CDC Issues Zika Virus Guidance for Brownsville, Texas

The Centers for Disease Control and Prevention (CDC) has issued Zika-related travel and testing guidance for Brownsville, Cameron County, Texas, following reports from Texas public health officials of five cases spread locally by mosquitoes. This information suggests that there may be a risk of continued spread of Zika virus and therefore pregnant women are at some risk for Zika virus infection. CDC is designating the city of Brownsville as a Zika cautionary area (yellow area). Texas Department of State Health Services (TDSHS), Cameron County Health Department, Brownsville Health Department and CDC are working together to rapidly learn more about the extent of Zika virus transmission in Brownsville.

Local spread of Zika virus by mosquitoes has also been reported in Mexico along the United States-Mexico border and CDC has had a travel notice for Zika virus in Mexico since December 10, 2015. Because many people with Zika virus infection will not have symptoms or will have only mild symptoms, additional people may be infected. In addition, active Zika virus spread may not be apparent yet, given that the incubation period for Zika virus infection can be as long as two weeks and the diagnosis and investigation of cases can take several weeks.

As of this time, only five cases are known to have been spread locally in the Brownsville area and there is not yet any evidence of widespread, sustained local spread of Zika. Still, temperatures in the region are conducive to mosquito-borne spread, and the risk of continued local spread cannot be ruled out. For these reasons, CDC is designating testing and travel recommendations for the city of Brownsville.
 
“We are working closely with Texas to gather and analyze new information every day. With the new information that there has been local spread of Zika for at least several weeks, we conclude that pregnant women should avoid the Brownsville area – and make every effort to prevent mosquito bites if they live or work there,” said CDC director Tom Frieden, MD, MPH. “Together with Texas officials we are working to protect pregnant women from the potentially devastating effects of this virus.” 
  
CDC recommendations are summarized below; specific guidance is at: https://emergency.cdc.gov/han/han00399.asp.
 
• Pregnant women who live in other areas should consider postponing travel to Brownsville.

• Pregnant women and their partners who live in or travel to Brownsville should be aware of local spread of Zika virus and should strictly follow steps to prevent mosquito bites.

• Women and men who live in or travel to Brownsville who are pregnant or have a pregnant sex partner should consistently and correctly use condoms to prevent Zika virus infection during sex (vaginal, anal or oral) or should not have sex during the pregnancy.

• Pregnant women who live in, traveled to or had sex without a condom with someone who lives in or traveled to Brownsville on or after October 29, 2016, should be tested for Zika virus infection in accordance with CDC guidance.

• Women who have limited risk (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) of possible exposure may consider waiting at least eight weeks from symptom onset (if they had symptoms) or last possible exposure (if they did not have symptoms) to attempt getting pregnant.

• Men who have limited risk (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) for exposure may consider waiting at least six months from symptom onset (if they had symptoms) or last possible exposure (if they did not have symptoms) to attempt conception.

• People living in Brownsville should be counseled on the possible risk for Zika virus infection before getting pregnant and through early pregnancy. Women and men should discuss their reproductive life plans with their healthcare provider in the context of potential and ongoing Zika virus exposure. Women and men with ongoing risks for exposure and who are diagnosed with Zika virus disease should wait at least eight weeks and at least six months, respectively, after symptom onset before attempting conception.

• Some couples in which one or both partners have had a possible Zika virus exposure might choose to wait longer or shorter than the recommended period to conceive, depending on individual circumstances (for example, age, fertility, details of possible exposure) and risk tolerance. Limited data exist on the persistence of Zika virus RNA in body fluids, and the risk for adverse pregnancy outcomes associated with maternal Zika virus infection around the time of conception is currently not known.

• Women and men attempting conception living in or traveling to Brownsville should be aware of Zika virus transmission and should strictly follow steps to prevent mosquito bites.
 
CDC continues to encourage everyone living in areas with Aedes aegypti and Aedes albopictus mosquitoes, especially pregnant women and women planning to become pregnant, to protect themselves from mosquito bites.  Apply Environmental Protection Agency (EPA)-approved insect repellent with one of the following active ingredients DEET, picaridin, IR3535, oil of lemon eucalyptus or para-menthane-diol, or 2-undecanone, following product label instructions, to uncovered skin; wear long-sleeved shirts and long pants; use or repair screens on windows and doors; use air conditioning when available; and remove standing water where mosquitoes can lay eggs.
For more information about Zika: http://www.cdc.gov/zika/.