Zika virus is a flavivirus spread primarily through an infected mosquito bite, but can also be transmitted through sexual contact, blood transfusion, and from mother to fetus during pregnancy (American College of Obstetricians and Gynecologists [ACOG], 2019; Centers for Disease Control and Prevention [CDC], 2019). The virus has been associated with serious adverse neonatal outcomes (see table), thus pregnant women and those planning a pregnancy should follow recommendations for prevention, screening, and monitoring from ACOG and the CDC.
Prevention
Although vaccine testing is underway, there is currently no vaccine available to prevent contracting or transmitting the Zika virus and no known effective treatment. Maternal-fetal transmission is estimated at 5% to 10% and can occur at any phase during pregnancy, including around conception; hence, many precautions are extended to partners as well (ACOG, 2019). Pregnant women and those planning to become pregnant should avoid travel to areas with current or past outbreaks. If such travel is unavoidable, certain precautions should be taken to prevent infection, including wearing an Environmental Protection Agency approved insect repellent and staying indoors in air-conditioned spaces (ACOG; CDC, 2019).
To prevent sexual transmission of the virus for women planning to attempt pregnancy: 1) If only the female partner has potential exposure, abstain from sex or use condoms for at least 8 weeks following symptom onset or last possible exposure; 2) If the male or both partners have potential exposure, abstain from sex or use condoms for at least 3 months from the male partner's last exposure; and 3) if one or both partners are regularly exposed to the virus, counseling should include information on the signs, symptoms, potential infection risks, and prevention strategies. If either partner has a suspected or confirmed infection, the time frames suggested should be used. Pregnant women whose male partner has potential exposure to the virus should abstain from sex or use condoms for the duration of the pregnancy (ACOG, 2019).
Testing and Fetal Evaluation
Confirmation of Zika virus is complicated by limitations of available tests and the complexity on results interpretation. Assistance from local or state health departments should be sought for testing pregnant women with suspected infection. Guidance is available from the CDC (2019). Ultrasound examination is the recommended method to evaluate for fetal abnormalities and monitor fetal growth (ACOG, 2019). Data are insufficient to determine timing and frequency of screening; it is important that clinicians are aware delays up to 29 weeks from onset of infection to detection of fetal abnormalities have been reported.
Neonatal Care and Breastfeeding
The CDC (2019) issues guidance on testing and caring for infants and children affected by the virus and neonatal and pediatric caregivers should be made aware of any suspected, probable, or confirmed infection. Although the virus has been detected in breast milk, there are no confirmed reports of viral transmission from breastfeeding; hence, the CDC and World Health Organization recommend women with suspected or confirmed infection or those with potential exposure should continue to breastfeed (ACOG, 2019; CDC, 2019).
Reporting and Infection Control
Laboratory-confirmed cases of Zika virus should be reported to local and state health agencies to register cases with the CDC. Because this virus has been found in body fluids, standard precautions are recommended to protect healthcare workers and other patients from contracting the virus (ACOG, 2019).
Our understanding of the Zika virus and its clinical implications is evolving. Stay up to date by checking the CDC site.
Sequelae from Congenital Zika Virus Syndrome
* Microcephaly with partially collapsed skull
* Thin cerebral cortex with calcifications in subcortical region
* Macular scarring, focal pigmentary retinal mottling, other retinal abnormalities
* Congenital contractures or arthrogryposis
* Marked early hypertonia and extrapyramidal involvement
* Cardiac anomalies
* Diaphragmatic hernia
* Pregnancy outcomes: miscarriage, preterm birth, growth restriction, stillbirth
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