Clinical Information

Zika virus is an RNA virus in the genus Flavivirus and is primarily transmitted through the bite of an infected Aedes species mosquito. Other means of transmission include through transfusion of blood and blood products, sexually through genital secretions, perinatally, vertically from mother to fetus, and, potentially, through contact with other body secretions, such as tears and sweat.

Historically, most cases of Zika virus infection have occurred in parts of Africa and Southeast Asia. However, Zika virus emerged in South America in early 2015 and is now endemic in over 50 countries in South, Central, and North America, including in several US territories and focal regions of the southern United States.

The majority (approximately 80%) of individuals infected with Zika virus are asymptomatic. Fever, headache, retro-orbital pain, conjunctivitis, maculopapular rash, myalgias and arthralgias are commonly reported among symptomatic patients. Notably, these symptoms are not distinct and can be seen with other emerging arboviruses, including dengue and chikungunya. Therefore, diagnostic testing for each of these viruses is recommended in patients returning form areas where these viruses cocirculate. Intrauterine or prenatal infection with Zika virus has been causally linked to development of microcephaly, with the greatest risk for fetal abnormality occurring if the infection is acquired during the first trimester. Finally, Zika virus has also been associated with development of Guillain-Barre syndrome.

A number of Zika virus serologic and nucleic acid amplification tests have received emergency use authorization (EUA) through the US Food and Drug Administration. The recommended tests vary by the patient's symptoms, course of illness, and whether or not the patient is pregnant.

For the most up-to-date information regarding the Centers of Disease Control and Prevention testing guidelines visit www.cdc.gov/zika/.

These guidelines are reflected in Assessment for Zika Virus Infection.

Zika virus testing is not recommended for asymptomatic couples attempting conception, given the potential for false-positive and false-negative results. Additionally, it is well established the Zika virus may remain in reproductive fluids despite negative serologic and molecular test results in blood and urine.