University Travel Advisory: Zika Virus

Columbia University continues to monitor Centers for Disease Control and Prevention (CDC) and NYC Department of Health and Mental Hygiene advisories regarding Zika virus. These travel advisories are for much of the Caribbean, Mexico, Central America, and South America, and some areas of Southeast Asia. (See map at http://www.cdc.gov/zika/geo/.)

Editor's note:

Originally posted February 9, 2016.

By:
Columbia University Health
October 20, 2016

All Columbia travelers must be aware of the current risks. Prior to departure, travelers from the Morningside campus heading to affected regions are encouraged to contact Columbia Health’s Travel Medicine program; travelers at CUMC are encouraged to contact the CUMC Student Health Service. Travelers may also contact Columbia Health’s Zika Infoline at (212) 854-8891 or the New York City Infoline at (866) 692-3641.

Any member of the Columbia community who has planned University travel to one of the affected areas and wishes to cancel, change, or delay their trip can do so by contacting their faculty advisor, project director, or Columbia Health’s Zika Infoline at (212) 854-8891.

On August 1, 2016, with the first reported cases of local mosquito-borne Zika virus transmission in Miami-Dade and Broward Counties in Florida, the CDC issued a Health Advisory with travel and testing guidelines for pregnant women and couples thinking about becoming pregnant. The CDC recommends that pregnant women avoid all non-essential travel to the identified areas, as well as applying existing guidelines for prevention of mosquito bites and prevention of Zika virus transmission through sexual contact, as described below.

In local updates, there has been no local Zika virus transmission in New York City. New York City has been monitoring mosquito populations and applying pesticides when appropriate to reduce the number of mosquitos, minimizing the risk of mosquito-borne diseases. The city is also continuing to offer testing to pregnant women returning from Zika-affected countries. Blood donor screening is being monitored. On June 14, 2016, the CDC published an Interim Response Plan for Zika Virus Infections in the continental US and Hawaii. This is due to the assumption that travel-associated and sexually transmitted Zika virus infections will continue to occur, and that there may be some further local mosquito transmission in limited areas of the continental US and Hawaii where competent mosquito vectors exist.

Zika virus is primarily transmitted to humans through the bite of an Aedes aegypti mosquito, often during daytime hours. This species of mosquito also carries the viruses for dengue and chikungunya. Although mosquito bites are the primary risk factor for infection, there are reports of male-to-female sexual transmission. Symptoms of Zika virus include rash, conjunctivitis, fever, and joint pain. Only 20-30% of infected individuals will become symptomatic. The incubation period of the virus is unknown, but thought to be in the range of 3-12 days. Zika virus infection during pregnancy has been associated with severe birth defects, including microcephaly, and poor pregnancy outcomes. Additionally, researchers are investigating probable associations between Zika virus and Guillain-Barré syndrome, an autoimmune disorder affecting nerves and that can lead to paralysis. There is currently no vaccine available to protect against Zika virus; treatment is aimed at relieving symptoms of infection and is not specific to Zika virus.

Traveling to the affected areas:

If traveling to areas affected by the Zika outbreak, adhere strictly to mosquito precautions:

  • Wear long-sleeved shirts and long pants.
  • Stay in places with air conditioning and window and door screens to keep mosquitoes outside.
  • Take steps to control mosquitoes inside and outside.
  • Sleep under a mosquito bed net.
  • Use Environmental Protection Agency (EPA)-registered insect repellents with one of the following active ingredients: DEET, picardin, IR3535, oil of lemon eucalyptus, or para-menthane-diol. Choosing an EPA-registered repellant ensures the EPA has evaluated the product for effectiveness. It is suggested that travelers bring their own supply of repellent as it may not be readily available in the affected regions.
  • Use permethrin-treatedclothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.

Returning from the affected areas:

If you develop fever, joint pains, rash, or conjunctivitis within a month of your return from an area affected by the Zika outbreak, contact your health care provider at Columbia Health or CUMC Student Health.

Sexual transmission of Zika virus:

The CDC has further updated their recommendations to reduce the risk of sexual transmission of Zika virus from both men and women to their sex partners. This guidance defines potential sexual exposure to Zika virus as having had sex with a person who has traveled to or lives in an area with active Zika virus transmission when the sexual contact did not include a barrier to protect against such infection. Such barriers include male or female condoms for vaginal or anal sex and other barriers for oral sex. Sexual exposure includes vaginal sex, anal sex, oral sex, or other activities that might expose a partner to genital secretions, such as the sharing of sex toys.

Recommendations for couples who are not pregnant and are not planning to become pregnant:

Men and women who want to reduce the risk for sexual transmission of Zika virus should use condoms consistently and correctly for all sexual activity or abstain from sex when one sex partner has traveled to or lives in an area with active Zika virus transmission, with the duration of condom use or abstinence varying depending on the specific scenario:

  • Couples in which a partner had confirmed Zika virus infection or clinical illness consistent with Zika virus disease should consider using barrier methods against infection consistently and correctly or abstaining from sex as follows:
    • Men with Zika virus infection for at least 6 months after onset of illness.
    • Women with Zika virus infection for at least 8 weeks after onset of illness.
  • Couples in areas without active Zika transmission in which one partner traveled to or resides in an area with active Zika virus transmission but did not develop symptoms of Zika virus disease should consider using barrier methods against infection or abstaining from sex for at least:
    • 8 weeks after the female partner departed the Zika-affected area.
    • 6 months after the male partner departed the Zika-affected area.
  • Couples who reside in an area with active Zika virus transmission might consider using barrier methods against infection or abstaining from sex while active transmission persists.

Recommendations for couples who may become pregnant:

  • Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception.
  • Men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception.
  • Women with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception.
  • Men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 6 months after exposure to attempt conception.

Recommendations for pregnant couples:

Pregnant women with sex partners (male or female) who live in or who have traveled to an area with active Zika virus transmission should consistently and correctly use barriers against infection during sex or abstain from sex for the duration of the pregnancy.

The CDC advises women who are pregnant to consider postponing travel to any area where Zika virus transmission is ongoing. Pregnant women who have traveled to an area with ongoing Zika virus transmission should see their healthcare provider to discuss testing for Zika virus exposure.

For more information on Zika virus, please visit the Centers for Disease Control (CDC), http://www.cdc.gov/zika/index.html and the Mailman School of Public Health, Experts Explain: Zika Virus: https://www.mailman.columbia.edu/public-health-now/news/what-we-know-and-don%E2%80%99t-know-about-zika

Sources:www.cdc.gov; http://www1.nyc.gov/site/doh/health/health-topics/zika-virus.page

Countries Affected by Zika

For an up-to-date list of countries affected by Zika, please visit the CDC’s website at:
http://www.cdc.gov/zika/geo/active-countries.html.