The U.S. Centers for Disease Control and Prevention (CDC) is getting a better indication of just how many pregnant women in the United States and its territories have Zika virus. CDC established the National Zika Pregnancy Registry and is collaborating with state and local health departments to collect information about pregnancy and infant outcomes in women with laboratory evidence of Zika. CDC says it will use the data to update recommendations for clinical care, to plan for services for pregnant women and families affected by Zika virus, and to improve prevention of Zika virus infection during pregnancy.
As of June 16, CDC reports it was monitoring 265 pregnant women in the U.S. states and 216 pregnant women in the U.S. territories with laboratory evidence of possible Zika virus infection. That is a total of 481 pregnant women.
According to CDC, pregnant women in the United States with laboratory evidence of Zika virus infection (positive or equivocal test results, regardless of whether they have symptoms), and periconceptionally, prenatally, or perinatally exposed infants born to these women are eligible for inclusion in the registry. Infants with laboratory evidence of congenital Zika virus infection (positive or equivocal test results, regardless of whether they have symptoms) and their mothers also may be included in the registry.
CDC says physicians can participate in the Zika pregnancy registry by reporting information about pregnant women with laboratory evidence of Zika to their local health department or the Texas Department of State Health Services (DSHS).
To discuss women with laboratory evidence of Zika virus infection, physicians can contact the CDC Zika pregnancy hotline at (770) 488-7100, ZikaMCH[at]cdc[dot]gov, or ZikaPregnancy[at]cdc[dot]gov.
To effectively combat Zika in Texas, Gov. Greg Abbott formally invited CDC to review Texas' Zika Virus Preparedness and Response Plan. Last month, he participated in a conference call hosted by the White House to discuss strategies to address the Zika threat and efforts to combat the virus.
In a letter to CDC Director Thomas R. Frieden, MD, Governor Abbott urged CDC to move swiftly to approve DSHS' funding requests for three projects to assist in funding Texas' Zika response plan:
- $1.5 million to support Zika preparedness and response efforts;
- $360,000 to support Zika-related birth outcomes surveillance; and
- $9.2 million to strengthen epidemiology and laboratory capacity and improve health information systems.
Congress has been dragging its feet on approving a Zika funding package. In a letter to the Texas congressional delegation, TMA President Don Read, MD, wrote it's "only a matter of time before one of those [Aedes aegypti] mosquitoes bites an infected traveler and then passes the disease on to another Texan." The letter stresses the need for federal money to bolster monitoring travelers, keeping Texans informed about the state of the disease, and lab testing — especially of pregnant women.
"We already have waited too long," Dr. Read wrote. "We need that action now. Several months from now will be too late."
In May, CDC began publically reporting the total number of pregnant women with Zika virus infection from two newly established enhanced surveillance systems: the U.S. Zika Pregnancy Registry and the Puerto Rico Zika Active Pregnancy Surveillance System. CDC says the new numbers reflect a broader group of pregnant women — those who have any laboratory evidence of possible Zika virus infection and who may or may not have reported any symptoms.
As of June 17, Texas had reported to the CDC one confirmed case of Zika in a pregnant woman who traveled abroad to an area with Zika transmission. DSHS says there have been 20 additional pregnancies in Texas with laboratory evidence of Zika infection since tracking and testing for Zika began, but all 20 had no symptoms and do not meet the CDC's Zika case definition. Texas provides the data to the CDC's pregnancy registry weekly.
DSHS reports that as of June 24, Texas had 47 reported cases of Zika virus disease. Of those, 46 were in travelers infected abroad and diagnosed after they returned home; one of those travelers was a pregnant woman. One case involved a Dallas County resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Nationally, as reported by CDC, 820 people in the continental United States, and 1,860 in U.S. territories had tested positive for the virus as of June 22.
DSHS is testing for Zika virus at its public health lab in Austin. DSHS encourages Texas physicians to report suspected Zika virus cases to DSHS or their local health department.
According to DSHS, Aedes aegypti mosquitoes can be found in Texas, particularly in urban areas in the south and southeast portions of the state. While there is no evidence of local transmission by Texas mosquitoes yet, state health officials have implemented Zika virus prevention plans in anticipation of increased mosquito activity and the potential for local mosquito transmission.
You can help educate patients on preventing the spread of Zika by downloading and printing educational materials to display in your office from the DSHS Zika toolkit. The toolkit features posters, push cards, and fact sheets, as well as TV and radio spots and graphics you can share and post via social media. DSHS also developed flyers and door hangers (available in English and Spanish) you can use in your office to educate your patients on protecting themselves from the disease.
To help ensure Texas physicians have all they need to know about the virus, the texaszika.org website features a supplemental testing information form and polymerase chain reaction (PCR) and serology specimen criteria form. The PCR test can confirm the presence of Zika virus. Serologic testing can detect Zika infection in people who may not have had symptoms, and the test can be conducted up to 12 weeks after infection. DSHS says a positive serologic test result requires confirmatory testing to pinpoint Zika because it can cross-react with other flaviviruses, such as dengue.
The disease can cause fever, rash, muscle and joint aches, and red eyes, and also has been linked to the birth defect microcephaly and other poor birth outcomes in some women infected during their pregnancy.
You can learn more about Zika by viewing this informative video by Houston obstetrician Catherine Eppes, MD, who delves into what physicians need to know about Zika. In May, Dr. Eppes, whose high-risk pregnancy clinic has been overrun by women concerned about Zika infection, told the Senate Health and Human Services Committee Texas needs to find more ways to screen pregnant women for the Zika virus. "The combination of a relatively new but profoundly significant disease with little knowledge about the exact timing and rates of transmission, and complex, often inaccessible testing options leaves pregnant women and physicians frustrated," the member of the TMA Committee on Maternal and Perinatal Health said. "I think doctors would benefit from statewide dissemination of the options and costs for testing within our state and city health departments."
Dr. Eppes also recommended Texas Medicaid and the Women's Health Program be authorized to support the screening and testing of their eligible populations.
TMA and the Texas Association of Obstetricians and Gynecologists have prepared guidance for physicians on the Zika virus and pregnant patients.
Read more about Zika preparedness and prevention in the August Texas Medicine cover story, "Confronting Zika."
General information about Zika virus
Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016
Information for clinicians
Protection against mosquitoes
Zika virus travel notices
DSHS Zika toolkit
Action, July 1, 2016