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A Special Notice Regarding the Zika Virus
Patricia Tietjen, MD
VPMA Danbury Hospital and New Milford Hospital
To all Members of the WCHN Medical Staff
Information regarding the Zika virus for you and our patients
Here is information related to the current Zika outbreak which is receiving significant media coverage. The Zika virus is spread to people primarily through the bite of an infected Aedes species mosquito. An estimated 80% of persons infected with Zika virus are asymptomatic. Symptomatic disease is generally mild, with symptoms of fever, maculopapular rash, arthralgia, or non-purulent conjunctivitis that typically last from several days to one week. The symptoms of Zika infection are generally mild and self-limited, and it is believed to pose little risk to the general population.
- In 2015, the first local Zika virus transmission in the Americas was reported in Brazil and local transmission has now been in several countries or territories in the Americas.
- In the current outbreak in Brazil, a marked increase in the number of infants born with microcephaly has been reported and Zika virus infections have been confirmed in some infants with microcephaly. However, it is not known how many of the microcephaly cases are associated with Zika virus infection. Travelers to areas with ongoing outbreaks are at risk of becoming infected and spreading the virus to new areas, including the continental United States.
- The symptoms of Zika infection are generally mild and self-limited, and it is believed to pose little risk to the general population.
- In response to the increased incidence of Zika virus infection, the Centers for Disease Control has released recommendations for the evaluation of pregnant women who have traveled to Zika-affected areas. At: http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1er.htm?s_cid=mm6502e1er_e.
- Healthcare clinicians and staff, as well as other patients, are not generally at risk of contracting Zika virus from a pregnant woman.
- CDC updated diagnostic testing for Zika, chikungunya, and dengue viruses in US Public Health laboratories: http://www.cdc.gov/zika/pdfs/denvchikvzikv-testing-algorithm.pdf. There are currently no commercially-available diagnostic assays or kits for Zika virus infection.
On 2/8/16, Dr. Dodge spoke to Dr. Joceyln Mullins at the CT state lab – 860-509-7994. They only need the CT state lab requisition filled out. The ordering clinician should fill out the CT state lab requisition and send it with the patient for phlebotomy. The state lab does not need the CDC requisition filled out. If the test at the CT state lab is positive, the state lab will call the ordering clinician's office and obtain the info to fill out the CDC requisition.
The CT Clinical Test Requisition form is available at http://www.ct.gov/dph/lib/dph/laboratory/labhome/forms/clinical_test_requisition_ol9b_fill.pdf (submitters should write in Zika testing at CDC in the space provided for diseases not listed).
Patients can have their blood drawn for Zika virus testing at:
Any WCHN patient service center
Danbury Hospital Laboratory: 2 Tower Building
Norwalk Hospital: One stop testing, after registering at Central Registration in the Trefz Lobby
For WCHN Phlebotomy and Laboratory:
The size of the specimen container for the serum is very specific (see highlighted text below). We are drawing 3 tall (6 mL) red top (plain) tubes, centrifuging them and transferring the serum into three screw-top plastic vials of the appropriate size. We are putting the vials into an insulated container with ice packs and sending it to the CT state lab.
Specimen Types and Amounts
- Acute and convalescent specimens, if available, should be sent together.
- Ideal timing of specimens for serology:
| Specimen |
Timing |
| Acute |
3 to 10 days after onset of symptoms |
| Convalescent |
2-3 weeks after acute sample |
- At least 0.5 mL of serum and/or 1.0 mL of CSF is required for serology testing. CSF specimens are routinely tested undiluted and therefore require larger amounts. Whole blood will not be accepted for serology testing. Please transfer serum or CSF to a plastic tube with screw cap measuring no more than 5 cm tall and approximately 13 mm in diameter (e.g. 1.8 mL cryotube or 2.0 mL microtube).
- For serology testing, the specimen should be kept cold or frozen. The sample may be placed in an insulated container with blue ice packs. Additional blue ice packs should be used in the summer to ensure specimen integrity in hot weather.
For virus isolation and/or nucleic acid amplification testing, acceptable specimens are fresh frozen tissue, serum, or cerebrospinal fluid. Tissue specimens should be approximately 1 cm⊃3; frozen as soon as possible at -70ºC, and shipped on enough dry ice so that specimens remain frozen until received. Formalin-fixed specimens are not tested at DVBD and can be submitted to the Special Pathogens Laboratory in Atlanta, GA for immunohistochemistry:
Western Connecticut Health Network is working closely with Maternal Child Health providers, the Departments of the Laboratory, Infectious Diseases and Infection Control to provide guidance to our clinicians on how to screen patients for possible Zika infection, as well as how to provide proper testing and follow-up. Attached you will also find a sample of the screening tool we are using in some of our clinics as well as instructions for collection and handling of specimens. The Western Connecticut Health Network Patient Services Centers will also be able to draw the blood for those patients at risk and will send the specimens to the CT state lab.
The CDC has also released guidance for testing for possible congenital transmission in newborns. http://www.cdc.gov/mmwr/volumes/65/wr/mm6503e3er.htm?s_cid=mm6503e3er.htm_w. Our Pediatric Departments are putting guidelines in place that will enable screening for newborns.
For additional information and guidelines specific to the Zika virus including an updated travel alert list, please visit the CDC site.
We will also send you more information as it becomes available.
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