Title: Establishing a #Timeline to Discontinue #Routine #Testing of Asymptomatic #Pregnant Women for #Zika Virus Infection — American #Samoa, 2016–17.
Subject: Zika Virus & Pregnancy, MMWR report.
Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.
Code: [ ]
Establishing a Timeline to Discontinue Routine Testing of Asymptomatic Pregnant Women for Zika Virus Infection — American Samoa, 2016–2017
Weekly / March 24, 2017 / 66(11);299–301
Format: [ PDF [102 KB] ]
W. Thane Hancock, MD1; Heidi M. Soeters, PhD2; Susan L. Hills, MBBS3; Ruth Link-Gelles, PhD4,5; Mary E. Evans, MD6; W. Randolph Daley, DVM1; Emily Piercefield, MD7; Magele Scott Anesi, MPH8; Mary Aseta Mataia8; Anaise M. Uso, BDS8; Benjamin Sili8; Aifili John Tufa, MPH9; Jacqueline Solaita8; Elizabeth Irvin-Barnwell, PhD10; Dana Meaney-Delman, MD11; Jason Wilken, PhD1; Paul Weidle, PharmD6; Karrie-Ann E. Toews, MPH1; William Walker, DVM3,4; Phillip M. Talboy12; William K. Gallo, MBA13; Nevin Krishna, MS1; Rebecca L. Laws, PhD4,14; Megan R. Reynolds, MPH15; Alaya Koneru, MPH5; Carolyn V. Gould, MD3
1Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC; 2Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC; 3Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 4Epidemic Intelligence Service, CDC; 5Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 6Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 7Division of Parasitic Diseases and Malaria, Center for Global Health, CDC; 8Department of Health, American Samoa Government; 9Pacific Islands Health Officer’s Association, Honolulu, Hawaii; 10Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry; 11Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 12Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; 13Office for State Tribal Local and Territorial Support, CDC; 14Division of Environmental and Occupational Disease Control, California Department of Health; 15Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC.
Corresponding author: W. Thane Hancock, firstname.lastname@example.org, 671-735-3339.
Suggested citation for this article: Hancock WT, Soeters HM, Hills SL, et al. Establishing a Timeline to Discontinue Routine Testing of Asymptomatic Pregnant Women for Zika Virus Infection — American Samoa, 2016–2017. MMWR Morb Mortal Wkly Rep 2017;66:299–301. DOI: http://dx.doi.org/10.15585/mmwr.mm6611a5.
- What is already known about this topic?
- CDC recommends Zika virus testing of asymptomatic pregnant women who live in areas with active Zika virus transmission as part of routine obstetric care during the first and second trimesters.
- Currently, there are no CDC recommendations to guide the discontinuation of testing for asymptomatic pregnant women following the end of Zika virus transmission in a jurisdiction.
- What is added by this report?
- Information on Zika virus transmission from the existing enhanced surveillance in American Samoa and current CDC guidance were used to develop criteria for calculating an end date (October 15, 2016) for active mosquito-borne transmission of Zika virus and to propose a timeline for discontinuation of routine screening of asymptomatic pregnant women in American Samoa (conception after December 10, 2016, with permissive testing for asymptomatic pregnant women who conceive through April 15, 2017).
- What are the implications for public health practice?
- The rationale described in this report might be adapted by similar jurisdictions with small populations and a potential for interruption of Zika virus transmission to help guide decisions about when to discontinue routine screening of asymptomatic pregnant women for Zika virus infection following the end of active mosquito-borne transmission.
The first patients with laboratory-confirmed cases of Zika virus disease in American Samoa had symptom onset in January 2016 (1). In response, the American Samoa Department of Health (ASDoH) implemented mosquito control measures (1), strategies to protect pregnant women (1), syndromic surveillance based on electronic health record (EHR) reports (1), Zika virus testing of persons with one or more signs or symptoms of Zika virus disease (fever, rash, arthralgia, or conjunctivitis) (1–3), and routine testing of all asymptomatic pregnant women in accordance with CDC guidance (2,3). All collected blood and urine specimens were shipped to the Hawaii Department of Health Laboratory for Zika virus testing and to CDC for confirmatory testing. Early in the response, collection and testing of specimens from pregnant women was prioritized over the collection from symptomatic nonpregnant patients because of limited testing and shipping capacity. The weekly numbers of suspected Zika virus disease cases declined from an average of six per week in January–February 2016 to one per week in May 2016. By August, the EHR-based syndromic surveillance (1) indicated a return to pre-outbreak levels. The last Zika virus disease case detected by real-time, reverse transcription–polymerase chain reaction (rRT-PCR) occurred in a patient who had symptom onset on June 19, 2016. In August 2016, ASDoH requested CDC support in assessing whether local transmission had been reduced or interrupted and in proposing a timeline for discontinuation of routine testing of asymptomatic pregnant women. An end date (October 15, 2016) was determined for active mosquito-borne transmission of Zika virus and a timeline was developed for discontinuation of routine screening of asymptomatic pregnant women in American Samoa (conception after December 10, 2016, with permissive testing for asymptomatic women who conceive through April 15, 2017).
Keywords: US CDC; USA; Updates; Zika Virus; Pregnancy; American Samoa.