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Travel-Associated Zika Virus Disease

TO THE EDITOR: Hamer and colleagues (1) provide informative data on the clinical manifestations and epidemiology of Zika virus infection in travelers returning from countries with ongoing viral transmission. Ninety-three cases of Zika virus infection were reported from 63 travel clinics in 30 countries in the GeoSentinel network. Among the reported cases, 4 pregnant women were infected and 3 developed severe fetal complications. The authors note the importance of counseling travelers before departure on measures to prevent sexual transmission of this virus. All pregnant women with a history of travel in an area of ongoing transmission during their current pregnancy regardless of whether they are symptomatic and all exposed partners of pregnant women should be tested for Zika virus. In addition, we have implemented an algorithm that includes testing all partners of women with a planned pregnancy who may have been exposed to Zika virus. From 2 February to 31 October 2016, a total of 199 women with ongoing or planned pregnancy were tested for Zika virus; 87 partners (43.7%) were counseled and analyzed. Although none of the women had Zika virus infection, 2 partners tested positive by both reverse transcription polymerase chain reaction and serologic testing. One partner of a woman planning pregnancy was symptomatic, and the partner of a woman who was 7 weeks pregnant was paucisymptomatic. Zika virus was detected by reverse transcription polymerase chain reaction testing in the seminal fluid of the 2 positive partners up to 4 months after symptom onset. Our expanded testing strategy allowed for the diagnosis of 2 additional cases of Zika virus infection that would have been missed because symptoms were absent or mild. The prolonged viral shedding in the semen of partners of Zika virusnegative women who are pregnant or plan to become so highlights the important role of testing partners to prevent possible sexual transmission (2). As with other sexually transmitted infections, family planning services in areas with no ongoing transmission of Zika virus should evaluate its inclusion in the epidemiologic and virologic risk assessment of couples with a history of travel in areas with ongoing transmission.