Tuesday, October 04, 2016

Texas DSHS Calls For Enhanced Zika Surveillance In The Rio Grande Valley



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Although no locally transmitted Zika cases have been reported from Texas, the DSHS yesterday released a Health Alert calling for enhanced surveillance and testing in 6 southern counties.

First the press release, followed by the text of the health alert.

State Health Officials Urge Zika Testing in Rio Grande Valley 


News Release
October 3, 2016

The Texas Department of State Health Services today issued a health alert encouraging health care providers in Cameron, Hidalgo, Starr, Webb, Willacy and Zapata counties to consider Zika virus infection in their patients and order testing as medically indicated.

DSHS recommends testing pregnant women who live in this area and have at least two of the four most common Zika symptoms – fever, rash, joint pain and conjunctivitis (eye redness) – regardless of their travel history or other risk factors. In line with current testing criteria, DSHS continues to recommend testing anyone with at least three of those symptoms statewide and all pregnant women who have traveled to an area with active Zika transmission, regardless of symptoms.


There have been no reported cases of Zika transmitted in Texas, but the Rio Grande Valley is considered to be at higher risk for Zika transmission because of previous outbreaks of dengue, a similar virus spread by the same type of mosquito.


“We don’t have any evidence that the virus is being transmitted by mosquitoes in Texas, but as Zika continues to spread in the Western Hemisphere, now is the time to increase our surveillance,” said Dr. John Hellerstedt, Commissioner of DSHS. “Doctors should be looking for Zika in their patients, and everyone should be taking personal precautions to prevent Zika infection.”  


People can help prevent the spread of Zika by mosquito bite by:

  • Using EPA-approved insect repellent every time they go outside.
  • Wearing long pants and long-sleeved shirts that cover exposed skin.
  • Using air conditioning or window and door screens that are in good repair to keep mosquitoes out of the home.
  • Removing standing water in and around homes, including water in trash cans, toys, tires, flower pots and any other container that can hold water.

Because of the risk of birth defects associated with Zika, pregnant women should consider delaying travel to areas where the virus is being spread and prevent sexual transmission by avoiding unprotected sexual contact with partners who have traveled to places with active Zika transmission.


Texas has had 218 reported Zika cases, all related to travel, including two cases transmitted via sexual contact with someone infected overseas and two infants who were infected before birth.




Summary
The Texas Department of State Health Services (DSHS) has long considered the southernmost areas of the state to be at greater risk of supporting local mosquito transmission of Zika virus. This is based upon historical experience with local transmission of dengue virus, which is related to the Zika virus and transmitted by the same type of mosquitoes. Local transmission of dengue is most commonly reported in Texas from August through December.
As testing options and availability have expanded and knowledge of the disease epidemiology has improved, guidance to healthcare providers on appropriate Zika infection testing of patients has evolved. The goals of testing are to diagnose patients and, from a public health perspective, to define the temporal and spatial distribution of the disease burden.
Enhanced Zika Surveillance
DSHS is asking the healthcare community to assist in improving surveillance for locally transmitted Zika disease. Toward that end, DSHS is expanding the testing criteria for those with major signs/symptoms of Zika disease (fever, arthralgia, rash, and conjunctivitis), but who have no travel history to an area of local Zika transmission or sexual exposure to Zika virus:

  • DSHS continues to recommend testing of male and female patients with no travel history or sexual exposure who have at least three of the four major signs/symptoms of Zika disease.
  • DSHS continues to recommend testing of pregnant women who have traveled to areas of active Zika transmission, regardless of presence or absence of symptoms.
  • The new recommendation is to test pregnant women residing in Cameron, Hidalgo, Starr, Webb, Willacy, or Zapata counties who are experiencing two or more of the major signs and symptoms of Zika disease and have no travel history or sexual exposure.
The current comprehensive guidance on Zika testing can be found at http://texaszika.org/healthcareprof.htm.
Background
Capacity for Zika testing has increased, as it is no longer limited to U.S. Centers for Disease Control and Prevention (CDC) or state public health laboratories. Under Emergency Use Authorizations issued by the Food and Drug Administration, there are now a number of commercial laboratories that offer molecular assays for detection of Zika virus RNA, and some are also offering serology for Zika IgM.
DSHS continues to recommend that healthcare providers consult with their local health department or DSHS Regional Office to facilitate appropriate test selection and submission of specimens. 
For More Information
Texas-specific information and links to CDC resources: TexasZika.org.
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