Zika Virus Testing Guidelines for Clinicians

*** Please note that Zika virus testing guidelines by the New York City Department of Health and Mental Hygiene (NYC DOHMH) changed in October 2016.  According to the NYC DOHMH, Zika virus testing for residents of NYC, including pregnant women, should be performed by FDA approved assays and/or commercial laboratories.  Zika virus testing should no longer be sent to NYC DOHMH except in special circumstances.  Read below for additional information ***

These guidelines are a summary of announcements and information from federal, New York State, and NYC agencies.   Recommendations evolve so please check for updates to ensure that you have the latest guidelines on testing.

Common symptoms of Zika virus include red eyes, fever, joint pain or rash. If your pregnant patient has experienced these symptoms and has recently lived or traveled to a region with active Zika virus transmission or had unprotected sex with a partner who traveled such a region with active Zika virus transmission while pregnant then testing is recommended.  Check the CDC Zika virus active transmission map for the latest information on areas with active Zika virus transmission.

Testing of patients may also be recommended in other special cases, like if the patient has an unusual clinical presentation associated with Zika (e.g., Guillain-Barré Syndrome or other unusual neurological manifestation) and recently lived or traveled to a region with active Zika virus transmission.

The CDC currently does not recommend routine testing for asymptomatic men, asymptomatic women who are not pregnant and asymptomatic children but testing is available through commercial laboratories if the provider believes testing is warranted.

Step 1: If testing is needed first check where the patient resides to determine which Zika virus testing guidelines to follow.

  1. If the patient resides within New York City’s (NYC) five boroughs (Manhattan, Brooklyn, Queens, Bronx, and Staten Island) go to Step 2
  2. If the patient resides in New York State outside of NYC (in Nassau County, Suffolk County, Westchester County, etc) go to Step 3.

Step 2: For patients who reside in New York City (Manhattan, Brooklyn, Queens, Bronx and Staten Island) the NYC DOHMH recommends that Zika virus testing be performed by now available FDA approved tests and/or commercial laboratories.  Zika virus testing requests are no longer be accepted by NYC DOHMH except in special circumstances.  NYC DOH guidelines

  1. Recommendation includes pregnant women, non-pregnant women and men
  2. Commercial Zika virus tests are available and can be ordered and sent to Northwell Core Lab:
    1. Pre-approval by NYC DOHMH is not required; ordering similar to other routine laboratory tests
    2. For Zika virus PCR: Order“ZIKA PCR URINE”  and “ZIKA PCR SERUM” (Cerner Codes: ZIKA PCR URINE  and ZIKA PCR SERUM) 
    3. For Zika virus IgM: Order“Zika Virus, MAC-ELISA IgM” (Cerner Code ZIKAIGM)
  3. If any of the following special circumstances apply please contact the NYC DOHMH provider number at 1-866-692-3641 to discuss possible testing.
    1. Newborns with findings concerning for congenital Zika virus infection or whose mother had laboratory evidence of Zika virus infection during pregnancy
    2. Placental/fetal tissue from mothers with laboratory evidence of Zika virus infection during pregnancy
    3. Guillaine-Barre syndrome or other unusual neurological manifestation in patient with recent exposure to Zika virus
    4. Possible unusual modes of transmission such as tranfusion or organ transplantation
    5. Patient needs testing but lacks insurance

If your patient wishes to have their sample collected at a Northwell patient service center, they can be directed to a designated Northwell patient service centers (PSCs).

  1. A prescription/order for specimen collection and test orders from the physician.
  2. The test ordered should be ordered electronically or handwritten on a Northwell Laboratory requisition form if not available in your electronic ordering system
  3. Collect blood in two gold-top tubes  (min 5 mL each) and urine (min 3 mL) in a clean sterile screw top container

Step 3: Testing for patients who reside in New York State outside of NYC did not change.  Patients who meet criteria may still qualify for testing at the New York State (NYS) Department of Health laboratory if clinicians obtain pre-approval.

  1. The following patients who reside in New York State outside of NYC may be eligible for testing at the NYS DOH laboratory at the Wadsworth Center in Albany, NY. The provider should contact their call the local health department of where your patient’s resides to get test approval prior to ordering a test or collecting specimens.  Here are some phone numbers for the Nassau, Suffolk, and Westchester counties departments of health.  For other New York State counties please select your county on this map to get more information.
    1. Any pregnant woman (symptomatic or asymptomatic) who was exposed to Zika virus
    2. fetus or infant with suspected or confirmed microcephaly or intracranial calcifications whose mother was exposed to Zika virus
    3. Anyone who presents with symptoms of Guillain-Barre syndrome after exposure to Zika virus
    4. Anyone who may have contracted Zika virus by unusual mode of transmission such as sexual contact, local mosquito vector or laboratory exposure.
    5. If testing is approved, the patient or provider will get an approval authorization document (by email or fax). Testing will not be performed if prior approval is not obtained.
  2. Order the test: Zika Virus NYSDOH (Cerner Code: ZIKA)
    1. For patient samples, please collect blood in two gold-top tubes  (min 5 mL each) and urine (min 3 mL) in a clean sterile screw top container
  3. Your patient can go to a designated Northwell patient service centers (PSCs) for Zika virus listed here.
    1. Patients should contact the PSC ahead of time to let them know that they are coming in for Zika virus testing and confirm which hours that the PSC is open.
    2. If the patient is eligible for public health laboratory testing, the patient should carry these documents:
      1. prescription/orderfor specimen collection from the physician.  The written order should clearly indicate the name, complete address and date of birth of the patient and the NYS license number of the provider
      2. completed test form for the correct laboratory
      3. The test approval authorization document(separate for New York State; same as completed test form for NYC)
  4. If the patient does not qualify for New York State DOH testing or if commercial testing is desired, then Zika virus tests are available and can be ordered and sent to Northwell Core Lab:
    1. Pre-approval is not required; ordering similar to other routine laboratory tests
    2. For Zika virus PCR: Order“ZIKA PCR URINE”  and “ZIKA PCR SERUM” (Cerner Codes: ZIKA PCR URINE  and ZIKA PCR SERUM)      
    3. For Zika virus IgM: Order“Zika Virus, MAC-ELISA IgM” (Cerner Code ZIKAIGM)
    4. For patient samples, please collect blood in two gold-top tubes  (min 5 mL each) and urine (min 3 mL) in a clean sterile screw top container

Step 4: Results and Interpretation

  1. Zika virus test results from a commercial reference laboratory will be reported in the same way that you usually receive laboratory results from Northwell Health Laboratories.
  2. If the patient was tested at the NYSDOH PHL at Wadsworth, then LDH will mail the results to the provider.  Providers can also log on to the New York State Health Commerce System website view their patient results directly.  Licensed medical practitioners can create an accountto access the Health Commerce site if they have not already done so.
  3. NYC DHMH has provided a useful guide to interpret test results.  This resource is helpful for patient samples tested at any laboratory.

For help with results or assistance with interpretation, you can contact the public health laboratories.

For NYC patients, call 1-866-692-3641 Monday – Friday (9 am to 5 pm).

For New York State patients outside of NYC, call 1-888-364-4723 Monday – Friday (9 am to 5 pm).

If you have any questions on how to arrange for testing please contact the Northwell Health Labs main number at 1-516-719-1100.

Additional information and resources

Last reviewed 11/22/16