CDC Updates Interim Guidance on Caring for Women with Possible Exposure to Zika Virus
NOTE: On September 30, 2016 the Centers for Disease Control and Prevention (CDC) provided updated guidance on Zika virus for preconception planning in persons with potential exposure and prevention of transmission through sexual contact. The new interim guidance recommends that all men with possible exposure not only delay attempts for conception for at least 6 months beyond symptom onset, but also for 6 months beyond the last exposure if symptomatic. Recommendations for women attempting conception are unchanged, but will be updated as data becomes available. Recommendations for testing in pregnancy were updated on July 29, 2016.
Am Fam Physician. 2016 May 15;93(10):874-876.
AAFP Webcast: Zika Virus: Information for Family Physicians
Key Points for Practice
• Women with Zika virus disease should wait at least eight weeks after symptom onset before attempting to conceive.
• UPDATED October 14, 2016: Men with possible Zika virus exposure who are considering attempting conception with their partner, regardless of symptom status, should wait to conceive until at least six months after symptom onset (if symptomatic) or last possible Zika virus exposure (if asymptomatic).
• UPDATED October 14, 2016: Asymptomatic women with possible Zika virus exposure should be advised to wait at least eight weeks after the last date of exposure before attempting to conceive.
• Serum testing for evidence of Zika virus infection should be performed in persons who have acute onset of fever, rash, arthralgia, or conjunctivitis within two weeks of possible exposure to the virus.
• Pregnant women who do not live in an area with active Zika virus transmission but who may have been exposed to the virus during pregnancy or in the eight weeks before conception should be tested.
From the AFP Editors
The current Zika virus outbreak was identified in Brazil in May 2015, and knowledge about the virus, its transmission, and its potential adverse effects on pregnancy outcomes is evolving. Epidemiologic, clinical, laboratory, and pathologic evidence supports a link between infection during pregnancy and outcomes such as pregnancy loss, fetal microcephaly, intracranial calcifications, and fetal brain and eye abnormalities. The level of risk of these outcomes is not known. Studies suggest that it may be as high as 29%, but microcephaly caused by viral destruction of brain tissue is likely part of a spectrum of neurologic damage caused by Zika virus, and this percentage may substantially underestimate the proportion of infants affected.
Thirty-nine countries and U.S. territories had reported active Zika virus transmission as of March 23, 2016. Updated information is available at http://wwwnc.cdc.gov/travel/notices. Based on limited evidence on the persistence of Zika virus RNA in blood and semen, the Centers for Disease Control and Prevention (CDC) has updated its interim guidance on caring for reproductive-aged women who may have been exposed to the virus, including those who do not live in areas with active transmission. Further updates to this guidance and other clinical information on Zika virus are available at http://www.cdc.gov/zika/hc-providers/index.html.
Physicians should provide preconception counseling to women who do not live in areas with active Zika virus transmission, but who may have been exposed to the virus. Discussions should include information about the signs and symptoms of Zika virus disease and the potential adverse outcomes
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
Copyright © 2016 by the American Academy of Family Physicians.
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