wearing long-sleeve shirts & pants, and
      • staying in places with air conditioning and/or intact window and door screens
      • taking steps to remove standing water around your home.
    • Use these same methods to avoid mosquitoes while traveling and for 3 weeks after returning to Arizona
    • Tell your health care provider about your travel history, even if you don't feel sick
  • If your sexual partner travels to areas with local Zika transmission, protect yourself from getting Zika by abstaining from sex or using condoms for the duration of your pregnancy.
  • Zika infection during pregnancy can cause certain birth defects, including microcephaly. However, it is not known how likely these outcomes are among women infected with Zika during pregnancy.

Resources

Fact Sheets

Testing

Testing for Zika virus *MUST* be coordinated with your health care provider and your county health department.

You are eligible for testing if you are *pregnant and traveled to a Zika-affected area or had sexual contact* with a partner who traveled to a Zika-affected area even if you don’t feel sick.

Reporting Zika pregnancy & infant outcomes

To understand more about Zika virus infection during pregnancy, the Centers for Disease Control and Prevention (CDC) established a national US Zika Pregnancy Registry. The Arizona Department of Health Services is participating in the Registry and has been working with county health departments to collect information about pregnancy and infant outcomes. Data from the Registry may provide information on the level of risk, timing of risk, and spectrum of outcomes associated with Zika virus infection during pregnancy. This information can then be used to direct testing, evaluation, and management of pregnant women and their babies.

Who should be included in the US Zika Pregnancy Registry?

  • Pregnant women in the United States with laboratory evidence of possible Zika virus infection and their infants
  • Infants with laboratory evidence of congenital Zika virus infection and their mothers

Pregnant women: what should I know about the registry?

You will not need to do extra paperwork, go to extra appointments, or have extra tests to be part of the Registry. Your health department will work with your doctor and other healthcare providers to collect all of the information needed. Being in the Registry will not cost you any money. All data submitted to the registry is anonymous; your name and other personal details will not be shared.

Healthcare providers: how to participate?

Contact your county health department

To report birth defects contact the Arizona Birth Defects Monitoring Program at [email protected]

CDC Resources

Local health departments: how to participate?

Prevention

Tips for avoiding mosquito bites:

  • Wear long-sleeved shirts and pants.
  • Stay in places with window and door screens or air conditioning to keep mosquitoes out.
  • Use insect repellents and always follow the product instructions.
  • Reapply insect repellent as directed.
  • Do not spray insect repellent on skin covered by clothing.
  • Be sure to apply sunscreen before applying insect repellent.
  • Use Permethrin to treat clothing and gear. Permethrin is registered by the Environmental Protection Agency (EPA) as an insecticide for use against mosquitoes, as well many other insects. Clothing treated with Permethrin will remain protective after multiple washes.

If you have a baby or young child:

  • Do not use insect repellent on babies younger than two months old.
  • Dress your children in clothing that covers their arms and legs.
  • Cover cribs, strollers, and baby carriers with mosquito netting.
  • Do not put insect repellent on children’s hands, eyes, mouths, cuts, or irritated skin.
  • Adults: Spray repellent onto your hands and then apply to children’s faces.

You can reduce the number of mosquitoes around your home by getting rid of standing water where mosquitoes can breed. See some examples of common mosquito breeding sites.

Here's what you can do outside of your home:

  • Install or repair and use window and door screens. Do not leave doors propped open.
  • Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like tires, buckets, planters, toys, pools, birdbaths, flowerpot saucers, or trash containers. Mosquitoes lay eggs near water.
  • Tightly cover water storage containers (buckets, cisterns, rain barrels) so that mosquitoes cannot get inside to lay eggs.
  • For containers without lids, use wire mesh with holes smaller than an adult mosquito.
  • Use larvicides to treat large containers of water that will not be used for drinking and cannot be covered or dumped out.
  • Use an outdoor flying insect spray where mosquitoes rest. Mosquitoes rest in dark, humid areas like under patio furniture, or under the carport or garage. When using insecticides, always follow label instructions.
  • If you have a septic tank, repair cracks or gaps. Cover open vent or plumbing pipes. Use wire mesh with holes smaller than an adult mosquito.
  • Hire a pest control expert to treat your yard and outdoor areas with long-lasting insecticide or larvicide to control mosquitoes up to several weeks.

Here’s what you can do inside your home:

  • Use air conditioning when possible.
  • Keep mosquitoes from laying eggs inside your home. Once a week, empty and scrub, turn over, cover, or throw out any items that hold water like vases and flowerpot saucers.
  • Kill mosquitoes inside your home. Use an indoor flying insect fogger* or indoor insect spray* to kill mosquitoes and treat areas where they rest. These products work immediately, but may need to be reapplied. Always follow label directions. Only using insecticide will not keep your home free of mosquitoes.
    • Mosquitoes rest in dark, humid places like under the sink, in closets, under furniture, or in the laundry room.
    • Use an indoor fogger* or indoor insect spray* to reach and treat areas were mosquitos rest inside the home.
  • Do-it-yourself products*:
Product Active ingredient Brand name examples** How long it works
Indoor flying insect spray Imidacloprid, β-Cyfluthrin Home Pest Insect Killer, Raid, Ortho, HotShot, EcoLogic 7-10 days
Indoor flying insect fogger Tetramethrin, Cypermethrin Hot Shot, Raid, Real Kill, Spectracide Up to 6 weeks

**Insecticide brand names are provided for your information only. The Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services cannot recommend or endorse any name brand products.

Build Your CDC Zika Prevention Kit

Providers

To date, Arizona has had travel-associated cases of Zika, but no local transmission. In order to protect Arizona from local spread and patients’ exposure to Zika, clinicians are urged to counsel Zika prevention for all patients.

Counseling recommendations

  • Zika Prevention Messages for Patients
  • Counsel all pregnant women to avoid nonessential travel to areas with local Zika transmission.
  • Advise all men and women with travel to Zika-affected areas who have a pregnant sex partner to use condoms or to abstain from sex for the duration of the pregnancy.
  • Advise all returning travelers from Zika-affected areas to prevent mosquito bites here in Arizona for the first three weeks post-travel.
  • Counsel patients to delay attempts at conception for the recommended time period until the couples' risk of Zika is minimal.

Testing recommendations:

  • The Arizona State Public Health Laboratory (ASPHL) can perform PCR and IgM Zika testing for individuals meeting testing criteria (see algorithm). Healthcare providers need to contact the local public health department in order to coordinate testing. Zika testing is also available commercially at select laboratories.
  • Zika testing algorithms for clinicians are available online. Recommended samples include serum, whole blood and urine. In general, PCR can be positive for the first 2 weeks after illness or exposure, and IgM from 2-12 weeks after illness or exposure. Depending on the patient’s presentation, reflex testing may be recommended. Concurrent testing for dengue and Chikungunya should also be sent.

Frequently Asked Questions for Providers

What is Zika virus?

Zika virus is a single-stranded RNA virus of the Flaviviridae family that is primarily spread through the bite of an infected Aedes species mosquito.

What are the symptoms of Zika?

The most common symptoms of Zika infection include acute onset of fever, maculopapular rash, arthralgia, and nonpurulent conjunctivitis, as well as myalgia and headache; however, nearly 80% of infected patients are asymptomatic. If symptoms occur, they are thought to occur 2-12 days after the bite of an infected mosquito and can last up to a week. Hospitalization is rarely required, and death from Zika complications is a rare occurrence. Guillain-Barre syndrome has also been reported in patients following suspected Zika virus infection.

How is Zika virus transmitted?

Zika is primarily transmitted through the bite of an infected Aedes species mosquito — the same vector that can spread chikungunya and dengue. If an uninfected mosquito bites a person acutely infected with Zika in the first week of illness, it can acquire the virus through blood and spread it to other people through bites. There are also reports of congenital, perinatal, sexual, and transfusion-related viral spread.

Can Zika virus infection in pregnant women cause birth defects?

Consensus is that there is sufficient evidence to establish causation between Zika virus infection during pregnancy and birth defects. CDC has identified a number of birth defects, including microcephaly, severe fetal brain abnormalities, eye defects, hearing loss, and impaired growth. Zika virus has been detected in products of conception, placenta and fetal membranes, umbilical cord, neural tissue, and fetal organs. Based on current knowledge, Zika virus infection in a woman who is not pregnant would likely not pose a risk for birth defects in future pregnancies.

What are the travel restrictions for pregnant or non-pregnant women trying to conceive?

Per CDC recommendations, pregnant women in any trimester as well as women trying to become pregnant should consider postponing travel to any area where Zika transmission is ongoing. (http://www.cdc.gov/zika/geo/index.html).

What specimens can be tested for Zika virus?

Serum, whole blood and urine should be collected for symptomatic and asymptomatic pregnant women who meet the criteria for Zika virus testing as outlined in the Zika Testing Algorithms for Healthcare Providers. Before submitting any specimens for testing, healthcare providers should consult with their local health department. Simultaneous testing for dengue and chikungunya is also recommended.

What workup is required for a pregnant woman who may have been exposed to Zika through travel or sexual contact?

  • Symptomatic and asymptomatic pregnant women who meet the criteria for Zika virus testing as outlined in the Zika Testing Algorithms for Healthcare Providers are eligible for Zika virus testing. Testing should be coordinated through the local health department.
  • Simultaneous testing for dengue and chikungunya is recommended.
  • Care for these patients should involve consultation with a perinatologist. 

What are the counseling and testing recommendations for a pregnant woman who has a sexual partner that has recently visited a place with Zika transmission?

  • According to CDC guidelines, couples in which a woman is pregnant should use condoms consistently and correctly or abstain from sex for the duration of the pregnancy.
  • Pregnant women who have a sexual partner that has recently visited a place with Zika transmission and meet the criteria for Zika virus testing as outlined in the Zika Testing Algorithms for Healthcare Providers are eligible for Zika virus testing. Testing should be coordinated through the local health department.

What are the counseling recommendations for couples who are concerned about sexual transmission of Zika virus?

  • Men who had confirmed Zika virus infection or who traveled to an area with active Zika virus transmission but did not develop symptoms should use condoms or abstain from sex for at least 6 months after onset of illness or date of department from the area.
  • Women who had confirmed Zika virus infection or who traveled to an area with active Zika virus transmission but did not develop symptoms should use condoms or abstain from sex for at least 8 weeks after onset of illness or date of department from the area.
  • Couples in which a man resides in an area with active Zika virus transmission but has not developed symptoms of Zika virus should use condoms or abstain from sex while active transmission persists.
  • Couples who are planning to conceive should follow these same recommendations.
  • Routine testing is not currently recommended for women or men who are attempting conception who have possible exposure to Zika virus but no clinical illness.
  • Providers should consult CDC’s guidelines for prevention of sexual transmission of Zika virus.

Special Considerations for Women Undergoing Fertility Treatment

The Food and Drug Administration (FDA) has developed guidance for donated tissues in the context of a Zika virus outbreak, including donated sperm, oocytes, and embryos; the guidance states that living donors will be deemed ineligible for anonymous donation if they have any of the following risk factors:

  • medical diagnosis of Zika virus in the past 6 months;
  • residence in or travel to an area with active Zika virus transmission within the past 6 months; or
  • within the past 6 months had sex with a male partner who, during the 6 months before this sexual contact, received a diagnosis of or experienced an illness consistent with Zika virus, or had traveled to an area of active Zika virus transmission.

Is there a vaccine to prevent Zika virus infection?

There is currently no vaccine for Zika virus.

Is there a treatment for Zika?

There is no specific treatment for Zika. Supportive care with rest, fluids, and acetaminophen is recommended.

How can women be counseled to protect themselves and their infants against Zika virus?

Pregnant women should be counseled to avoid travel to areas with Zika virus transmission, and should be advised to take actions to prevent mosquito bites.

  • Wear long-sleeved shirts and long pants.
  • Use Environmental Protection Agency-registered insect repellents that are safe and effective for infants aged 2 months and older, pregnant women, and breastfeeding women. Caretakers should apply repellent to their own hands first and then put it on the child, avoiding irritated skin and hands because children frequently put their hands in their eyes and mouths. Products containing oil of lemon eucalyptus should not be used on children under the age of three years.
  • Eliminate mosquito breeding sites, like containers with standing water.
  • Avoid situations and environments where there is a risk of increased exposure to mosquitoes, which can bite all day long and into the evening and early morning. 
  • Use mosquito netting on beds, carriers, strollers, and cribs as appropriate to protect infants from mosquito bites.

How can health care providers be protected against Zika virus infection while caring for women and their infants?

The CDC has developed guidance for health care providers in the context of preventing Zika virus transmission.

Health care personnel should follow Standard Precautions to prevent possible transmission of Zika virus from patient to health care personnel, particularly during the labor and delivery process. Standard Precautions include:

  1. hand hygiene,
  2. use of personal protective equipment (PPE),
  3. respiratory hygiene and cough etiquette,
  4. safe injection practices, and
  5. safe handling of potentially contaminated equipment or surfaces in the patient environment.

Health care personnel should assess their risk for exposure and select PPE appropriate for the situation. For example, if taking part in procedures where exposure to body fluids is anticipated, protect mucous membranes, skin, and clothing, use mask and eye protection, in addition to gloves and an impermeable gown.

In addition to use of PPE by health care personnel, placement of disposable absorbent material on the floor around the procedure and delivery area to absorb fluid can reduce the risk for splash exposure to body fluids. Infection control supplies should be available and accessible in all patient care areas where they will be needed. Standard cleaning and disinfection procedures for environmental surfaces, using Environmental Protection Agency-registered hospital disinfectants, should be followed.

What is the risk for Zika in Arizona?

There are NO locally acquired cases of Zika virus in Arizona. However, a competent mosquito vector for Zika virus, Aedes aegypti, is present in the state. To lower the risk for local disease transmission, persons returning from travel to a Zika-affected area should be advised to avoid mosquitoes for at least three weeks after their return.

What are the Arizona Department of Health Services (ADHS) and county health departments doing to prepare for Zika?

ADHS has been following the Zika outbreak in other countries and working with local public health departments and the Centers for Disease Control and Prevention (CDC) to coordinate testing, control the mosquito population, and provide information to the public and providers. (www.azdhs.gov/mosquito)

CDC Resources:

For more information, contact your county’s public health department:
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