Zika Virus Testing Guidelines for Clinicians

Zika Virus Testing Guidelines for Clinicians

***For routine Zika virus testing, pre-approval by city or state department of health agencies is no longer necessary***

Zika virus infection during pregnancy can cause fetal brain abnormalities and other birth defects.  It is an important zoonotic and communicable disease that warrants careful consideration in testing and diagnosis.  These guidelines summarize expert information from the CDC, New York State, and New York City department of health agencies.  Zika recommendations evolve over time so please check for updates to ensure that you have the latest guidelines on testing.

Common symptoms of Zika virus infection include red eyes, fever, joint pain or rash after travel history. Possible exposure includes traveling to, or having unprotected sex with someone who lives in or traveled to an area with risk of Zika transmission.  Ongoing possible exposure is residing in an area with risk of Zika transmission.

Check the CDC website map for the latest information on areas with active Zika virus transmission.

Zika virus testing is RECOMMENDED by the CDC for:

  1. Symptomatic pregnant women with possible Zika virus exposure
  2. Asymptomatic pregnant women with ongoing possible Zika virus exposure
  3. Pregnant women with possible Zika virus exposure who have a fetus with prenatal ultrasound findings consistent with congenital Zika virus infection
  4. Symptomatic nonpregnant adults and children with possible Zika virus exposure where testing will affect clinical management decisions

Zika virus testing MAY be considered for:

  1. Asymptomatic pregnant women with recent possible but no ongoing exposure to Zika virus (i.e., travelers)

Zika virus testing is NOT recommended at this time for:

  1. Asymptomatic nonpregnant adults and children

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.  Additionally, based on a study published in August 2018, the CDC recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset or their last possible Zika virus exposure before engaging in unprotected sex.

2018https://www.cdc.gov/mmwr/volumes/67/wr/mm6731e2.htm

In-house and commercial FDA-approved Zika virus tests are available and can be ordered through the Northwell Core Lab.  Pre-approval by the New York City Department of Health and Mental Hygiene (NYC DOHMH) or New York is not required in routine cases; ordering similar to other routine laboratory tests.

For diagnosis of Zika virus infection, both Zika virus serology and PCR on blood and urine should be ordered:

  1. PCR: Order “ZIKA PCR URINE” and “ZIKA PCR SERUM” (Cerner Codes: ZIKA PCR URINE and ZIKA PCR SERUM) – Zika virus is not detectable by PCR after 12 weeks and only serology may be helpful.       
    1. Collect blood in a gold-top serum tubes (min 3 mL) 
    2. Collect urine (min 3 mL) for PCR in a clean sterile screw top container
  2. SEROLOGY: Order “Zika Virus, MAC-ELISA IgM” (Cerner Code ZIKAIGM)
    1. Collect blood in a gold-top serum tubes (min 3 mL) – (please note separate gold-top serum tubes are needed if both serology and PCR are ordered)

 Key CDC recommendations include the following:

  • All pregnant women in the United States and U.S. territories should be asked about possible Zika virus exposure before and during the current pregnancy, at every prenatal care visit.
  • Pregnant women with recent possible Zika virus exposure and symptoms of Zika virus disease should be tested to diagnose the cause of their symptoms. The updated recommendations include concurrent Zika virus nucleic acid test (NAT) and serologic testing as soon as possible through 12 weeks after symptom onset.
  • Asymptomatic pregnant women with ongoing possible Zika virus exposure should be offered Zika virus NAT testing three times during pregnancy. IgM testing is no longer routinely recommended for asymptomatic women because IgM can persist for months after infection; therefore, IgM results cannot reliably determine whether an infection occurred during the current pregnancy.
  • Asymptomatic pregnant women who have recent possible Zika virus exposure (i.e., through travel or sexual exposure) but without ongoing possible exposure are not routinely recommended to have Zika virus testing.  Patients and providers work together to make decisions about testing based on patient preferences and values, clinical judgment, a balanced assessment of risks and expected outcomes, current expert recommendations, and possible clinical care decisions.
  • Pregnant women who have recent possible Zika virus exposure and who have a fetus with abnormal prenatal ultrasound findings consistent with congenital Zika virus syndrome should receive Zika virus testing to assist in establishing the etiology of the birth defects.Testing should include both NAT and IgM tests.
  • Testing placental and fetal tissue specimens is not routinely recommended or performed. Specialized testing on placental or fecal tissue may needed in certain scenarios (e.g., women without a diagnosis of laboratory-confirmed Zika virus infection and who have a fetus or infant with possible Zika virus-associated birth defects).  Placental or fetal tissue testing requires pre-approval by the NYC or New York State DOH; DOH test requisition forms to be completed and the specimens sent to the NYC or NY DOH public health laboratories.  Contact Northwell Laboratories if you need more information.
  • Zika virus IgM testing as part of preconception counseling to establish baseline IgM results for nonpregnant women with ongoing possible Zika virus exposure is not warranted because Zika virus IgM testing is no longer routinely recommended for asymptomatic pregnant women with ongoing possible Zika virus exposure.
  • Zika virus NAT testing is recommended for up to 2 weeks after exposure or travel for symptomatic non-pregnant patients. Pregnant patients may have detectable Zika virus for longer periods of time (up to 12 weeks) and NAT testing may still be useful.

 

If any of the following special circumstances apply please contact the NYC DOHMH provider number at 1-866-692-3641 or call the local health department or 1-888-364-4723 if the patient resides outside the five boroughs 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 transfusion or organ transplantation
  5. Patient needs Zika testing but lacks access to laboratory testing (ex. lacks acceptable insurance)

 

If your patient wishes to have their sample collected at a Northwell patient service center (PSC), 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
    1. Zika virus testing (usually serology or PCR) should be ordered electronically when possible. As a last resort, if Zika test is not available in your electronic ordering system, Zika test orders can be clearly handwritten on a Northwell Laboratory requisition form.
  2. If the patient needs testing to be sent to the New York Department of Health (newborn or special clinical case or potential issues with insurance coverage – see previous section), then also bring the pre-approval form issued by the DOH (after the provider calls the city or local DOH). This pre-approval will accompany samples and orders to DOH.  Please indicate on prescription that the test should be sent to New York State department of Health.
  3. Have the patient 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.

 

Contact information:

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:

New York City Department of Health and Mental Hygiene (NYC DOHMH)

New York State Department of Health (NYSDOH)

Center for Disease Control and Prevention (CDC)

 

Last reviewed 01/11/19