Hidalgo County (HC), located along the Texas–Mexico border, was listed as a high-risk county for Zika virus (ZIKV) in 2017 by the Texas Department of State Health Services, based on its historical presence of Dengue. Due to its subtropical climate, active binational travel, and population of low socioeconomic status, Hidalgo County focused on disease detection activities for the prevention of further transmission. Therefore, Hidalgo County Health and Human Services enacted public health surveillance, reviewed laboratory results, and conducted epidemiological investigations from 2016 to 2018. In 2017, Hidalgo County experienced a locally-acquired outbreak of Zika virus disease, resulting in the highest local mosquito-borne acquisition case count for the year within the United States. This resulted in Hidalgo County reviewing epidemiological data for disease detection and risk areas. With the data review, key outcomes of testing were identified. This included the importance of both RT-PCR and IgM-ELISA/PRNT testing methods. In addition, increased antenatal testing and surveillance also recognized the need of improved disease identification and testing among the general population, especially during localized outbreaks.