July 20, 2016

Dear Colleague:

The Department of Health is currently investigating a possible non-travel related case of Zika virus in Miami-Dade County. We must remain vigilant and increase our level of questioning when considering Zika virus disease. At this time, it is important to review what we know about this disease and act accordingly to prevent transmission and mitigate negative health outcomes. Remember to identify, test and inform. Please contact your county health department immediately if you suspect a patient has Zika fever (per rule 64D-3.029, Florida Administrative Code), to ensure prompt mosquito control efforts.

Zika fever, a dengue-like illness caused by a mosquito-borne flavivirus, has been identified in numerous countries. Zika virus infection during pregnancy can cause serious birth defects, including microcephaly. Links between Zika virus infection and Guillain-Barre syndrome (GBS) are also suspected. Transmission occurs through the bite of an infected mosquito. Perinatal, in utero, sexual, transfusion and contact with body fluids transmissions have also been reported. Suspect Zika fever patients should be advised to avoid mosquito bites while ill, to prevent potential infection of local mosquitoes.

Clinical Presentation: The incubation period is approximately two to 14 days. Only about one in five people infected with Zika virus are symptomatic. Signs/symptoms of Zika fever may include acute fever (often low grade), maculopapular rash, arthralgia, conjuctivitis, myalgia, headache, retro-orbital pain and vomiting. Zika fever is generally a mild illness with symptoms similar to mild dengue fever. Severe disease requiring hospitalization is uncommon. Treatment is symptomatic and illness typically resolves within a week. Co-infections with dengue or chikungunya are possible and should be considered. Aspirin and other non-steroidal anti-inflammatory drugs are not advised in case of co-infection with dengue. Pregnant women with fever should be treated with acetaminophen.

This is an evolving situation and there will be additional guidance issued when it is available. Additional resources you may find helpful:

• Current Zika virus information from CDC: https://www.cdc.gov/zika
• Florida mosquito-borne disease information including weekly surveillance reports: https://www.floridahealth.gov/diseases-and-conditions/mosquito-borne-diseases/index.html
• Contact information for county and state DOH: https://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/index.html

Please share this information with other relevant partners. The department's Bureau of Epidemiology and our county health departments are available to assist you with questions about Zika virus testing protocols and sample submission requests.

Sincerely,

Celeste Philip, MD, MPH