CDC releases Zika virus guidelines for treating pregnant women

In the wake of the recent advisories warning pregnant women to avoid travel to Zika-endemic regions, the CDC has released interim guidelines for physicians advising and caring for pregnant women during a Zika virus 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,” Emily E. Petersen, MD, of the division of reproductive health at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and colleagues wrote in MMWR. “Health care providers should ask all pregnant women about recent travel.”

The guidelines come after cases of microcephaly, a birth defect that affects the size of a newborn’s head and causes neurological complications, rose dramatically in Brazil and other South American countries. The CDC recently confirmed that new evidence supports the link between Zika virus and microcephaly.

The CDC recommends that physicians advise all pregnant women to avoid traveling to regions where Zika virus transmission is ongoing. The CDC expanded its list to eight more countries today, and it now includes: Barbados, Bolivia, Brazil, Cape Verde, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Puerto Rico, Saint Martin, Samoa, Suriname, and Venezuela.

The CDC expects this list to grow as more cases of Zika are reported. Recent travel-based infections also have been confirmed in Hawaii, Illinois and Texas. In response, health officials representing some Zika-endemic countries, such as Brazil and Jamaica, have officially advised women to delay pregnancy.

“From the information coming out of Brazil and reported by the CDC, there is significant risk for birth defects, particularly microcephaly, in the fetuses of mothers who become infected during the early stages of pregnancy,” James H. Brien, DO, of the department of infectious diseases at McLane Children’s Hospital, Baylor Scott & White Health, Texas A&M College of Medicine, and Infectious Diseases in Children Editorial Board member, said in an interview. “It would be best for the trip to be delayed until after delivery, but if unavoidable mosquito avoidance is the only current option. Most experts recommend repellent containing 20% DEET, which is safe to use during pregnancy.”

The guidelines listed in MMWR recommend mosquito avoidance for pregnant women who must travel to regions where Zika virus is active. Pregnant women should be advised to wear long-sleeved shirts and long pants, use EPA-registered insect repellents, use permethrin-treated gear and clothing, and sleep in screened or air-conditioned areas.

Physicians are advised to inquire about recent travel when caring for pregnant women. Women who indicate they have traveled to a Zika-endemic area should be evaluated and tested for the presence of the virus. Physicians are advised also to test for dengue and chikungunya due to their similar clinical presentations. Testing for Zika virus should be conducted on symptomatic patients via maternal serum evaluation using reverse transcription-PCR. Immunoglobulin M and neutralizing antibody testing should be performed 4 days after initial symptoms occur. The guidelines note that testing of asymptomatic pregnant women is not advised unless there is suspicion of fetal microcephaly.

The report also said the CDC is developing guidelines to address caring for infants with confirmed Zika virus.

According to Brien, Zika diagnostic alertness is required of all U.S. physicians during the transition into the summer months.

“It is reasonable to assume that the Zika virus will be seen in the continental U.S. sooner or later,” Brien said. “In a highly mobile world community, where within 48 hours, one can literally travel half-way around the world, a traveler can board a plane in one of the endemic countries while well, but incubating the virus, and be viremic after arrival. Then, just as with other mosquito-borne diseases, all it takes is for the infected person to pass the virus on to an uninfected mosquito for it to be transmitted to others, who might not otherwise be at risk.” – by David Costill

Disclosure: The researchers report no relevant financial disclosures.