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Update : Interim Guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure — United States, 2016
  • Published Date:
    February 5, 2016
  • Language:
    English
Filetype[PDF - 396.09 KB]


Details:
  • Corporate Authors:
    National Center for Chronic Disease Prevention and Health Promotion (U.S.). Division of Reproductive Health. ; Centers for Disease Control and Prevention (U.S.). Center for Surveillance, Epidemiology, and Laboratory Services. Division of Public Health Information Dissemination. ; National Center for Emerging and Zoonotic Infectious Diseases (U.S.) ; ... More ▼
  • Description:
    Updated Recommendations for Testing Pregnant Women with a History of Travel to Areas with Ongoing Zika Virus Transmission -- Guidelines for Pregnant Women Residing in Areas with Ongoing Zika Virus Transmission -- Special Considerations for Women of Reproductive Age Residing in Areas of Ongoing Zika Virus Transmission.

    CDC has updated its interim guidelines for U.S. health care providers caring for pregnant women during a Zika virus outbreak (1). Updated guidelines include a new recommendation to offer serologic testing to asymptomatic pregnant women (women who do not report clinical illness consistent with Zika virus disease) who have traveled to areas with ongoing Zika virus transmission. Testing can be offered 2–12 weeks after pregnant women return from travel. This update also expands guidance to women who reside in areas with ongoing Zika virus transmission, and includes recommendations for screening, testing, and management of pregnant women and recommendations for counseling women of reproductive age (15–44 years). Pregnant women who reside in areas with ongoing Zika virus transmission have an ongoing risk for infection throughout their pregnancy. For pregnant women with clinical illness consistent with Zika virus disease,* testing is recommended during the first week of illness. For asymptomatic pregnant women residing in areas with ongoing Zika virus transmission, testing is recommended at the initiation of prenatal care with follow-up testing mid-second trimester. Local health officials should determine when to implement testing of asymptomatic pregnant women based on information about levels of Zika virus transmission and laboratory capacity. Health care providers should discuss reproductive life plans, including pregnancy intention and timing, with women of reproductive age in the context of the potential risks associated with Zika virus infection.

    Zika virus is primarily transmitted by Aedes aegypti mosquitoes, which are found throughout much of the region of the Americas, including parts of the United States (2,3). These mosquitoes can also transmit dengue and chikungunya viruses (4). The Zika virus outbreak continues to spread (http://www.cdc.gov/zika/geo/index.html), with ongoing Zika virus transmission recently reported in U.S. territories. Evidence suggesting an association of Zika virus infection with an increased risk for congenital microcephaly and other abnormalities of the brain and eye (5) prompted the World Health Organization to declare the Zika virus outbreak a Public Health Emergency of International Concern on February 1, 2016 (http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/).

    There is currently no vaccine or medication to prevent Zika virus infection. All travelers to or residents of areas with ongoing Zika virus transmission should be advised to strictly follow steps to avoid mosquito bites because of the potential for exposure to Zika, dengue, and chikungunya viruses (6). Aedes vector mosquitoes bite mostly during daylight hours; thus, protection from mosquito bites is required throughout the day (7). Prevention of mosquito bites includes wearing long-sleeved shirts, pants, permethrin-treated clothing, and using United States Environmental Protection Agency (EPA)-registered insect repellents. Insect repellents containing ingredients such as DEET, picaridin, and IR3535 are safe for use during pregnancy when used in accordance with the product label (6). To prevent human-to-mosquito-to-human transmission, persons infected with Zika, dengue, or chikungunya virus should protect themselves from mosquito exposure during the first week of illness. The number of mosquitoes in and around homes can be reduced by emptying standing water from containers, installing or repairing screens on windows and doors, and using air conditioning if available. Further information on preventing mosquito bites is available online (http://www.cdc.gov/features/stopmosquitoes/).

    Antiviral treatment is not currently available for Zika virus disease; treatment is supportive and includes rest, fluids, and analgesic and antipyretic medications. Aspirin and other nonsteroidal anti-inflammatory medications should be avoided until dengue virus infection can be ruled out (8). Dengue virus infection can cause serious complications, including hemorrhage and death, which might be substantially reduced by early recognition and supportive treatment (4,8). Pregnant women with fever should be treated with acetaminophen (9).

    Suggested citation for this article: Oduyebo T, Petersen EE, Rasmussen SA, et al. Update: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–6. DOI: http://dx.doi.org/10.15585/mmwr.mm6505e2er.

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