Fwd: CDC Health Alert Network (HAN) Health Advisory Regarding Interim Guidelines for Prevention of Sexual Transmission of Zika Virus -United States, 2016

[Professor Ramon Shaban, ACIPC President]

Colleagues,

For your information and noting.

Kind regards,
Ramon

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*Professor Ramon Z ShabanPRESIDENT*

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

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Guidelines for Prevention of Sexual Transmission of Zika Virus United
States, 2016
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The following CDC Health Alert Network (HAN) Health Advisory message was
issued February 23, 2016. You are receiving this information because you
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*This is an official*
*CDC HEALTH ADVISORY*

Distributed via the CDC Health Alert Network
February 23, 2016, 14:15 EST (2:15 PM EST)
CDCHAN-00388
Virus United States, 2016

*Summary *The Centers for Disease Control and Prevention (CDC) recently
published recommendations for protecting people against sexual transmission
of Zika virus (1). As stated in that report, information about possible
sexual transmission of Zika virus was based on one published report of
transmission from a man to a woman, one published report in which Zika
virus was detected in semen of a man with hematospermia, and one case of
possible sexual transmission then under investigation in Texas. An
additional case of Zika virus detected in semen in a man was reported after
the CDC recommendations were published (2). As of February 23, 2016, CDC
and state public health departments are investigating 14 additional reports
of possible sexual transmission of the virus, including several involving
pregnant women. While additional investigations are being completed, CDC is
issuing this HAN Advisory as a strong reminder to state, local, and US
territorial public health departments, clinicians, and the public to be
aware of and adhere to current recommendations for preventing sexual
transmission of Zika virus, particularly for men with pregnant partners.
These recommendations may change as more information becomes available.

*Background*
CDC is working with state, local, and US territorial public health
departments, US Government agencies, and international partners in response
to outbreaks of Zika virus disease (Zika) in multiple territories and
countries in the Americas. Accumulating evidence links maternal Zika virus
infection with congenital microcephaly, miscarriages, and other adverse
fetal outcomes (3). In addition, there are reports of a possible
association with Guillain-Barr syndrome (4). No vaccine or specific
antiviral drug is currently available to prevent or treat Zika.

Zika virus is spread primarily by the bite of infected *Aedes *species
mosquitoes (most commonly, *Aedes aegypti*). In areas where Zika virus
transmission is ongoing, people should follow precautions to prevent
mosquito bites (http://www.cdc.gov/zika/prevention/
).
Sexual transmission of Zika virus also can occur and is of particular
concern during pregnancy. In early February 2016, the Dallas County
Department of Health and Human Services announced an occurrence of sexually
transmitted Zika infection (5). On February 5, 2016, following the
confirmation of this Texas sexual transmission event, CDC published interim
guidelines for preventing sexual transmission of Zika virus (1).

As of February 23, 2016, CDC and state public health departments are
investigating 14 additional reports of possible sexual transmission of the
virus, including several events involving possible transmission to pregnant
women. In two of these new suspected sexual transmission events that have
been investigated to date, Zika virus infection has been confirmed in women
whose only known risk factor was sexual contact with an ill male partner
who had recently travelled to an area with local Zika virus transmission;
testing for the male partners is pending. For four additional suspected
sexual transmission events, preliminary laboratory evidence (IgM antibody
test) is available for the women, but confirmatory testing is still
pending. For eight suspected events, the investigation is ongoing. In all
events for which information is available, travelers reported symptom onset
within 2 weeks prior to their non-traveling female partners symptom onset.

Because these reports suggest sexual transmission may be a more likely
means of transmission for Zika virus than previously considered, CDC is
issuing this HAN Advisory to underscore the importance of adhering to the
interim guidance published on February 5 and outlined below. The
recommendations, which apply to men who reside in or have traveled to areas
with active Zika virus transmission (http://wwwnc.cdc.gov/travel/notices/
)
and their sex partners, will be revised as more information becomes
available.

*Recommendations for 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 (i.e.,
vaginal intercourse, anal intercourse, or fellatio) for the duration of the
pregnancy. Pregnant women should discuss their male partners potential
exposures to mosquitoes and history of Zika-like illness (
http://www.cdc.gov/zika/symptoms
)
with their health care provider; providers can consult CDCs guidelines for
evaluation and testing of pregnant women (6).

*Recommendations for 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. Couples considering this personal
decision should take several factors into account. Most infections are
asymptomatic, and when illness does occur, it is usually mild with symptoms
lasting from several days to a week; severe disease requiring
hospitalization is uncommon. The risk for acquiring vector-borne Zika virus
in areas of active transmission depends on the duration and extent of
exposure to infected mosquitoes and the steps taken to prevent mosquito
bites (http://www.cdc.gov/zika/prevention
).
After infection, Zika virus might persist in semen when it is no longer
detectable in blood; studies to determine the duration of persistence in
semen are not yet completed.

Accumulating evidence of sexual transmission suggests that exposure to Zika
virus includes unprotected sexual contact with a symptomatic male partner
who resides in or has traveled to an area of active Zika virus
transmission. Zika virus testing is currently recommended to establish a
diagnosis of infection in exposed persons with signs or symptoms consistent
with Zika virus disease, and may be offered to asymptomatic pregnant women
with possible exposure to Zika virus (6). However, interpretation of
results is complex, and health care providers should contact their state,
local, or territorial health department for assistance with arranging
testing and interpreting results. At this time, testing of exposed,
asymptomatic men for the purpose of assessing risk for sexual transmission
is not recommended. Sexual transmission of Zika virus from infected women
to their sex partners has not been documented, nor has transmission from
persons who are asymptomatically infected. Sexual transmission of many
infections, including those caused by other viruses, is reduced by
consistent and correct use of latex condoms.
As we learn more about the incidence and duration of seminal shedding from
infected men and the utility and availability of testing in this context,
recommendations to prevent sexual transmission of Zika virus will be
updated.

*References*

1. Oster AM, Brooks JT, Stryker JE, et al. Interim Guidelines for
prevention of sexual transmission of Zika virus United States, 2016. MMWR
Morb Mortal Wkly Rep 2016;65:120121.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1.htm

2. Atkinson B, Hearn P, Afrough B, et al. Detection of Zika virus in
semen [letter]. Emerg Infect Dis. 2016 May [*cited February 22, 2016*].
http://dx.doi.org/10.3201/eid2205.160107

3. Martines RB, Bhatnagar J, Keating MK, et al. Evidence of Zika virus
infection in brain and placental tissues from two congenitally infected
newborns and two fetal losses Brazil, 2015. *MMWR Morb Mortal Wkly Rep*.
2016;65 (Early Release)(06):1-2.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6506e1.htm?s_cidmm6506e1_e
.
Published February 19, 2016.
4. European Centre for Disease Prevention and Control. Rapid risk
assessment: Zika virus epidemic in the Americas: potential association with
microcephaly and Guillain-Barr syndrome 10 December 2015.
http://ecdc.europa.eu/en/publications/Publications/zika-virus-americas-association-with-microcephaly-rapid-risk-assessment.pdf
.
Published 2015. Accessed Feb 1, 2016.
5. Dallas County Health and Human Services. DCHHS reports first Zika
virus case in Dallas County acquired through sexual transmission. February
2, 2016.
http://www.dallascounty.org/department/hhs/press/documents/PR2-2-16DCHHSReportsFirstCaseofZikaVirusThroughSexualTransmission.pdf

6. Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: interim
guidelines for health care providers caring for pregnant women and women of
reproductive age with possible Zika virus exposureUnited States, 2016.
MMWR Morb Mortal Wkly Rep 2016;65.
http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2.htm?s_cidmm6505e2_e

*For More Information*

– General information about Zika virus and disease:
http://www.cdc.gov/zika/

– Zika virus information for clinicians:
http://www.cdc.gov/zika/hc-providers/index.html

– Protection against mosquitoes:
http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods

– Travel notices related to Zika virus:
http://wwwnc.cdc.gov/travel/notices

– Information about Zika virus for travelers and travel health
providers:
http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/zika

– HAN Advisory: Recognizing, managing, and reporting Zika virus
infections in travelers returning from Central America, South America, the
Caribbean, and Mexico. January 15, 2016.
http://emergency.cdc.gov/han/han00385.asp

– Pan American Health Organization PAHO):
http://www.paho.org/hq/index.php?optioncom_content&viewarticle&id11585&Itemid41688&langen

– Approximate distribution of *Aedes aegypti* and *Ae. albopictus*
mosquitoes in the United States:
http://www.cdc.gov/chikungunya/resources/vector-control.html

* DEPARTMENT OF HEALTH AND HUMAN SERVICES*

* 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.*
——————————

*Categories of Health Alert Network messages:*

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level of importance

*Health Advisory* May not require immediate action; provides important
information for a specific incident or situation

*Health Update * Unlikely to require immediate action; provides updated
information regarding an incident or situation

*HAN Info Service* Does not require immediate action; provides general
public health information
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