Zika Virus

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  • Background
  • Lab Tests
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Laboratory Testing

Zika virus is primarily transmitted to humans in tropical regions through the bite of an infected mosquito from the Aedes genus (mainly Aedes aegypti). Zika virus is usually mild and self-limiting with symptoms lasting from several days to a week. However, infection with Zika virus during pregnancy has been linked to congenital microcephaly and other serious brain defects in fetuses and infants. Sexual transmission of Zika virus is also of great concern; several cases of individuals contracting the disease from partners in the U.S. have been reported. Transfer from infected patient to other patients without sexual contact was also recently described, but the exact mechanism is not understood (Swaminathan, et al, 2016). 

Epidemiology

  • Transmission (CDC, 2016)
    • Mosquito vectors
      • Same vector as those for dengue fever, yellow fever, and chikungunya viruses
        • Primary vector is Aedes aegypti – subtropical and tropical locations worldwide, including many South and Central American countries and Caribbean countries, as well as >25 U.S. states
    • Perinatal/in utero
    • Sexual contact
    • Blood transfusion (likely to occur, but not confirmed)
    • Contact with infected patients without sexual contact (poorly understood mechanism)

Organism

  • Single-stranded RNA virus of the Flaviviridae family
  • Serologic cross reactions between members of Flaviviridae are common (eg, dengue fever virus)

Clinical Presentation

  • Most people who are infected with Zika virus are nonsymptomatic; those that are symptomatic typically have mild symptoms
    • Most symptoms resolve on their own within a week
  • Characteristic clinical findings
    • Acute onset of fever
    • Maculopapular rash
    • Arthralgia
    • Conjunctivitis – the most distinct symptom of Zika virus infection compared to other arthropod-borne flaviviruses
    • Myalgia
    • Headache
  • Fetuses and infants of women infected with Zika virus during pregnancy
    • May present with microcephaly and severe fetal brain defects
  • Guillain-Barré syndrome
    • Has been reported in patients following Zika virus infection
Tests generally appear in the order most useful for common clinical situations. Click on number for test-specific information in the ARUP Laboratory Test Directory.

Zika Virus by PCR, Blood 2014065
Method: Qualitative Polymerase Chain Reaction

Limitations 

Test is not FDA cleared or approved and is intended for in vitro diagnostic use under FDA Emergency Use Authorization (EUA)

The possibility of false-positive or false-negative results must be considered

For more information, please refer to the current CDC clinical guidance for Zika virus testing

Zika Virus by PCR, Urine 2014069
Method: Qualitative Polymerase Chain Reaction

Limitations 

Test is not FDA cleared or approved and is intended for in vitro diagnostic use under FDA Emergency Use Authorization (EUA)

The possibility of false-positive or false-negative results must be considered

For more information, please refer to the current CDC clinical guidance for Zika virus testing

Zika Virus IgM Antibody Capture (MAC), by ELISA 2013942
Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Limitations 

Test is not FDA cleared or approved and is intended for in vitro diagnostic use under FDA Emergency Use Authorization (EUA)

The possibility of false-positive or false-negative results must be considered. RT-PCR testing on both a serum and urine specimen is recommended by the CDC to rule out false-negative IgM results in patients experiencing symptoms for <14 days; specimens collected for IgM testing ≥14 days after symptom onset do not require any additional testing

For more information, please refer to the current CDC clinical guidance for Zika virus testing

Guidelines

Brooks J, Friedman A, Kachur R, et al. Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, July 2016. July 29, 2016 / 65(29);745–747. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Last updated Jul 2016; Accessed: Jan 2017]

Centers for Disease Control and Prevention (CDC). Interim Guidance for Zika Virus Testing of Urine — United States, 2016. May 13, 2016 / 65(18). Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Last updated May 2016; Accessed: Oct 2016]

Guidance for U.S. Laboratories Testing for Zika Virus Infection. Centers for Disease Control and Prevention. Atlanta, GA [Last updated Nov 2016; Accessed: Dec 2016]

Oduyebo T, Igbinosa I, Petereson E, et al. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure — United States, July 2016. July 29, 2016 / 65(29);739–744. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Last updated Jul 2016; Accessed: Jan 2017]

Petersen EE, Meaney-Delman D, Neblett-Fanfair R, et al. Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Persons with Possible Zika Virus Exposure — United States, September 2016. October 7, 2016 / 65(39);1077-1081. Centers for Disease Control and Prevention. Atlanta, GA [Last updated Oct 2016; Accessed: Jan 2017]

Rabe I, Staples J, Villanueva J, et al. Interim Guidance for Interpretation of Zika Virus Antibody Test Results. June 3, 2016 / 65(21). Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Last updated Jun 2016; Accessed: Jan 2017]

Russell K, Oliver S, Lewis L, et al. Update: Interim Guidance for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection — United States, August 2016. August 26, 2016 / 65(33);870–878. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Last updated Aug 2016; Accessed: Jan 2017]

General References

Bingham A, Cone M, Mock V, et al. Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease — Florida, 2016. May 13, 2016 / 65(18). Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Atlanta, GA [Last Updated May 2016; Accessed: Jan 2017]

Brasil P, Pereira JP, Gabaglia CR, Damasceno L, Wakimoto M, Nogueira RM, de Sequeira PC, Siqueira AM, de Carvalho LM, da Cunha DC, Calvet GA, Neves ES, Moreira ME, Baião AE, de Carvalho PR, Janzen C, Valderramos SG, Cherry JD, de Filippis AM, Nielsen-Saines K. Zika Virus Infection in Pregnant Women in Rio de Janeiro - Preliminary Report N Engl J Med. 2016; PubMed

Driggers RW, Ho C, Korhonen EM, Kuivanen S, Jääskeläinen AJ, Smura T, Rosenberg A, Hill A, DeBiasi RL, Vezina G, Timofeev J, Rodriguez FJ, Levanov L, Razak J, Iyengar P, Hennenfent A, Kennedy R, Lanciotti R, Plessis Ad, Vapalahti O. Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities N Engl J Med. 2016; 374(22): 2142-51. PubMed

Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Rus KR, Vipotnik TV, Vodušek VF, Vizjak A, Pižem J, Petrovec M, Županc TA. Zika Virus Associated with Microcephaly N Engl J Med. 2016; 374(10): 951-8. PubMed

Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus and Birth Defects--Reviewing the Evidence for Causality N Engl J Med. 2016; 374(20): 1981-7. PubMed

Swaminathan S, Schlaberg R, Lewis J, Hanson KE, Couturier MR. Fatal Zika Virus Infection with Secondary Nonsexual Transmission N Engl J Med. 2016; PubMed

Zika Virus. Centers for Disease Control and Prevention. Atlanta, GA [Last Updated Nov 2016; Accessed: Nov 2016]

Medical Reviewers

Last Update: February 2017