病史和体格检查
关键诊断因素
关键危险因素包括曾居住于/前往疫区，以及在疫区被蚊虫叮咬。
一般认为只有 20% 的感染是症状性的。[13]Pan American Health Organization; World Health Organization. Provisional remarks on Zika virus infection in pregnant women: document for health care professionals. January 2016 [internet publication]. http://iris.paho.org/xmlui/handle/123456789/18600
发热通常为低热（即，<38.5°C [<101.3°F]）。[152]Pan American Health Organization. Case definitions. April 2016 [internet publication]. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en
皮疹（有时为麻疹样）是感染的特征性表现，且有可能伴瘙痒。[13]Pan American Health Organization; World Health Organization. Provisional remarks on Zika virus infection in pregnant women: document for health care professionals. January 2016 [internet publication].
http://iris.paho.org/xmlui/handle/123456789/18600
[152]Pan American Health Organization. Case definitions. April 2016 [internet publication].
http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en
[Figure caption and citation for the preceding image starts]: 一位感染寨卡病毒的孕妇特征性的斑丘疹来自 Geraldo Furtado 医生（医学博士、科学硕士）的个人收藏（获准使用） [Citation ends].
在一项研究中，发现皮疹平均涉及体表面积的 45%，最常见的部位为面部和上肢 (95%)、躯干 (93%) 和下肢 (86%)。手掌和足底皮疹较少见。有 82% 的患者出现严重瘙痒。[173]Cordel N, Birembaux X, Chaumont H, et al. Main characteristics of Zika virus exanthema in Guadeloupe. JAMA Dermatol. 2017 Apr 1;153(4):326-8. http://www.ncbi.nlm.nih.gov/pubmed/28241170?tool=bestpractice.com
尤其是在手和足的小关节。
可能出现关节周围水肿。[152]Pan American Health Organization. Case definitions. April 2016 [internet publication]. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en
通常为非化脓性。[13]Pan American Health Organization; World Health Organization. Provisional remarks on Zika virus infection in pregnant women: document for health care professionals. January 2016 [internet publication]. http://iris.paho.org/xmlui/handle/123456789/18600 [152]Pan American Health Organization. Case definitions. April 2016 [internet publication]. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en [174]World Health Organization. Zika virus disease: interim case definition. February 2016 [internet publication]. http://www.who.int/csr/disease/zika/case-definition/en/
可能出现结膜充血。[152]Pan American Health Organization. Case definitions. April 2016 [internet publication]. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en [174]World Health Organization. Zika virus disease: interim case definition. February 2016 [internet publication]. http://www.who.int/csr/disease/zika/case-definition/en/
已认识到先天性寨卡综合征是一种由孕期感染寨卡病毒所致的婴儿先天性异常（即，小头畸形、颅内钙化或其他脑部异常、或眼部异常等）。[2]Adebanjo T, Godfred-Cato S, Viens L, et al. Update: interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection - United States, October 2017. MMWR Morb Mortal Wkly Rep. 2017 Oct 20;66(41):1089-99. https://www.cdc.gov/mmwr/volumes/66/wr/mm6641a1.htm?s_cid=mm6641a1_w http://www.ncbi.nlm.nih.gov/pubmed/29049277?tool=bestpractice.com [3]França GV, Schuler-Faccini L, Oliveira WK, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016 Aug 27;388(10047):891-7. http://www.ncbi.nlm.nih.gov/pubmed/27372398?tool=bestpractice.com [4]Melo AS, Aguiar RS, Amorim MM, et al. Congenital Zika virus infection: beyond neonatal microcephaly. JAMA Neurol. 2016 Dec 1;73(12):1407-16. http://jamanetwork.com/journals/jamaneurology/fullarticle/2557231 http://www.ncbi.nlm.nih.gov/pubmed/27695855?tool=bestpractice.com [5]Moore CA, Staples JE, Dobyns WB, et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr. 2017 Mar 1;171(3):288-95. http://www.ncbi.nlm.nih.gov/pubmed/27812690?tool=bestpractice.com [6]Lucey D, Cummins H, Sholts S. Congenital Zika syndrome in 2017. JAMA. 2017 Apr 4;317(13):1368-9. http://www.ncbi.nlm.nih.gov/pubmed/28384812?tool=bestpractice.com
其他表现包括，没有小头畸形或其他脑部异常的患者出现眼部异常、出生时头围正常的婴儿出现产后小头畸形、出生时患小头畸形的婴儿患产后脑积水、睡眠脑电图 (EEG) 异常、出生患小头畸形和关节挛缩症的婴儿出现膈肌麻痹。[2]Adebanjo T, Godfred-Cato S, Viens L, et al. Update: interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection - United States, October 2017. MMWR Morb Mortal Wkly Rep. 2017 Oct 20;66(41):1089-99. https://www.cdc.gov/mmwr/volumes/66/wr/mm6641a1.htm?s_cid=mm6641a1_w http://www.ncbi.nlm.nih.gov/pubmed/29049277?tool=bestpractice.com [171]van der Linden V, de Lima Petribu NC, Pessoa A, et al. Association of severe hydrocephalus with congenital Zika syndrome. JAMA Neurol. 2019 Feb 1;76(2):203-10. http://www.ncbi.nlm.nih.gov/pubmed/30452526?tool=bestpractice.com
婴儿可能表现为小头畸形或有其他临床表现，包括痉挛、惊厥、颅面不相称、脑干功能不全、眼部异常、耳聋、神经影像学发现（例如，皮质障碍、钙化、脑室扩张）、关节挛缩症（例如，先天性关节挛缩）、易激惹、吞咽困难、[154]Leal MC, van der Linden V, Bezerra TP, et al. Characteristics of dysphagia in infants with microcephaly caused by congenital Zika virus infection, Brazil, 2015. Emerg Infect Dis. 2017 Aug;23(8):1253-9. https://wwwnc.cdc.gov/eid/article/23/8/17-0354_article http://www.ncbi.nlm.nih.gov/pubmed/28604336?tool=bestpractice.com 以及喂食困难。
可能还会出现胎儿活动受限的临床特征（例如，骶部凹陷、足位置不正、手部/手指远端挛缩）。[155]Del Campo M, Feitosa IM, Ribeiro EM, et al; Zika Embryopathy Task Force-Brazilian Society of Medical Genetics ZETF-SBGM. The phenotypic spectrum of congenital Zika syndrome. Am J Med Genet A. 2017 Apr;173(4):841-57. http://www.ncbi.nlm.nih.gov/pubmed/28328129?tool=bestpractice.com
在那些出生头围正常，且母亲并未在妊娠期出现皮疹的婴儿身上，也报道了此类神经系统异常。[156]Martines RB, Bhatnagar J, de Oliveira Ramos AM, et al. Pathology of congenital Zika syndrome in Brazil: a case series. Lancet. 2016 Aug 27;388(10047):898-904. http://www.ncbi.nlm.nih.gov/pubmed/27372395?tool=bestpractice.com [3]França GV, Schuler-Faccini L, Oliveira WK, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016 Aug 27;388(10047):891-7. http://www.ncbi.nlm.nih.gov/pubmed/27372398?tool=bestpractice.com [157]Leal MC, Muniz LF, Caldas Neto SD, et al. Sensorineural hearing loss in a case of congenital Zika virus. Braz J Otorhinolaryngol. 2016 Jun 30. pii: S1808-8694(16)30127-6. http://www.sciencedirect.com/science/article/pii/S1808869416301276 http://www.ncbi.nlm.nih.gov/pubmed/27444419?tool=bestpractice.com [158]van der Linden V, Filho EL, Lins OG, et al. Congenital Zika syndrome with arthrogryposis: retrospective case series study. BMJ. 2016 Aug 9;354:i3899. http://www.bmj.com/content/354/bmj.i3899.long http://www.ncbi.nlm.nih.gov/pubmed/27509902?tool=bestpractice.com [159]Leal MC, Muniz LF, Ferreira TS, et al. Hearing loss in infants with microcephaly and evidence of congenital Zika virus infection - Brazil, November 2015-May 2016. MMWR Morb Mortal Wkly Rep. 2016 Sep 2;65(34):917-9. http://www.cdc.gov/mmwr/volumes/65/wr/mm6534e3.htm http://www.ncbi.nlm.nih.gov/pubmed/27585248?tool=bestpractice.com 这些症状似乎与母体疾病的严重程度无关。[160]Halai UA, Nielsen-Saines K, Moreira ME, et al. Maternal Zika virus disease severity, virus load, prior dengue antibodies and their relationship to birth outcomes. Clin Infect Dis. 2017 Sep 15;65(6):877-83. http://www.ncbi.nlm.nih.gov/pubmed/28535184?tool=bestpractice.com 巴西的一小部分患者，出生后因小头畸形出现颅脑发育不良。[162]van der Linden V, Pessoa A, Dobyns W, et al. Description of 13 infants born during October 2015-January 2016 with congenital Zika virus infection without microcephaly at birth - Brazil. MMWR Morb Mortal Wkly Rep. 2016 Dec 2;65(47):1343-8. https://www.cdc.gov/mmwr/volumes/65/wr/mm6547e2.htm http://www.ncbi.nlm.nih.gov/pubmed/27906905?tool=bestpractice.com
眼异常可能是唯一的初步发现；因此，无论是否存在其他症状，均建议所有可能暴露于寨卡病毒的婴儿进行眼科检查。[163]Zin AA, Tsui I, Rossetto J, et al. Screening criteria for ophthalmic manifestations of congenital Zika virus infection. JAMA Pediatr. 2017 Sep 1;171(9):847-54. http://www.ncbi.nlm.nih.gov/pubmed/28715527?tool=bestpractice.com
关键诊断因素包括感觉异常（通常为手和脚）、肌无力、疼痛（通常起始于背部和双腿）及瘫痪。亦可有口咽、面部和眼外肌无力。WHO 推荐使用 Brighton 标准对格林-巴利综合征（Guillain-Barre syndrome, GBS）进行病例定义。[151]World Health Organization. Identification and management of Guillain-Barré syndrome in the context of Zika virus - interim guidance. August 2016 [internet publication]. http://www.who.int/csr/resources/publications/zika/guillain-barre-syndrome/en/ 泛美卫生组织 (PAHO) 也曾发表过寨卡病毒相关 GBS 的病例定义。[152]Pan American Health Organization. Case definitions. April 2016 [internet publication]. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en
医生应警惕 GBS 的早期体征和症状，因对于寨卡病毒感染的患者，可能较通常情况进展要更快。[24]Cao-Lormeau VM, Blake A, Mons S, et al. Guillain-Barré syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet. 2016 Apr 9;387(10027):1531-39. http://www.ncbi.nlm.nih.gov/pubmed/26948433?tool=bestpractice.com
其他诊断因素
包括全身乏力、肌痛、和/或头痛。[13]Pan American Health Organization; World Health Organization. Provisional remarks on Zika virus infection in pregnant women: document for health care professionals. January 2016 [internet publication]. http://iris.paho.org/xmlui/handle/123456789/18600 [136]World Health Organization. Zika virus fact sheet. July 2018 [internet publication]. https://www.who.int/en/news-room/fact-sheets/detail/zika-virus [152]Pan American Health Organization. Case definitions. April 2016 [internet publication]. http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en
包括呕吐、腹泻、和/或腹痛。[13]Pan American Health Organization; World Health Organization. Provisional remarks on Zika virus infection in pregnant women: document for health care professionals. January 2016 [internet publication]. http://iris.paho.org/xmlui/handle/123456789/18600
某些病例中报道的不常见的症状[13]Pan American Health Organization; World Health Organization. Provisional remarks on Zika virus infection in pregnant women: document for health care professionals. January 2016 [internet publication]. http://iris.paho.org/xmlui/handle/123456789/18600
某些病例中报道的不常见的症状[13]Pan American Health Organization; World Health Organization. Provisional remarks on Zika virus infection in pregnant women: document for health care professionals. January 2016 [internet publication]. http://iris.paho.org/xmlui/handle/123456789/18600
在少数病例中报道了寨卡病毒感染和一过性耳聋之间具有相关性。[175]Vinhaes ES, Santos LA, Dias L, et al. Transient hearing loss in adults associated with Zika virus infection. Clin Infect Dis. 2017 Mar 1;64(5):675-7. http://cid.oxfordjournals.org/content/early/2016/12/05/cid.ciw770.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/27927858?tool=bestpractice.com
危险因素
对于在症状发作前 2 周曾居住于/曾前往有正在传播疫情地区的患者，诊断高度可疑。 CDC: Zika travel information
居住于有正在传播疫情地区的孕妇，其整个妊娠期均有持续的感染风险。
主要通过已感染蚊子的叮咬传播给人类。最常由分布于热带地区的埃及伊蚊传播，但也可由分布于温带地区的白纹伊蚊携带。[45]Hayes EB. Zika virus outside Africa. Emerg Infect Dis. 2009 Sep;15(9):1347-50. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819875/ http://www.ncbi.nlm.nih.gov/pubmed/19788800?tool=bestpractice.com [51]Fauci AS, Morens DM. Zika virus in the Americas - yet another arbovirus threat. N Engl J Med. 2016 Feb 18;374(7):601-4. http://www.nejm.org/doi/full/10.1056/NEJMp1600297 http://www.ncbi.nlm.nih.gov/pubmed/26761185?tool=bestpractice.com 越来越多的证据表明，寨卡病毒也可由致倦库蚊传播。[52]Aliota MT, Peinado SA, Osorio JE, et al. Culex pipiens and Aedes triseriatus mosquito susceptibility to Zika virus. Emerg Infect Dis. 2016 Oct;22(10):1857-9. http://wwwnc.cdc.gov/eid/article/22/10/16-1082_article http://www.ncbi.nlm.nih.gov/pubmed/27434194?tool=bestpractice.com 不过这还存在争议。[53]Huang YS, Ayers VB, Lyons AC, et al. Culex species mosquitoes and Zika virus.Vector Borne Zoonotic Dis. 2016 Oct;16(10):673-6. http://www.ncbi.nlm.nih.gov/pubmed/27556838?tool=bestpractice.com [54]Amraoui F, Atyame-Nten C, Vega-Rúa A, et al. Culex mosquitoes are experimentally unable to transmit Zika virus. Euro Surveill. 2016 Sep 1;21(35):30333. http://www.ncbi.nlm.nih.gov/pubmed/27605159?tool=bestpractice.com [55]Boccolini D, Toma L, Di Luca M, et al. Experimental investigation of the susceptibility of Italian Culex pipiens mosquitoes to Zika virus infection. Euro Surveill. 2016 Sep 1;21(35):30328. http://www.ncbi.nlm.nih.gov/pubmed/27605056?tool=bestpractice.com
几乎所有经性传播的病例，均涉及与表现出急性寨卡病毒感染症状的男性、症状发作前不久或症状刚消失的男性的经阴道性交或肛交。然而，也有从无症状男性传播给女性的病例。有女性通过性传播将病毒传播至其性伴侣的报道。[68]Davidson A, Slavinski S, Komoto K, et al. Suspected female-to-male sexual transmission of Zika virus - New York City, 2016. MMWR Morb Mortal Wkly Rep. 2016 Jul 22;65(28):716-7. http://www.cdc.gov/mmwr/volumes/65/wr/mm6528e2.htm http://www.ncbi.nlm.nih.gov/pubmed/27442327?tool=bestpractice.com 也有男性之间通过性传播的报道。[69]Deckard DT, Chung WM, Brooks JT, et al. Male-to-male sexual transmission of Zika virus - Texas, January 2016. MMWR Morb Mortal Wkly Rep. 2016 Apr 15;65(14):372-4. http://www.cdc.gov/mmwr/volumes/65/wr/mm6514a3.htm http://www.ncbi.nlm.nih.gov/pubmed/27078057?tool=bestpractice.com 亦有通过精液而经口传播病毒的可能。[70]D'Ortenzio E, Matheron S, Yazdanpanah Y, et al. Evidence of sexual transmission of Zika virus. N Engl J Med. 2016 Jun 2;374(22):2195-8. http://www.ncbi.nlm.nih.gov/pubmed/27074370?tool=bestpractice.com
有数据能够支持将寨卡病毒感染归类为性传播感染这一呼吁。[124]Allard A, Althouse BM, Hébert-Dufresne L, et al. The risk of sustained sexual transmission of Zika is underestimated. PLoS Pathog. 2017 Sep 21;13(9):e1006633. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626499/ http://www.ncbi.nlm.nih.gov/pubmed/28934370?tool=bestpractice.com
一般认为输血可导致病毒传播；[60]Musso D, Nhan T, Robin E, et al. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014. Euro Surveill. 2014 Apr 10;19(14). pii: 20761. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20761 http://www.ncbi.nlm.nih.gov/pubmed/24739982?tool=bestpractice.com [61]Vasquez AM, Sapiano MR, Basavaraju SV, et al. Survey of blood collection centers and implementation of guidance for prevention of transfusion-transmitted Zika virus infection - Puerto Rico, 2016. MMWR Morb Mortal Wkly Rep. 2016 Apr 15;65(14):375-8. http://www.cdc.gov/mmwr/volumes/65/wr/mm6514e1.htm?s_cid=mm6514e1_w http://www.ncbi.nlm.nih.gov/pubmed/27078190?tool=bestpractice.com [62]Barjas-Castro ML, Angerami RN, Cunha MS, et al. Probable transfusion-transmitted Zika virus in Brazil. Transfusion. 2016 Jul;56(7):1684-8. http://onlinelibrary.wiley.com/doi/10.1111/trf.13681/full http://www.ncbi.nlm.nih.gov/pubmed/27329551?tool=bestpractice.com 但是还需进一步的研究。巴西报道了经输注血小板导致的传播。[64]Motta IJ, Spencer BR, Cordeiro da Silva SG, et al. Evidence for transmission of Zika virus by platelet transfusion. N Engl J Med. 2016 Sep 15;375(11):1101-3. http://www.nejm.org/doi/full/10.1056/NEJMc1607262 http://www.ncbi.nlm.nih.gov/pubmed/27532622?tool=bestpractice.com 约有 1% 的波多黎各献血者被发现有寨卡病毒血症。[125]Kuehnert MJ, Basavaraju SV, Moseley RR, et al. Screening of blood donations for Zika virus infection - Puerto Rico, April 3-June 11, 2016. MMWR Morb Mortal Wkly Rep. 2016 Jun 24;65(24):627-8. http://www.ncbi.nlm.nih.gov/pubmed/27337368?tool=bestpractice.com
目前不建议在感染或暴露于寨卡病毒的 1 个月内献血。[126]US Food and Drug Administration. FDA issues recommendations to reduce the risk for Zika virus blood transmission in the United States. February 2016 [internet publication]. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm486359.htm [127]World Health Organization. Maintaining a safe and adequate blood supply during Zika virus outbreaks. February 2016 [internet publication]. http://www.who.int/csr/resources/publications/zika/safe-blood/en/
美国食品药品监督管理局 (FDA) 推荐在美国及其领土内，对所有捐献的全血或成分血进行寨卡病毒检测。FDA 已经批准将 cobas 寨卡病毒检测用于此种情况（以及对活体器官捐赠者样本的检测）。[128]US Food and Drug Administration. FDA approves first test for screening Zika virus in blood donations. 5 October 2017 [internet publication]. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm579313.htm
对于有寨卡病毒感染史者，在取得病毒检测阳性结果后 120 天内或症状消失前（以两者中时间更长的为准）不应献血。[129]US Food and Drug Administration. Revised recommendations for reducing the risk of Zika virus transmission by blood and blood components. July 2018 [internet publication]. http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM518213.pdf 一项调查测试可用于筛查捐献的血制品。[130]US Food and Drug Administration. FDA allows use of investigational test to screen blood donations for Zika virus. March 2016 [internet publication]. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm493081.htm 在美国的筛查中发现了寨卡病毒阳性的血液捐献制品。[131]Williamson PC, Linnen JM, Kessler DA, et al. First cases of Zika virus-infected US blood donors outside states with areas of active transmission. Transfusion. 2017 Mar;57(3pt2):770-8. http://onlinelibrary.wiley.com/wol1/doi/10.1111/trf.14041/full http://www.ncbi.nlm.nih.gov/pubmed/28229475?tool=bestpractice.com [132]Galel SA, Williamson PC, Busch MP, et al. First Zika-positive donations in the continental United States. Transfusion. 2017 Mar;57(3pt2):762-9. https://onlinelibrary.wiley.com/doi/10.1111/trf.14029/full http://www.ncbi.nlm.nih.gov/pubmed/28164310?tool=bestpractice.com
虽然理论上可通过精子捐献发生传播，但目前还没有任何女性或其胎儿通过这种传播方式感染病毒的报道。
居住于或曾前往传播活跃地区的精子捐献者不应捐献精子。
目前还没有任何研究方法可用于检测精液中的寨卡病毒。但是，应获取所有捐献者的完整旅行史。
曾暴露于可能感染寨卡病毒男性精液的女性应咨询感染病毒的风险。
应考虑到在辅助生殖的不同阶段均有受到感染的可能性。[133]Cordeiro CN, Bano R, Washington Cross CI, et al. Zika virus and assisted reproduction. Curr Opin Obstet Gynecol. 2017 Jun;29(3):175-9. http://www.ncbi.nlm.nih.gov/pubmed/28410349?tool=bestpractice.com
在除血液或精液外的其他体液中也检测到寨卡病毒 RNA，包括羊水、脑脊液（cerebrospinal fluid, CSF）、尿液、唾液、阴道分泌物和眼部液体；然而，目前尚无病毒经这些体液传播的记录。[58]Schuler-Faccini L, Ribeiro EM, Feitosa IM, et al. Possible association between Zika virus infection and microcephaly - Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016 Jan 29;65(3):59-62. http://dx.doi.org/10.15585/mmwr.mm6503e2 http://www.ncbi.nlm.nih.gov/pubmed/26820244?tool=bestpractice.com [77]Musso D, Roche C, Robin E, et al. Potential sexual transmission of Zika virus. Emerg Infect Dis. 2015 Feb;21(2):359-61. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313657/ http://www.ncbi.nlm.nih.gov/pubmed/25625872?tool=bestpractice.com [78]Musso D, Roche C, Nhan TX, et al. Detection of Zika virus in saliva. J Clin Virol. 2015 Jul;68:53-5. http://www.ncbi.nlm.nih.gov/pubmed/26071336?tool=bestpractice.com [79]Gourinat AC, O'Connor O, Calvez E, et al. Detection of Zika virus in urine. Emerg Infect Dis. 2015 Jan;21(1):84-6. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25530324/ http://www.ncbi.nlm.nih.gov/pubmed/25530324?tool=bestpractice.com [80]Sun J, Wu, Zhong H, et al. Presence of Zika virus in conjunctival fluid. JAMA Ophthalmol. 2016 Nov 1;134(11):1330-2. http://archopht.jamanetwork.com/article.aspx?articleid=2552685 http://www.ncbi.nlm.nih.gov/pubmed/27632055?tool=bestpractice.com [81]Murray KO, Gorchakov R, Carlson AR, et al. Prolonged detection of Zika virus in vaginal secretions and whole blood. Emerg Infect Dis. 2017 Jan;23(1):99-101. http://wwwnc.cdc.gov/eid/article/23/1/16-1394_article http://www.ncbi.nlm.nih.gov/pubmed/27748649?tool=bestpractice.com [82]Heck E, Cavanagh HD, Robertson DM. Zika virus RNA in an asymptomatic donor's vitreous: risk for transmission? Am J Transplant. 2017 Aug;17(8):2227-8. http://www.ncbi.nlm.nih.gov/pubmed/28452113?tool=bestpractice.com
虽然曾在母乳中检测到病毒，但目前还没有经母乳传播的报道。[88]Colt S, Garcia-Casal MN, Peña-Rosas JP, et al. Transmission of Zika virus through breast milk and other breastfeeding-related bodily-fluids: a systematic review. PLoS Negl Trop Dis. 2017 Apr 10;11(4):e0005528. http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005528 http://www.ncbi.nlm.nih.gov/pubmed/28394887?tool=bestpractice.com
已在一位已感染女性的生殖道中检测到病毒，这可能会对垂直传播有所影响。[85]Prisant N, Bujan L, Benichou H, et al. Zika virus in the female genital tract. Lancet Infect Dis. 2016 Sep;16(9):1000-1. http://www.ncbi.nlm.nih.gov/pubmed/27427201?tool=bestpractice.com 在一位出生后至少 67 天的新生儿中出现病毒血症。[87]Oliveira DB, Almeida FJ, Durigon EL, et al. Prolonged shedding of Zika virus associated with congenital infection. N Engl J Med. 2016 Sep 22;375(12):1202-4. http://www.nejm.org/doi/full/10.1056/NEJMc1607583 http://www.ncbi.nlm.nih.gov/pubmed/27653589?tool=bestpractice.com
美国疾病预防控制中心 (CDC) 调查了与犹他州一位死于寨卡病毒感染的患者有过接触的家庭是如何感染寨卡病毒的。死者血液循环内的病毒水平非常高。传播途径的机制仍不明确，但可能是由于家庭成员与先证者之间人与人的传播造成的。[90]Krow-Lucal ER, Novosad SA, Dunn AC, et al. Zika virus infection in patient with no known risk factors, Utah, USA, 2016. Emerg Infect Dis. 2017 Aug;23(8):1260-7. https://wwwnc.cdc.gov/eid/article/23/8/17-0479_article http://www.ncbi.nlm.nih.gov/pubmed/28726601?tool=bestpractice.com
用于医疗、生殖或手术治疗的人（包括妊娠相关）细胞、组织和基于细胞/组织的制品（如，角膜、心瓣膜、骨、皮肤）有潜在的病毒传播风险。[67]Levi ME. Zika virus: a cause of concern in transplantation? Curr Opin Infect Dis. 2017 Aug;30(4):340-5. http://www.ncbi.nlm.nih.gov/pubmed/28632511?tool=bestpractice.com 一小部分接受肝肾移植的患者也患有感染，[65]Nogueira ML, Estofolete CF, Terzian AC, et al. Zika virus infection and solid organ transplantation: a new challenge. Am J Transplant. 2017 Mar;17(3):791-5. http://www.ncbi.nlm.nih.gov/pubmed/27629942?tool=bestpractice.com 且一位儿科患者在接受造血干细胞移植后，出现了格林-巴利综合征，高度怀疑该患者感染了寨卡病毒。[66]Raboni SM, Bonfim C, Almeida BM, et al. Flavivirus cross-reactivity in serological tests and Guillain-Barré syndrome in a hematopoietic stem cell transplant patient: a case report. Transpl Infect Dis. 2017 Aug;19(4). http://www.ncbi.nlm.nih.gov/pubmed/28306183?tool=bestpractice.com
若已故捐献者在过去 6 个月内曾被诊断为寨卡病毒感染，则应被视为不符合捐献标准。若活体捐献者在过去 6 个月内曾被诊断为寨卡病毒感染、过去 6 个月内曾前往寨卡病毒传播风险增加的地区，或过去 6 个月内曾与存在以上任意一项风险因素的患者发生性行为，则应被视为不符合捐献标准。[134]US Food and Drug Administration. Donor screening recommendations to reduce the risk of transmission of Zika virus by human cells, tissues, and cellular and tissue-based products. May 2018 [internet publication]. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/donor-screening-recommendations-reduce-risk-transmission-zika-virus-human-cells-tissues-and-cellular
脐带血、胎盘或其他妊娠相关组织捐献者的生母若存在以下任意一项风险因素，则应被视为不符合捐献标准：在妊娠的任何阶段被医学诊断为寨卡病毒感染；在妊娠的任何阶段曾居住于/前往寨卡病毒传播风险增加的地区；或在妊娠的任何阶段曾与已知存在以上风险因素的患者发生性行为。[134]US Food and Drug Administration. Donor screening recommendations to reduce the risk of transmission of Zika virus by human cells, tissues, and cellular and tissue-based products. May 2018 [internet publication]. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/donor-screening-recommendations-reduce-risk-transmission-zika-virus-human-cells-tissues-and-cellular
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