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Zika
Topic Collection
March 18, 2022

Topic Collection: Zika

Healthcare providers and emergency medical professionals need to be able to recognize and treat diseases caused by novel pathogens. Zika virus can be more difficult than many other diseases to recognize and, though it has less implications for emergency care, it can result in severe health consequences.

This Topic Collection contains resources that can help our audience: learn more about managing patients at risk of or infected by Zika virus disease (particularly pregnant women who contract the virus during pregnancy); understand related infection control principles; and develop plans based on research and existing materials. Note: Jurisdictional Zika plans generally reflect a focus on vector control and risk communication without significant information about clinical information or coordination with the healthcare system. Where these issues are mentioned they are mentioned in passing.

For more information, we encourage you to access our factsheet, Zika: Resources at Your Fingertips. Information on Zika is constantly evolving. If you are a clinician treating a patient, please check the Centers for Disease Control and Prevention (CDC) Zika site for the most current information and clinical guidance.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

ASPR TRACIE. (2022). Zika: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides Zika virus disease resources and an overview of public health and healthcare system considerations and implications that are applicable to professionals in those systems, emergency management stakeholders, and other audiences. Appendix A contains resources from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and relevant contact links. Appendix B includes citations with annotations for additional relevant resources and Zika Guidance.
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Center for Infectious Disease Research and Policy. (2016). Zika Resource Page.
This webpage offers a compilation of resources on Zika virus disease including governmental publications, academic publications, research pieces, and popular media mentions. The compilation is updated regularly.
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Centers for Disease Control and Prevention. (2016). Zika Virus.
This website provides the Centers for Disease Control and Prevention resources related to Zika Virus disease including outbreak status, current clinical recommendations, and prevention and mitigation information.
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Rasmussen, S., Jamieson, D., Honein, M., and Petersen, L. (2016). Zika Virus and Birth Defects - Reviewing the Evidence for Causality. The New England Journal of Medicine. 374:1981-1987.
The authors evaluated available data to determine causality of Zika infection and birth defects, most notably microcephaly. This evidence included Zika virus infection during specific times in pregnancy, a specific rare phenotype involving microcephaly, and data that support biologic plausibility. The researchers concluded that the evidence supports a causal relationship between Zika virus infection and birth defects.
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World Health Organization. (2016). Zika: Strategic Response Plan (Revised for July 2016-December 2017).
This World Health Organization (WHO) plan provides the basis for coordination and collaboration among WHO and its partners to ensure international preparedness and response capacities are supported to the fullest extent possible. The plan focuses on preventing and managing medical complications caused by Zika virus infection (with a focus on pregnant women, their partners, and their households) and integrated mosquito management, sexual and reproductive health counselling, and related health education and care.
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Zika Overview Resources

American Medical Association. (2016). Zika Virus Resource Center.
This webpage provides a compilation of resources related to Zika virus disease.
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ASPR TRACIE. (2022). Zika: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides Zika virus disease resources and an overview of public health and healthcare system considerations and implications that are applicable to professionals in those systems, emergency management stakeholders, and other audiences. Appendix A contains resources from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) and relevant contact links. Appendix B includes citations with annotations for additional relevant resources and Zika Guidance.
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Center for Infectious Disease Research and Policy. (2016). Zika Resource Page.
This webpage offers a compilation of resources on Zika virus disease including governmental publications, academic publications, research pieces, and popular media mentions. The compilation is updated regularly.
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Centers for Disease Control and Prevention. (2016). Zika Virus.
This website provides the Centers for Disease Control and Prevention resources related to Zika Virus disease including outbreak status, current clinical recommendations, and prevention and mitigation information.
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Centers for Medicare & Medicaid Services. (2016). Medicaid Benefits Available for the Prevention, Detection and Response to the Zika Virus. U.S. Department of Health and Human Services.
This Informational Bulletin is geared towards Medicaid agencies and other stakeholders and highlights how Medicaid services and authorities can help states and territories prevent, detect, and respond to the Zika virus.
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Lucey, D.R. and Gostin, L.O. (2016). The Emerging Zika Pandemic: Enhancing Preparedness. Journal of the American Medical Association. 315(9):865-866.
The authors discuss the outbreak of Zika virus disease and why it is a concern for the U.S. public health and healthcare systems. They also describe steps that should be taken to prevent and mitigate spread and steps that should be taken to prepare. The article also includes an outline for a Zika virus disease research agenda.
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Pan American Health Organization. (2016). Zika Virus Infection.
This website provides an outline of the disease and its progression specifically in the Americas. It provides information for the general public and health professionals on disease spread, identification, treatment and prevention.
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* U.S. Food and Drug Administration. (2016). Zika Virus Response Updates from FDA.
This page, provided by the U.S. Food and Drug Administration, includes links to Zika-specific information in English, Spanish, and Portuguese. Links to resources on emergency use authorization (which allows the use of certain medical products for emergencies based on scientific data); information regarding the blood supply; and information on the safety and use of insect repellants are also provided.
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World Health Organization. (2016). Zika Virus.
This World Health Organization website provides an outline of Zika and an overview of its progression around the world. Links to Situation Reports and information on signs and symptoms, transmission, diagnosis, treatment, and prevention are included on the page.
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World Health Organization. (2016). Zika Virus and Complications: Questions and Answers.
This webpage provides responses to commonly asked questions about Zika virus and mosquito protection and surveillance, sexual transmission, travel, neurological syndromes, pregnancy, and government response.
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Blood, Organ, and Tissue Donation and Transfusion/Transplant Issues

U.S. Food and Drug Administration. (2021). Information for Blood Establishments Regarding FDA’s Determination that Zika Virus is no Longer a Relevant Transfusion-Transmitted Infection. U.S. Department of Health and Human Services.
The U.S. Food and Drug Administration announced withdrawal of its guidance requiring blood establishments to test donations for Zika virus.
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Vasquez, A., Sapiano, M., Basavaraju, S., et al. (2016). Survey of Blood Collection Centers and Implementation of Guidance for Prevention of Transfusion-Transmitted Zika Virus Infection Puerto Rico, 2016. Morbidity and Mortality Weekly Report. 65(14): 375-378.
The authors gathered information on blood collection operations in Puerto Rico to assess the impact the Zika-related restriction on blood collection is having and what would be needed to replace the affected products.
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Clinical Management – General

* Centers for Disease Control and Prevention. (2016). For Healthcare Providers. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provide Zika virus medical management guidance on this webpage. Resources are categorized under: clinical evaluation and disease, testing for Zika, sexual transmission, infection control, and training.
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* Centers for Disease Control and Prevention. (2016). Symptoms, Testing, and Treatment.
This webpage includes information on the symptoms of Zika, how it is diagnosed, and how it is treated.
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Centers for Disease Control and Prevention. (2016). Zika and Guillain-Barré Syndrome.
This webpage includes information on the relationship between Zika and Guillain-Barré Syndrome (e.g., symptoms, causes, links to related resources).
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Koenig, K., Almadhyan, A., and Burns, M. (2016). Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department. Western Journal of Emergency Medicine. 17(3).
The authors report how the Identify-Isolate-Inform (3I) tool, originally conceived for healthcare providers to use with Ebola virus disease patients, can be adapted for real-time use for detection and management of patients under investigation for Zika.
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Madad, S., Masci, J., Cagliuso, N., and Allen, M. (2016). Preparedness for Zika Virus Disease — New York City, 2016. Morbidity and Mortality Weekly. 65(7):182-187.
The authors share how NYC Health + Hospitals built upon a framework that was established in 2014 to screen patients for possible exposure to Ebola virus disease to create and implement a Zika Preparedness and Response Action Plan. The plan--which can be replicated by other healthcare systems-- includes universal travel screening, signage depicting areas with active Zika virus transmission, evaluation for possible Zika virus exposure, diagnostic testing and linking of infected patients to appropriate specialists, and education on Zika virus disease and preventive measures.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Guillain-Barré Syndrome and Other Neurological Deficits Planning Resource.
This planning resource can enhance healthcare coalition and healthcare system preparedness and response to a domestic Zika virus disease outbreak, as it highlights some of the anticipated hospital resource needs essential to caring for Guillain-Barré syndrome and other neurological deficits.
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Clinical Management –Infants and Children

* Adebanjo, T., Godfred-Cato, S., Viens, L., et al. (2017). Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017. Morbidity and Mortality Weekly. 66(41): 1089-1099.
This document summarizes interim guidelines for U.S. healthcare providers caring for infants with possible congenital Zika virus infection.
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Centers for Disease Control and Prevention. (2016). Caring for Infants and Children. U.S. Department of Health and Human Services.
This resource provides information on clinical and social support services available to children with special medical needs.
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* Centers for Disease Control and Prevention. (2016). Congenital Zika Syndrome and Other Birth Defects. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention share information and definitions for definite and possible congenital microcephaly related to Zika on this webpage.
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* Centers for Disease Control and Prevention. (2016). Facts about Microcephaly.
This webpage includes a definition and links to information on microcephaly. It also includes a link to the page "Zika Virus and Pregnancy."
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Centers for Disease Control and Prevention. (2016). Webcast Recordings: Clinical Evaluation and Management of Infants with Congenital Zika Infection.
Sponsored by the Centers for Disease Control and Prevention and the American Academy of Pediatrics, this meeting provided information to clinicians on congenital Zika virus infection including the evaluation, diagnosis and management of infants.
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* Costello, A., Dua, T., Duran, P., et al. (2016). Defining the Syndrome Associated with Congenital Zika Virus Infection. Bulletin of the World Health Organization.
The authors provide an overview of the congenital abnormalities associated with Zika.
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da Silva, A., Ganz, J., Sousa, P., et al. (2016). Early Growth and Neurologic Outcomes of Infants with Probable Congenital Zika Virus Syndrome. Emerging Infectious Diseases. 22(11).
This article describes findings from a study of 48 infants up to eight months of age with probable congenital Zika virus syndrome. The study found that additional neurological symptoms emerged with age and that head circumference measurements fell further from the mean, suggesting that affected infants may continue to fall further behind non-affected children.
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Goodman, A., Dziuban, E., Powell, K., et al. (2016). Characteristics of Children Aged <18 Years with Zika Virus Disease Acquired Postnatally--U.S. States, January 2015-July 2016. Morbidity and Mortality Weekly Report. 65(39): 1082-1085.
This early release examined 158 cases of confirmed or probable Zika virus disease in children under 18 reported to the CDC by 30 states. All cases were acquired postnatally and most had mild symptoms, with 2 hospitalizations and no deaths reported. Nearly half of the cases were aged 15-17, which the authors attributed to healthcare-seeking or testing bias (five cases were pregnant) or a greater likelihood of exposure through travel.
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Honein, M., Woodworth, K., and Gregory, C. (2020). Neurodevelopmental Abnormalities Associated with In Utero Zika Virus Infection in Infants and Children - The Unfolding Story. JAMA Pediatrics. 174(3): 237-238.
The authors review the current state of knowledge about potential neurodevelopmental abnormalities in children who had congenital Zika virus exposure but without Zika virus-associated birth defects. They stress the importance of follow-up developmental screenings to detect any potential issues and refer children to appropriate services.
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Mulkey, S., Arroyave-Wessel, M., Peyton, C., et al. (2020). Neurodevelopmental Abnormalities in Children with In Utero Zika Virus Exposure Without Congenital Zika Syndrome. JAMA Pediatrics. 174(3): 269-276.
The authors of this cohort study investigate infants exposed to Zika virus (ZIKV) in utero with no clinical sign of Congenital Zika Syndrome (CZS). A longitudinal study of infant neurodevelopment includes infants born to women who met the Centers for Disease Control and Prevention criteria for probable Zika virus infection and laboratory confirmed tests during their pregnancies. The focus is to evaluate the early neurodevelopmental outcomes of infants with normocephaly who were exposed to the virus and had normal neuroimaging findings at birth and whether they are at risk as they age for neurodevelopmental delays.
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Muniz, L., Maciel, R., Ramos, D., et al. (2022). Audiological Follow-Up of Children with Congenital Zika Syndrome. Heliyon. 8:e08720.
The authors of this prospective observational study describe the frequency of hearing loss in children with congenital Zika syndrome (CZS). They hypothesized CZS may contribute to functional disabilities due to continued viral activity in neural tissue following birth. The study showed that sensorineural hearing loss is a clinical feature of CZS and present at birth with no delayed onset or progressive decline in hearing.
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Paixao, E., Cardim, L., Costa, M., et al. (2022). Mortality from Congenital Zika Syndrome - Nationwide Cohort Study in Brazil. The New England Journal of Medicine. 386: 757-767.
The authors describe results from a retrospective population-based cohort study of live births in Brazil between January 1, 2015 and December 31, 2018. They found an overall mortality rate 11 times higher in children with congenital Zika syndrome compared to those without. They also found that the increased mortality risk for children with congenital Zika syndrome persisted throughout the first three years of life.
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Roth, N., Reynolds, M., Lewis, E., et al. (2022). Zika-Associated Birth Defects Reported in Pregnancies with Laboratory Evidence of Confirmed or Possible Zika Virus Infection - U.S. Zika Pregnancy and Infant Registry, December 1, 2015-March 31, 2018. Morbidity and Mortality Weekly Report. 71(3): 73-79.
The authors provide an updated report on previous data collected in the U.S. Zika Pregnancy and Infant Registry (USZPIR) regarding the frequency of Zika associated brain and eye defects from laboratory confirmation or known Zika virus infection. The report includes data from December 2020 with follow-up on cases from infancy to 5 years of age. The aggregate exposed the potential of associated abnormalities and aligns with continuing USZPIR surveillance in understanding the effects of Zika and future outbreaks.
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Ticona, J., Nery, N., Doss-Gollin, S., et al. (2021). Heterogeneous Development of Children with Congenital Zika Syndrome-Associated Microcephaly. PLoS One. 16(9):e0256444.
The authors of this study followed 42 children, 2 years of age and older with Congenital Zika Syndrome (CZS) related to microcephaly. A correlation was observed between heterogenous neurodevelopment and neurological capabilities which indicate cognitive and motor development outcomes to children exposed to Zika virus in utero. The children experienced major neurodevelopmental delays to include spasticity.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Supporting Children with Special Healthcare Needs Planning Resource.
This matrix highlights some of the existing federal and national services and programs for supporting children with special healthcare needs in the context of Zika. It includes guidance and links to helpful resources.
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World Health Organization. (2016). Psychosocial Support for Pregnant Women and for Families with Microcephaly and other Neurological Complications in the Context of Zika Virus: Interim Guidance for Healthcare Providers.
This resource provides a framework for healthcare providers to work with other sectors, such as social work and education to provide a comprehensive support network for pregnant women and their families following a diagnosis of congenital Zika infection.
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World Health Organization. (2016). Screening, Assessment, and Management of Neonates and Infants with Complications Associated with Zika Virus Exposure in Utero.
This guidance is designed to support the development of national and local clinical protocols and policies to address infants and children’s medical, developmental, and social needs following Zika virus exposure in utero.
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Clinical Management – Maternal/Fetal

Adams Waldorf, K., Nelson, B., Stencel-Baerenwald, J., et al. (2018). Congenital Zika Virus Infection as a Silent Pathology with Loss of Neurogenic Output in the Fetal Brain. Nature Medicine. 24(3): 368-374.
The authors describe the findings of studies on Zika virus infection in a non-human primate model. They recommend long-term follow-up of children exposed to Zika virus disease in utero for neurocognitive deficits even if the child had a normal head size at birth.
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* Adebanjo, T., Godfred-Cato, S., Viens, L., et al. (2017). Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017. Morbidity and Mortality Weekly. 66(41): 1089-1099.
This document summarizes interim guidelines for U.S. healthcare providers caring for infants with possible congenital Zika virus infection.
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Brasil, P., Pereira, J., Gabaglia, C., et al. (2016). Zika Virus Infection in Pregnant Women in Rio de Janeiro - Preliminary Report. The New England Journal of Medicine.
Researchers in Rio de Janeiro enrolled 88 pregnant women in a prospective study, where they were tested for Zika virus and then followed throughout their pregnancies. Seventy-two of the 88 women enrolled tested positive for Zika virus infection. The authors concluded that “despite mild clinical symptoms, Zika virus infection during pregnancy appears to be associated with grave outcomes, including fetal death, placental insufficiency, fetal growth restriction, and CNS injury.”
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* Centers for Disease Control and Prevention. (2016). Congenital Zika Syndrome and Other Birth Defects. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention share information and definitions for definite and possible congenital microcephaly related to Zika on this webpage.
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* Centers for Disease Control and Prevention. (2016). Facts about Microcephaly.
This webpage includes a definition and links to information on microcephaly. It also includes a link to the page "Zika Virus and Pregnancy."
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* Centers for Disease Control and Prevention. (2016). For Healthcare Providers. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provide Zika virus medical management guidance on this webpage. Resources are categorized under: clinical evaluation and disease, testing for Zika, sexual transmission, infection control, and training.
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* Centers for Disease Control and Prevention. (2016). Protect Yourself and Family from Mosquito Bites.
This webpage includes information on insect repellent, including safety, and application.
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* Centers for Disease Control and Prevention. (2016). Symptoms, Testing, and Treatment.
This webpage includes information on the symptoms of Zika, how it is diagnosed, and how it is treated.
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* Centers for Disease Control and Prevention. (2019). Infographic: Zika Virus Testing for any Pregnant Woman Not Living in an Area with Zika. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provide an easy to read infographic that depicts the testing algorithm for pregnant women NOT living in an area with Zika.
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* Costello, A., Dua, T., Duran, P., et al. (2016). Defining the Syndrome Associated with Congenital Zika Virus Infection. Bulletin of the World Health Organization.
The authors provide an overview of the congenital abnormalities associated with Zika.
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Martines, R., Bhatnagar, J., Keating, M.K., et al. (2016). Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses Brazil, 2015. Morbidity and Mortality Weekly. 65(06):159-160.
The authors share evidence regarding the link between Zika virus infection and microcephaly and fetal demise based on viral RNA and antigens in brain tissues from infants with microcephaly and placental tissues from early miscarriages.
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Mlakar, J., Korva, M., Tul, N., et al. (2016). Zika Virus Associated with Microcephaly. New England Journal of Medicine. 374(10): 951-958.
This article discusses a case report of an expectant mother infected with Zika during the end of her first trimester while in Brazil. Serial ultrasounds at 14 and 20 weeks showed normal fetal growth and anatomy. An ultrasound performed at 29 weeks confirmed intrauterine growth retardation and fetal anomalies. Medical termination of the pregnancy occurred at 32 weeks of gestation. Fetal autopsy findings detail the severe brain injury and placental damage associated with the infection. Genome sequence identity was also performed.
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Oduyebo, T., Polen, K., Walke, H., et al. (2017). Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure – United States (Including U.S. Territories), July 2017. Morbidity and Mortality Weekly Report. 66(29): 781-793.
The authors list guidelines healthcare providers can use to evaluate pregnant women with possible Zika virus exposure.
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Rasmussen, S., Jamieson, D., Honein, M., and Petersen, L. (2016). Zika Virus and Birth Defects - Reviewing the Evidence for Causality. The New England Journal of Medicine. 374:1981-1987.
The authors evaluated available data to determine causality of Zika infection and birth defects, most notably microcephaly. This evidence included Zika virus infection during specific times in pregnancy, a specific rare phenotype involving microcephaly, and data that support biologic plausibility. The researchers concluded that the evidence supports a causal relationship between Zika virus infection and birth defects.
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* Reefhuis, J., Gilboa, S., Johansson, M., et al. (2016). Projecting Month of Birth for At-Risk Infants after Zika Virus Disease Outbreaks. Emerging Infectious Diseases. 22(5).
This article looked at Zika virus occurrence and surges of microcephaly births to determine if projections could be made. Researchers developed a modifiable spreadsheet tool that public health officials can use to plan for delivery of infants from mothers infected with Zika virus.
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* Tepper, N., Goldberg, H., Vargas Bernal, M., et al. (2016). Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak Puerto Rico, 2016. Morbidity and Mortality Weekly. 65(12):311-314.
The authors explain how increased access to contraception could reduce the rates of unintended pregnancy and fewer adverse Zika-related pregnancy and birth outcomes.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Maternal-Fetal Health Planning Resource.
This matrix illustrates some of the anticipated hospital and healthcare system resources needs essential to caring for high-risk pregnancies and children born with microcephaly or other birth defects that may be associated with Zika virus infection.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response. (2016). Promoting Stress Management for Pregnant Women during the Zika Virus Disease Outbreak.
The guidance on this webpage includes strategies healthcare providers can use to help their pregnant patients manage stress during a Zika virus update. Guidance includes communication tips, actual strategies for stress reduction, and links to related resources. It is also available in Spanish: https://www.phe.gov/Preparedness/planning/abc/Documents/zika-stress-ed-preg-factsheet-sp.pdf.
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Clinical Management - Testing

Centers for Disease Control and Prevention. (2016). Collecting and Submitting Body Fluid Specimens for Zika Virus Testing. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provide guidelines for collecting, testing, and shipping spinal fluid, urine, and other body fluids for Zika virus. Guidelines for reporting results are also included.
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* Centers for Disease Control and Prevention. (2016). For Healthcare Providers. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provide Zika virus medical management guidance on this webpage. Resources are categorized under: clinical evaluation and disease, testing for Zika, sexual transmission, infection control, and training.
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Centers for Disease Control and Prevention. (2016). Interim Guidance for Zika Virus Testing of Urine--United States, 2016. Morbidity and Mortality Weekly. 65(18).
The Centers for Disease Control and Prevention provide guidelines for testing urine for Zika virus.
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Centers for Disease Control and Prevention. (2019). For Laboratories. U.S. Department of Health & Human Services .
This webpage provides Zika related resources for laboratories such as lab guidance, lab safety, diagnostic tests, test specimens, and training.
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* Centers for Disease Control and Prevention. (2019). Infographic: Zika Virus Testing for any Pregnant Woman Not Living in an Area with Zika. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provide an easy to read infographic that depicts the testing algorithm for pregnant women NOT living in an area with Zika.
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Centers for Disease Control and Prevention. (2019). Testing for Zika Virus Infections. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention share information and related links on Zika diagnostic testing. Instructions for specimen collection and submission are also included.
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Gaynor, A. (2016). 3 Zika Tests Explained. Association of Public Health Laboratories.
The author summarizes three tests being used to test patients for Zika virus: Polymerase Chain Reaction, Enzyme Linked Immunosorbent Assay, and Plaque Reduction Neutralization Test.
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Rabe, I., Staples, E., Villanueva, J., et al. (2016). Interim Guidance for Interpretation of Zika Virus Antibody Test Results. Morbidity and Mortality Weekly Report. 65(21).
The authors provide guidelines for interpreting Zika virus antibody test results and managing patients with suspected Zika or Dengue virus infection.
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Sharp, T., Fischer, M., Munoz-Jordan, J., et al. (2019). Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses. Morbidity and Mortality Weekly Report. 68(1): 1-10.
The authors summarize current guidance on dengue and Zika virus diagnostic testing.
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Education and Training

Arizona Department of Health Services. (2017). Zika on The Border Tabletop Exercise Situation Manual-Facilitator’s Guide.
This resource is a Situation Manual/Facilitator’s Guide for a public health-focused tabletop exercise to discuss a Zika Virus outbreak on the border between Arizona and Mexico.
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Centers for Disease Control and Prevention. (2019). Zika Training for Healthcare Providers. U.S. Department of Health and Human Services.
The Centers for Disease Control and Prevention provides links to select training resources on the Zika virus and related topics for health professionals.
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Ethical Considerations

MacDonald, N. (2016). Zika Outbreak Raises Familiar Ethical Questions. Impact Ethics.
The author summarizes four ethical issues related to Zika, including: research, travel, healthcare, and prevention.
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Nuffield Council on Bioethics. (2016). Zika: Ethical Considerations.
This document highlights Zika-specific ethical considerations related to public health ethics, research in developing countries, solidarity, the sharing of biological and health data, and the regulation of emerging biotechnologies.
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Pan American Health Organization and World Health Organization. (2016). Experts Analyze Ethics of the Response to Zika Virus in the Americas.
A group of bioethicists who formed the Zika Ethics Consultation concluded that that countries are obliged to share all available information on Zika, including what is not known.
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Zielinski, A. (2016). The Ethical Risks of Engineering Mosquitoes Into Extinction to Stop Zika.
The author highlights the ethical considerations associated with altering/genetically engineering and/or entirely destroying the mosquito.
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Centers for Disease Control and Prevention. (2016). Executive Orders and Emergency Declarations for the West Nile Virus: Applying Lessons from Past Outbreaks to Zika.
This document provides an overview of Executive Orders and Emergency Declarations issued by states and territories in the past (specific to West Nile Virus), and how those authorities may be used to support prevention, response, and recovery actions for Zika virus.
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The Network for Public Health Law. (2017). Primer: Emergency Legal Preparedness Concerning Zika Virus.
This primer, presented in a PowerPoint format, outlines public health concerns from Zika Virus disease and discusses potential legal issues in the U.S. and abroad.
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* U.S. Food and Drug Administration. (2016). Zika Virus Response Updates from FDA.
This page, provided by the U.S. Food and Drug Administration, includes links to Zika-specific information in English, Spanish, and Portuguese. Links to resources on emergency use authorization (which allows the use of certain medical products for emergencies based on scientific data); information regarding the blood supply; and information on the safety and use of insect repellants are also provided.
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World Health Organization. (2016). WHO Announces a Public Health Emergency of International Concern.
This statement includes the official statement from the World Health Organization Director-General declaring Zika virus disease a Public Health Emergency of International Concern. The declaration was made on February 1, 2016 after a meeting of the International Health Regulations (2005) Emergency Committee.
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Occupational Safety

Centers for Disease Control and Prevention. (2016). Laboratory Safety when Working with Zika Virus.
Guidance related to Zika virus in the laboratory is provided on this Centers for Disease Control and Prevention webpage.
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Mavity, H. and Rivera, M. (2016). The Zika Virus: Answers to Employers' FAQs. EHS Today.
The authors--attorneys who specialize in labor and employment law--explain what the World Health Organization's declaration of Zika as a global health emergency could mean for employers.
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National Institute for Occupational Safety and Health. (2016). Mosquito-Borne Diseases. Centers for Disease Control and Prevention.
The information on this webpage is geared towards employers and workers, and includes tips for preventing mosquito-borne diseases such as Zika and West Nile.
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Occupational Safety and Health Administration. (2019). Interim Guidance for Managing Occupational Exposures to Zika Virus for Healthcare Personnel. U.S. Department of Labor.
This guidance is geared towards employers and workers who are interested in preventing occupational exposure to the Zika virus.
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Olson, C., Iwamoto, M., Perkins, K., et al. (2016). Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions United States, 2016. Morbidity and Mortality Weekly Report. 65(11): 290-292.
The authors note the potential for exposure to large volumes of body fluids during the labor and delivery process and encourage the use of Standard Precautions to prevent possible transmission of Zika virus from patients to healthcare personnel.
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U.S. Office of Personnel Management. (2016). Human Resources Flexibilities and Authorities for Federal Employees Affected by the Zika Virus.
The U.S. Office of Personnel Management issued this guidance on protecting workers from occupational exposure to the Zika virus. The attachments can help federal employees learn more about human resources flexibilities and helpful authorities.
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World Health Organization. (2016). Protecting the Health and Safety of Workers in Emergency Vector Control of Aedes Mosquitoes.
This document--developed for use by vector control managers, public health workers, healthcare providers, and the like--provides recommendations on essential measures to protect the health and safety of those involved in emergency vector control of Aedes spp. mosquitoes (e.g., space spraying of insecticides and larvicide application).
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Plans, Tools, and Templates

Centers for Disease Control and Prevention. (2017). Zika: CDC Interim Response Plan. U.S. Department of Health and Human Services.
This document describes the Centers for Disease Control and Prevention response plan for the first locally acquired cases of Zika virus infection in the continental United States and Hawaii.
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Centers for Disease Control and Prevention. (2019). Epidemiological Investigation Toolkit for Investigating Possible Local Mosquito-Borne Transmission of Zika Virus. U.S. Department of Health and Human Services.
This toolkit includes resources to assist state and local health departments investigate possible local mosquito-borne Zika virus transmission.
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Department of Public Health and Wellness, Office of Emergency and Public Health Planning. (2016). Louisville (KY) Zika Response Plan.
This plan highlights actions that will be taken in the event of locally-acquired/transmitted by the bite of a local vector cases of Zika virus disease in Kentucky, and morespecifically, within the Louisville Metro jurisdiction.
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Texas Department of State Health Services. (2016). Regional Response Teams: Zika Response.
This document highlights the roles and responsibilities of Zika response teams in Texas. It can serve as a model for other states and jurisdictions.
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Texas Department of State Health Services. (2019). Zika Virus Annex.
Developed by and for the State of Texas, this Zika preparedness and response plan can be used by others charged with creating related guidance.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). About the Zika Virus Planning Resources.
This document provides an overview of the planning resources documents designed to enhance healthcare coalition and healthcare system preparedness and response to a domestic Zika virus disease outbreak.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Guillain-Barré Syndrome and Other Neurological Deficits Planning Resource.
This planning resource can enhance healthcare coalition and healthcare system preparedness and response to a domestic Zika virus disease outbreak, as it highlights some of the anticipated hospital resource needs essential to caring for Guillain-Barré syndrome and other neurological deficits.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Maternal-Fetal Health Planning Resource.
This matrix illustrates some of the anticipated hospital and healthcare system resources needs essential to caring for high-risk pregnancies and children born with microcephaly or other birth defects that may be associated with Zika virus infection.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Supporting Children with Special Healthcare Needs Planning Resource.
This matrix highlights some of the existing federal and national services and programs for supporting children with special healthcare needs in the context of Zika. It includes guidance and links to helpful resources.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2016). Zika Virus Planning Considerations for Healthcare Facilities and Coalitions.
This document highlights some of the anticipated hospital and healthcare system planning issues essential to caring for suspect Zika cases, complicated Zika cases, pregnancies associated with Zika virus infection, and children born to Zika-infected mothers who have birth defects that may be associated with Zika virus infection.
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World Health Organization. (2016). Zika App.
Healthcare providers and others can download this app to access the latest World Health Organization information Zika virus disease.
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World Health Organization. (2016). Zika: Strategic Response Plan (Revised for July 2016-December 2017).
This World Health Organization (WHO) plan provides the basis for coordination and collaboration among WHO and its partners to ensure international preparedness and response capacities are supported to the fullest extent possible. The plan focuses on preventing and managing medical complications caused by Zika virus infection (with a focus on pregnant women, their partners, and their households) and integrated mosquito management, sexual and reproductive health counselling, and related health education and care.
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Prevention and Vector Control

Centers for Disease Control and Prevention. (2016). Controlling Mosquitoes at Home.
The Centers for Disease Control and Prevention share tips for mosquito control outside and inside the home. This webpage also includes links to related graphics.
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Centers for Disease Control and Prevention. (2016). Prevent Mosquito Bites.
The Centers for Disease Control and Prevention share information on mosquito bite protection, focusing on Zika, dengue, chikungunya, and how to prevent bites when traveling.
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Centers for Disease Control and Prevention. (2016). Prevention and Transmission.
The Centers for Disease Control and Prevention share strategies for preventing Zika, including how to prevent mosquito bites, how to prevent others from getting sick, and information on sexual transmission.
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* Centers for Disease Control and Prevention. (2016). Protect Yourself and Family from Mosquito Bites.
This webpage includes information on insect repellent, including safety, and application.
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Centers for Disease Control and Prevention. (2016). Zika and Animals.
This webpage contains information about Zika and animals and emphasizes that there have not been any reports of pets or other types of animals becoming sick with the virus.
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Centers for Disease Control and Prevention. (2020). Aerial Spraying. U.S. Department of Health and Human Services.
This webpage explains aerial spraying (to control disease such as Zika virus), when and how it is used, and includes links to related resources.
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Centers for Disease Control and Prevention. (2022). Resources for Mosquito Control Professionals. U.S. Department of Health and Human Services.
This webpage includes guidance and best practices, an identification key, surveillance software, and links to publications and other resources related to mosquito control.
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Organization of Teratology Information Specialists. (2016). DEET (N,N-ethyl-m-toluamide).. MotherToBaby.
This factsheet includes a definition of DEET (the ingredient found in many insect repellants), explains how it is absorbed by humans, and provides information on safety of use by pregnant women and women who have recently given birth.
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Texas Department of State Health Services. (2016). Texas Integrated Vector Management Capacity.
The Texas Department of State Health Services surveyed 46 Public Health Emergency Preparedness (PHEP) participating local health departments to understand the state’s integrated vector management capacity in the context of Zika. The primary finding was that 65% of the state’s population lives in a PHEP jurisdiction that has an integrated vector management plan and/or activities.
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Texas Department of State Health Services. (2016). Zika Prevention.
These 15- and 30- second videos were developed by and for the State of Texas. Available on YouTube, in English and Spanish, these videos encourage residents to visit www.texaszika.org to learn more about preventing Zika.
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U.S. Food and Drug Administration. (2016). Draft Environmental Assessment and Preliminary Finding of No Significant Impact Concerning Investigational Use of Oxitec OX513A Mosquitoes; Availability.
This notice published by the U.S. Food and Drug Administration requests public feedback on the investigational release of genetically engineered (GE) mosquitoes under an investigational new animal drug exemption.
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Reproductive Health (Prevention/Transmission)

Atkinson, B., Hearn, P., Afrough, B., et al. (2016). Detection of Zika Virus in Semen. (Letter). Emerging Infectious Disease.
The authors tested serum, urine, and semen from a Zika-positive patient and found that only semen was positive for Zika virus by rRT-PCR, at 27 and 62 days after onset of febrile illness. The authors discuss the implications of this finding.
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Centers for Disease Control and Prevention. (2016). Clinical Guidance for Healthcare Providers for Prevention of Sexual Transmission of Zika Virus.
The Centers for Disease Control and Prevention shares updated interim guidance for those with possible Zika virus exposure who are planning to conceive and interim guidance to prevent transmission of Zika virus through sexual contact.
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Centers for Disease Control and Prevention. (2016). Zika Sexual Transmission and Prevention.
Resources on this page are focused primarily on the sexual transmission of Zika, including knows and unknowns. Links to resources in English and Spanish are also provided.
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Centers for Disease Control and Prevention. (2020). Couples Trying to Conceive. U.S. Department of Health and Human Services.
The guidance on this webpage can help healthcare providers provide Zika-related reproductive health information to their patients.
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Centers for Medicare & Medicaid Services. (2016). Re: Medicaid Family Planning Services and Supplies. U.S. Department of Health and Human Services.
This letter was sent from the Centers for Medicare and Medicaid Services to all State Health Officials (SHOs) to clarify previous guidance on the delivery of family planning services and supplies to all Medicaid beneficiaries.
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Deckard, D., Chung, W., Brooks, J., et al. (2016). Male-to-Male Sexual Transmission of Zika Virus - Texas, January 2016. Morbidity and Mortality Weekly Report. 65(14): 372-374.
This case report highlights how Zika virus can be transmitted through anal and vaginal sex.
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Mansuy, J.M., Dutertre, M., Mengell, C., et al. (2016). Zika Virus: High Infectious Viral Load in Semen, a New Sexually Transmitted Pathogen? The Lancet Infectious Diseases. 16(4): 405.
The authors tested a Zika patients' semen two weeks after system onset and found viral load was nearly 100,000 times that of his blood or urine. The authors discuss implications regarding sexual transmission.
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Polen, K., Gilboa, S., Hills, S., et al. (2018). Update: Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure – United States, August 2018. Morbidity and Mortality Weekly Report. 67(31): 868-871.
The recommendations in this guidance document apply to men who have traveled to or reside in areas with active Zika virus transmission and their female or male sex partners.
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* Tepper, N., Goldberg, H., Vargas Bernal, M., et al. (2016). Estimating Contraceptive Needs and Increasing Access to Contraception in Response to the Zika Virus Disease Outbreak Puerto Rico, 2016. Morbidity and Mortality Weekly. 65(12):311-314.
The authors explain how increased access to contraception could reduce the rates of unintended pregnancy and fewer adverse Zika-related pregnancy and birth outcomes.
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U.S. Department of Health and Human Services, Office of Population Affairs. (2018). Providing Family Planning Care for Non-Pregnant Women and Men of Reproductive Age in the Context of Zika.
This toolkit was developed to help providers of family planning services share information with non-pregnant clients about the risk of Zika infection.
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World Health Organization. (2016). Prevention of Sexual Transmission of Zika Virus: Interim Guidance Update.
The World Health Organization explains updated guidance regarding prevention of sexual transmission of the Zika virus.
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Research

Bhatnagar, J., Rabeneck, D., Martines, R., et al. (2016). Zika Virus RNA Replication and Persistence in Brain and Placental Tissue. Emerging Infectious Diseases. 23(3).
This study examined placental tissues from 44 women and brain tissues from 8 deceased infants who had microcephaly. All samples were from patients suspected to be infected with Zika, and testing detected Zika virus in all infant tissues and nearly three-quarters of the placental tissues of women with adverse pregnancy or birth outcomes. Zika virus RNA was found in placentas and fetal brains more than seven months after pregnant women contracted Zika. Additionally, Zika RNA levels were 1,000 times higher in the brain than the placenta tissues.
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Bingham, A., Cone, M., Mock, V., et al. (2016). Comparison of Test Results for Zika Virus RNA in Urine, Serum, and Saliva Specimens from Persons with Travel-Associated Zika Virus Disease - Florida, 2016. Morbidity and Mortality Weekly Report. 65(18).
The Florida Department of Health Bureau of Public Health Laboratories conducted testing on samples from 913 persons who met the state criteria for testing. Test results for urine and serum samples showed that approximately twice as many urine specimens tested positive for Zika virus than serum specimens, suggesting that urine might be a more useful specimen for identifying acute Zika virus infection.
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Bogoch, I., Brady, O., Kraemer, M., et al. (2016). Anticipating the International Spread of Zika Virus from Brazil. The Lancet. Volume 387(10016): 335-336.
Through evaluation of travel patterns from current countries with Zika virus disease spread and mosquito habitation patterns, the authors have predicted possible Zika virus disease spread throughout the Americas, including the U.S. The authors also included a predictive map.
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Lima, A, Lovin, D.D., Hickner, P.V., et al. (2015). Evidence for an Overwintering Population of Aedes aegypti in Capitol Hill Neighborhood, Washington, DC. The American Journal of Tropical Medicine and Hygiene. 94(1):231-5.
This article describes a research study demonstrating that Aedes aegypti mosquitoes were present in samples taken in Capitol Hill, Washington, DC throughout 2011-2014. These mosquitoes were not previously thought to travel further north than the average 10 degree Celsius isotherm.
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Lucey, D. (2016). Will Zika Virus and Microcephaly Epidemics Emerge After Ebola in West Africa? The Need for Prospective Studies Now. (Abstract only) Health Security. 14(2): 53-54.
The author discusses the emerging cases of Zika virus in Cape Verde, West Africa and the need to begin surveillance and mosquito control to prevent more transmission. The author also discusses the timeline of the epidemic, beginning in October 2015 and predicting an increase in cases of microcephaly in May/June 2016, from mothers infected with Zika virus who have not been properly screened and evaluated.
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Santiago, G., Kalinich, C., Cruz-Lopez, F., et al. (2021). Tracing the Origin, Spread, and Molecular Evolution of Zika Virus in Puerto Rico, 2016-2017. Emerging Infectious Diseases. 27(11).
The authors describe their use of genomic epidemiology to trace the origin, spread, and evolution of the Zika virus disease epidemic in Puerto Rico.
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Tang, H., Hammack, C., Ogden, S., et al. (2016). Zika Virus Infects Human Cortical Neural Progenitors and Attenuates Their Growth. Cell Stem Cell. 18(5):1-4.
Researchers working with Zika virus and human neural cells demonstrated that Zika virus does infect the neural cells and affects their ability to replicate and survive.
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Risk Communications

Centers for Disease Control and Prevention. (2016). Make Sure to Get Your Zika Test Results.
Healthcare providers can download, print, and complete this card and share it with patients as a reminder to follow up on Zika testing results.
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Centers for Disease Control and Prevention. (2016). Mosquito Control and Bite Prevention.
Speakers can use this flipbook when communicating about Zika risk to community members.
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Centers for Disease Control and Prevention. (2016). Print Resources.
This webpage includes links to Zika-specific factsheets, posters, palm cards, and other resources in several languages.
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Texas Department of State Health Services. (2016). Zika Communications Toolkit.
This Zika toolkit includes posters, push cards, and fact sheets--specific to Texas and available in English and Spanish--that can be tailored to other states and jurisdictions.
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Agencies and Organizations

American Medical Association. Zika Virus Resource Center.
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Center for Infectious Disease Research and Policy. Zika Resource Page.
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Centers for Disease Control and Prevention. Zika Virus.
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Pan American Health Organization. Zika Virus Infection.
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U.S. Food and Drug Administration. Zika Virus Response Updates from FDA.
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World Health Organization. Zika Virus Disease.
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This Topic Collection contains all of the resources found in the ASPR TRACIE document Zika: Resources at Your Fingertips. That document was updated regularly and reviewed by the following subject matter experts, listed in alphabetical order (an asterisk indicates the expert also reviewed this Topic Collection): Marion Danis,* MD, Department of Bioethics, National Institutes of Health; Dan Hanfling, MD, Contributing Scholar, UPMC Center for Health Security, Member, InterAgency Board, Health and Medical Responder Safety, Attending Physician, BestPractices, Inc. (a division of EmCare), Clinical Professor of Emergency Medicine, George Washington University, and Strategic Advisor, U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR), Hospital Preparedness Program; John Hick,* MD, HHS ASPR and Hennepin County Medical Center; Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health; Gavin Macgregor-Skinner, BVSc, MSc, MPH, MRCVS, Global Projects Manager, Elizabeth R. Griffin Foundation, Director of Global Response, BIDMC/HHI Fellowship in Disaster Medicine, Harvard Medical School Teaching Hospital, Assistant Professor, and Penn State College of Medicine; Anthony Macintyre, MD, The George Washington University Department of Emergency Medicine; Nancy Petit, MD, Head, Division of Obstetrics, Trinity Health, SFDE; Mary Russell,* EdD, MSN, Emergency Services, Boca Raton Regional Hospital; Meghan Treber,* MS, Principal, Public Health Preparedness Practice, ICF International, ICF ASPR TRACIE Project Director; and Ty J. Vannieuwenhoven,* DVM, MPH, MSS, DACVPM, Chief Veterinary Officer, National Disaster Medical System (NDMS), HHS ASPR.

Additional review conducted by Mili Patel, JD, MPH, Public Health Analyst, HHS ASPR, Division for At-Risk Individuals, Behavioral Health & Community Resilience.
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