CDC updates guidance related to local Zika transmission in Miami-Dade County, Florida

The Centers for Disease Control and Prevention (CDC) continues to work with Florida health officials to investigate new cases of locally transmitted Zika virus infection in Miami-Dade County, Florida. The Florida Department of Health (FLDOH) identified last week an additional area where local, state, and CDC officials have determined that the intensity of Zika virus transmission presents a significant risk to pregnant women.  The designated location is a one-square mile area of Miami-Dade County (NW 79th St. to the north, NW 63rd St. to the south, NW 10th Ave. to the west and N. Miami Ave. to the east).

Because local spread of Zika virus continues to be reported in Miami-Dade County, CDC is strengthening its travel recommendations for pregnant women and also reinforcing recommendations for the use of protective measures to prevent exposure to Zika. CDC is also updating recommendations to emphasize testing for pregnant women who have lived in, traveled to, or had unprotected sex with someone who lived in or traveled to any area of Miami-Dade County. In addition, CDC has made specific recommendations for areas of identified active spread of Zika virus. 

“Zika continues to pose a threat to pregnant women living in or traveling to Miami-Dade County,” said Lyle Petersen, MD, MPH, Director, Division of Vector-Borne Diseases. “Our guidance today strengthens our travel advice and testing recommendations for pregnant women, to further prevent the spread of the infection among those most vulnerable.”

CDC designates areas with Zika transmission as red or yellow

CDC defines two types of geographic areas within the continental United States and Hawaii to implement measures to prevent Zika virus transmission: Zika active transmission areas (designated as red) and Zika cautionary areas (designated as yellow).

• Zika active transmission area (red area): A geographic area where local, state, and CDC officials have determined that the intensity of Zika virus transmission presents a significant risk to pregnant women. The intensity of Zika virus transmission is determined by several factors, including geographic distribution of cases, number of cases identified, known or suspected links between cases and population density. 
• Zika cautionary area (yellow area): A geographic area where local transmission has been identified, but evidence is lacking that the intensity of transmission is comparable to that in a red area. Although the specific level of risk in yellow areas is unknown, pregnant women are still considered to be at risk. Also, areas adjacent or close to red areas may have a greater likelihood of active spread of Zika virus and are considered to pose a risk to pregnant women.

Currently, a 4.5-square-mile area of Miami Beach and one-square-mile area in Little River located in Miami-Dade County (http//www.cdc.gov/zika/intheus/florida-update.html) are red areas. The rest of Miami-Dade County is s a yellow area. Because this is an ongoing investigation, the designation of areas is likely to change over time. For the most up-to-date designation of red and yellow areas, check the CDC website on Florida’s Zika situation: http//www.cdc.gov/zika/intheus/florida-update.html.

The updated recommendations for Miami-Dade County are as follows:

Travel Recommendations for Pregnant Women

• Pregnant women should consider postponing travel to yellow areas of Miami-Dade County.
• Pregnant women should specifically avoid travel to red areas (http//www.cdc.gov/zika/intheus/florida-update.html) because the intensity of Zika virus transmission confirmed in these areas is a significant risk to pregnant women.

Testing Recommendations for Pregnant Women

Pregnant women who have lived in, traveled to, or had unprotected sex with someone who lived in or traveled to Miami-Dade County since August 1, 2016, should be tested for Zika virus. Pregnant women who have lived in, traveled to, or had unprotected sex with someone who lived in or traveled to the 4.5-square-mile area of Miami Beach with active spread of Zika virus since July 14, 2016, should be tested for Zika virus (http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e).

Women and men planning pregnancy

• Women and men who are planning pregnancy in the near future should consider avoiding nonessential travel to red areas.
• Women  and men who have a link to a red area through residence, travel, or sex there, and who do not have ongoing risks from a continuing link to a red area should wait at least 8 weeks or 6 months, respectively,  after symptoms start  (if symptomatic) or last possible exposure (if no symptoms develop) before attempting conception.
• Women and men who have a link to a yellow area and who do not have ongoing risks from a continuing link to a yellow area may consider waiting at least 8 weeks or 6 months, respectively, after symptoms start (if symptomatic) or last possible exposure (without symptoms) before attempting conception. Although the level of risk in yellow areas is unknown, pregnant women are still considered to be at risk. Also, areas adjacent to or close to red areas may have a greater likelihood of active spread of Zika virus and are considered to pose a risk to pregnant women.
• People living in an area with possible Zika virus transmission should be counseled on the possible risk for Zika virus infection during the pre-conception period. Women and men should discuss their reproductive life plans with their healthcare provider given potential and ongoing Zika virus exposure. Women and men with ongoing risks for exposure 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.
•  Given the limited available information about how long Zika virus can stay in body fluids and the chances of harm to a pregnancy when a woman is infected with Zika virus around the time of conception, some couples in which one or both partners have had a possible Zika virus exposure may choose to wait longer or shorter than the recommended period to conceive, depending on individual circumstances like age, fertility, and the details of possible exposure, and their risk tolerance.

Other recommendations to prevent or identify Zika virus infection

Women and men who live in or traveled to Miami-Dade County should be aware of active Zika virus transmission. Those who are pregnant or have a pregnant sex partner should consistently and correctly use condoms to prevent Zika virus infection during sex or should not have sex during the pregnancy.

Pregnant women and their partners living in or traveling to the Miami-Dade County should be aware of active Zika virus transmission and should strictly follow steps to prevent mosquito bites. (http://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html).

Depending on local circumstances, public health officials may implement additional Zika-related interventions (such as testing of non-pregnant people with symptoms).

For more information about Zika: http://www.cdc.gov/zika/.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES