A Zika Q&A for Ob/Gyns
According to a recent Medscape poll, a majority of ob/gyns don’t feel well prepared to care for patients infected with Zika, a mosquito-borne virus thought to be causing microcephaly among thousands of newborns in Latin America and the Caribbean. To answer your questions, the Centers for Disease Control and Prevention (CDC) put together the following Q&A. Visit the CDC website for the full text.
Update: This article was last updated February 8th.
How is Zika virus transmitted?
Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito. Aedes mosquitoes are aggressive daytime biters and feed both indoors and outdoors. They can also bite at night. Zika virus can be transmitted from a pregnant mother to her fetus during pregnancy or around the time of birth. We do not know how often Zika perinatal transmission occurs. Sexual transmission of Zika virus is possible.
What are symptoms of Zika virus infection?
About 1 in 5 people infected with Zika virus become symptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild, with symptoms lasting for several days to a week.
What is the potential for Zika virus to spread to the United States?
Currently, local transmission of Zika virus has not been reported in the continental United States but has been reported in the Commonwealth of Puerto Rico and the US Virgin Islands. With the current outbreaks in the Americas, the number of cases among U.S. travelers is expected to increase. As the number of returning travelers with Zika virus disease increases, viral introduction and local spread in the U.S. may occur. As more information before available, CDC will provide updates on its Zika website.
How to Test for Zika
When should asymptomatic pregnant women with a history of travel be tested for Zika virus infection?
Testing should be offered from 2 to 12 weeks after pregnant women return from travel to areas of ongoing Zika virus transmission. Information about serologic testing of asymptomatic persons is limited; on the basis of experience with other flaviviruses, we expect that antibodies will be present from 2 weeks after virus exposure and can persist for up to 12 weeks.
How can I order a Zika virus test for a patient that has traveled to an area with Zika virus transmission?
There are no commercially available tests for Zika virus. Zika virus testing is performed at the CDC Arbovirus Diagnostic Laboratory and a few state health departments. Healthcare providers should contact their state and local health department to facilitate testing. See the Diagnostic Testing webpage for information on how to obtain Zika testing.
How to Manage Pregnant Patients
Who should be offered amniocentesis?
Amniocentesis should be offered to pregnant women with recent travel to an area with Zika virus transmission, reporting two or more symptoms within 2 weeks of travel and a positive or inconclusive maternal serum test. For pregnant women with recent travel to an area with Zika virus transmission and ultrasound findings of microcephaly or intracranial calcifications, amniocentesis may also be considered. Consultation with a maternal-fetal medicine specialist should be considered.
How is microcephaly diagnosed prenatally?
Microcephaly can be diagnosed during pregnancy with ultrasound. Microcephaly is most easily diagnosed by ultrasound late in the second trimester or early in the third trimester of pregnancy.
How to Counsel Patients
How should pregnant patients who are considering travel to an area with Zika virus transmission be counseled?
CDC recommends that pregnant women in any trimester consider postponing travel to an area where Zika virus transmission is ongoing. If a pregnant woman is considering travel to one of these areas, she should talk to her healthcare provider. If she travels, she should strictly follow steps to avoid mosquito bites during the trip.
How should women trying to become pregnant who are considering travel to an area with Zika virus transmission be counseled?
They should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.
How can Zika virus infection be prevented?
There is no vaccine to prevent Zika virus infection. Travelers can protect themselves by taking steps to prevent mosquito bites. Use insect repellent; wear long-sleeved shirts and long pants; and stay in places with air conditioning or with window and door screens. Pregnant women can and should choose an EPA-registered insect repellent and use it according to the product label. Given the potential risks of maternal Zika virus infection, pregnant women whose male partners have or are at risk for Zika virus infection should consider using condoms or abstaining from sexual intercourse.
Cite this article: A Zika Q&A for Ob/Gyns. Medscape. Feb 03, 2016.