Deepak Chitnis

Health officials in Florida have identified 10 new cases of locally transmitted Zika virus infections in the neighborhood just north of downtown Miami where four other cases were reported earlier.

Persistent mosquito populations in southern Florida are the leading cause of the disease’s growing incursion into the continental United States, according to Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention.

©AlexLMX/Thinkstock

“This suggests that there is a risk of continued, active transmission of Zika in that area,” Dr. Frieden said Aug. 1 during a press call regarding the discovery of new cases by Florida officials.

The CDC is issuing new recommendations for people who either have visited, are currently visiting, or plan to visit this Miami neighborhood at any point after June 15, the earliest known date on which the infected individuals could have been exposed to the virus.

Women who are pregnant or planning to become pregnant are advised to stay away from the neighborhood north of downtown Miami. Women who live in or around Miami, and who either are or plan to become pregnant, should take steps to protect themselves from mosquitoes. Individuals living in Miami should take precautions to prevent transmitting the disease sexually.

Additionally, the CDC is sending an Emergency Response Team to Florida to assist with efforts to quell the mosquito population and spread awareness about Zika virus prevention.

“These experts include individuals with extensive experience in Zika, in addressing pregnancy and birth defects, in mosquito control, in laboratory science, and community engagement,” Dr. Frieden said.

Dr. Frieden reiterated that controlling the local mosquito population is one of the most effective ways to stop ongoing Zika virus transmission. However, current efforts are being hampered by several factors, including small bodies of standing water near which mosquitoes are breeding, the inherent difficulty in killing this species of mosquito, and the possibility that the Aedes aegypti mosquito is resistant to the insecticides being used.

Vector control experts will work with health officials on the ground in Miami to conduct resistance testing on local mosquitoes, in order to confirm whether the insecticides are working. These tests could be done after just 1 week, but may take 3 or more weeks. Further discussion is also ongoing to determine other ways of bringing down the mosquito population.

“What we know about Zika is scary [but] in some ways, what we don’t know about Zika is even more unsettling,” said Dr. Frieden, who added that “at CDC, more than 1,600 of our experts have been working since January to learn more about Zika and protect the health of pregnant women and others.”

[email protected]

Health officials in Florida have identified 10 new cases of locally transmitted Zika virus infections in the neighborhood just north of downtown Miami where four other cases were reported earlier.

Persistent mosquito populations in southern Florida are the leading cause of the disease’s growing incursion into the continental United States, according to Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention.

©AlexLMX/Thinkstock

“This suggests that there is a risk of continued, active transmission of Zika in that area,” Dr. Frieden said Aug. 1 during a press call regarding the discovery of new cases by Florida officials.

The CDC is issuing new recommendations for people who either have visited, are currently visiting, or plan to visit this Miami neighborhood at any point after June 15, the earliest known date on which the infected individuals could have been exposed to the virus.

Women who are pregnant or planning to become pregnant are advised to stay away from the neighborhood north of downtown Miami. Women who live in or around Miami, and who either are or plan to become pregnant, should take steps to protect themselves from mosquitoes. Individuals living in Miami should take precautions to prevent transmitting the disease sexually.

Additionally, the CDC is sending an Emergency Response Team to Florida to assist with efforts to quell the mosquito population and spread awareness about Zika virus prevention.

“These experts include individuals with extensive experience in Zika, in addressing pregnancy and birth defects, in mosquito control, in laboratory science, and community engagement,” Dr. Frieden said.

Dr. Frieden reiterated that controlling the local mosquito population is one of the most effective ways to stop ongoing Zika virus transmission. However, current efforts are being hampered by several factors, including small bodies of standing water near which mosquitoes are breeding, the inherent difficulty in killing this species of mosquito, and the possibility that the Aedes aegypti mosquito is resistant to the insecticides being used.

Vector control experts will work with health officials on the ground in Miami to conduct resistance testing on local mosquitoes, in order to confirm whether the insecticides are working. These tests could be done after just 1 week, but may take 3 or more weeks. Further discussion is also ongoing to determine other ways of bringing down the mosquito population.

“What we know about Zika is scary [but] in some ways, what we don’t know about Zika is even more unsettling,” said Dr. Frieden, who added that “at CDC, more than 1,600 of our experts have been working since January to learn more about Zika and protect the health of pregnant women and others.”

[email protected]

Health officials in Florida have identified 10 new cases of locally transmitted Zika virus infections in the neighborhood just north of downtown Miami where four other cases were reported earlier.

Persistent mosquito populations in southern Florida are the leading cause of the disease’s growing incursion into the continental United States, according to Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention.

©AlexLMX/Thinkstock

“This suggests that there is a risk of continued, active transmission of Zika in that area,” Dr. Frieden said Aug. 1 during a press call regarding the discovery of new cases by Florida officials.

The CDC is issuing new recommendations for people who either have visited, are currently visiting, or plan to visit this Miami neighborhood at any point after June 15, the earliest known date on which the infected individuals could have been exposed to the virus.

Women who are pregnant or planning to become pregnant are advised to stay away from the neighborhood north of downtown Miami. Women who live in or around Miami, and who either are or plan to become pregnant, should take steps to protect themselves from mosquitoes. Individuals living in Miami should take precautions to prevent transmitting the disease sexually.

Additionally, the CDC is sending an Emergency Response Team to Florida to assist with efforts to quell the mosquito population and spread awareness about Zika virus prevention.

“These experts include individuals with extensive experience in Zika, in addressing pregnancy and birth defects, in mosquito control, in laboratory science, and community engagement,” Dr. Frieden said.

Dr. Frieden reiterated that controlling the local mosquito population is one of the most effective ways to stop ongoing Zika virus transmission. However, current efforts are being hampered by several factors, including small bodies of standing water near which mosquitoes are breeding, the inherent difficulty in killing this species of mosquito, and the possibility that the Aedes aegypti mosquito is resistant to the insecticides being used.

Vector control experts will work with health officials on the ground in Miami to conduct resistance testing on local mosquitoes, in order to confirm whether the insecticides are working. These tests could be done after just 1 week, but may take 3 or more weeks. Further discussion is also ongoing to determine other ways of bringing down the mosquito population.

“What we know about Zika is scary [but] in some ways, what we don’t know about Zika is even more unsettling,” said Dr. Frieden, who added that “at CDC, more than 1,600 of our experts have been working since January to learn more about Zika and protect the health of pregnant women and others.”

[email protected]

Administering 5 mg of zoledronic acid at the start of antiretroviral therapy to HIV-infected patients who have never previously undergone ART can significantly decrease the risk of bone density loss.

Those are the findings reported in a study of 63 viremic HIV patients, all of whom were aged 30 to 50 and had never undergone ART before. The participants were randomized into cohorts receiving either a single dose of 5 mg zoledronic acid or a placebo. ART consisted of atazanavir / ritonavir in combination with tenofovir / emtricitabine. “The skeletal effects of ART, though varied in magnitude, appear to be universal to all ART types including tenofovir alafenamide (TAF) containing and tenofovir disoproxil fumarate (TDF) sparing regimens,” according to the study, led by Ighovwerha Ofotokun, MD, of Emory University in Atlanta, and colleagues.

“We hypothesized that the preponderance of bone loss in this setting would occur during early period of therapy when T-cell recovery is most pronounced, providing an exploitable window for preemptive intervention to mitigate ART-induced bone resorption and preserve natural bone in this population,” the authors added.

Investigators performed plasma bone turnover markers and bone mineral density analyses at 0, 12, 24, and 48 weeks. Significant reductions in bone resorption was noted as early as 12 weeks after commencement, with a 73% reduction (P < .001); resorption reductions did not stay as robust but were similarly strong through 48 weeks (57%, P < .001).

C-terminal telopeptide of collagen (CTx) levels, the primary outcome, was not significantly different between the two cohorts at baseline: 0.154 nanograms per milliliter (ng/ml) for zoledronic acid vs. 0.190 ng/ml for placebo (P = 0.22). However, zoledronic acid was significantly lower than placebo at 12-, 24-, and 48-week follow-ups: 0.083 ng/ml vs. 0.305 ng/ml (P < .001) at 12 weeks, 0.117 ng/ml vs. 0.338 ng/ml (P < 0.001) at 24 weeks, and 0.116 ng/ml vs. 0.269 ng/ml, (P < 0.001) at 48 weeks. Additionally, higher improvements in lumbar spine, hip, and femoral BMD were noted in the zoledronic acid group at 12, 24, and 48 weeks, compared with the placebo group.

“[Zoledronic acid] at a single dose was safe and well tolerated, and resulted in comparable rate of virologic suppression and similar magnitude of CD4 T-cell reconstitution,” the authors concluded, adding that “these data define an optimal window for a pre-emptive intervention to forestall ART-induced bone loss and provide robust information needed to guide the design and implementation of larger confirmatory phase III, multicenter randomized clinical trials.”

The study was funded by the National Institute on Aging, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Ofotokun and other colleagues did not report relevant financial disclosures.

[email protected]

Administering 5 mg of zoledronic acid at the start of antiretroviral therapy to HIV-infected patients who have never previously undergone ART can significantly decrease the risk of bone density loss.

Those are the findings reported in a study of 63 viremic HIV patients, all of whom were aged 30 to 50 and had never undergone ART before. The participants were randomized into cohorts receiving either a single dose of 5 mg zoledronic acid or a placebo. ART consisted of atazanavir / ritonavir in combination with tenofovir / emtricitabine. “The skeletal effects of ART, though varied in magnitude, appear to be universal to all ART types including tenofovir alafenamide (TAF) containing and tenofovir disoproxil fumarate (TDF) sparing regimens,” according to the study, led by Ighovwerha Ofotokun, MD, of Emory University in Atlanta, and colleagues.

“We hypothesized that the preponderance of bone loss in this setting would occur during early period of therapy when T-cell recovery is most pronounced, providing an exploitable window for preemptive intervention to mitigate ART-induced bone resorption and preserve natural bone in this population,” the authors added.

Investigators performed plasma bone turnover markers and bone mineral density analyses at 0, 12, 24, and 48 weeks. Significant reductions in bone resorption was noted as early as 12 weeks after commencement, with a 73% reduction (P < .001); resorption reductions did not stay as robust but were similarly strong through 48 weeks (57%, P < .001).

C-terminal telopeptide of collagen (CTx) levels, the primary outcome, was not significantly different between the two cohorts at baseline: 0.154 nanograms per milliliter (ng/ml) for zoledronic acid vs. 0.190 ng/ml for placebo (P = 0.22). However, zoledronic acid was significantly lower than placebo at 12-, 24-, and 48-week follow-ups: 0.083 ng/ml vs. 0.305 ng/ml (P < .001) at 12 weeks, 0.117 ng/ml vs. 0.338 ng/ml (P < 0.001) at 24 weeks, and 0.116 ng/ml vs. 0.269 ng/ml, (P < 0.001) at 48 weeks. Additionally, higher improvements in lumbar spine, hip, and femoral BMD were noted in the zoledronic acid group at 12, 24, and 48 weeks, compared with the placebo group.

“[Zoledronic acid] at a single dose was safe and well tolerated, and resulted in comparable rate of virologic suppression and similar magnitude of CD4 T-cell reconstitution,” the authors concluded, adding that “these data define an optimal window for a pre-emptive intervention to forestall ART-induced bone loss and provide robust information needed to guide the design and implementation of larger confirmatory phase III, multicenter randomized clinical trials.”

The study was funded by the National Institute on Aging, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Ofotokun and other colleagues did not report relevant financial disclosures.

[email protected]

Administering 5 mg of zoledronic acid at the start of antiretroviral therapy to HIV-infected patients who have never previously undergone ART can significantly decrease the risk of bone density loss.

Those are the findings reported in a study of 63 viremic HIV patients, all of whom were aged 30 to 50 and had never undergone ART before. The participants were randomized into cohorts receiving either a single dose of 5 mg zoledronic acid or a placebo. ART consisted of atazanavir / ritonavir in combination with tenofovir / emtricitabine. “The skeletal effects of ART, though varied in magnitude, appear to be universal to all ART types including tenofovir alafenamide (TAF) containing and tenofovir disoproxil fumarate (TDF) sparing regimens,” according to the study, led by Ighovwerha Ofotokun, MD, of Emory University in Atlanta, and colleagues.

“We hypothesized that the preponderance of bone loss in this setting would occur during early period of therapy when T-cell recovery is most pronounced, providing an exploitable window for preemptive intervention to mitigate ART-induced bone resorption and preserve natural bone in this population,” the authors added.

Investigators performed plasma bone turnover markers and bone mineral density analyses at 0, 12, 24, and 48 weeks. Significant reductions in bone resorption was noted as early as 12 weeks after commencement, with a 73% reduction (P < .001); resorption reductions did not stay as robust but were similarly strong through 48 weeks (57%, P < .001).

C-terminal telopeptide of collagen (CTx) levels, the primary outcome, was not significantly different between the two cohorts at baseline: 0.154 nanograms per milliliter (ng/ml) for zoledronic acid vs. 0.190 ng/ml for placebo (P = 0.22). However, zoledronic acid was significantly lower than placebo at 12-, 24-, and 48-week follow-ups: 0.083 ng/ml vs. 0.305 ng/ml (P < .001) at 12 weeks, 0.117 ng/ml vs. 0.338 ng/ml (P < 0.001) at 24 weeks, and 0.116 ng/ml vs. 0.269 ng/ml, (P < 0.001) at 48 weeks. Additionally, higher improvements in lumbar spine, hip, and femoral BMD were noted in the zoledronic acid group at 12, 24, and 48 weeks, compared with the placebo group.

“[Zoledronic acid] at a single dose was safe and well tolerated, and resulted in comparable rate of virologic suppression and similar magnitude of CD4 T-cell reconstitution,” the authors concluded, adding that “these data define an optimal window for a pre-emptive intervention to forestall ART-induced bone loss and provide robust information needed to guide the design and implementation of larger confirmatory phase III, multicenter randomized clinical trials.”

The study was funded by the National Institute on Aging, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Ofotokun and other colleagues did not report relevant financial disclosures.

[email protected]

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

[email protected]

Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

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Four cases of Zika virus infection in Florida have been confirmed as the first cases of local transmission of the Zika virus in the continental United States, the Centers for Disease Control and Prevention announced.

“As we have anticipated, Zika is now here,” CDC Director Tom Frieden, MD, MPH, said during a conference call with the media. “These cases are not unexpected [as] we’ve been saying for months, based on our experiences with chikungunya virus and dengue – which are viruses spread by the same mosquitoes that spread Zika – that individual cases and potentially small clusters of Zika are possible in the U.S.”

CDC

The cases in question occurred within several blocks of each other in Miami. The individuals were infected in early July, became symptomatic within a few days, and were diagnosed a few days later. Frieden explained that the CDC is proceeding as though these are confirmed cases of local mosquito-borne transmission, which he emphasized is not the same as simply confirming that a person has Zika virus infection.

“We’ve been working closely with Florida and we’ve been impressed by the comprehensiveness of their investigation,” Dr. Frieden said.

Since these cases became diagnosed, Florida officials have implemented “aggressive” mosquito control protocols, which include trying to significantly reduce the local mosquito population by spraying both adult and larval mosquitoes. Dr. Frieden reiterated that killing mosquitoes is one of the most effective ways to ensure local transmission does not occur. Screening of travelers coming into Florida has also been ramped up. Teams are also going door-to-door to eliminate any standing water that may be harboring mosquitoes.

“We’re coordinating closely with Florida, and will continue to support their efforts to assess the situation on a daily basis,” he said.

To reduce the chances of an individual contracting the virus through mosquitos, the CDC continues recommending mosquito repellent; wearing clothing that covers as much of the body as possible; avoiding any areas with still water; and staying in rooms that have air conditioning, fans, or mosquito nets.

“We have been working with state and local governments to prepare for the likelihood of local mosquito-borne Zika virus transmission in the continental United States and Hawaii,” said Lyle R. Petersen, MD, MPH, Director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for the CDC’s Zika Response efforts, in a statement. “We anticipate that there may be additional cases of ‘homegrown’ Zika in the coming weeks. Our top priority is to protect pregnant women from the potentially devastating harm caused by Zika.”

To combat the growing domestic Zika burden, the American Public Health Association called on Congress to allocate more funding, saying that the lack of Congressional support is directly leading to the disease’s incursion into the United States.

“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response [and] now Congress has adjourned for summer recess.” said Georges C. Benjamin, MD, Executive Director of the APHA, adding that “when Congress comes back in September, it must make sending bipartisan Zika legislation to the president a top priority.”

The American Medical Association echoed that position. “This should be a wake up call to Congress and the Administration that they must resolve their differences and immediately make the necessary resources available for our country to combat the growing threat of the virus,” Andrew W. Gurman, MD, AMA President, said in a statement.

The announcement of locally transmitted Zika virus cases in the continental U.S. comes on the heels of the CDC’s latest Morbidity and Mortality Weekly Report, which found that cases of Zika virus have increased dramatically in Puerto Rico. There have been 5,582 individuals diagnosed with Zika virus so far in 2016, as of July 7. That figure includes 672 pregnant women, with the rate of positive tests increasing from just 14% in February to 64% in June, according to the MMWR (doi: 10.15585/mmwr.mm6530e1).

“Puerto Rico is in the midst of a Zika epidemic. The virus is silently and rapidly spreading in Puerto Rico,” Dr. Peterson said in a separate statement. “This could lead to hundreds of infants being born with microcephaly or other birth defects in the coming year. We must do all we can to protect pregnant women from Zika and to prepare to care for infants born with microcephaly.”

[email protected]

People attending the 2016 Summer Olympic games in Rio de Janeiro stand a low risk of contracting or spreading the Zika virus, says a new report in the Annals of Internal Medicine.

Attendance at the Rio Olympics is estimated to be between 350,000 and 500,000, according to the report – written by Albert I. Ko, MD, of Yale University in New Haven, Conn. and his colleagues – and in the worst-case scenario, the projected likelihood of infection will be between 1 in 56,300 and 1 in 6,200. This means that, at most, 80 people attending the games will contract the Zika virus (95% confidence interval, 63-98), while the lower bound of the estimate is a mere 6 individuals (95% CI, 2-12). Furthermore, only 1-16 individuals (95% CI, 0-4 and 9-24, respectively) of infected individuals are expected to be symptomatic (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-1628).

©Rattikankeawpun/Thinkstock.com

Data from the 2014 FIFA World Cup tournament – which also took place in Brazil – estimates that 53.3% of attendees will come from one of eight countries or regions: United States, Canada, Europe, Oceania, Japan, South Korea, and Israel, all of which are locations where mosquito-borne disease transmission rates are expected to be low. Individuals who contract Zika virus and take it back home with them are expected to number between 3 (95% CI, 0-7) and 37 (95% CI, 25-49), mainly because the Zika virus is only expected to take 9.9 days to naturally clear any infected individual.

“Most of the remaining travelers (30.2% of the total) are expected to return to Latin American countries already experiencing autochthonous ZIKV transmission, contributing 9.0 (0.0 to 29.7) to 116.0 (59.4 to 188.1) additional person-days of viremia,” the report states. “This effect is negligible relative to prevalent infections caused by ongoing transmission in these countries.”

Recently, the U.S. Centers for Disease Control and Prevention also announced that chances of acquiring the Zika virus are low for those attending the 2016 Summer Olympics, and that only individuals from a small number of countries have any real danger of introducing the disease into a previously unaffected and potentially dangerous climate.

Sexual transmission of Zika virus remains a risk, however, the Annals report notes. People are urged to use condoms or abstain from sex during the Olympics in order to mitigate the risk of spreading the disease. Additionally, women who attend the games are best advised to delay getting pregnant for several weeks, if not months, after returning home. Women who are already pregnant should not attend the games, and everyone who attends the Olympics should wear mosquito repellent, long-sleeve shirts and pants, and use either a fan or a mosquito net in their hotel rooms to avoid getting bitten.

Dr. Ko and his coauthors declared no conflicts of interest.

[email protected]

People attending the 2016 Summer Olympic games in Rio de Janeiro stand a low risk of contracting or spreading the Zika virus, says a new report in the Annals of Internal Medicine.

Attendance at the Rio Olympics is estimated to be between 350,000 and 500,000, according to the report – written by Albert I. Ko, MD, of Yale University in New Haven, Conn. and his colleagues – and in the worst-case scenario, the projected likelihood of infection will be between 1 in 56,300 and 1 in 6,200. This means that, at most, 80 people attending the games will contract the Zika virus (95% confidence interval, 63-98), while the lower bound of the estimate is a mere 6 individuals (95% CI, 2-12). Furthermore, only 1-16 individuals (95% CI, 0-4 and 9-24, respectively) of infected individuals are expected to be symptomatic (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-1628).

©Rattikankeawpun/Thinkstock.com

Data from the 2014 FIFA World Cup tournament – which also took place in Brazil – estimates that 53.3% of attendees will come from one of eight countries or regions: United States, Canada, Europe, Oceania, Japan, South Korea, and Israel, all of which are locations where mosquito-borne disease transmission rates are expected to be low. Individuals who contract Zika virus and take it back home with them are expected to number between 3 (95% CI, 0-7) and 37 (95% CI, 25-49), mainly because the Zika virus is only expected to take 9.9 days to naturally clear any infected individual.

“Most of the remaining travelers (30.2% of the total) are expected to return to Latin American countries already experiencing autochthonous ZIKV transmission, contributing 9.0 (0.0 to 29.7) to 116.0 (59.4 to 188.1) additional person-days of viremia,” the report states. “This effect is negligible relative to prevalent infections caused by ongoing transmission in these countries.”

Recently, the U.S. Centers for Disease Control and Prevention also announced that chances of acquiring the Zika virus are low for those attending the 2016 Summer Olympics, and that only individuals from a small number of countries have any real danger of introducing the disease into a previously unaffected and potentially dangerous climate.

Sexual transmission of Zika virus remains a risk, however, the Annals report notes. People are urged to use condoms or abstain from sex during the Olympics in order to mitigate the risk of spreading the disease. Additionally, women who attend the games are best advised to delay getting pregnant for several weeks, if not months, after returning home. Women who are already pregnant should not attend the games, and everyone who attends the Olympics should wear mosquito repellent, long-sleeve shirts and pants, and use either a fan or a mosquito net in their hotel rooms to avoid getting bitten.

Dr. Ko and his coauthors declared no conflicts of interest.

[email protected]

People attending the 2016 Summer Olympic games in Rio de Janeiro stand a low risk of contracting or spreading the Zika virus, says a new report in the Annals of Internal Medicine.

Attendance at the Rio Olympics is estimated to be between 350,000 and 500,000, according to the report – written by Albert I. Ko, MD, of Yale University in New Haven, Conn. and his colleagues – and in the worst-case scenario, the projected likelihood of infection will be between 1 in 56,300 and 1 in 6,200. This means that, at most, 80 people attending the games will contract the Zika virus (95% confidence interval, 63-98), while the lower bound of the estimate is a mere 6 individuals (95% CI, 2-12). Furthermore, only 1-16 individuals (95% CI, 0-4 and 9-24, respectively) of infected individuals are expected to be symptomatic (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-1628).

©Rattikankeawpun/Thinkstock.com

Data from the 2014 FIFA World Cup tournament – which also took place in Brazil – estimates that 53.3% of attendees will come from one of eight countries or regions: United States, Canada, Europe, Oceania, Japan, South Korea, and Israel, all of which are locations where mosquito-borne disease transmission rates are expected to be low. Individuals who contract Zika virus and take it back home with them are expected to number between 3 (95% CI, 0-7) and 37 (95% CI, 25-49), mainly because the Zika virus is only expected to take 9.9 days to naturally clear any infected individual.

“Most of the remaining travelers (30.2% of the total) are expected to return to Latin American countries already experiencing autochthonous ZIKV transmission, contributing 9.0 (0.0 to 29.7) to 116.0 (59.4 to 188.1) additional person-days of viremia,” the report states. “This effect is negligible relative to prevalent infections caused by ongoing transmission in these countries.”

Recently, the U.S. Centers for Disease Control and Prevention also announced that chances of acquiring the Zika virus are low for those attending the 2016 Summer Olympics, and that only individuals from a small number of countries have any real danger of introducing the disease into a previously unaffected and potentially dangerous climate.

Sexual transmission of Zika virus remains a risk, however, the Annals report notes. People are urged to use condoms or abstain from sex during the Olympics in order to mitigate the risk of spreading the disease. Additionally, women who attend the games are best advised to delay getting pregnant for several weeks, if not months, after returning home. Women who are already pregnant should not attend the games, and everyone who attends the Olympics should wear mosquito repellent, long-sleeve shirts and pants, and use either a fan or a mosquito net in their hotel rooms to avoid getting bitten.

Dr. Ko and his coauthors declared no conflicts of interest.

[email protected]

Women and couples planning to get pregnant may want to delay that pregnancy more than 9 months if there is an ongoing outbreak of the Zika virus in their area of residence, although that measure alone is not powerful enough to make a significant dent in stopping the Zika virus from spreading.

That is according to a new study in which investigators examined epidemiological data from Colombian Zika virus cases to determine if delaying pregnancies – which has been advised by a number of Central and South American health ministries – would be an effective course of action against the disease and its effects on both pregnant mothers and their fetuses (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-0919).

©Alexander Traksel/Thinkstock

“We developed a data-driven Zika virus transmission model to evaluate the effect of a mass pregnancy delay strategy in which women of reproductive age avoid pregnancy for the recommended duration, at varying degrees of adherence,” wrote Martial L. Ndeffo-Mbah, PhD, of Yale University in New Haven, Conn., and his coauthors.

Cases included were reported to Colombia’s National Institute of Health between Oct. 11, 2015, and May 8, 2016. Investigators classified cases as “suspected cases” of Zika virus infection if the patient presented to a hospital or clinic with “rash, fever (temperature higher than 37.2 degrees C), and at least one of the following symptoms within 5 days of symptom onset that could not be explained by other medical conditions: nonpurulent conjunctivitis or conjunctival hyperemia, arthralgia, myalgia, headache, or malaise.”

Modeling was used to project incidence rates of Zika virus infections, based on a 50% adherence rate to the recommendations.

Among those women who would delay getting pregnant by 6 months or less after possible exposure to Zika virus, prenatal Zika virus infections would decrease by 2%-7%. However, that number would decrease substantially, by 7%-44%, for those who delayed their pregnancy by as much as 9-24 months after exposure.

“Because the incidence peak of the epidemic occurs around 8 months into the outbreak, a strategy to delay pregnancy by more than 9 months, initiated at the onset of the epidemic, would allow women of reproductive age to avoid being pregnant during the incidence peak, when risk for exposure to Zika virus is highest,” Dr. Ndeffo-Mbah and his coauthors noted.

While delaying pregnancy can significantly reduce the risk of birth defects in infants, the authors noted, it won’t have the same effect on reducing the overall spread of Zika virus in an affected region.

“Our results indicate that delays in pregnancy alone will probably be insufficient to curtail Zika-related birth abnormalities,” the authors concluded. “In the absence of a vaccine or therapeutic drugs for Zika virus infection, a combination of mass and individual pregnancy-delay strategies with effective vector-control measures is needed to curtail the spread and burden of the ongoing outbreak in the Americas.”

The National Institutes of Health funded the study. Dr. Ndeffo-Mbah and his coauthors reported no relevant financial disclosures.

Women and couples planning to get pregnant may want to delay that pregnancy more than 9 months if there is an ongoing outbreak of the Zika virus in their area of residence, although that measure alone is not powerful enough to make a significant dent in stopping the Zika virus from spreading.

That is according to a new study in which investigators examined epidemiological data from Colombian Zika virus cases to determine if delaying pregnancies – which has been advised by a number of Central and South American health ministries – would be an effective course of action against the disease and its effects on both pregnant mothers and their fetuses (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-0919).

©Alexander Traksel/Thinkstock

“We developed a data-driven Zika virus transmission model to evaluate the effect of a mass pregnancy delay strategy in which women of reproductive age avoid pregnancy for the recommended duration, at varying degrees of adherence,” wrote Martial L. Ndeffo-Mbah, PhD, of Yale University in New Haven, Conn., and his coauthors.

Cases included were reported to Colombia’s National Institute of Health between Oct. 11, 2015, and May 8, 2016. Investigators classified cases as “suspected cases” of Zika virus infection if the patient presented to a hospital or clinic with “rash, fever (temperature higher than 37.2 degrees C), and at least one of the following symptoms within 5 days of symptom onset that could not be explained by other medical conditions: nonpurulent conjunctivitis or conjunctival hyperemia, arthralgia, myalgia, headache, or malaise.”

Modeling was used to project incidence rates of Zika virus infections, based on a 50% adherence rate to the recommendations.

Among those women who would delay getting pregnant by 6 months or less after possible exposure to Zika virus, prenatal Zika virus infections would decrease by 2%-7%. However, that number would decrease substantially, by 7%-44%, for those who delayed their pregnancy by as much as 9-24 months after exposure.

“Because the incidence peak of the epidemic occurs around 8 months into the outbreak, a strategy to delay pregnancy by more than 9 months, initiated at the onset of the epidemic, would allow women of reproductive age to avoid being pregnant during the incidence peak, when risk for exposure to Zika virus is highest,” Dr. Ndeffo-Mbah and his coauthors noted.

While delaying pregnancy can significantly reduce the risk of birth defects in infants, the authors noted, it won’t have the same effect on reducing the overall spread of Zika virus in an affected region.

“Our results indicate that delays in pregnancy alone will probably be insufficient to curtail Zika-related birth abnormalities,” the authors concluded. “In the absence of a vaccine or therapeutic drugs for Zika virus infection, a combination of mass and individual pregnancy-delay strategies with effective vector-control measures is needed to curtail the spread and burden of the ongoing outbreak in the Americas.”

The National Institutes of Health funded the study. Dr. Ndeffo-Mbah and his coauthors reported no relevant financial disclosures.

Women and couples planning to get pregnant may want to delay that pregnancy more than 9 months if there is an ongoing outbreak of the Zika virus in their area of residence, although that measure alone is not powerful enough to make a significant dent in stopping the Zika virus from spreading.

That is according to a new study in which investigators examined epidemiological data from Colombian Zika virus cases to determine if delaying pregnancies – which has been advised by a number of Central and South American health ministries – would be an effective course of action against the disease and its effects on both pregnant mothers and their fetuses (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-0919).

©Alexander Traksel/Thinkstock

“We developed a data-driven Zika virus transmission model to evaluate the effect of a mass pregnancy delay strategy in which women of reproductive age avoid pregnancy for the recommended duration, at varying degrees of adherence,” wrote Martial L. Ndeffo-Mbah, PhD, of Yale University in New Haven, Conn., and his coauthors.

Cases included were reported to Colombia’s National Institute of Health between Oct. 11, 2015, and May 8, 2016. Investigators classified cases as “suspected cases” of Zika virus infection if the patient presented to a hospital or clinic with “rash, fever (temperature higher than 37.2 degrees C), and at least one of the following symptoms within 5 days of symptom onset that could not be explained by other medical conditions: nonpurulent conjunctivitis or conjunctival hyperemia, arthralgia, myalgia, headache, or malaise.”

Modeling was used to project incidence rates of Zika virus infections, based on a 50% adherence rate to the recommendations.

Among those women who would delay getting pregnant by 6 months or less after possible exposure to Zika virus, prenatal Zika virus infections would decrease by 2%-7%. However, that number would decrease substantially, by 7%-44%, for those who delayed their pregnancy by as much as 9-24 months after exposure.

“Because the incidence peak of the epidemic occurs around 8 months into the outbreak, a strategy to delay pregnancy by more than 9 months, initiated at the onset of the epidemic, would allow women of reproductive age to avoid being pregnant during the incidence peak, when risk for exposure to Zika virus is highest,” Dr. Ndeffo-Mbah and his coauthors noted.

While delaying pregnancy can significantly reduce the risk of birth defects in infants, the authors noted, it won’t have the same effect on reducing the overall spread of Zika virus in an affected region.

“Our results indicate that delays in pregnancy alone will probably be insufficient to curtail Zika-related birth abnormalities,” the authors concluded. “In the absence of a vaccine or therapeutic drugs for Zika virus infection, a combination of mass and individual pregnancy-delay strategies with effective vector-control measures is needed to curtail the spread and burden of the ongoing outbreak in the Americas.”

The National Institutes of Health funded the study. Dr. Ndeffo-Mbah and his coauthors reported no relevant financial disclosures.

Women and couples planning to get pregnant may want to delay that pregnancy more than 9 months if there is an ongoing outbreak of the Zika virus in their area of residence, although that measure alone is not powerful enough to make a significant dent in stopping the Zika virus from spreading.

That is according to a new study in which investigators examined epidemiological data from Colombian Zika virus cases to determine if delaying pregnancies – which has been advised by a number of Central and South American health ministries – would be an effective course of action against the disease and its effects on both pregnant mothers and their fetuses (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-0919).

©Alexander Traksel/Thinkstock

“We developed a data-driven Zika virus transmission model to evaluate the effect of a mass pregnancy delay strategy in which women of reproductive age avoid pregnancy for the recommended duration, at varying degrees of adherence,” wrote Martial L. Ndeffo-Mbah, PhD, of Yale University in New Haven, Conn., and his coauthors.

Cases included were reported to Colombia’s National Institute of Health between Oct. 11, 2015, and May 8, 2016. Investigators classified cases as “suspected cases” of Zika virus infection if the patient presented to a hospital or clinic with “rash, fever (temperature higher than 37.2 degrees C), and at least one of the following symptoms within 5 days of symptom onset that could not be explained by other medical conditions: nonpurulent conjunctivitis or conjunctival hyperemia, arthralgia, myalgia, headache, or malaise.”

Modeling was used to project incidence rates of Zika virus infections, based on a 50% adherence rate to the recommendations.

Among those women who would delay getting pregnant by 6 months or less after possible exposure to Zika virus, prenatal Zika virus infections would decrease by 2%-7%. However, that number would decrease substantially, by 7%-44%, for those who delayed their pregnancy by as much as 9-24 months after exposure.

“Because the incidence peak of the epidemic occurs around 8 months into the outbreak, a strategy to delay pregnancy by more than 9 months, initiated at the onset of the epidemic, would allow women of reproductive age to avoid being pregnant during the incidence peak, when risk for exposure to Zika virus is highest,” Dr. Ndeffo-Mbah and his coauthors noted.

While delaying pregnancy can significantly reduce the risk of birth defects in infants, the authors noted, it won’t have the same effect on reducing the overall spread of Zika virus in an affected region.

“Our results indicate that delays in pregnancy alone will probably be insufficient to curtail Zika-related birth abnormalities,” the authors concluded. “In the absence of a vaccine or therapeutic drugs for Zika virus infection, a combination of mass and individual pregnancy-delay strategies with effective vector-control measures is needed to curtail the spread and burden of the ongoing outbreak in the Americas.”

The National Institutes of Health funded the study. Dr. Ndeffo-Mbah and his coauthors reported no relevant financial disclosures.

[email protected]

Women and couples planning to get pregnant may want to delay that pregnancy more than 9 months if there is an ongoing outbreak of the Zika virus in their area of residence, although that measure alone is not powerful enough to make a significant dent in stopping the Zika virus from spreading.

That is according to a new study in which investigators examined epidemiological data from Colombian Zika virus cases to determine if delaying pregnancies – which has been advised by a number of Central and South American health ministries – would be an effective course of action against the disease and its effects on both pregnant mothers and their fetuses (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-0919).

©Alexander Traksel/Thinkstock

“We developed a data-driven Zika virus transmission model to evaluate the effect of a mass pregnancy delay strategy in which women of reproductive age avoid pregnancy for the recommended duration, at varying degrees of adherence,” wrote Martial L. Ndeffo-Mbah, PhD, of Yale University in New Haven, Conn., and his coauthors.

Cases included were reported to Colombia’s National Institute of Health between Oct. 11, 2015, and May 8, 2016. Investigators classified cases as “suspected cases” of Zika virus infection if the patient presented to a hospital or clinic with “rash, fever (temperature higher than 37.2 degrees C), and at least one of the following symptoms within 5 days of symptom onset that could not be explained by other medical conditions: nonpurulent conjunctivitis or conjunctival hyperemia, arthralgia, myalgia, headache, or malaise.”

Modeling was used to project incidence rates of Zika virus infections, based on a 50% adherence rate to the recommendations.

Among those women who would delay getting pregnant by 6 months or less after possible exposure to Zika virus, prenatal Zika virus infections would decrease by 2%-7%. However, that number would decrease substantially, by 7%-44%, for those who delayed their pregnancy by as much as 9-24 months after exposure.

“Because the incidence peak of the epidemic occurs around 8 months into the outbreak, a strategy to delay pregnancy by more than 9 months, initiated at the onset of the epidemic, would allow women of reproductive age to avoid being pregnant during the incidence peak, when risk for exposure to Zika virus is highest,” Dr. Ndeffo-Mbah and his coauthors noted.

While delaying pregnancy can significantly reduce the risk of birth defects in infants, the authors noted, it won’t have the same effect on reducing the overall spread of Zika virus in an affected region.

“Our results indicate that delays in pregnancy alone will probably be insufficient to curtail Zika-related birth abnormalities,” the authors concluded. “In the absence of a vaccine or therapeutic drugs for Zika virus infection, a combination of mass and individual pregnancy-delay strategies with effective vector-control measures is needed to curtail the spread and burden of the ongoing outbreak in the Americas.”

The National Institutes of Health funded the study. Dr. Ndeffo-Mbah and his coauthors reported no relevant financial disclosures.

[email protected]

Women and couples planning to get pregnant may want to delay that pregnancy more than 9 months if there is an ongoing outbreak of the Zika virus in their area of residence, although that measure alone is not powerful enough to make a significant dent in stopping the Zika virus from spreading.

That is according to a new study in which investigators examined epidemiological data from Colombian Zika virus cases to determine if delaying pregnancies – which has been advised by a number of Central and South American health ministries – would be an effective course of action against the disease and its effects on both pregnant mothers and their fetuses (Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-0919).

©Alexander Traksel/Thinkstock

“We developed a data-driven Zika virus transmission model to evaluate the effect of a mass pregnancy delay strategy in which women of reproductive age avoid pregnancy for the recommended duration, at varying degrees of adherence,” wrote Martial L. Ndeffo-Mbah, PhD, of Yale University in New Haven, Conn., and his coauthors.

Cases included were reported to Colombia’s National Institute of Health between Oct. 11, 2015, and May 8, 2016. Investigators classified cases as “suspected cases” of Zika virus infection if the patient presented to a hospital or clinic with “rash, fever (temperature higher than 37.2 degrees C), and at least one of the following symptoms within 5 days of symptom onset that could not be explained by other medical conditions: nonpurulent conjunctivitis or conjunctival hyperemia, arthralgia, myalgia, headache, or malaise.”

Modeling was used to project incidence rates of Zika virus infections, based on a 50% adherence rate to the recommendations.

Among those women who would delay getting pregnant by 6 months or less after possible exposure to Zika virus, prenatal Zika virus infections would decrease by 2%-7%. However, that number would decrease substantially, by 7%-44%, for those who delayed their pregnancy by as much as 9-24 months after exposure.

“Because the incidence peak of the epidemic occurs around 8 months into the outbreak, a strategy to delay pregnancy by more than 9 months, initiated at the onset of the epidemic, would allow women of reproductive age to avoid being pregnant during the incidence peak, when risk for exposure to Zika virus is highest,” Dr. Ndeffo-Mbah and his coauthors noted.

While delaying pregnancy can significantly reduce the risk of birth defects in infants, the authors noted, it won’t have the same effect on reducing the overall spread of Zika virus in an affected region.

“Our results indicate that delays in pregnancy alone will probably be insufficient to curtail Zika-related birth abnormalities,” the authors concluded. “In the absence of a vaccine or therapeutic drugs for Zika virus infection, a combination of mass and individual pregnancy-delay strategies with effective vector-control measures is needed to curtail the spread and burden of the ongoing outbreak in the Americas.”

The National Institutes of Health funded the study. Dr. Ndeffo-Mbah and his coauthors reported no relevant financial disclosures.

[email protected]

The Food and Drug Administration has amended the boxed warning on labels for fluoroquinolone antibiotics, taken either orally or by injection, to reflect recent findings of the drugs’ alarming potential adverse events.

“These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient,” the FDA stated in its Safety Announcement.

As a result, health care providers should reserve systemic fluoroquinolones for patients who have no other treatment options for any of the following conditions: acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTIs). The FDA also said that, for some serious bacterial infections, the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.

Patients taking fluoroquinolones must also be vigilant and let their provider know immediately if they begin suffering from any new pain in their joints, tendons, or muscles. Additionally, if patients begin feeling any numbness in their arms and legs, a prickling or “pins and needles” sensation, or confusion and hallucinations, they should contact their health care provider right away so that they may be switched onto a nonfluoroquinolone antibacterial drug for the remainder of their treatment regimen.

Avelox; Cipro, both standard and extended release; Factive; Levaquin; and ofloxacin are the fluoroquinolones currently approved by the FDA for systemic use. Their active ingredients are moxifloxacin, ciprofloxacin, gemifloxacin, levofloxacin, and ofloxacin, respectively.

Additional side effects for patients taking fluoroquinolones could include tendinitis, tendon rupture, and joint swelling. Central nervous system afflictions could include depression and thoughts of suicide. Fluoroquinolones could also bring about skin rashes, sunburn, arrhythmia, diarrhea, as well as aggravate myasthenia gravis in patients who suffer from it. Warnings regarding these conditions are already included on the drugs’ existing boxed warning.

“In addition to updating information in the Boxed Warning, we are also including information about these safety issues in the Warnings and Precautions section of the label,” the FDA stated. “The Indications and Usage section contains new limitation-of-use statements to reserve fluoroquinolones for patients who do not have other available treatment options for ABS, ABECB, and uncomplicated UTIs.”

The FDA also added that it will continue to monitor and assess safety issues associated with fluoroquinolones and will issue any further updates if necessary.

[email protected]

The Food and Drug Administration has amended the boxed warning on labels for fluoroquinolone antibiotics, taken either orally or by injection, to reflect recent findings of the drugs’ alarming potential adverse events.

“These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient,” the FDA stated in its Safety Announcement.

As a result, health care providers should reserve systemic fluoroquinolones for patients who have no other treatment options for any of the following conditions: acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTIs). The FDA also said that, for some serious bacterial infections, the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.

Patients taking fluoroquinolones must also be vigilant and let their provider know immediately if they begin suffering from any new pain in their joints, tendons, or muscles. Additionally, if patients begin feeling any numbness in their arms and legs, a prickling or “pins and needles” sensation, or confusion and hallucinations, they should contact their health care provider right away so that they may be switched onto a nonfluoroquinolone antibacterial drug for the remainder of their treatment regimen.

Avelox; Cipro, both standard and extended release; Factive; Levaquin; and ofloxacin are the fluoroquinolones currently approved by the FDA for systemic use. Their active ingredients are moxifloxacin, ciprofloxacin, gemifloxacin, levofloxacin, and ofloxacin, respectively.

Additional side effects for patients taking fluoroquinolones could include tendinitis, tendon rupture, and joint swelling. Central nervous system afflictions could include depression and thoughts of suicide. Fluoroquinolones could also bring about skin rashes, sunburn, arrhythmia, diarrhea, as well as aggravate myasthenia gravis in patients who suffer from it. Warnings regarding these conditions are already included on the drugs’ existing boxed warning.

“In addition to updating information in the Boxed Warning, we are also including information about these safety issues in the Warnings and Precautions section of the label,” the FDA stated. “The Indications and Usage section contains new limitation-of-use statements to reserve fluoroquinolones for patients who do not have other available treatment options for ABS, ABECB, and uncomplicated UTIs.”

The FDA also added that it will continue to monitor and assess safety issues associated with fluoroquinolones and will issue any further updates if necessary.

[email protected]

The Food and Drug Administration has amended the boxed warning on labels for fluoroquinolone antibiotics, taken either orally or by injection, to reflect recent findings of the drugs’ alarming potential adverse events.

“These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient,” the FDA stated in its Safety Announcement.

As a result, health care providers should reserve systemic fluoroquinolones for patients who have no other treatment options for any of the following conditions: acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTIs). The FDA also said that, for some serious bacterial infections, the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.

Patients taking fluoroquinolones must also be vigilant and let their provider know immediately if they begin suffering from any new pain in their joints, tendons, or muscles. Additionally, if patients begin feeling any numbness in their arms and legs, a prickling or “pins and needles” sensation, or confusion and hallucinations, they should contact their health care provider right away so that they may be switched onto a nonfluoroquinolone antibacterial drug for the remainder of their treatment regimen.

Avelox; Cipro, both standard and extended release; Factive; Levaquin; and ofloxacin are the fluoroquinolones currently approved by the FDA for systemic use. Their active ingredients are moxifloxacin, ciprofloxacin, gemifloxacin, levofloxacin, and ofloxacin, respectively.

Additional side effects for patients taking fluoroquinolones could include tendinitis, tendon rupture, and joint swelling. Central nervous system afflictions could include depression and thoughts of suicide. Fluoroquinolones could also bring about skin rashes, sunburn, arrhythmia, diarrhea, as well as aggravate myasthenia gravis in patients who suffer from it. Warnings regarding these conditions are already included on the drugs’ existing boxed warning.

“In addition to updating information in the Boxed Warning, we are also including information about these safety issues in the Warnings and Precautions section of the label,” the FDA stated. “The Indications and Usage section contains new limitation-of-use statements to reserve fluoroquinolones for patients who do not have other available treatment options for ABS, ABECB, and uncomplicated UTIs.”

The FDA also added that it will continue to monitor and assess safety issues associated with fluoroquinolones and will issue any further updates if necessary.

[email protected]

Updated guidelines released by the Centers for Disease Control and Prevention outline how to diagnose suspected cases of Zika virus infection among pregnant women based on how quickly they present with symptoms.

The guidance was updated in light of “the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women,” the CDC wrote in the July 25 issue of the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6529e1).

©Alexander Traksel/Thinkstock

All pregnant women should be assessed for Zika virus at each of their prenatal care visits, regardless of their recent travel history or exposure to mosquitoes, by being evaluated for signs and symptoms of infection, such as fever, rash, and arthralgia. From there, management can take one of two directions.

The first direction involves women who are tested within 2 weeks of either symptom onset, or their suspected exposure to the virus. Pregnant women who are asymptomatic and do not live in an area with an ongoing Zika virus outbreak, as well as women who are symptomatic, should have their serum and urine analyzed using a real-time reverse transcription–polymerase chain reaction (rRT-PCR) test. If the result of this test is positive, it should be considered as confirmation that the woman has a “recent Zika virus infection.”

However, if the test results are negative, symptomatic women should undergo immunoglobin M testing for both Zika virus and dengue virus, while asymptomatic women should undergo just Zika virus IgM testing within 2-12 weeks of the possible exposure. In either case, if the tests come back negative, then the patient can be definitively cleared of any recent Zika virus infection. However, if either the Zika virus or dengue virus tests are positive or equivocal, then there is a “presumptive recent Zika virus or dengue virus or Flavivirus infection” in the woman, at which point plaque reduction neutralization testing (PRNT) must be conducted.

The second direction for management involves pregnant women who are initially tested within 2-12 weeks of either symptom onset or suspected exposure to the virus. Asymptomatic women who do not live in an area with active Zika virus transmission, or do live in an area with ongoing Zika virus cases but are already in the first or second trimester of their pregnancy – along with any women who are symptomatic – should have their serum analyzed through IgM testing for both Zika virus and dengue virus.

If both results are negative, then there is no Zika virus infection. If the Zika virus test is negative but the dengue virus test is either positive or equivocal, the woman has a “presumptive dengue virus infection” and should undergo PRNT. If the Zika virus test is either positive or equivocal, then the woman has a “presumptive recent Zika virus or Flavivirus infection,” regardless of the dengue virus IgM result. In the latter case, the next step is to conduct a reflex Zika virus rRT-PCR test on both serum and urine. A negative result on the serum test should be followed by PRNT; a positive result should be taken as proof of a “recent Zika virus infection.”

For any diagnostic chain that ends with a PRNT, the results of that test can be interpreted in one of three ways. If the Zika virus PRNT result is at least 10 and the dengue virus result is less than 10, then there is a recent Zika virus infection. If both the Zika virus and dengue virus PRNT results are 10 or greater, than there is a Flavivirus infection, but the specific one cannot be determined. Finally, if both results are less than 10, then there is no evidence of a recent Zika virus infection.

“For symptomatic and asymptomatic pregnant women with possible Zika virus exposure who seek care [more than] 12 weeks after symptom onset or possible exposure, IgM antibody testing might be considered,” the CDC wrote. “If fetal abnormalities are present, rRT-PCR testing should also be performed on maternal serum and urine [but] a negative IgM antibody test or rRT-PCR result [more than] 12 weeks after symptom onset or possible exposure does not rule out recent Zika virus infection.”

For pregnant women with a diagnosis of a confirmed or presumptive Flavivirus infection, regardless of whether it’s specifically Zika virus or not, the CDC recommends getting serial ultrasounds every 3-4 weeks during pregnancy in order to monitor the fetus’s development, while “decisions regarding amniocentesis should be individualized for each clinical circumstance.” After the child’s birth, rRT-PCR should be conducted on the child’s cord blood and serum; Zika virus and dengue virus IgM are also recommended.

Pregnant women without a diagnosis of either Zika virus or dengue virus should have a prenatal ultrasound; if abnormalities are found in the fetus, CDC recommends that they have a repeat Zika virus rRT-PCR and IgM test and that clinicians base management on corresponding laboratory results. If nothing is found, however, then standard care can resume with ongoing vigilance to avoid Zika virus infections. Women with dengue virus diagnoses should follow the guidance that is currently in place.

“Pregnant women with laboratory evidence of confirmed or possible Zika virus infection who experience a fetal loss or stillbirth should be offered pathology testing for Zika virus infection,” the CDC added. “This testing might provide insight into the etiology of the fetal loss, which could inform a woman’s future pregnancy planning.”

The CDC also issued updated guidance for preventing sexual transmission of Zika virus and that applies to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners (MMWR. ePub: 2016 25 Jul. doi: 10.15585/mmwr.mm6529e2). The CDC advises couples in which a woman is pregnant to use barriers methods or abstain from sex for the duration of the pregnancy. For couples not planning pregnancy and in which there is a male partner with confirmed Zika virus infection or symptoms of infection, the men should use barrier methods or abstain from sex for at least 6 months after the onset of illness. For women with Zika virus infection, they should use barrier protection or abstain from sex for at least 8 weeks after the onset of illness.

Updated guidelines released by the Centers for Disease Control and Prevention outline how to diagnose suspected cases of Zika virus infection among pregnant women based on how quickly they present with symptoms.

The guidance was updated in light of “the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women,” the CDC wrote in the July 25 issue of the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6529e1).

©Alexander Traksel/Thinkstock

All pregnant women should be assessed for Zika virus at each of their prenatal care visits, regardless of their recent travel history or exposure to mosquitoes, by being evaluated for signs and symptoms of infection, such as fever, rash, and arthralgia. From there, management can take one of two directions.

The first direction involves women who are tested within 2 weeks of either symptom onset, or their suspected exposure to the virus. Pregnant women who are asymptomatic and do not live in an area with an ongoing Zika virus outbreak, as well as women who are symptomatic, should have their serum and urine analyzed using a real-time reverse transcription–polymerase chain reaction (rRT-PCR) test. If the result of this test is positive, it should be considered as confirmation that the woman has a “recent Zika virus infection.”

However, if the test results are negative, symptomatic women should undergo immunoglobin M testing for both Zika virus and dengue virus, while asymptomatic women should undergo just Zika virus IgM testing within 2-12 weeks of the possible exposure. In either case, if the tests come back negative, then the patient can be definitively cleared of any recent Zika virus infection. However, if either the Zika virus or dengue virus tests are positive or equivocal, then there is a “presumptive recent Zika virus or dengue virus or Flavivirus infection” in the woman, at which point plaque reduction neutralization testing (PRNT) must be conducted.

The second direction for management involves pregnant women who are initially tested within 2-12 weeks of either symptom onset or suspected exposure to the virus. Asymptomatic women who do not live in an area with active Zika virus transmission, or do live in an area with ongoing Zika virus cases but are already in the first or second trimester of their pregnancy – along with any women who are symptomatic – should have their serum analyzed through IgM testing for both Zika virus and dengue virus.

If both results are negative, then there is no Zika virus infection. If the Zika virus test is negative but the dengue virus test is either positive or equivocal, the woman has a “presumptive dengue virus infection” and should undergo PRNT. If the Zika virus test is either positive or equivocal, then the woman has a “presumptive recent Zika virus or Flavivirus infection,” regardless of the dengue virus IgM result. In the latter case, the next step is to conduct a reflex Zika virus rRT-PCR test on both serum and urine. A negative result on the serum test should be followed by PRNT; a positive result should be taken as proof of a “recent Zika virus infection.”

For any diagnostic chain that ends with a PRNT, the results of that test can be interpreted in one of three ways. If the Zika virus PRNT result is at least 10 and the dengue virus result is less than 10, then there is a recent Zika virus infection. If both the Zika virus and dengue virus PRNT results are 10 or greater, than there is a Flavivirus infection, but the specific one cannot be determined. Finally, if both results are less than 10, then there is no evidence of a recent Zika virus infection.

“For symptomatic and asymptomatic pregnant women with possible Zika virus exposure who seek care [more than] 12 weeks after symptom onset or possible exposure, IgM antibody testing might be considered,” the CDC wrote. “If fetal abnormalities are present, rRT-PCR testing should also be performed on maternal serum and urine [but] a negative IgM antibody test or rRT-PCR result [more than] 12 weeks after symptom onset or possible exposure does not rule out recent Zika virus infection.”

For pregnant women with a diagnosis of a confirmed or presumptive Flavivirus infection, regardless of whether it’s specifically Zika virus or not, the CDC recommends getting serial ultrasounds every 3-4 weeks during pregnancy in order to monitor the fetus’s development, while “decisions regarding amniocentesis should be individualized for each clinical circumstance.” After the child’s birth, rRT-PCR should be conducted on the child’s cord blood and serum; Zika virus and dengue virus IgM are also recommended.

Pregnant women without a diagnosis of either Zika virus or dengue virus should have a prenatal ultrasound; if abnormalities are found in the fetus, CDC recommends that they have a repeat Zika virus rRT-PCR and IgM test and that clinicians base management on corresponding laboratory results. If nothing is found, however, then standard care can resume with ongoing vigilance to avoid Zika virus infections. Women with dengue virus diagnoses should follow the guidance that is currently in place.

“Pregnant women with laboratory evidence of confirmed or possible Zika virus infection who experience a fetal loss or stillbirth should be offered pathology testing for Zika virus infection,” the CDC added. “This testing might provide insight into the etiology of the fetal loss, which could inform a woman’s future pregnancy planning.”

The CDC also issued updated guidance for preventing sexual transmission of Zika virus and that applies to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners (MMWR. ePub: 2016 25 Jul. doi: 10.15585/mmwr.mm6529e2). The CDC advises couples in which a woman is pregnant to use barriers methods or abstain from sex for the duration of the pregnancy. For couples not planning pregnancy and in which there is a male partner with confirmed Zika virus infection or symptoms of infection, the men should use barrier methods or abstain from sex for at least 6 months after the onset of illness. For women with Zika virus infection, they should use barrier protection or abstain from sex for at least 8 weeks after the onset of illness.

Updated guidelines released by the Centers for Disease Control and Prevention outline how to diagnose suspected cases of Zika virus infection among pregnant women based on how quickly they present with symptoms.

The guidance was updated in light of “the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women,” the CDC wrote in the July 25 issue of the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6529e1).

©Alexander Traksel/Thinkstock

All pregnant women should be assessed for Zika virus at each of their prenatal care visits, regardless of their recent travel history or exposure to mosquitoes, by being evaluated for signs and symptoms of infection, such as fever, rash, and arthralgia. From there, management can take one of two directions.

The first direction involves women who are tested within 2 weeks of either symptom onset, or their suspected exposure to the virus. Pregnant women who are asymptomatic and do not live in an area with an ongoing Zika virus outbreak, as well as women who are symptomatic, should have their serum and urine analyzed using a real-time reverse transcription–polymerase chain reaction (rRT-PCR) test. If the result of this test is positive, it should be considered as confirmation that the woman has a “recent Zika virus infection.”

However, if the test results are negative, symptomatic women should undergo immunoglobin M testing for both Zika virus and dengue virus, while asymptomatic women should undergo just Zika virus IgM testing within 2-12 weeks of the possible exposure. In either case, if the tests come back negative, then the patient can be definitively cleared of any recent Zika virus infection. However, if either the Zika virus or dengue virus tests are positive or equivocal, then there is a “presumptive recent Zika virus or dengue virus or Flavivirus infection” in the woman, at which point plaque reduction neutralization testing (PRNT) must be conducted.

The second direction for management involves pregnant women who are initially tested within 2-12 weeks of either symptom onset or suspected exposure to the virus. Asymptomatic women who do not live in an area with active Zika virus transmission, or do live in an area with ongoing Zika virus cases but are already in the first or second trimester of their pregnancy – along with any women who are symptomatic – should have their serum analyzed through IgM testing for both Zika virus and dengue virus.

If both results are negative, then there is no Zika virus infection. If the Zika virus test is negative but the dengue virus test is either positive or equivocal, the woman has a “presumptive dengue virus infection” and should undergo PRNT. If the Zika virus test is either positive or equivocal, then the woman has a “presumptive recent Zika virus or Flavivirus infection,” regardless of the dengue virus IgM result. In the latter case, the next step is to conduct a reflex Zika virus rRT-PCR test on both serum and urine. A negative result on the serum test should be followed by PRNT; a positive result should be taken as proof of a “recent Zika virus infection.”

For any diagnostic chain that ends with a PRNT, the results of that test can be interpreted in one of three ways. If the Zika virus PRNT result is at least 10 and the dengue virus result is less than 10, then there is a recent Zika virus infection. If both the Zika virus and dengue virus PRNT results are 10 or greater, than there is a Flavivirus infection, but the specific one cannot be determined. Finally, if both results are less than 10, then there is no evidence of a recent Zika virus infection.

“For symptomatic and asymptomatic pregnant women with possible Zika virus exposure who seek care [more than] 12 weeks after symptom onset or possible exposure, IgM antibody testing might be considered,” the CDC wrote. “If fetal abnormalities are present, rRT-PCR testing should also be performed on maternal serum and urine [but] a negative IgM antibody test or rRT-PCR result [more than] 12 weeks after symptom onset or possible exposure does not rule out recent Zika virus infection.”

For pregnant women with a diagnosis of a confirmed or presumptive Flavivirus infection, regardless of whether it’s specifically Zika virus or not, the CDC recommends getting serial ultrasounds every 3-4 weeks during pregnancy in order to monitor the fetus’s development, while “decisions regarding amniocentesis should be individualized for each clinical circumstance.” After the child’s birth, rRT-PCR should be conducted on the child’s cord blood and serum; Zika virus and dengue virus IgM are also recommended.

Pregnant women without a diagnosis of either Zika virus or dengue virus should have a prenatal ultrasound; if abnormalities are found in the fetus, CDC recommends that they have a repeat Zika virus rRT-PCR and IgM test and that clinicians base management on corresponding laboratory results. If nothing is found, however, then standard care can resume with ongoing vigilance to avoid Zika virus infections. Women with dengue virus diagnoses should follow the guidance that is currently in place.

“Pregnant women with laboratory evidence of confirmed or possible Zika virus infection who experience a fetal loss or stillbirth should be offered pathology testing for Zika virus infection,” the CDC added. “This testing might provide insight into the etiology of the fetal loss, which could inform a woman’s future pregnancy planning.”

The CDC also issued updated guidance for preventing sexual transmission of Zika virus and that applies to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners (MMWR. ePub: 2016 25 Jul. doi: 10.15585/mmwr.mm6529e2). The CDC advises couples in which a woman is pregnant to use barriers methods or abstain from sex for the duration of the pregnancy. For couples not planning pregnancy and in which there is a male partner with confirmed Zika virus infection or symptoms of infection, the men should use barrier methods or abstain from sex for at least 6 months after the onset of illness. For women with Zika virus infection, they should use barrier protection or abstain from sex for at least 8 weeks after the onset of illness.

Updated guidelines released by the Centers for Disease Control and Prevention outline how to diagnose suspected cases of Zika virus infection among pregnant women based on how quickly they present with symptoms.

The guidance was updated in light of “the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women,” the CDC wrote in the July 25 issue of the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6529e1).

©Alexander Traksel/Thinkstock

All pregnant women should be assessed for Zika virus at each of their prenatal care visits, regardless of their recent travel history or exposure to mosquitoes, by being evaluated for signs and symptoms of infection, such as fever, rash, and arthralgia. From there, management can take one of two directions.

The first direction involves women who are tested within 2 weeks of either symptom onset, or their suspected exposure to the virus. Pregnant women who are asymptomatic and do not live in an area with an ongoing Zika virus outbreak, as well as women who are symptomatic, should have their serum and urine analyzed using a real-time reverse transcription–polymerase chain reaction (rRT-PCR) test. If the result of this test is positive, it should be considered as confirmation that the woman has a “recent Zika virus infection.”

However, if the test results are negative, symptomatic women should undergo immunoglobin M testing for both Zika virus and dengue virus, while asymptomatic women should undergo just Zika virus IgM testing within 2-12 weeks of the possible exposure. In either case, if the tests come back negative, then the patient can be definitively cleared of any recent Zika virus infection. However, if either the Zika virus or dengue virus tests are positive or equivocal, then there is a “presumptive recent Zika virus or dengue virus or Flavivirus infection” in the woman, at which point plaque reduction neutralization testing (PRNT) must be conducted.

The second direction for management involves pregnant women who are initially tested within 2-12 weeks of either symptom onset or suspected exposure to the virus. Asymptomatic women who do not live in an area with active Zika virus transmission, or do live in an area with ongoing Zika virus cases but are already in the first or second trimester of their pregnancy – along with any women who are symptomatic – should have their serum analyzed through IgM testing for both Zika virus and dengue virus.

If both results are negative, then there is no Zika virus infection. If the Zika virus test is negative but the dengue virus test is either positive or equivocal, the woman has a “presumptive dengue virus infection” and should undergo PRNT. If the Zika virus test is either positive or equivocal, then the woman has a “presumptive recent Zika virus or Flavivirus infection,” regardless of the dengue virus IgM result. In the latter case, the next step is to conduct a reflex Zika virus rRT-PCR test on both serum and urine. A negative result on the serum test should be followed by PRNT; a positive result should be taken as proof of a “recent Zika virus infection.”

For any diagnostic chain that ends with a PRNT, the results of that test can be interpreted in one of three ways. If the Zika virus PRNT result is at least 10 and the dengue virus result is less than 10, then there is a recent Zika virus infection. If both the Zika virus and dengue virus PRNT results are 10 or greater, than there is a Flavivirus infection, but the specific one cannot be determined. Finally, if both results are less than 10, then there is no evidence of a recent Zika virus infection.

“For symptomatic and asymptomatic pregnant women with possible Zika virus exposure who seek care [more than] 12 weeks after symptom onset or possible exposure, IgM antibody testing might be considered,” the CDC wrote. “If fetal abnormalities are present, rRT-PCR testing should also be performed on maternal serum and urine [but] a negative IgM antibody test or rRT-PCR result [more than] 12 weeks after symptom onset or possible exposure does not rule out recent Zika virus infection.”

For pregnant women with a diagnosis of a confirmed or presumptive Flavivirus infection, regardless of whether it’s specifically Zika virus or not, the CDC recommends getting serial ultrasounds every 3-4 weeks during pregnancy in order to monitor the fetus’s development, while “decisions regarding amniocentesis should be individualized for each clinical circumstance.” After the child’s birth, rRT-PCR should be conducted on the child’s cord blood and serum; Zika virus and dengue virus IgM are also recommended.

Pregnant women without a diagnosis of either Zika virus or dengue virus should have a prenatal ultrasound; if abnormalities are found in the fetus, CDC recommends that they have a repeat Zika virus rRT-PCR and IgM test and that clinicians base management on corresponding laboratory results. If nothing is found, however, then standard care can resume with ongoing vigilance to avoid Zika virus infections. Women with dengue virus diagnoses should follow the guidance that is currently in place.

“Pregnant women with laboratory evidence of confirmed or possible Zika virus infection who experience a fetal loss or stillbirth should be offered pathology testing for Zika virus infection,” the CDC added. “This testing might provide insight into the etiology of the fetal loss, which could inform a woman’s future pregnancy planning.”

The CDC also issued updated guidance for preventing sexual transmission of Zika virus and that applies to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners (MMWR. ePub: 2016 25 Jul. doi: 10.15585/mmwr.mm6529e2). The CDC advises couples in which a woman is pregnant to use barriers methods or abstain from sex for the duration of the pregnancy. For couples not planning pregnancy and in which there is a male partner with confirmed Zika virus infection or symptoms of infection, the men should use barrier methods or abstain from sex for at least 6 months after the onset of illness. For women with Zika virus infection, they should use barrier protection or abstain from sex for at least 8 weeks after the onset of illness.

[email protected]

Updated guidelines released by the Centers for Disease Control and Prevention outline how to diagnose suspected cases of Zika virus infection among pregnant women based on how quickly they present with symptoms.

The guidance was updated in light of “the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women,” the CDC wrote in the July 25 issue of the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6529e1).

©Alexander Traksel/Thinkstock

All pregnant women should be assessed for Zika virus at each of their prenatal care visits, regardless of their recent travel history or exposure to mosquitoes, by being evaluated for signs and symptoms of infection, such as fever, rash, and arthralgia. From there, management can take one of two directions.

The first direction involves women who are tested within 2 weeks of either symptom onset, or their suspected exposure to the virus. Pregnant women who are asymptomatic and do not live in an area with an ongoing Zika virus outbreak, as well as women who are symptomatic, should have their serum and urine analyzed using a real-time reverse transcription–polymerase chain reaction (rRT-PCR) test. If the result of this test is positive, it should be considered as confirmation that the woman has a “recent Zika virus infection.”

However, if the test results are negative, symptomatic women should undergo immunoglobin M testing for both Zika virus and dengue virus, while asymptomatic women should undergo just Zika virus IgM testing within 2-12 weeks of the possible exposure. In either case, if the tests come back negative, then the patient can be definitively cleared of any recent Zika virus infection. However, if either the Zika virus or dengue virus tests are positive or equivocal, then there is a “presumptive recent Zika virus or dengue virus or Flavivirus infection” in the woman, at which point plaque reduction neutralization testing (PRNT) must be conducted.

The second direction for management involves pregnant women who are initially tested within 2-12 weeks of either symptom onset or suspected exposure to the virus. Asymptomatic women who do not live in an area with active Zika virus transmission, or do live in an area with ongoing Zika virus cases but are already in the first or second trimester of their pregnancy – along with any women who are symptomatic – should have their serum analyzed through IgM testing for both Zika virus and dengue virus.

If both results are negative, then there is no Zika virus infection. If the Zika virus test is negative but the dengue virus test is either positive or equivocal, the woman has a “presumptive dengue virus infection” and should undergo PRNT. If the Zika virus test is either positive or equivocal, then the woman has a “presumptive recent Zika virus or Flavivirus infection,” regardless of the dengue virus IgM result. In the latter case, the next step is to conduct a reflex Zika virus rRT-PCR test on both serum and urine. A negative result on the serum test should be followed by PRNT; a positive result should be taken as proof of a “recent Zika virus infection.”

For any diagnostic chain that ends with a PRNT, the results of that test can be interpreted in one of three ways. If the Zika virus PRNT result is at least 10 and the dengue virus result is less than 10, then there is a recent Zika virus infection. If both the Zika virus and dengue virus PRNT results are 10 or greater, than there is a Flavivirus infection, but the specific one cannot be determined. Finally, if both results are less than 10, then there is no evidence of a recent Zika virus infection.

“For symptomatic and asymptomatic pregnant women with possible Zika virus exposure who seek care [more than] 12 weeks after symptom onset or possible exposure, IgM antibody testing might be considered,” the CDC wrote. “If fetal abnormalities are present, rRT-PCR testing should also be performed on maternal serum and urine [but] a negative IgM antibody test or rRT-PCR result [more than] 12 weeks after symptom onset or possible exposure does not rule out recent Zika virus infection.”

For pregnant women with a diagnosis of a confirmed or presumptive Flavivirus infection, regardless of whether it’s specifically Zika virus or not, the CDC recommends getting serial ultrasounds every 3-4 weeks during pregnancy in order to monitor the fetus’s development, while “decisions regarding amniocentesis should be individualized for each clinical circumstance.” After the child’s birth, rRT-PCR should be conducted on the child’s cord blood and serum; Zika virus and dengue virus IgM are also recommended.

Pregnant women without a diagnosis of either Zika virus or dengue virus should have a prenatal ultrasound; if abnormalities are found in the fetus, CDC recommends that they have a repeat Zika virus rRT-PCR and IgM test and that clinicians base management on corresponding laboratory results. If nothing is found, however, then standard care can resume with ongoing vigilance to avoid Zika virus infections. Women with dengue virus diagnoses should follow the guidance that is currently in place.

“Pregnant women with laboratory evidence of confirmed or possible Zika virus infection who experience a fetal loss or stillbirth should be offered pathology testing for Zika virus infection,” the CDC added. “This testing might provide insight into the etiology of the fetal loss, which could inform a woman’s future pregnancy planning.”

The CDC also issued updated guidance for preventing sexual transmission of Zika virus and that applies to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners (MMWR. ePub: 2016 25 Jul. doi: 10.15585/mmwr.mm6529e2). The CDC advises couples in which a woman is pregnant to use barriers methods or abstain from sex for the duration of the pregnancy. For couples not planning pregnancy and in which there is a male partner with confirmed Zika virus infection or symptoms of infection, the men should use barrier methods or abstain from sex for at least 6 months after the onset of illness. For women with Zika virus infection, they should use barrier protection or abstain from sex for at least 8 weeks after the onset of illness.

[email protected]

Updated guidelines released by the Centers for Disease Control and Prevention outline how to diagnose suspected cases of Zika virus infection among pregnant women based on how quickly they present with symptoms.

The guidance was updated in light of “the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women,” the CDC wrote in the July 25 issue of the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6529e1).

©Alexander Traksel/Thinkstock

All pregnant women should be assessed for Zika virus at each of their prenatal care visits, regardless of their recent travel history or exposure to mosquitoes, by being evaluated for signs and symptoms of infection, such as fever, rash, and arthralgia. From there, management can take one of two directions.

The first direction involves women who are tested within 2 weeks of either symptom onset, or their suspected exposure to the virus. Pregnant women who are asymptomatic and do not live in an area with an ongoing Zika virus outbreak, as well as women who are symptomatic, should have their serum and urine analyzed using a real-time reverse transcription–polymerase chain reaction (rRT-PCR) test. If the result of this test is positive, it should be considered as confirmation that the woman has a “recent Zika virus infection.”

However, if the test results are negative, symptomatic women should undergo immunoglobin M testing for both Zika virus and dengue virus, while asymptomatic women should undergo just Zika virus IgM testing within 2-12 weeks of the possible exposure. In either case, if the tests come back negative, then the patient can be definitively cleared of any recent Zika virus infection. However, if either the Zika virus or dengue virus tests are positive or equivocal, then there is a “presumptive recent Zika virus or dengue virus or Flavivirus infection” in the woman, at which point plaque reduction neutralization testing (PRNT) must be conducted.

The second direction for management involves pregnant women who are initially tested within 2-12 weeks of either symptom onset or suspected exposure to the virus. Asymptomatic women who do not live in an area with active Zika virus transmission, or do live in an area with ongoing Zika virus cases but are already in the first or second trimester of their pregnancy – along with any women who are symptomatic – should have their serum analyzed through IgM testing for both Zika virus and dengue virus.

If both results are negative, then there is no Zika virus infection. If the Zika virus test is negative but the dengue virus test is either positive or equivocal, the woman has a “presumptive dengue virus infection” and should undergo PRNT. If the Zika virus test is either positive or equivocal, then the woman has a “presumptive recent Zika virus or Flavivirus infection,” regardless of the dengue virus IgM result. In the latter case, the next step is to conduct a reflex Zika virus rRT-PCR test on both serum and urine. A negative result on the serum test should be followed by PRNT; a positive result should be taken as proof of a “recent Zika virus infection.”

For any diagnostic chain that ends with a PRNT, the results of that test can be interpreted in one of three ways. If the Zika virus PRNT result is at least 10 and the dengue virus result is less than 10, then there is a recent Zika virus infection. If both the Zika virus and dengue virus PRNT results are 10 or greater, than there is a Flavivirus infection, but the specific one cannot be determined. Finally, if both results are less than 10, then there is no evidence of a recent Zika virus infection.

“For symptomatic and asymptomatic pregnant women with possible Zika virus exposure who seek care [more than] 12 weeks after symptom onset or possible exposure, IgM antibody testing might be considered,” the CDC wrote. “If fetal abnormalities are present, rRT-PCR testing should also be performed on maternal serum and urine [but] a negative IgM antibody test or rRT-PCR result [more than] 12 weeks after symptom onset or possible exposure does not rule out recent Zika virus infection.”

For pregnant women with a diagnosis of a confirmed or presumptive Flavivirus infection, regardless of whether it’s specifically Zika virus or not, the CDC recommends getting serial ultrasounds every 3-4 weeks during pregnancy in order to monitor the fetus’s development, while “decisions regarding amniocentesis should be individualized for each clinical circumstance.” After the child’s birth, rRT-PCR should be conducted on the child’s cord blood and serum; Zika virus and dengue virus IgM are also recommended.

Pregnant women without a diagnosis of either Zika virus or dengue virus should have a prenatal ultrasound; if abnormalities are found in the fetus, CDC recommends that they have a repeat Zika virus rRT-PCR and IgM test and that clinicians base management on corresponding laboratory results. If nothing is found, however, then standard care can resume with ongoing vigilance to avoid Zika virus infections. Women with dengue virus diagnoses should follow the guidance that is currently in place.

“Pregnant women with laboratory evidence of confirmed or possible Zika virus infection who experience a fetal loss or stillbirth should be offered pathology testing for Zika virus infection,” the CDC added. “This testing might provide insight into the etiology of the fetal loss, which could inform a woman’s future pregnancy planning.”

The CDC also issued updated guidance for preventing sexual transmission of Zika virus and that applies to all men and women who have traveled to or reside in areas with active Zika virus transmission and their sex partners (MMWR. ePub: 2016 25 Jul. doi: 10.15585/mmwr.mm6529e2). The CDC advises couples in which a woman is pregnant to use barriers methods or abstain from sex for the duration of the pregnancy. For couples not planning pregnancy and in which there is a male partner with confirmed Zika virus infection or symptoms of infection, the men should use barrier methods or abstain from sex for at least 6 months after the onset of illness. For women with Zika virus infection, they should use barrier protection or abstain from sex for at least 8 weeks after the onset of illness.

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