The Zika Virus
On January 15, 2016, the Centers for Disease Control (CDC) issued a Health Advisory regarding the Zika virus which has now been noted in 14 countries in the Western Hemisphere and continues to spread rapidly. The Zika virus has been implicated as a potential cause for microcephaly, or delayed growth of the fetal head and brain. It is transmitted through the bite of infected Aedes mosquitoes, and could result in fetal infection (vertical transmission) if a mother is bitten during her pregnancy. This has, understandably, resulted in many of our patients presenting with questions and concerns about their travel plans.
Unfortunately, there is a great deal of unknown with the Zika virus at this time, including the rate of vertical transmission, other potential pregnancy effects, or factors that may increase risk of fetal infection. Additional studies are planned to learn more about the risks of Zika virus infection during pregnancy. It is important to note that Zika virus only remains in the blood of an infected person for up to a week, and will not cause infections in a baby that is conceived after the virus is cleared from the blood.
Exposure to Zika and Infection Control
New Jersey Perinatal Associates, in accordance with the CDC, recommends that pregnant women should avoid travel to the areas where Zika virus has been noted if possible. These can be found on the CDC and Pan American Health Organization sites, and are being updated daily. Pregnant women who must travel to these areas, must be diligent in taking steps to prevent mosquito bites including using insect repellents, remaining indoors at times of peak mosquito activity (dawn and dusk), and wearing protective clothing such as long sleeves, pants, and socks. Repellents containing active ingredients, such as DEET and Picaridin, which have been registered with the EPA, are considered safe for pregnant and breastfeeding women.
The American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine have issued a joint Practice Advisory with recommendations for management of pregnant women that may have been exposed to Zika virus. Serial ultrasound screening is recommended to be performed every 4 weeks to evaluate for abnormalities consistent with fetal infection. Diagnostic testing with PCR and serology is recommended for any women who is symptomatic within 2 weeks of travel. If you have traveled to an affected area, and develop fever, rash, joint pain or conjunctivitis within two weeks, you should contact your physician for diagnostic testing immediately. If you have more questions about Zika Virus or concerns regarding recent travel, you should discuss these with your obstetrician. Additionally, the physicians at NJPA are always available for consultation and evaluation; please call 973-322-5287 to schedule an appointment.
CDC Update on Zika Virus
**UPDATE: The CDC has updated its interim guidelines for pregnant women exposed to Zika virus. At this time, serologic testing IS recommended for all pregnant women that have traveled to areas with ongoing Zika virus transmission. Testing can be offered 2–12 weeks after pregnant women return from travel; however, interpretation of results is complex. Because of cross-reactivity among similar viruses, a positive result can be difficult to interpret. For this reason, there is no commercially available test and all testing must be performed through the State Department of Health. We recommend for all exposed patients to be seen at our office in consultation so that the proper testing can be ordered and we have established a system for close follow up. Results take approximately 2-3 weeks and patients will be contacted as soon as we have them available. The CDC is working with all state health departments and other organizations to rapidly increase the availability of testing for Zika virus.
The CDC has also confirmed that Zika virus can be transmitted by men to their sex partners, and the virus is present in semen for longer than in blood. Therefore, men who are travelling to affected countries whose partners are pregnant are advised to either use condoms or abstain from sexual activity for the duration of the pregnancy. At this time, there is no evidence that women can transmit Zika virus to their sex partners.