Zika Virus Outbreak in New Hampshire

March 02, 2016

Key Points and Recommendations:

  • Today, the New Hampshire Department of Health and Human Services (NH DHHS) is announcing the first New Hampshire resident confirmed with Zika virus infection. The adult female patient contracted the virus after sexual contact with a male who had a compatible illness following travel to a country where Zika virus transmission is ongoing. The patient has fully recovered and is not pregnant.

  • To date, 55 samples from residents across New Hampshire have been sent for testing for the Zika virus. Of the tests that have been completed, this is the first positive in the state.

  • To review current information and recommendations about risks of sexual transmission of Zika, DHHS recommends reviewing the Centers for Disease Control and Prevention (CDC) MMWR.

  • To review testing and prevention recommendations for pregnant and non-pregnant women, we recommend reviewing NH Division of Public Health Services (DPHS) HAN.

  • To review recently updated guidance for testing and monitoring infants and children with possible Zika virus infection, we recommend reviewing the CDC MMWR.

  • Healthcare providers should call the NH DPHS to request testing for Zika virus infection or with questions. For efficiency and to facilitate appropriate counseling, please do not direct your patients to call NH DPHS directly. NH DPHS's number is 1-603-271-4496 (after hours, 1-800-852-3345, ext. 5300).

Zika Transmission & Prevention:

Zika virus is mainly transmitted through the bite of an infected Aedes mosquito (most commonly Aedes aegypti). These mosquito vectors are not present in New Hampshire, but individuals traveling to countries in South America, Central America, and the Caribbean where Zika virus is spreading are at risk and should take strict precautions to avoid mosquito bites as outlined by the CDC.

Zika virus can also transmit sexually from a man to a woman. Preliminary studies suggest that the virus persists in semen longer than in blood, but duration is not known. It is not known whether men who are asymptomatically infected have virus in their semen or can transmit Zika virus through sexual activity. There have been no reports of sexual transmission from an infected woman to a male partner. Any person who had condomless sex (i.e., vaginal, anal, or oral intercourse) with a male partner who traveled to an area of ongoing Zika virus transmission, and who has had symptoms of Zika virus disease during travel or within 2 weeks of return, is potentially exposed.

Because of the accumulating evidence of an association between maternal Zika virus infection and adverse fetal outcomes, including congenital microcephaly, healthcare providers should counsel pregnant and non-pregnant women to take precautions as outlined below:

Healthcare providers should counsel pregnant women:

  • To postpone travel to a Zika-affected area, if possible.

  • To follow strict precautions to avoid mosquito bites if they must travel to a Zika-affected area.

  • To abstain from sexual activity or consistently and correctly use condoms during sex (vaginal, anal, or oral intercourse) for the duration of pregnancy if a male sexual partner recently traveled to a Zika-affected area.

Healthcare providers should counsel non-pregnant women who are:

  • Not intending pregnancy and either traveled OR have a male sexual partner that traveled to a Zika-affected area

    • Take steps to prevent unintended pregnancy.

  • Intending pregnancy and traveled to a Zika-affected area

    • Postpone pregnancy for one month after returning from travel.

  • Intending pregnancy and did not travel but have a male sex partner that traveled to a Zika-affected area

    • Discuss the risks with their healthcare provider and consider postponing pregnancy until more is known about the risk of sexual transmission by abstaining from sexual activity or consistently and correctly using condoms.

This is an evolving situation, and guidance around sexual transmission of Zika virus is likely to change as more is learned about the virus and risk of sexual transmission.

Testing:

Healthcare providers should consult with NH DHHS DPHS if a patient meets criteria for testing based on the algorithm outlined in the previous HAN dated February 5, 2016. Please see the previous HAN for more details.

For any questions regarding the contents of this message, please contact NH DHHS, DPHS, Bureau of Infectious Disease Control at 1-603-271-4496 (after hours, 1-800-852-3345, ext. 5300).

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