Zika in 2018: Advising Travelers Amid Changing Incidence
Authors: Daniel S. Graciaa, Matthew H. Collins, Henry M. Wu
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions4 September 2018Zika in 2018: Advising Travelers Amid Changing IncidenceDaniel S. Graciaa, MD, MPH, Matthew H. Collins, MD, PhD, and Henry M. Wu, MDDaniel S. Graciaa, MD, MPHEmory University School of Medicine, Atlanta, Georgia (D.S.G., M.H.C., H.M.W.), Matthew H. Collins, MD, PhDEmory University School of Medicine, Atlanta, Georgia (D.S.G., M.H.C., H.M.W.), and Henry M. Wu, MDEmory University School of Medicine, Atlanta, Georgia (D.S.G., M.H.C., H.M.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-1112 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Recent epidemics of Zika virus have revealed previously unrecognized complications (including microcephaly and Guillain–Barré syndrome), alarming public health institutions and communities. Since Zika's peak incidence in 2016, however, public attention has waned with the decline in reported cases (1). The decreased prevalence and resulting increased likelihood of false-positive test results led the Centers for Disease Control and Prevention to eliminate routine testing of asymptomatic pregnant women from its Zika guidance (2). This change remains controversial: Some experts argue that removing uniform testing of this group may lead to underappreciation of risk and decreased access to testing (3).Every year, approximately ...References1. Centers for Disease Control and Prevention. Zika virus: 2017 case counts in the US. 3 May 2018. Accessed at www.cdc.gov/zika/reporting/2017-case-counts.html on 5 June 2018. Google Scholar2. Oduyebo T, Polen KD, Walke HT, Reagan-Steiner S, Lathrop E, Rabe IB, et al. Update: interim guidance for health care providers caring for pregnant women with possible Zika virus exposure—United States (including U.S. territories), July 2017. MMWR Morb Mortal Wkly Rep. 2017;66:781-93. [PMID: 28749921] doi:10.15585/mmwr.mm6629e1 CrossrefMedlineGoogle Scholar3. Goldfarb IT, Jaffe E, Lyerly AD. Responsible care in the face of shifting recommendations and imperfect diagnostics for Zika virus. JAMA. 2017;318:2075-6. [PMID: 29084310] doi:10.1001/jama.2017.15680 CrossrefMedlineGoogle Scholar4. Lammert S, Walker AT, Erskine S, Rao SR, Esposito DH, Ryan ET, et al. Characteristics of US travelers to Zika virus-affected countries in the Americas, March 2015-October 2016. Emerg Infect Dis. 2017;23:324-7. [PMID: 27926355] doi:10.3201/eid2302.161292 CrossrefMedlineGoogle Scholar5. Mead PS, Duggal NK, Hook SA, Delorey M, Fischer M, OlzenakMcGuire D, et al. Zika virus shedding in semen of symptomatic infected men. N Engl J Med. 2018;378:1377-85. [PMID: 29641964] doi:10.1056/NEJMoa1711038 CrossrefMedlineGoogle Scholar6. Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, et al; US Zika Pregnancy Registry Collaboration. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA. 2017;317:59-68. [PMID: 27960197] doi:10.1001/jama.2016.19006 CrossrefMedlineGoogle Scholar7. Brooks RB, Carlos MP, Myers RA, White MG, Bobo-Lenoci T, Aplan D, et al. Likely sexual transmission of Zika virus from a man with no symptoms of infection—Maryland, 2016. MMWR Morb Mortal Wkly Rep. 2016;65:915-6. [PMID: 27585037] doi:10.15585/mmwr.mm6534e2 CrossrefMedlineGoogle Scholar8. Moghadas SM, Shoukat A, Espindola AL, Pereira RS, Abdirizak F, Laskowski M, et al. Asymptomatic transmission and the dynamics of Zika infection. Sci Rep. 2017;7:5829. [PMID: 28724972] doi:10.1038/s41598-017-05013-9 CrossrefMedlineGoogle Scholar9. Balmaseda A, Stettler K, Medialdea-Carrera R, Collado D, Jin X, Zambrana JV, et al. Antibody-based assay discriminates Zika virus infection from other flaviviruses. Proc Natl Acad Sci U S A. 2017;114:8384-9. [PMID: 28716913] doi:10.1073/pnas.1704984114 CrossrefMedlineGoogle Scholar10. Premkumar L, Collins M, Graham S, Liou GA, Lopez CA, Jadi R, et al. Development of envelope protein antigens to serologically differentiate Zika virus infection from dengue virus infection. J Clin Microbiol. 2018;56. [PMID: 29263206] doi:10.1128/JCM.01504-17 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Emory University School of Medicine, Atlanta, Georgia (D.S.G., M.H.C., H.M.W.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1112.Corresponding Author: Daniel S. Graciaa, MD, MPH, Department of Family and Preventive Medicine, Emory University School of Medicine, 1841 Clifton Road, 5th Floor, Atlanta, GA 30322; e-mail, [email protected]edu.Current Author Addresses: Dr. Graciaa: Department of Family and Preventive Medicine, Emory University School of Medicine, 1841 Clifton Road, 5th Floor, Atlanta, GA 30322.Drs. Collins and Wu: Emory TravelWell Center, Medical Office Tower 7, 550 Peachtree Street NE, Atlanta, GA 30308.Author Contributions: Conception and design: D.S. Graciaa, M.H. Collins, H.M. Wu.Analysis and interpretation of the data: D.S. Graciaa, M.H. Collins, H.M. Wu.Drafting of the article: D.S. Graciaa, M.H. Collins, H.M. Wu.Critical revision of the article for important intellectual content: M.H. Collins, H.M. Wu.Final approval of the article: D.S. Graciaa, M.H. Collins, H.M. Wu.Collection and assembly of data: D.S. Graciaa.This article was published at Annals.org on 17 July 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySystematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus1Detecting Vertical Zika Transmission: Emerging Diagnostic Approaches for an Emerged FlavivirusUse of the immunoglobulin G avidity assay to differentiate between recent Zika and past dengue virus infectionsZika virus and sexual transmission: updated preconception guidance 4 September 2018Volume 169, Issue 5Page: 337-338KeywordsDecision makingDisclosureEpidemiologyMalariaPregnancyPrevention, policy, and public healthPreventive medicineSemenToxoplasmosisZika virus ePublished: 17 July 2018 Issue Published: 4 September 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...