In July 2016, CDC issued Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure – United States, July 2016 (https://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm) that includes Zika virus immunoglobulin M (IgM) testing of pregnant women. However, some flavivirus infections can result in prolonged IgM responses (>12 weeks) that make it difficult to determine the timing of infection, especially in testing of asymptomatic people. Emerging epidemiologic and laboratory data indicate that Zika virus IgM can persist beyond 12 weeks in a subset of infected people. Therefore, detection of IgM may not always indicate a recent infection. Although IgM persistence could affect IgM test interpretation for all infected people, it would have the greatest effect on clinical management of pregnant women with a history of living in or traveling to areas with Zika virus transmission. Pregnant women who test positive for IgM antibody may have been infected with Zika virus and developed an IgM response before conception.
Tickborne diseases occur annually in West Virginia with most cases developing symptoms between April and September. Lyme disease is the most commonly reported tickborne disease in West Virginia. In 2016, West Virginia recorded 368 Lyme disease cases, the most ever in a single year. Counties in the northwestern and southwestern parts of the state have had increasing case counts in recent years. In 2016, 43 counties reported at least one confirmed or probable Lyme disease case. Based on new national reporting standards, West Virginia is considered a high incidence Lyme disease state.
This Health Advisory describes the identification of emerging Shigella strains with elevated minimum inhibitory concentration values for ciprofloxacin and outlines new recommendations for clinical diagnosis, management, and reporting, as well as new recommendations for laboratories and public health officials. Current interpretive criteria provided by the Clinical and Laboratory Standards Institute (CLSI) categorize these strains as susceptible to ciprofloxacin, which is a fluoroquinolone antibiotic and a key agent in the management of Shigella infections.
The epidemic of non-prescription opioid addiction has led to an increase in injection drug use, hepatitis C virus (HCV) infections, and hepatitis B virus (HBV) infections in West Virginia. Though West Virginia is a low incidence state for human immunodeficiency virus (HIV) infections, several counties have been deemed at high-risk for an HIV outbreak similar to the one in Scott County, Indiana in 2015 predominantly among people who inject drugs (PWID). In order to detect an outbreak of HIV among PWID, increased screening is necessary.