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Update : Interim guidance for health care providers caring for women of reproductive age with possible Zika virus exposure — United States, 2016
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Details:
  • Pubmed ID:
    27031943
  • Series:
    MMWR. Morbidity and mortality weekly report ; v. 65, no. 12, p. 315-322
  • Document Type:
  • Description:
    On March 25, 2016, this report was posted as an MMWR Early Release on the MMWR website.

    CDC has updated its interim guidance for U.S. health care providers caring for women of reproductive age with possible Zika virus exposure (1) to include recommendations on counseling women and men with possible Zika virus exposure who are interested in conceiving. This guidance is based on limited available data on persistence of Zika virus RNA in blood and semen (2–5). Women who have Zika virus disease* should wait at least 8 weeks after symptom onset to attempt conception, and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception. Possible exposure to Zika virus is defined as travel to or residence in an area of active Zika virus transmission (http://www.cdc.gov/zika/geo/active-countries.html), or sex (vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who traveled to or resided in an area of active transmission. Women and men who reside in areas of active Zika virus transmission should talk with their health care provider about attempting conception. This guidance also provides updated recommendations on testing of pregnant women with possible Zika virus exposure. These recommendations will be updated when additional data become available.



    The current Zika virus outbreak was identified in Brazil in May 2015, and knowledge about Zika virus infection, its potential adverse effects on pregnancy, and transmission is rapidly evolving. As of March 23, 2016, there were 39 countries and U.S. territories reporting active Zika virus transmission (6). Updates on areas with active Zika virus transmission are available online at http://wwwnc.cdc.gov/travel/notices.



    Zika virus is primarily transmitted through the bite of infected Aedes species mosquitoes. However, Zika virus can also be sexually transmitted from a man infected with the virus to his sexual partners (3,5,7–10). Based on data from a previous outbreak, most persons infected with Zika virus are asymptomatic (11). Signs and symptoms, when present, are typically mild, with the most common being acute onset of fever, macular or papular rash, arthralgia, and conjunctivitis (11).



    Increasing epidemiologic, clinical, laboratory, and pathologic evidence supports a link between Zika virus infection during pregnancy and adverse pregnancy and birth outcomes, including pregnancy loss, microcephaly, and brain and eye abnormalities (12–16). A critical knowledge gap for health care providers counseling women is the level of risk for adverse pregnancy and birth outcomes associated with Zika virus infection. That risk is currently unknown, but two recent studies might be informative. A retrospective analysis of the 2013–2014 Zika virus outbreak in French Polynesia identified eight fetuses and infants with microcephaly; using mathematical modeling, it was estimated that microcephaly affected approximately 1% of fetuses or infants born to women infected with Zika virus during the first trimester of pregnancy (17). In a recent study from Brazil, among 42 women with laboratory-confirmed Zika virus infection at any time during pregnancy who underwent prenatal ultrasonographic studies, 12 (29%) had abnormal findings; these included microcephaly, intracranial calcifications, other brain abnormalities, abnormal cerebral artery flow, intrauterine growth restriction, and fetal death (16). Further studies are underway to better estimate this risk but it is important to recognize that microcephaly caused by viral destruction of brain tissue is likely to be part of a spectrum of neurological damage; the percentages in both studies may substantially underestimate the proportion of infants affected.



    The risk for adverse pregnancy outcomes associated with maternal Zika virus infection around the time of conception is currently unknown. However, early reports suggest there might be adverse outcomes associated with Zika virus infection in early pregnancy: two women with Zika virus disease at <7 weeks’ gestation both had pregnancy losses, with Zika virus RNA detected in products of conception, and another woman with clinical illness consistent with Zika virus disease at 7–8 weeks’ gestation delivered a full-term infant with severe microcephaly (15). Other viral infections (e.g., cytomegalovirus, rubella, and parvovirus) that have occurred around the time of conception have been associated with congenital infection and associated adverse pregnancy and birth outcomes (18–22); however, in these cases the exact timing of infection relative to timing of conception was often unknown.



    Because currently available data are limited, providing preconception counseling following possible Zika virus exposure is challenging. Decisions about pregnancy timing are personal and complex, and discussions with patients should be individualized. CDC and state health departments have received numerous inquiries from health care providers requesting information on how best to counsel patients regarding timing of pregnancy following possible Zika virus exposure and diagnosis of Zika virus disease. CDC has developed updated interim guidance to address these concerns. This guidance is based on expert opinion, the limited available data on Zika virus, and knowledge about risks for other viral infections in the periconceptional period. CDC continues to evaluate all available evidence and to update recommendations as new information becomes available.

    Suggested citation for this article: Petersen EE, Polen KN, Meaney-Delman D, et al. Update: Interim Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:315–322. DOI: http://dx.doi.org/10.15585/mmwr.mm6512e2.

    PMID: 27031943

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