CDC has updated guidelines that contain a recommendation for routine care for babies whose mothers traveled to or resided in areas with Zika virus outbreak during pregnancy. Dengue Zika manifests itself by fever, rash, arthralgia, or conjunctivitis. Evidence shows that Zika virus disease in children is usually mild. Healthcare providers should report suspected cases to their local or state health departments so that action can be taken to reduce the risk of local Zika virus transmission.
Zika and Pregnancy
Zika virus is transmitted to humans through the bite of Aedes species mosquitoes, especially Aedes aegypti and Aedes albopictus. Zika virus was first found in Brazil in the spring of 2015 and had spread to tropics and subtropics throughout the world. In October 2015, a significant increase in the number of babies born with microcephaly was reported. Zika virus can be transmitted from an infected mother to her infant, through sexual transmission and laboratory exposures. Besides, blood transfusion and organ transplantation also pose theoretical risks of transmission. There is no evidence of transmission through breastfeeding even though Zika virus RNA has been found in breast milk.
The incubation period of Zika virus is likely from three days to two weeks. Mother-to-infant transmission during the perinatal period has led to findings in the newborn ranging from no symptoms to serious illness (including fever, hemorrhage, and thrombocytopenia), with fever onset during the first week. The clinical features that should be observed in infants who contract Zika virus during the perinatal period are still unknown. Deaths from Zika virus infection seem to be rare in people of all ages. Guillain-Barré syndrome is believed to follow Zika virus infection even though a causal connection has not been established. Guillain-Barré syndrome incidence seems to develop with increasing age.
The results of prenatal ultrasounds and maternal testing should be considered. A thorough newborn physical examination, with measurement of head circumference, length, and weight, should also be conducted. It is important to evaluate infants with microcephaly or intracranial calcifications or babies whose mothers have positive test results for Zika virus infection. Healthcare providers should perform clinical judgment in newborns with abnormalities such as microcephaly or intracranial calcifications. They also should test the mother before testing the baby.
Evaluation of children for acute Zika virus infection should include testing of serum and cerebrospinal fluid (CSF) specimens by using RT-PCR. If Zika virus RNA is not found and symptoms have been present for more than four days, serum may be tested for immunoglobulin M (IgM) and neutralizing antibodies. In any clinical specimen, laboratory evidence of Zika virus infection would include Zika virus in culture, Zika virus RNA, or a clinical specimen positive for IgM. More information on laboratory testing is available online.
Illness associated with Zika virus is often mild, and treatment involves supportive care. Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided due to the potential for hemorrhagic complications. Aspirin should not be used in children and teenagers with acute viral illnesses due to its association with Reye’s syndrome. The decision to perform additional laboratory tests, diagnostic studies, and disease consultation should be based on clinical judgment and findings from a full history and physical examination.
Zika virus RNA has been detected in breast milk but attempts to culture the virus have not been successful yet. No cases of Zika virus infection through breastfeeding have been reported. CDC recommends mothers with Zika virus infection who live in or travel to areas with ongoing Zika virus outbreak to breastfeed their babies. The benefits of breast milk are more valuable than the theoretical risks of Zika virus transmission through breastfeeding.
Prevention of mosquito bites is the best means of preventing Zika virus infection in people of all ages residing in or traveling to areas with ongoing Zika virus transmission. Wear long-sleeved shirts, long pants, or any clothing that can cover as much exposed skin as possible. Purchase permethrin-treated clothing and gear. Use air conditioning or window and door screens when indoors. Apply insect repellents; most EPA–registered products can be used on children, pregnant women, and lactating women. Oil of lemon eucalyptus is not good for children under three years of age. Cover carriers, strollers, or cribs by mosquito netting to protect infants from mosquito bites.
Evidence indicates that Zika virus infection during pregnancy leads to microcephaly. Studies are underway to confirm the association between Zika virus infection and microcephaly, as well as the role of other factors (e.g., previous infections, nutrition, and environment). Other problems appear among fetuses and infants infected with Zika virus before birth, such as poorly developed brain structures, impaired growth, and defects of the eye. Researchers are collecting data to understand how Zika virus affects mothers and their children. Pregnant women in any trimester should not travel to an area where Zika virus is prevalent. If the travel is compulsory, she should consult with her healthcare provider or obstetrician. She needs to follow strict steps to avoid mosquito bites. If a pregnant woman has a sexual partner who lives in or has returned from an area with Zika, the couple needs to either use condoms or abstain from sex for the duration of her pregnancy.
Consideration of amniocentesis should depend on the patient’s clinical circumstance, the evaluation of potential Zika virus infection and other congenital infections. Healthcare providers should thoroughly explain the risks and benefits of amniocentesis to their patients. However, amniocentesis is not advisable until after 15 weeks of gestation. The exact timing of amniocentesis must be individualized based on the patient’s clinical circumstances. Referral to a maternal-fetal specialist may be necessary.
In the special context of Zika virus disease, it is crucial for women and their partners to plan pregnancies. Obstetricians should discuss reproductive life plans, especially pregnancy intentions and timing with women of childbearing age. This discussion should include signs and symptoms of Zika, the possible adverse outcomes of Zika infection during pregnancy, and an assessment of the risk of dengue Zika exposure. Do not miss factors that might influence the timing of pregnancy, such as age, fertility, medical history, reproductive history, and personal values and preferences.
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