New information added 7/28/2016
The FDA posted an update to its website with advice to blood collection establishments on non-travel related cases of Zika virus in Florida.
The CDC also updated its website to include areas at risk for locally acquired vector-borne Zika cases.
Zika virus is an arbovirus transmitted to humans via mosquito bites. Zika virus has been recently identified in South America and Central America Mexico and the Caribbean.
The OPTN/UNOS Ad Hoc Disease Transmission Advisory Committee (DTAC), after careful review of information available from the Centers for Disease Control and Prevention (CDC), offers the following information to transplant centers and OPOs in light of recent spread of Zika virus throughout large parts of the Americas. Zika virus may infect deceased donors prior to, or during their terminal illness. Further, living donors may become infected prior to transplant. In addition, Zika virus is likely to present a concern for solid organ recipients travelling into affected regions.
The risk of transmitting the disease through solid organ transplantation is unknown at this time, however it appears likely to be transmissible through blood transfusion. Therefore, it is important for the transplant community to be aware of risk factors for this disease.
What are the clinical symptoms?
Infection with Zika virus is asymptomatic in most people. For those that develop symptoms, the most common include fever, rash, joint pain, or conjunctivitis (red eyes). Muscle pain and headache can also occur. The incubation period appears to be a few days to a week, and symptoms typically resolve within a week. Serious illness and/or death appear to be very rare. Fetal microcephaly has been associated with maternal Zika infection. Guillain-Barre syndrome has also been noted to occur.
There is currently no vaccine and no treatment for Zika infection. It is not known whether the disease is more severe in the immunosuppressed patient.
Where has Zika virus been found?
CDC maps detailing Zika spread are available at: http://www.cdc.gov/zika/geo/
Issues for OPOs and Transplant Centers to consider when evaluating potential organ donors:
OPOs should focus on recent travel history and epidemiologic risk factors, as well as recent donor symptoms, and highlight this information when organ offers are made. DTAC does not believe concern for Zika should summarily exclude donors from transplantation; rather, the risk of donor derived infection should be balanced with the benefits of transplantation in each potential recipient. Other travel related conditions should also be considered.
In the case of potential living donors with Zika infection, donation should be deferred where possible.
ssues for Transplant Centers to consider when discussing travel with patients
For patients who are either pre or post-transplant and wish to travel to areas endemic for Zika virus, standard travel precautions are advised. These include seeking expert advice from a Travel Medicine clinic or Infectious Disease physician, as well as routine counselling on preventative measures such as mosquito avoidance. Pregnant patients or women who are trying to become pregnant are specifically advised to follow CDC travel guidance available at: www.cdc.gov/zika/pregnancy/index.html
Laboratory Testing for Zika virus
Testing for Zika virus should be conducted in consultation with the state public health officials and the CDC. Commercially available tests do not currently exist for Zika, nor have tests been validated for routine donor screening. Routine donor screening is not recommended. Because of concurrent circulation of Zika, Dengue, and Chikungunya viruses and the similarity of illness presentation, CDC and many state health officials recommend concurrent testing for all three viruses in patients with a recent history of travel to an affected area and clinically compatible illness.
Appropriate testing is determined based on how long after symptom onset the specimen was collected. (Of note, the performance characteristics of these tests post-transplant are not known at this time)
Specimens collected <4 days after symptom onset should be subjected to molecular testing (RT-PCR) for all three viruses.
Specimens collected 4–7 days after symptom onset should be subjected to molecular testing and serologic testing for virus-specific IgM antibodies, with a convalescent-phase sample also sent later.
Specimens collected >7 days after symptom onset should be subjected to serologic testing for virus-specific IgM antibodies.