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Guidance for Areas with a Previous Zika Cautionary (Yellow) Designation in the Continental United States and Hawaii

Notice: On July 24, 2017, CDC released updated interim guidance for the care of pregnant women with possible Zika virus exposure. CDC no longer recommends routine Zika virus testing for asymptomatic pregnant women without ongoing exposure to Zika virus. CDC will be updating this webpage in the near future. In the meantime, please see updated interim guidance for updated testing recommendations.

These recommendations provide guidance for health departments and healthcare providers caring for people with exposure1 to areas where the Zika cautionary (yellow) designation has been lifted. Although the level of risk of Zika virus transmission after a yellow area designation is lifted is unknown, it is likely to be low; sporadic cases may still occur. Healthcare providers should continue to evaluate pregnant women for potential exposure to Zika virus and symptoms of Zika virus disease.

All women and men who live in or travel to an area that had a yellow area designation lifted should check the CDC website frequently for updates about Zika virus transmission.

Recommendations for areas where the Zika cautionary (yellow) designation has been lifted
Travel
  • Lifting of a yellow area designation means that there are no longer precautionary travel recommendations for the area.
  • Healthcare providers should continue to discuss the risks of Zika for all pregnant woman with exposure1 to an area where the yellow designation has been lifted.
Prevention
Because we do not know the level of risk for local transmission in areas where a yellow designation has been lifted, CDC recommends
  • Pregnant women and their partners who live in or travel to these areas and who wish to reduce their risk of Zika virus infection should be counseled to consistently and correctly use condoms every time they have sex (including vaginal, anal, and oral sex) or they should not have sex during the pregnancy. Because Zika virus can persist for months in semen, there may still be a continuing risk for sexual transmission, whether or not the partner had symptoms of Zika virus infection.
  • Women who are not pregnant and men who travel to these areas who wish to reduce their risk of Zika virus infection should consider using condoms consistently and correctly during sex, or not having sex, to maximally reduce their risk for sexually transmitting Zika virus to the uninfected partner. Men should consider this for at least 6 months, and women should consider this for at least 8 weeks from the date the yellow designation was lifted. Please see Preconception Counseling below.

In addition, all women including pregnant women and men who live in or travel to these areas should be advised to remain aware of any new reports of Zika virus transmission and should follow steps to prevent mosquito bites to reduce their risk for mosquito- borne illnesses, including Zika virus.

Testing and Diagnosis
CDC recommends Zika virus laboratory testing for the following groups
  • Pregnant women, regardless of symptoms, who lived in or traveled to a previously designated yellow area between the earliest date that testing was recommended for the area and the date the yellow designation was lifted.
  • Pregnant women who have had sex without a condom
    1. With a partner who has been diagnosed with Zika virus disease.
    2. With a partner who lived in or traveled to a previously designated yellow area between the earliest date that testing was recommended for the area and the date the designation was lifted. In addition, consider testing pregnant women who have had sex without a condom up to 6 months after the designation was lifted with a partner who lived in or traveled to one of these areas while it had a yellow area designation.
    3. With a partner who traveled to any area with risk of Zika and a CDC travel notice.
  • Pregnant women who have an exposure1 to previously designated yellow areas and who have prenatal findings suggestive of congenital Zika syndrome.
  • Pregnant women who lived in or traveled to the area before the yellow area designation was lifted and conceived up to 8 weeks after the designation was lifted.
  • Consider testing pregnant women who conceived up to 6 months after the yellow area designation was lifted with a partner who traveled to or lived in the area before the designation was lifted.
  • Neonates who have abnormalities consistent with congenital Zika syndrome and whose mothers have an exposure1 to areas with risk of Zika including previously designated yellow areas.
  • Anyone with an exposure1 to areas with risk of Zika including previously designated yellow areas who have signs and symptoms consistent with Zika virus disease.
Preconception Counseling
If the person has Zika symptoms and/or diagnosis Women and men who are planning to conceive in the near future should be advised to wait at least 8 weeks after symptom onset if a woman had Zika symptoms and/or diagnosis, and at least 6 months after symptom onset if a man had Zika symptoms and/or diagnosis, before attempting conception.
If the person has no Zika symptoms and does not have ongoing exposure2 Women and men with an exposure1 to previously designated yellow areas between the earliest date that testing was recommended for the area and the date the yellow designation was lifted should consider waiting at least 8 weeks after last possible exposure if female, and at least 6 months if male, before attempting conception.
If the person has no Zika symptoms and has ongoing exposure2 Healthcare providers should discuss reproductive life plans with women and men who are planning to become pregnant in the near future who live in or frequently travel to previously designated yellow areas. Although the level of Zika virus transmission is likely to be low, sporadic cases may still occur. In addition, couples should consider the possible resurgence of active transmission of Zika virus during the next mosquito season in their pregnancy planning. Couples may choose not to wait or may choose to delay attempting conception depending on individual circumstances (e.g., age, fertility) and risk tolerance.
Please refer to the information from the Food and Drug Administration for guidance on reducing the risk for Zika virus transmission by donated human cells, tissues, and cellular and tissue-based products, including reproductive tissues.

1 An exposure means that a person has lived in, traveled to, or had sex without a condom with someone who lived in or traveled to a designated red or yellow area.

2 People with ongoing exposure include those who live in or frequently travel (e.g., daily, weekly) to a red or yellow area.

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