Zika Updates

Most recent updates:

4/7/17 - DSHS News Release on Zika Risk in Texas and Updated Testing Recommendations for Rio Grande Valley

DSHS Updates Testing Recommendations for Rio Grande Valley

As the state prepares for additional local transmission of the Zika virus during the 2017 mosquito season, the Texas Department of State Health Services is expanding its testing guidance for residents of six South Texas counties.

DSHS Friday issued a health alert that now recommends testing all pregnant residents of Cameron, Hidalgo, Starr, Webb, Willacy and Zapata counties in both the first and second trimesters of pregnancy and any resident who has a rash plus at least one other common Zika symptom: fever, joint pain or eye redness.

For the rest of the state, DSHS continues to recommend testing anyone who has at least three of those four Zika symptoms and all pregnant women who have traveled to areas with ongoing Zika transmission, including any travel to any part of Mexico.

“Zika remains a significant health risk to pregnant women and their babies, and it’s only a matter of time until we see local transmission here again,” said DSHS Commissioner Dr. John Hellerstedt. “We want to cast as wide a net as possible with testing to increase our ability to find and respond to cases, and the Lower Rio Grande Valley remains the part of the state most at risk for Zika transmission.”

Zika testing is widely available through commercial labs, so health care providers can order testing through their normal channels. “We don't want cost to prevent anyone from getting tested,” Hellerstedt said. “If the cost of testing would be a barrier for a patient, providers should contact their local or regional health department for information about testing through the public health system.”

Texas had six cases of local mosquito transmission of Zika virus disease in Brownsville in November and December 2016. The region is considered a likely place for Zika to spread because of its history of local transmission of dengue, a closely related virus, and its proximity to Mexico, where there continues to be ongoing local Zika transmission, including in communities just across the border.

As temperatures continue to warm up, mosquito activity will increase, so people statewide should protect themselves from mosquitoes at home and while traveling to areas where Zika is spreading. Precautions include consistently using mosquito repellent when outside, wearing long sleeves and pants, and using air conditioning or making sure window screens will keep mosquitoes out of the home. Texas is also calling on people to pick up trash and dump out containers that could hold standing water in and around their homes and businesses to deny mosquitoes a place to lay their eggs, decrease the overall number of mosquitoes, and help protect family members and neighbors from Zika.

Zika virus is transmitted to people primarily through the bite of an infected mosquito, though it can also spread by sexual contact. While symptoms are usually minor, Zika can cause severe birth defects in babies of some women infected during pregnancy. DSHS recommends pregnant women follow CDC advice to avoid traveling to locations with sustained, local Zika transmission, including all areas of Mexico. Pregnant women and their sexual partners who have traveled to those areas should use condoms or avoid sexual contact during the course of the pregnancy. The health alert and additional information on precautions and travel advice are available at TexasZika.org.

4/3/17 - Updated CDC Guidance on Infants with Possible Congenital Zika Virus Infection

The Centers for Disease Control and Prevention posted “Additional Considerations for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection” on April 3rd. Please take a moment to review this new guidance on the CDC Website here.

12/22/16 - Another Locally-Acquired Zika Case Found in Cameron County

The Texas Department of State Health Services (DSHS) issued a news release on 12/22/16 regarding an additional locally-acquired Zika case found in Cameron County. This is not believed to be connected to the other 5 cases that have already been identified in Cameron County. So far, there have been a total of 6 local mosquito-transmitted cases in Texas including this most recent one. 

According to the news release, "Local public health workers have responded to the case by providing testing to members of the patient’s household and going door-to-door in the area around the patient’s home. They’re working to identify and offer testing to anyone with possible Zika symptoms and to all pregnant women in the area with or without symptoms. Local officials have also been educating neighbors about Zika and conducting environmental assessments to help reduce mosquito habitats in the area.

The Centers for Disease Control and Prevention updated its testing guidance last week to recommend testing all pregnant women living in Brownsville or who have travelled to Brownsville on or after Oct. 29. DSHS continues to urge pregnant women and their health care providers to follow that guidance and the recommendation to test pregnant women who have traveled to places where Zika is being spread, including anywhere in Mexico." 

Click here for the full news release. To find out more about Zika in Texas, visit TexasZika.org. For additional information on Zika, see the list of resources at the end of this webpage. 

12/14/16 - CDC Issues Health Advisory for Travel to Brownsville, Texas

On 12/14/16, the Centers for Disease Control and Prevention (CDC) released a health advisory, “CDC Guidance for Travel and Testing of Pregnant Women and Women of Reproductive Age for Zika Virus Infection Related to the Investigation for Local Mosquito-borne Zika Virus Transmission in Brownsville, Cameron County, Texas”.

According to the advisory, Brownsville is being considered a "Zika cautionary (yellow) area for testing and travel guidance, as recommended in the CDC Interim Zika Response Plan (https://www.cdc.gov/zika/pdfs/zika-draft-interim-conus-plan.pdf). Based on the earliest time of symptom onset for cases of locally acquired Zika virus infection in Brownsville and a maximum 2-week incubation period for Zika virus, this guidance applies to pregnant women, women of reproductive age, and their sexual partners who live in or traveled to Brownsville on or after October 29, 2016. Because many people with Zika virus will not have symptoms, or will have only mild symptoms, additional people may be infected."

CDC Recommendations for Brownsville, Texas (yellow area) are as follows:

Travel Recommendations for Pregnant Women:

Pregnant women who live in other areas should consider postponing travel to Brownsville. Areas of mosquito-borne transmission can arise and resolve over time. Travelers, and in particular, pregnant women, are urged to monitor the CDC website to ensure they have access to the most up-to-date information and recommendations (https://www.cdc.gov/zika/).

Prevention Recommendations for Pregnant Women:

  1. Pregnant women and their partners who live in or travel to Brownsville should be aware of local Zika virus transmission and should strictly follow steps to prevent mosquito bites. (https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html).
  2. Pregnant women and their partners who live in or travel to Brownsville 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.

Testing Recommendations for Pregnant Women:

  1. Pregnant women with an epidemiologic link to Brownsville on or after October 29, 2016, should be tested for Zika virus infection in accordance with CDC guidance. An epidemiologic link means that they live in, traveled to, or had sex without using a condom with someone who lives in or traveled to Brownsville on or after this date      (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e).
    1. Pregnant women with symptoms of Zika virus disease should be tested according to CDC guidance, which is based on the time of evaluation relative to symptom onset.
    2. Pregnant women with ongoing risks for exposure (who live in or frequently travel [for example, daily, weekly]) to Brownsville and who are without symptoms of Zika virus disease should consult with their healthcare provider to obtain testing for Zika virus infection in both the first and second trimesters of pregnancy.
    3. Pregnant women who are asymptomatic but who have had limited risks for exposure (limited travel to or sex without using a condom with a partner who lives in or has traveled to Brownsville) should also be tested for Zika virus infection. Laboratory testing for these women should be performed based on the time of clinical evaluation relative to last possible exposure in accordance with CDC guidance (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm).
  2. Healthcare providers should contact their state, local, or territorial health department to coordinate testing and interpret results. Healthcare providers should discuss the limitations of laboratory tests used to diagnose Zika virus infection with pregnant women and their partners, including the possibility of false positive results related to prior exposure to other flaviviruses (for example, dengue).

Women and Their Partners Who are Planning to Conceive in the Near Future:

  1. 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 8 weeks from symptom onset (if symptomatic) or last possible exposure (if asymptomatic) to attempt conception.
  2. 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) of possible exposure may consider waiting at least 6 months from symptom onset (if symptomatic) or last possible exposure (if asymptomatic) to attempt conception.
  3. People living in Brownsville should be counseled on the possible risk for Zika virus infection during the periconceptional period. 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 8 weeks and at least 6 months, respectively, after symptom onset before attempting conception.
  4. 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.
  5. Women and their partners who are attempting conception and live in or travel to Brownsville should be aware of Zika virus transmission and should strictly follow steps to prevent mosquito bites. (https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html).

For More Information:

  • Interim Guidance for Health Care Providers Caring for Pregnant Women:

MMWR: https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_w

Summary: https://www.cdc.gov/zika/hc-providers/pregnant-woman.html

12/9/16 - Four Additional Local Zika Cases Identified

On 12/9/16, The Texas Department of State Health Services (DSHS) issued a news release announcing four additional suspected locally transmitted Zika cases in Cameron County. The cases were identified in the follow-up from the first case announced on 11/28/16. 

According to the DSHS news release,"'These cases were found through careful public health work and collaboration at the local, state and federal levels,' said Dr. John Hellerstedt, DSHS commissioner, 'and we’ll continue to follow through with the investigation and additional surveillance to identify other cases and other places experiencing local mosquito transmission of Zika. That information will be crucial to any future public health guidance.'

It’s also important that health care providers continue to be on the lookout for Zika and pursue testing pregnant women who have traveled to Mexico or other areas where Zika is spreading and testing anyone with symptoms compatible with Zika. More specific guidance for clinicians is available at www.texaszika.org/healthcareprof.htm."

DSHS reports that, "Prompted by the additional cases, the Texas Health and Human Services Commission is expanding the Medicaid benefit for mosquito repellent beyond Dec. 31 for residents of Cameron County. The benefit was recently brought back with news of the first Zika case likely transmitted locally and is in place statewide through Dec. 31. For Cameron County, the benefit will be in place indefinitely as state health officials collect more information about the scope of transmission in Texas." 

To read the full news release, visit http://dshs.texas.gov/news/releases/2016/20161209.aspx

11/28/16 - Local Zika Virus Case Identified in Rio Grande Valley

On 11/28/16, DSHS issued a news release announcing the first case of Zika virus disease likely transmitted by a mosquito in Texas. Please read the following excerpt from the release:

"The patient is a Cameron County resident who is not pregnant and who was confirmed last week by lab test to have been infected. She reported no recent travel to Mexico or anywhere else with ongoing Zika virus transmission and no other risk factors. Laboratory testing found genetic material from the Zika virus in the patient’s urine, but a blood test was negative, indicating that the virus can no longer be spread from her by a mosquito. There are no other cases of suspected local transmission at this time, but health officials continue to conduct disease surveillance activities as part of the state's ongoing Zika response.

'We knew it was only a matter of time before we saw a Zika case spread by a mosquito in Texas,' said Dr. John Hellerstedt, DSHS commissioner. 'We still don’t believe the virus will become widespread in Texas, but there could be more cases, so people need to protect themselves from mosquito bites, especially in parts of the state that stay relatively warm in the fall and winter.'

Cameron County, DSHS and the Centers for Disease Control and Prevention are working together to investigate and respond to the case. Further investigation will be necessary to attempt to pinpoint how and where the infection occurred, and health officials are also responding in a number of other ways. DSHS has activated the State Medical Operations Center to support the response and is providing expertise, personnel and equipment for activities from disease investigation to mosquito surveillance to public education.

With DSHS support, Cameron County and the City of Brownsville have conducted an environmental assessment at the patient’s home and have been trapping and testing mosquitoes to learn more about activity in the area. Brownsville has recently sprayed for mosquitoes in the area and will continue to take action to reduce the mosquito population. Health workers from Cameron County and DSHS will be going door to door in the area around where the case lived beginning this evening to educate the public about Zika, help people reduce potential mosquito breeding habitat on their property, and collect voluntary urine samples to determine whether other infections are present. The samples collected will be tested at the DSHS laboratory in Austin. The DSHS regional office in Harlingen has delivered laboratory supplies, boxes of educational materials and mosquito traps to Cameron County and will continue to assist in the response. Additionally, state and local public health has been in communication with CDC, which is providing additional assistance and expertise.

Travel back-and-forth across the border is a way of life in the Valley, and news reports from Mexico indicate Zika transmission by mosquitoes in multiple communities on the Mexican side of the border. Due to the risk of birth defects associated with Zika, pregnant women should avoid traveling to Mexico and should avoid sexual contact or use condoms with partners who have traveled there.

DSHS is again asking health care providers to consider Zika virus infection in their patients and order the appropriate testing. DSHS recommends testing all pregnant women who have traveled to areas with active Zika transmission during their pregnancy. DSHS also recommends testing pregnant women who have two or more of the typical Zika symptoms in Cameron, Hidalgo, Starr, Webb, Willacy or Zapata counties without travel history, and anyone with at least three symptoms statewide. Providers can find additional information at www.texaszika.org/healthcareprof.htm.”

Read the full news release at http://dshs.texas.gov/news/releases/2016/20161128.aspx

11/28/16 - Medicaid Mosquito Repellent Benefit Reinstated

The Texas Health and Human Services Commission issued a news release on 11/28/2016 regarding the reinstatement of the Texas Medicaid Mosquito Repellent Benefit. According to the release, the benefit began 11/29/2016 and will be in place through December.

"Eligible Texas women can go to participating pharmacies to pick up mosquito repellent, as Texas Medicaid has a standing order for mosquito repellent prescriptions for women who are between the ages of 10 and 45 or pregnant.

The benefit includes two cans per month per eligible beneficiary. Women are encouraged to call the pharmacy ahead of time because supply can vary by location.

Women eligible for the Medicaid, CHIP and CHIP-Perinate programs are covered. Women covered under the Healthy Texas Women and Children with Special Health Care Needs programs also can receive the benefit.

The following Zika-related items also are covered under current Texas Medicaid benefits:

·         Family planning services

·         Contraceptives

·         Diagnostic testing

·         Targeted case management

·         Physical therapy

·         Long term services and support

·         Acetaminophen and oral electrolytes for Zika symptoms

·         Potential coverage for additional ultrasounds for pregnant women"

Read the full news release here: https://hhs.texas.gov/about-hhs/communications-events/news-releases/2016/11/texas-medicaid-brings-back-mosquito-repellent-benefit

For more information about the Zika virus in Texas, visit TexasZika.org.

Zika Information and Resources: 

Zika virus is spread to people through mosquito bites. Spread of the virus through blood transfusion and sexual contact have also been reported. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis. The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon and fatalities are rare. An increase in Guillain-Barré syndrome was noted during an outbreak of Zika virus in French Polynesia in 2014. An increase in microcephaly was noted during an outbreak of Zika virus in Brazil in 2015. Whether Zika virus infection causes these conditions has not yet been established.

On January 29, 2016, the CDC issued Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection on January 29, 2016 in MMWR and updated guidelines on February 19, 2016 and guidelines were again updated in August. Zika virus testing is recommended for:

  • Infants born to mothers with laboratory evidence of Zika virus infection during pregnancy
  • Infants who have abnormal clinical or neuroimaging findings suggestive of congenital Zika syndrome and a maternal epidemiologic link suggesting possible transmission, regardless of maternal Zika virus test results.
  • Lab testing includes rRT-PCR and serologic IgM testing. Initial samples should be collected directly from the infant in the first 2 days of life. If possible, testing of cord blood is not recommended.
  • Positive infant serum or urine rRT-PCR test confirms congenital Zika virus infection
  • Positive Zika virus IgM with a negative rRT-PCR indicates probable Zika virus infection

CDC also updated the recommendations for outpatient management, referral to services, and follow-up of infants with laboratory evidence of congenital Zika virus infection, with or without abnormalities consistent with Congenital Zika Syndrome. The updated recommendations are:

  • The updated guidance does not include dengue testing and recommends against testing cord blood specimens.
  • The new guidance provides information on how infant laboratory testing results should be interpreted.
  • The previous guidance recommended performing a cranial ultrasound unless prenatal ultrasound results from the third trimester demonstrated no abnormalities of the brain. The updated guidance recommends a cranial ultrasound even if the prenatal ultrasound was normal.
  • Beyond initial evaluation, the previous guidance only recommended considering an additional hearing screen at 6 months, and evaluating head circumference and developmental milestones throughout the first year of life. The updated guidance provides additional recommendations for the outpatient management of infants through the first year of life.
  • The updated guidance emphasizes the importance of establishing a medical home and of providing support for families affected by Zika.
  • Repeat eye and hearing assessments and a new recommendation for endocrine (hormonal) evaluation are new in the updated guidance.

Read more about updated recommendations on the DSHS Zika website or CDC's website.

The CDC also developed Questions and Answers for Pediatric Healthcare Providers: Infants and Zika Virus Infection.

Visit the CDC's website for fact sheets, resources, and more.

Texas Governor Greg Abbott has taken action and appointed an infectious disease task force to prepare for the Zika virus in the Lone Star state. The Governor appointed 31 members to the Task Force on Infectious Disease Preparedness and Response. Dr. John Hellerstedt will serve as director.

The Department of State Health Services is now testing for Zika virus at its public health lab in Austin. This testing, called polymerase chain reaction or “PCR” testing, is used to detect Zika virus in human specimens collected less than seven days after illness onset. The PCR test is considered confirmatory for the presence of Zika virus. Texas is also adding the more complex serologic testing for Zika virus. The benefit of serologic testing is that it can detect Zika infection in people who may not have had symptoms, and the test can be conducted up to 12 weeks after a person is infected. 

As part of its efforts to prevent Zika transmission in Texas, DSHS has developed outreach materials (available on English and Spanish) that can be used to educate the public on how to protect against Zika virus. Please feel free to download and distribute these materials as needed:
  • Protect Yourself from Mosquitoes (Flyer)
  • Protect Yourself from Mosquitoes (Door Hanger)
  • What to Know Before You Travel (Flyer)
  • Zika Communications Toolkit

These can be found at http://texaszika.org/materials.htm

For more information about Zika in Texas, see the following resources:

MMWR: https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_w 

Summary: https://www.cdc.gov/zika/hc-providers/pregnant-woman.html