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Zika concerns prompt CDC warning about semen donations in Florida
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Semen donations made by men in two Florida counties are at an increased risk of being infected with Zika virus because some donors may have traveled to areas in and around Miami, where the virus was being actively transmitted, and failed to report it, federal health officials said.
There is an increased risk to blood and tissue donations made in Broward and Palm Beach counties, but the risk is particularly relevant to semen because of how long the virus can persist in the reproductive fluid, and because there is no licensed Zika test for it.
Zika infection in pregnant women can cause congenital Zika syndrome, a grave suite of illnesses that include microcephaly.
Despite the warning, officials from the CDC and FDA said no cases of Zika being transmitted through donated semen have been reported in the United States. They made the announcement out of an abundance of caution so patients and practitioners would have the latest information when they make reproductive choices.
“We don’t have to have a report of transmission to have a concern,” Peter W. Marks, MD, PhD, director of the Center for Biologics Evaluation and Research at the FDA, said during a teleconference with reporters.
Semen donations not tested
Blood donations are routinely tested for Zika in the U.S., and positive samples are thrown out. But no such testing is done for tissue donations, including semen. Tissue donors are asked about their travel history and are deemed ineligible to donate if they have traveled to or live in an area of active transmission.
The concern is that men who live in Broward and Palm Beach counties might have traveled to Miami-Dade County, where there was ongoing active Zika transmission, for routine reasons such as work, school, socializing, shopping, or receiving medical care, but did not mention it when they donated semen.
“In fact, this is part of the daily lives of many people in the tricounty area and these people may not consider their routine activity as travel to an area of active transmission, therefore they may not recognize the risk that they can become infected,” Denise J. Jamieson, MD, incident commander for the CDC’s Zika Emergency Response and chief of the CDC’s Women’s Health and Fertility Branch, said during the teleconference.
Later, Jamieson said the issue extends beyond men simply not reporting where they have been.
“Some of them might have unknowingly gone to Miami-Dade. It’s not that they didn’t report it,” she told Infectious Disease News in an interview. “What we learned is that travel in that area is very fluid and people cross county lines all the time. We learned that from investigating cases and talking to people about where they’ve been and realizing it’s not always that clear where they have been and when.”
Miami was the first place in the U.S. to see local Zika infections amid a wider outbreak in the Americas. Officials eventually identified four active transmission zones in Miami-Dade County — two in Miami and two in Miami Beach — but the last zone was lifted on Dec. 9 and the state has not reported any locally acquired cases since Dec. 21, officials said. In all, 215 of the country’s 221 local Zika infections have occurred in Florida, according to the CDC.
Although Zika has been detected in semen after 3 months, recent findings by CDC show that such persistence is rare. The virus can be sexually transmitted by both men and women, possibly even by patients without symptoms. About 80% of people with Zika infection are asymptomatic.
Officials said blood and tissue donations from men in Broward, Miami-Dade and Palm Beach counties dating back to June 15 should be considered at an increased risk for Zika infection.
According to Marks, there are 12 sperm banks in the tricounty area.
“I think the ultimate advice is that if you’re a woman who is considering using a donated semen sample that’s been collected during this period of time, you need to have a conversation with your provider about the potential benefits and risks of using it,” he said.
Updated travel guidance
The CDC also recently updated its travel guidance to recommend that pregnant women avoid any areas where there is a risk for Zika infection, including places where the virus has not been documented but is likely to be circulating.
The broad travel guidance covers dozens of countries, including most of Latin America, Africa and Southeast Asia. It came after the CDC collaborated with WHO and the European Center for Disease Prevention and Control on a new Zika virus country classification scheme that defines four categories of risk, which countries can then use to create travel recommendations.
Jamieson told Infectious Disease News that the new CDC travel guidance for pregnant women was based on these categories. Every country or territory in the Caribbean and Central America, as well as every country in South America except Chile and Uruguay, are on the list of places where pregnant women should not travel, according to the agency.
The CDC created an interactive map that pregnant women and other travelers can use to see country-specific notes and recommendations.
The agency also added travel notices for people going to Angola, Guinea-Bissau, Maldives and Solomon Islands, identifying them as places where Zika-infected mosquitoes are biting people.
Jamieson said the agency has issued Zika travel notices for 64 countries and territories. Angola and Guinea-Bissau are the first countries in Africa to be included in such a notice. Zika was first discovered in 1947 in Uganda, but the African strain of the virus has not been associated with the kinds of severe health problems that have been caused by the epidemic Asian strain responsible for the current outbreak.
The CDC does not take into account which Zika strain is circulating when it determines the risk for each country, and it was unclear what strain prompted the notices for Angola and Guinea-Bissau.
“Hopefully in the next few years we’ll have a vaccine, women will be vaccinated and congenital Zika syndrome will be eliminated,” Jamieson said. – by Gerard Gallagher
References:
CDC. CDC identifies potential risk of Zika virus transmission since June 15, 2016, in Miami-Dade, Broward, and Palm Beach counties. 2017. https://www.cdc.gov/media/releases/2017/s0313-risk-of-zika-transmission-florida.html. Accessed March 14, 2017.
CDC. CDC updates Zika travel guidance for pregnant women to not travel to any area with Zika risk. 2017. https://www.cdc.gov/media/releases/2017/s0310-zika-travel-guidance.html. Accessed March 14, 2017.
CDC. World map of areas with risk of Zika. 2017. https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika. Accessed March 14, 2017.
WHO. Zika virus country classification scheme. 2017. http://apps.who.int/iris/bitstream/10665/254619/1/WHO-ZIKV-SUR-17.1-eng.pdf. Accessed March 14, 2017.
WHO. Zika virus situation report. 2017. http://apps.who.int/iris/bitstream/10665/254714/1/zikasitrep10Mar17-eng.pdf?ua=1. Accessed March 14, 2017.
Disclosures: Jamieson and Marks report no relevant financial disclosures.