Congenital Zika Virus Infection

The Hawaii Department of Health (DOH) has received laboratory confirmation of congenital Zika virus infection in a microcephalic infant born in Hawaii to a mother who emigrated from Brazil early in her pregnancy. Maternal infection likely occurred in the first trimester while the family was still living in Brazil; mother and child pose NO risk for Zika virus transmission in Hawaii.

Zika virus is a mosquito-borne viral infection transmitted by Aedes species mosquitoes, which can be found throughout the state (and can also transmit other viruses like dengue). Zika is not endemic in Hawaii. Hawaii providers must be alert for Zika infection in persons who develop illness within 2 weeks of returning from affected areas as well as in pregnant women who report having had compatible illness during their travel. Zika virus is endemic in parts of Africa and Asia, but disease activity has been reported in other parts of the world, including the Pacific Islands and Latin America.

Symptoms and Treatment

Zika virus infection generally causes a mild dengue-like illness. Infected persons present approximately 3–12 days after bite by an infected mosquito with acute onset low-grade fever, rash, arthralgia, and conjunctivitis; myalgia, headache, retro-orbital pain, and emesis may also occur. Up to 80% of infections may be subclinical or asymptomatic. Patient symptoms self-resolve within 2-7 days, and hospitalization is uncommon. Treatment is supportive.

Diagnosis

Zika virus infection can be diagnosed serologically to detect IgM and neutralizing antibodies; however, cross-reaction with dengue and West Nile viruses is common. Polymerase chain reaction (PCR) at the DOH State Laboratories Division to detect virus RNA can be performed on blood specimens collected during the first week of illness. Healthcare providers should report suspect cases to DOH to assure coordination and routing of specimens as well as any necessary immediate public health response.

As with any mosquito-borne infection, individuals suspected to have Zika virus infection should be advised to stay indoors and avoid mosquito bites during their first week of illness. Travelers to affected areas should use mosquito repellents containing 20–30% DEET and wear long sleeves and pants when possible.

Please note Zika virus infection is an urgent category notifiable condition and must be reported by phone.

For further information please refer to http://www.cdc.gov/zika/ as well as http://wwwnc.cdc.gov/travel/notices for specific country travel advisories.