Zika virus (ZIKV) arrived in the Americas in 2015 and reached the United States in July, 2016. Although infection is often asymptomatic or produces a self-limited illness, viremia in pregnant women allows transplacental passage of virus, with the potential to result in congenital infection. Several major outbreaks have been reported, with the proportion of affected newborns ranging from 6% to 46%. Congenital Zika syndrome is comprised of a wide range of manifestations, although the main viral tropism is for the central nervous system, resulting in microcephaly and other neurologic abnormalities. Pregnant women with ZIKV exposure who display symptoms of Zika virus disease (ZVD) should be tested with nucleic acid amplification tests and IgM serology to diagnose the cause of their symptoms. For people living in endemic areas, preventing mosquito bites is key to avoid infection, as no specific and effective antiviral treatment is available. Worldwide epidemiology of Zika virus has decreased since 2018 but has not ceased, and incomplete surveillance makes a resurgence possible.