How to Treat Pregnant Women With Diagnoses of Zika Virus Disease
Zika Fever
A viral infection transmitted by the Aedes aegypti mosquito.
Should pregnant women be tested for Zika virus?
· How to Treat Pregnant Women with Diagnoses of Zika Virus Disease. No specific antiviral treatment is available for Zika virus disease. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics ( 4 ). Fever should be treated with acetaminophen ( 21 ).
What is the interval for Zika virus NAT testing during pregnancy?
Infection during pregnancy can cause a birth defect called microcephaly and other severe fetal brain defects; Zika primarily spreads through infected mosquitoes. You can also get Zika through sex without a condom with someone infected by Zika, even if that person does not show symptoms of Zika. There is no vaccine to prevent or medicine to treat Zika.
Which tests are used in the evaluation of congenital Zika virus syndrome?
· CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of …
How does Zika virus affect pregnancy?
· Pregnant women can protect their babies from these Zika-related health conditions by not traveling to areas with Zika. Men and women who live in or travel to an area with Zika …
What is the best treatment for Zika virus?
There is no specific treatment for infection with the Zika virus. To help relieve symptoms, get plenty of rest and drink plenty of fluids to prevent dehydration. The over-the-counter (OTC) medication acetaminophen (Tylenol, others) may help relieve joint pain and fever.
What drug is used in treatment of Zika virus?
There is no specific medicine or vaccine for Zika virus. Treat the symptoms.
What do you do if your pregnant and have Zika?
Talk to your doctor or other healthcare provider to plan for a healthy and safe pregnancy. If families would like to speak to someone about a possible Zika virus infection or diagnosis during pregnancy and risk to the baby, please contact MotherToBaby.
What is Zika virus symptoms prevention and treatment?
There is no treatment available for Zika virus infection or its associated diseases. Symptoms of Zika virus infection are usually mild. People with symptoms such as fever, rash, or arthralgia should get plenty of rest, drink fluids, and treat pain and fever with common medicines.
Is there vaccine for Zika?
Although Zika virus (ZIKV) infection is typically self-limiting, other associated complications such as congenital birth defects and the Guillain–Barré syndrome are well described. There are no approved vaccines against ZIKV infection.
How do doctors test for Zika virus?
To diagnose Zika, a doctor or other healthcare provider will ask about any recent travel and any signs and symptoms. They may order blood or urine tests to help determine if you have Zika.
Can you get tested for Zika while pregnant?
Testing for Zika genetic material, RNA, is recommended for pregnant women without symptoms who live in or frequently travel to an area with risk of Zika. Because you have ongoing exposure to Zika, you may receive up to three Zika tests at various points throughout your pregnancy.
What happens if you test positive for Zika?
Zika virus may cause birth defects if a fetus becomes infected. The virus can prevent normal brain development and may cause microcephaly, which is an abnormally small head size. Zika infection of a fetus may also lead to hearing, vision, cognitive, and developmental disorders.
How do you prevent Zika virus?
The best way to prevent Zika is to protect yourself from mosquito bites. Everyone, including pregnant and breastfeeding women, should take steps to prevent mosquito bites. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women.
Is there treatment for West Nile virus?
There is no specific treatment for West Nile virus (WNV) disease; clinical management is supportive. Patients with severe meningeal symptoms often require pain control for headaches and antiemetic therapy and rehydration for associated nausea and vomiting.
When providing client education about the Zika virus What should the nurse explain is the primary mode of transmission?
Mosquito Transmission Zika virus is transmitted to people via a bite from an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. This mosquito also transmits chikungunya, dengue, and yellow fever (WHO, 2016d).
When can Zika affect a pregnancy?
How can I protect my pregnancy from Zika virus? If you are not pregnant yet, it is recommended to wait before trying to get pregnant after a known or possible exposure to Zika virus. Women should wait at least 2 months and men should wait at least 3 months, even if they do not have symptoms.
What are the guidelines for pregnant women during a Zika outbreak?
These guidelines include recommendations for pregnant women considering travel to an area with Zika virus transmission and recommendations for screening, testing, and management of pregnant returning travelers. Updates on areas with ongoing Zika virus transmission are available online ( http://wwwnc.cdc.gov/travel/notices/ ). Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with 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 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department. Testing is not indicated for women without a travel history to an area with Zika virus transmission. In pregnant women with 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; supportive care is recommended.
What tests are needed for Zika?
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. CDC is developing guidelines for infants infected by Zika virus. If a pregnancy results in a fetal loss in a woman with history of travel to an area of Zika virus transmission with symptoms consistent with Zika virus disease during or within 2 weeks of travel or findings of fetal microcephaly, Zika virus RT-PCR and immunohistochemical staining should be performed on fetal tissues, including umbilical cord and placenta.
What is the CDC?
1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2 Arboviral Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3 Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, CDC.
Can a Zika test be performed on amniotic fluid?
Zika virus RT-PCR testing can be performed on amniotic fluid ( 7, 9 ). Currently, it is unknown how sensitive or specific this test is for congenital infection. Also, it is unknown if a positive result is predictive of a subsequent fetal abnormality, and if so, what proportion of infants born after infection will have abnormalities. Amniocentesis is associated with an overall 0.1% risk of pregnancy loss when performed at less than 24 weeks of gestation ( 19 ). Amniocentesis performed ≥15 weeks of gestation is associated with lower rates of complications than those performed at earlier gestational ages, and early amniocentesis (≤14 weeks of gestation) is not recommended ( 20 ). Health care providers should discuss the risks and benefits of amniocentesis with their patients. A positive RT-PCR result on amniotic fluid would be suggestive of intrauterine infection and potentially useful to pregnant women and their health care providers ( 20 ).
Should pregnant women be tested for Zika?
Women who traveled to an area with ongoing Zika virus transmission during pregnancy should be evaluated for Zika virus infection and tested in accordance with CDC Interim Guidance ( Figure ). Because of the similar geographic distribution and clinical presentation of Zika, dengue, and chikungunya virus infection, patients with symptoms consistent with Zika virus disease should also be evaluated for dengue and chikungunya virus infection, in accordance with existing guidelines ( 16, 17 ).
Is Zika a maternal or fetal virus?
Maternal-fetal transmission of Zika virus has been documented throughout pregnancy ( 4, 7, 8 ). Although Zika virus RNA has been detected in the pathologic specimens of fetal losses ( 4 ), it is not known if Zika virus caused the fetal losses. Zika virus infections have been confirmed in infants with microcephaly ( 4 ), and in the current outbreak in Brazil, a marked increase in the number of infants born with microcephaly has been reported ( 9 ). However, it is not known how many of the microcephaly cases are associated with Zika virus infection. Studies are under way to investigate the association of Zika virus infection and microcephaly, including the role of other contributory factors (e.g., prior or concurrent infection with other organisms, nutrition, and environment). The full spectrum of outcomes that might be associated with Zika virus infections during pregnancy is unknown and requires further investigation.
Can pregnant women get Zika?
Pregnant women can be infected with Zika virus in any trimester ( 4, 7, 8 ). The incidence of Zika virus infection in pregnant women is not currently known, and data on pregnant women infected with Zika virus are limited. No evidence exists to suggest that pregnant women are more susceptible to Zika virus infection or experience more severe disease during pregnancy.
Why should pregnant women be tested for Zika?
For asymptomatic pregnant women with ongoing exposure to Zika virus, testing for Zika virus infection should be offered as part of routine obstetric care because it might identify acute infection during pregnancy (Figure 2).
What is the CDC's guidance for the evaluation of infants with congenital Zika virus exposure?
Interim guidance for the evaluation of infants with congenital Zika virus exposure has been previously published; infants who meet one or more of the published criteria for testing for congenital Zika virus infection should be tested and evaluated in accordance with the updated CDC interim guidance for the evaluation and management of infants with possible Zika virus infection ( 34 ). However, in light of the updated recommendations that will likely reduce routine Zika virus testing of asymptomatic pregnant women with recent possible Zika virus exposure but without ongoing possible exposure, it is critical that pediatric health care providers inquire about possible maternal and congenital Zika virus exposure for every newborn. Infants born to mothers with possible Zika virus exposure during pregnancy but who did not receive testing, including asymptomatic pregnant women with recent possible Zika virus exposure but without ongoing possible exposure, should receive a comprehensive physical examination, including standardized measurement of head circumference and newborn hearing screen, as part of routine pediatric care. In addition, based on the level of possible Zika virus exposure (e.g., duration and type of exposure, use of prevention measures, intensity of Zika virus transmission at the location of travel), the provider should consider whether further evaluation of the newborn for possible congenital Zika virus infection is warranted, in which case, a head ultrasound, and ophthalmologic assessment should be considered. Based on results of the evaluation, testing of the infant for Zika virus infection could be considered.
What tests should be done for Zika?
Testing should include both NAT and IgM tests.
How soon after symptom onset should you get tested for Zika?
The updated recommendations include concurrent Zika virus nucleic acid test (NAT) and serologic testing as soon as possible through 12 weeks after symptom onset.
Why is it important to ascertain whether a woman had exposure to flaviviruses other than Zika virus
It is important to ascertain whether a woman had exposure to flaviviruses other than Zika virus before the current pregnancy because a positive IgM result might have been caused by cross-reactivity from a previous flavivirus exposure.
Can you get a positive IgM before pregnancy?
A positive Zika virus IgM result could indicate antibodies from infection before the current pregnancy, thus limiting the ability to distinguish between an infection that occurred before the current pregnancy and one that occurred during the current pregnancy.
Can pregnant women get Zika?
Pregnant women with possible Zika virus exposure should be asked about their risk for exposure both before and during the current pregnancy. Health care providers should ask about the presence of symptoms of Zika virus disease (e.g., fever, rash, arthralgia, and conjunctivitis), and place, duration, and type of travel to assess a woman’s potential for exposure to Zika virus and other flaviviruses (e.g., dengue or West Nile viruses).
When can you evaluate a baby for Zika?
The initial evaluation of infants born to women with possible Zika virus exposure during pregnancy can be done before or after birth hospital discharge, taking into account hospital capabilities and the needs of the family.
What is the best test for Zika virus?
The optimal assays, specimens, and timing of testing for congenital Zika virus infection are unknown. Recommended laboratory testing for possible congenital Zika virus infection includes evaluation for Zika virus RNA in infant serum and urine and Zika virus IgM antibodies in serum. In addition, if cerebrospinal fluid (CSF) is obtained for other purposes, NAAT and IgM antibody testing should be performed on CSF because in some reported infants, CSF was the only specimen that tested positive for Zika virus infection. Testing of cord blood is not recommended because it can yield false positive and false negative test results.
Does a positive NAAT confirm a Zika virus?
A positive Zika virus NAAT confirms Zika virus infection. However, because Zika virus RNA in serum and urine decreases over time, a negative NAAT does not rule out Zika virus infection; in this case, serologic testing should be performed.
What age should an infant be tested for Zika?
Criteria for testing will vary by state. However, postnatal Zika virus disease should be suspected in an infant or child aged <18 years who 1) traveled to or resided in an area with risk of Zika virus infection within the past 2 weeks or who might have been exposed to Zika virus through sexual contact with a partner who traveled to or resided in an area with risk of Zika, and 2) has one or more of the following manifestations: fever, rash, conjunctivitis, and arthralgia. Because perinatal transmission of Zika virus from mother to infant during delivery is possible, Zika virus disease should also be considered in an infant 1) who has one or more of the following manifestations: fever, rash, conjunctivitis, and arthralgia during the first 2 weeks of life, and 2) whose mother was potentially exposed to Zika virus within approximately 2 weeks of delivery.
Can a PRNT test detect maternal antibodies?
PRNT cannot distinguish between maternal or infant antibodies. Maternal antibodies in the infant are expected to wane by 18 months. PRNT might help confirm or rule out infection in a sample collected from an infant aged 18 months whose initial sample collected at birth was IgM non-negative and neutralizing antibodies were detected by PRNT in either the infant’s or mother’s sample. If PRNT results at 18 months are negative, the infant is considered not to have congenital Zika virus infection. If PRNT results are positive, congenital Zika virus infection is presumed, but postnatal infection cannot be excluded, especially among infants living in an area with active Zika virus transmission.
What is a positive NAAT result for Zika?
A Zika virus NAAT positive result in an infant sample confirms the diagnosis of congenital Zika virus infection. Zika virus IgM detected in an infant with a negative NAAT result should be interpreted as probable congenital Zika virus infection. If neither Zika virus RNA nor Zika IgM antibodies are detected on the appropriate specimens (e.g., serum or urine) obtained within the first few days after birth, congenital Zika virus infection is unlikely.
Why should IgM be tested on CSF?
In addition, if cerebrospinal fluid (CSF) is obtained for other purposes, NAAT and IgM antibody testing should be performed on CSF because in some reported infants, CSF was the only specimen that tested positive for Zika virus infection.
Congenital Zika Virus Infection
- Initial Evaluation
Because changes in the updated interim guidance for pregnant people may lead to fewer pregnant people people Zika symptoms being tested, it is critical that pediatricians ask about potential congenital Zika exposure for every newborn.All infants from pregnancies with possible Zika viru… - Recommendations for Clinical Evaluation
The initial evaluation of infants born to people with possible Zika virus exposure during pregnancy can be done before or after birth hospital discharge, taking into account hospital capabilities and the needs of the family. Infants with birth defects consistent with congenital Zika syndrome bor…
Remain Alert to Possible Clinical Findings
- For infants without clinical findings of congenital Zika syndrome and without laboratory evidence of Zika virus infection born to people with possible Zika virus exposure during pregnancy, healthcare providers should remain alert for any new findings of possible congenital Zika virus infection. If findings suggestive of congenital Zika syndrome are identified at any time, refer to a…
Postnatal Zika Virus Infection
- Criteria for testing will vary by state. However, postnatal Zika virus disease should be suspected in an infant or child aged <18 years who 1) traveled to or resided in an area with risk of Zikavirus infection within the past 2 weeks or who might have been exposed to Zika virus through sexual contact with a partner who traveled to or resided in an area with risk of Zika, and 2) has one or m…
Ordering Tests
- Zika virus testing is performed at many state and territorial health departments, at CDC, and at commercial laboratories that perform Zika testing using a validated assay with demonstrated analytical and clinical performance. Healthcare providers should contact their local, state, or territorial health department to facilitate testing. See Testing for Zika Virusfor information on Zik…
Testing Challenges
- Zika virus testing in infants and children has several challenges. NAAT tests may not detect Zika virus RNA in an infant who had Zika virus infection in utero or in a child if the period of viremia has passed. Serologic tests for Zika virus can be falsely positive because of cross-reacting antibodies against related flaviviruses (e.g., dengue and yellow fever viruses). Plaque-reduction neutralizati…