In light of concerns about the deleterious effects of Zika virus infection in pregnancy, the CDC has developed interim guidelines(www.cdc.gov) for health care professionals in the United States caring for pregnant women during a Zika virus outbreak.
The guidelines include recommendations for pregnant women considering travel to an area in which Zika virus transmission is ongoing (Central America, South America, Mexico, Puerto Rico and the Caribbean) and recommendations for screening, testing and management of pregnant returning travelers.
On Jan. 15, the CDC issued a travel alert warning of the Zika virus outbreak and related precautions.
The CDC now recommends health care professionals ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with ongoing Zika virus transmission and who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia or conjunctivitis) during or within two weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for viral infection in consultation with their state or local health department.
Testing includes reverse transcription-polymerase chain reaction testing of maternal serum for symptomatic patients whose symptoms began within the previous week. Immunoglobulin M (IgM) and neutralizing antibody testing should be performed on specimens collected four or more days after onset of symptoms.
Testing is not indicated for women with no suspicious travel history.
For pregnant women who show laboratory evidence of Zika virus infection, serial ultrasound examination should be considered to monitor fetal growth and anatomy, and referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended. There is no specific antiviral treatment for Zika virus disease; instead, supportive care should be initiated.
Supportive measures can include rest, fluids, and use of analgesics and antipyretics. Fever should be treated with acetaminophen. It should be noted that although aspirin and other nonsteroidal anti-inflammatory drugs are not typically used in pregnancy, these medications should specifically be avoided to reduce the risk for hemorrhage until dengue can be ruled out.
For a live birth with evidence of maternal or fetal Zika virus infection, the following tests are recommended: histopathologic examination of the placenta and umbilical cord; testing of frozen placental tissue and cord tissue for Zika virus RNA; and testing of cord serum for Zika and dengue virus IgM and neutralizing antibodies.
The CDC is developing guidelines for infants infected with Zika virus.
Because there is no vaccine or prophylactic treatment to prevent Zika virus infection, the CDC recommends all pregnant women consider postponing travel to areas where transmission of the virus is ongoing. If a pregnant woman travels to such an area, she should be advised to strictly follow steps to avoid mosquito bites. Mosquitoes that spread Zika virus bite both indoors and outdoors, mostly during the daytime; therefore, it is important to ensure protection from mosquitoes throughout the entire day.
Specifically, the agency recommends
- covering exposed skin;
- using permethrin-coated clothing and gear; and
- using an insect repellant that contains N,N-diethyl-meta-toluamide (DEET), oil of lemon eucalyptus, picaridin or 3-(N-Butyl-N-acetyl)-aminopropionic acid, ethyl ester (IR3535).