First isolated in 1947 from a monkey in the Zika forest in Uganda, and from 
mosquitoes in the same forest the following year, Zika virus has gained 
international attention due to concerns for infection in pregnant women 
potentially causing fetal microcephaly. More than one million people have been 
infected since the appearance of the virus in Brazil in 2015. Approximately 80% 
of infected patients are asymptomatic. An association with microcephaly and 
other birth defects as well as Guillain-Barre Syndrome has led to a World Health 
Organization declaration of Zika virus as a Public Health Emergency of 
International Concern in February 2016. Zika virus is a vector-borne disease 
transmitted primarily by the Aedes aegypti mosquito. Male to female sexual 
transmission has been reported and there is potential for transmission via blood 
transfusions. After an incubation period of 2-7 days, symptomatic patients 
develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, 
often associated with headache and myalgias. Emergency department (ED) personnel 
must be prepared to address concerns from patients presenting with symptoms 
consistent with acute Zika virus infection, especially those who are pregnant or 
planning travel to Zika-endemic regions, as well as those women planning to 
become pregnant and their partners. The identify-isolate-inform (3I) tool, 
originally conceived for initial detection and management of Ebola virus disease 
patients in the ED, and later adjusted for measles and Middle East Respiratory 
Syndrome, can be adapted for real-time use for any emerging infectious disease. 
This paper reports a modification of the 3I tool for initial detection and 
management of patients under investigation for Zika virus. Following an 
assessment of epidemiologic risk, including travel to countries with mosquitoes 
that transmit Zika virus, patients are further investigated if clinically 
indicated. If after a rapid evaluation, Zika or other arthropod-borne diseases 
are the only concern, isolation (contact, droplet, airborne) is unnecessary. 
Zika is a reportable disease and thus appropriate health authorities must be 
notified. The modified 3I tool will facilitate rapid analysis and triggering of 
appropriate actions for patients presenting to the ED at risk for Zika.