Thank you for taking the time to stay engaged and up-to-date about this tremendously critical issue.

Transcription

1 Octber 14, 2016 Dear Clinician, In the past year, the incidence and prevalence f Zika virus (ZIKV) has explded in the Americas. As yu knw, ZIKV has been assciated with devastating utcmes including micrcephaly, spntaneus abrtins, and pst-infectius Guillain-Barre syndrme. The Salt Lake Cunty Health Department (SLCHD) recgnizes that clinicians are ne f the mst imprtant lines f defense fr educating the public and preventing ZIKV in ur cmmunity. As research prvides us mre knwledge n the epidemilgical and clinical features f the virus, the guidelines and recmmendatins pertaining t ZIKV are changing frequently. The enclsed infrmatin aims t prvide yu with an verview f the current testing prcess, specimen cllectin, and recmmendatins. We encurage health care prviders t btain a travel histry frm all patients, particularly wmen wh are pregnant, f childbearing age, r shwing the signs and symptms f ZIKV. The vast majrity f peple with the infectin d nt have symptms, but thse wh are symptmatic experience a mild fever, rash, arthralgia, and cnjunctivitis fr 2 7 days. If yu have a patient with risk factrs fr ZIKV, please refer t the handut attached entitled Instructins fr Prviders n Zika Virus Testing, Fllw-up, and Recmmendatins fr guidance. If yur patient fits testing criteria, the cst f ZIKV testing will be cvered by the Utah Department f Health. Yu are imprtant partners in this effrt, and we will d everything we can t help keep yu apprised abut the rapidly changing guidelines. In additin t the materials enclsed, we wuld like t ffer t cme t yur facility t give a presentatin t staff abut ZIKV, testing prtcls, and current recmmendatins. Please cntact Carlyn Brent at r Andrew Dibb at with any ZIKV-related questins, r t request a presentatin at yur practice. Thank yu fr taking the time t stay engaged and up-t-date abut this tremendusly critical issue. Sincerely, Dagmar Vitek, MD Directr, Medical Divisin Salt Lake Cunty Health Department prmtes and prtects cmmunity and envirnmental health saltlakehealth.rg

2 Instructins fr Prviders n Zika Testing, Fllw-up, and Recmmendatins TESTING INFORMATION FOR HEALTHCARE PROVIDERS AND FACILITIES Belw are the steps required fr Zika virus testing: 1. Healthcare prvider identifies a patient presenting fr care wh meets the fllwing criteria: Pregnant wmen wh traveled t an area with active Zika virus transmissin while pregnant (see OR Pregnant wmen wh had unprtected sex with a partner wh traveled t an area with active Zika virus transmissin OR All persns wh traveled t an area with active Zika virus transmissin wh present with Guillain-Barre syndrme OR Nn-pregnant wman r man wh develps (r develped) cmpatible symptms (i.e., fever, maculpapular rash, cnjunctivitis, arthralgia) during r within 14 days f travel t an area with active Zika virus transmissin 2. Fr patients residing in Salt Lake Cunty, the prvider must cntact Carlyn Brent ( ) r Andrew Dibb ( ) at Salt Lake Cunty Health Department fr pre-authrizatin f Zika virus testing. Fr patients residing utside f Salt Lake Cunty, please cntact Utah Department f Health at Yu may cllect samples befre r after cntacting the health department. Health department staff will fill ut a case investigatin frm that asks abut travel histry, vaccinatin histry, transmissin mdes, and symptms. 3. If apprved, samples shuld be sent in t the Utah Public Health Labratry at 4431 Suth 2700 West, Taylrsville, Utah At this time, Zika tests ffered by UPHL are free. If patient is/was symptmatic, yu shuld send serum samples (>3mL in a large, red tp tube) and urine samples (.5-1.0mL sample) within 14 days f symptm nset. If patient was asymptmatic r mre than 14 days have passed since symptm nset, yu shuld send serum samples (>3mL in a large, red tp tube) t UPHL fr IgM testing. All tests shuld be accmpanied by a UPHL Infectius Disease Test Request Frm. 4. Test results shuld be available within 1 week. Health department will ntify prvider f results and recmmendatins. All equivcal, incnclusive, r psitive test results must be cnfirmed. Smetimes, cnfirmatin requires specimens be sent t CDC. Turnarund time at CDC is usually 2 t 4 weeks. Salt Lake Cunty Health Department prmtes and prtects cmmunity and envirnmental health saltlakehealth.rg

3 Instructins fr Prviders n Zika Testing, Fllw-up, and Recmmendatins KEY RECOMMENDATIONS FOR PATIENTS If patients ptentially expsed t Zika virus are trying t cnceive, CDC s recmmendatin is fr wmen t use cndms r abstain frm sex fr 8 weeks after ptential expsure. Guidelines recmmend that men abstain r use cndms fr 6 mnths. Partners f pregnant wmen shuld abstain r use cndms fr the remainder f their partner s pregnancy if they have recently traveled t areas with lcal transmissin f Zika. Regardless f IgM results, a man ptentially expsed t Zika virus shuld abstain r use cndms fr the remainder the recmmended time perid. FOLLOW UP FOR POSITIVE AND NEGATIVE RESULTS Fr psitive pregnant wmen: The patient shuld be given serial ultrasunds every 3-4 weeks t check fr abnrmalities in brain develpment. Public health will fllw thrughut pregnancy. The patient will be asked which hspital she plans t deliver at, and hspital will be given paperwrk t cllect and submit samples f infant urine, infant serum, placenta, and umbilical crd t be sent in fr testing. The patient will be given a card t bring with them at delivery ntifying prviders f their Zika psitive status, cntaining guidelines fr specimen submissin, and prviding public health cntact infrmatin. We recmmend that the cuple abstain frm sex r use prtectin fr the remainder f her pregnancy. Fr negative pregnant wmen: The patient shuld be given an ultrasund that checks fr abnrmalities in brain develpment. If the ultrasund appears nrmal, fllw up as a nrmal pregnancy. If the patient s partner culd have als been expsed t Zika virus, we recmmend that the cuple abstain frm sex r use prtectin fr the remainder f her pregnancy. Fr men with pregnant partners that tested negative r psitive: Abstain r use cndms fr the remainder f their partner s pregnancy. Fr symptmatic patients that tested negative r psitive: Treatment includes rest, fluids, and acetaminphen t reduce symptms. Advise against using NSAIDS until dengue can be ruled ut t reduce the risk f bleeding. Advise patients t take steps t prevent msquit bites during the first week f their illness. Fr infants f mthers that tested psitive: Cntact Salt Lake Cunty Health Department at during delivery t ensure samples are cllected crrectly. If delivery is ccurring after-hurs, please cntact Utah Birth Defects Netwrk will fllw up t ensure CDC received required frms, including ne fr the mther at delivery, ne fr the infant at delivery, and frms at 2,6, and 12 mnths fllw up appintments. Salt Lake Cunty Health Department prmtes and prtects cmmunity and envirnmental health saltlakehealth.rg

4 Specimen Requirements fr Zika Testing Serum specimens Cllect serum ( 3 ml) in a large, serum separatr (SST) tube. Samples cllected and shipped with expected arrival the same day can be shipped n cld packs (4 C); nt frzen. If strage/transprt will exceed 24 hurs, serum shuld be frzen at -20 C r lwer and shipped n dry ice t the Utah Public Health Labratry (UPHL). Urine specimens Prvide 1.0 ml f urine in a sterile, screw-capped vial secured with thermplastic, sel-sealing lab film. Fr RT-PCR testing specimens shuld be kept cld ( 6 C) if shipped within 24 hurs, r frzen (-70 C) fr strage and shipping if greater than 24 hurs. Fr virus islatin testing, specimens shuld bfrzen as sn as pssible (-70 C). Urine specimens shuld always be accmpanied with a serum specimen. Tissue samples Placenta Tissues shuld be placed int a sterile cntainer cntaining adequate frmalin. Cllect a minimum f three (3) x 3-4 cm in depth) squares frm the placenta. One frmalin-fixed (wet) r frmalin-fixed paraffin-embedded (FFPE) placental tissue sample shuld be stred and sent at rm temperature t UPHL. Umbilical crd Fresh tissues shuld be placed int a sterile cntainer. Cllect a minimum f fur (4) 0.25 cm squares frm the umbilical crd. One frmalin-fixed (wet) r frmalin-fixed paraffin-embedded (FFPE) umbilical crd tissue sample shuld be stred and sent at rm temperature t UPHL. Bureau f Epidemilgy $ Utah Birth Defect Netwrk $

5 UTAH PUBLIC HEALTH LABORATORY FOR UPHL USE ONLY 4431 SOUTH 2700 WEST TAYLORSVILLE, UTAH TELEPHONE: (801) FAX: (801) LAB# DATE STAMP PLEASE PRINT CLEARLY FOR ACCURACY. PATIENT INFORMATION: PATIENT STATE OF RESIDENCE: PATIENT COUNTY OF RESIDENCE: ZIP CODE: DATE OF BIRTH (mm/dd/yyyy) AGE SEX Utah Salt Lake Cunty / /_ PATIENT NAME (Last, First): Is Patient Insured? STI TESTING ONLY: Is patient MSM? PATIENT ID # ETHNICITY RACE [ ] Hispanic [ ] White [ ] Black r African American [ ] American Indian r Alaska Native PROVIDER INFORMATION Prvider Cde: [ ] Nn-Hispanic [ ] Asian [ ] Native Hawaiian r ther Pacific Islander Physician: Prvider Phne: Prvider Secure Fax #: SPECIMEN COLLECTION DATE AND TIME SPECIMEN SOURCE/SITE (CHOOSE 1): [ ] Bld [ ] Envirnmental (specify): [ ] Plasma [ ] Urethra [ ] Bdy Fluid (specify): [ ] Fd (specify): [ ] Rectum [ ] Urine [ ] Brnchalvelar lavage [ ] Islate (surce): [ ] Serum [ ] Vagina [ ] Brnchial aspirate/wash [ ] Lesin (site): [ ] Sputum (natural / induced) [ ] Vmitus (mm/dd/yy) / / Time: [ ] Cerebrspinal Fluid [ ] Liquid Pap [ ] Stl [ ] Wund/Abcess [ ] Cervix [ ] Nasal (aspirate /swab / wash) [ ] Thrat swab [ ] Other (specify): [ ] (End)tracheal aspirate/wash [ ] Naspharyngeal swab [ ] Tissue (specify): BACTERIOLOGY/TUBERCULOSIS TESTS VIROLOGY / IMMUNOLOGY TESTS Bacterilgy Specimen [ ] C. trachmatis and N. gnrrhea by NAAT [ ] QuantiFERON-TB Gld REQUIRED Shipping Temperature: [ ] Patient is a partner f a year ld female REQUIRED infrmatin: [ ] Bacterial Culture Bld draw date/time: [ ] Bacterial ID / Referral [ ] Herpes/VZV PCR (HSV-1, HSV-2, VZV) Incubatin at 37 C cmpleted? [ ] Yes [ ] N Presumptive ID: Signature: [ ] Mycbacterial culture [ ] Virus Identificatin (culture) Incubatin starte date/time: [ ] Mycbacterial referral Virus suspected Incubatin end date/time: Presumptive ID: [ ] Cytmegalvirus [ ] Syphilis IgG EIA (includes cnfirmatry testing) [ ] Other (specify): [ ] RPR (suspect acute infectin/previus psitive) [ ] Varicella zster virus BIOTERRORISM TESTS [ ] HIV Antigen/Antibdy (includes cnfirm. testing) (Ntify Lab befre submitting) [ ] Previus psitive [ ] Bacillus anthracis Detectin/Identificatin [ ] Multi-Pathgen Respiratry Panel [ ] Brucella species Detectin/Identificatin (Includes Adenvirus, Crnvirus, Human [ ] Hepatitis C Antibdy [ ] Brucella antibdy Metapneumvirus, Rhin/Entervirus, Influenza A, [ ] Add HCV RNA Testing if Psitive [ ] Burkhlderia mallei/pseudmallei Detectin/ID [ ] Clstridium btulinum culture & txin Influenza B, Parainfluenza 1-4, RSV, Brdetella pertussis, C. pneumniae, M. pneumniae) [ ] Hepatitis C RNA [ ] Cxiella burnetii Detectin (Qualitative; Antibdy screen nt included) [ ] Francisella tularensis Detectin/Identificatin [ ] F. tularensis antibdy [ ] Hepatitis B Antibdy [ ] Orthpx viruses Detectin [ ] Influenza A & B virus PCR (with subtyping) Virus Suspected: [ ] Hspitalized w/ Influenza-like illness [ ] Hepatitis B Antigen [ ] Vaccinia virus [ ] Other (i.e., cluster investigatin) [ ] Varicella zster virus Cluster lcatin: [ ] Hantavirus (Sin Nmbre) IgG/IgM [ ] Varila virus Other reasn fr testing: [ ] Acute Serum (mm/dd/yy) / / [ ] Yersinia pestis Detectin/Identificatin [ ] Cnvalescent serum (mm/dd/yy) / / [ ] Yersinia pestis antibdy [ ] Other (specify): [ ] West Nile virus IgM (Human) ADDITIONAL INFORMATION [x] Other Disease Suspected: Zika COMMENTS: INFECTIOUS DISEASE TEST REQUEST FORM [ ] Yes [ ] N [ ] Yes [ ] N [x ] Referral Test t CDC (frm REQUIRED) specify: Cntact UPHL fr CDC frm Date in use: 2/18/2014