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Infection with Zika virus has attained epidemic proportions in parts of the Americas. Cases have now been reported in U.S. women who did not travel to endemic areas or were not in locales in which the mosquito existed during the season of acquisition, but who had sexual exposure to males who had recently traveled to such areas.
During February 6 to 22, 2016, 14 cases involving suspected sexual transmission, based on the above criteria, were reported to the CDC from multiple states. Two laboratory-confirmed cases and four probable cases of sexual transmission were culled from these reports. Several women involved were pregnant. Contact included vaginal sex without condom use that occurred while, or shortly after, the male partner experienced symptoms consistent with Zika virus infection. No cases have been reported of sexual transmission from asymptomatic males to females or from infected females to males.
Another report from the CDC presents data as of February 17, 2016, on pregnancy outcomes in nine U.S. women with Zika virus infection who had traveled to affected areas. Outcomes included two early pregnancy losses; two elective terminations; three term births, one of which involved an infant with severe microcephaly; and two in-progress pregnancies. An additional 10 cases are under investigation. Screening for Zika infection is available from the CDC for pregnant women traveling from endemic areas. Of 257 pregnant women who were tested from August 1, 2015, through February 10, 2016, 97% were Zika-negative, and 3% were Zika-positive. Among the Zika-positive group, no hospitalizations or deaths have been reported.
Hills SL et al. Transmission of Zika virus through sexual contact with travelers to areas of ongoing transmission — Continental United States, 2016. MMWR Morb Mortal Wkly Rep 2016 Mar 4; 65:215. (http://www.cdc.gov/mmwr/volumes/65/wr/mm6508e2er.htm)
Meaney-Delman D et al. Zika virus infection among U.S. pregnant travelers — August 2015–February 2016. MMWR Morb Mortal Wkly Rep 2016 Mar 4; 65:211. (http://www.cdc.gov/mmwr/volumes/65/wr/mm6508e1er.htm)
Comment
The data in these two reports must be considered preliminary because we are still at the earliest stages of understanding the epidemiology and geographic distribution of the Zika virus. In particular, the relative contribution of sexual transmission is unknown, but its existence must be taken as fact. Although authorities are unable to confirm that the pregnancy outcomes seen thus far are caused by Zika virus infection, it seems highly likely that they are. Zika infection is a nationally reportable disease, and the CDC has published (and will be revising) guidelines for sexual contact during and after symptomatic diseases as well as for the management of pregnancy in Zika-infected women.