444. Zika Testing in a Large Academic Center During a Continental US Outbreak

BACKGROUND: Zika virus (ZIKV) is a flavivirus that is associated with spontaneous abortions, microcephaly and severe neurological complications. The first continental outbreak of ZIKV in the United States was declared in Miami in 2016. This study reports reasons for performing ZIKV testing and the characteristics of nonpregnant individuals tested for ZIKV during the ZIKV outbreak in the largest academic center in Miami. The medical center is in close proximity to ongoing transmission areas and an emergency response system was rapidly initiated in response to the outbreak. METHODS: This study is a retrospective review of medical records from nonpregnant individuals who were tested for ZIKV at the largest academic center in Miami from September 2016 to January 2017. Demographic, clinical data, and rationale for testing for ZIKV were collected from the electronic medical record and compared between individuals who tested positive for ZIKV vs. those who tested negative. RESULTS: Forty nonpregnant individuals were tested for ZIKV and 14 tested positive for ZIKV. Individuals who tested positive for ZIKV were more likely to reside in an area with active ZIKV transmission (39% vs. 4%, P = 0.012). Thirty-four (92%) of tests were performed in the hospital setting (inpatient setting and emergency room) compared with outpatient setting. Individuals who tested positive for ZIKV were more likely to have been tested in the ER than in other settings. The most common symptoms prompting testing for ZIKV were fever, myalgia, arthralgia and headache however the presence of these symptoms was not significantly different in individuals who tested positive for ZIKV than in those who tested negative. Skin rash was more common in individuals who tested positive for ZIKV than in those who tested negative for ZIKV (93% vs. 27% P < .001). More individuals who tested positive for ZIKV personally requested testing (36% vs. 0%, P = 0.003). CONCLUSION: In our study, clinical symptoms alone are not reliable for differentiating between individuals with positive ZIKV test results vs. those with negative test results. Patient request, rash, and exposure to transmission areas are important factors for healthcare personnel to consider when identifying ZIKV infection. Similar approaches should be utilized in response to future emerging infectious threats. DISCLOSURES: All authors: No reported disclosures.