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Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016.

Abstract

CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.(†) Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease(§) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated <2 weeks after symptom onset should receive serum and urine Zika virus rRT-PCR testing. Symptomatic pregnant women who are evaluated 2-12 weeks after symptom onset should first receive a Zika virus immunoglobulin (IgM) antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR testing should be performed. Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated <2 weeks after last possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR should be performed. Asymptomatic pregnant women with ongoing risk for exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate rRT-PCR testing should be performed when IgM antibody test results are positive or equivocal. This guidance also provides updated recommendations for the clinical management of pregnant women with confirmed or possible Zika virus infection. These recommendations will be updated when additional data become available.

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  • Authors

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    Source

    MeSH

    Centers for Disease Control and Prevention (U.S.)
    Diagnostic Tests, Routine
    Disease Outbreaks
    Female
    Humans
    Immunoglobulin M
    Practice Guidelines as Topic
    Pregnancy
    Pregnancy Complications, Infectious
    RNA, Viral
    Residence Characteristics
    Reverse Transcriptase Polymerase Chain Reaction
    Travel
    United States
    Zika Virus Infection

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    27467820

    Citation

    Oduyebo, Titilope, et al. "Update: Interim Guidance for Health Care Providers Caring for Pregnant Women With Possible Zika Virus Exposure - United States, July 2016." MMWR. Morbidity and Mortality Weekly Report, vol. 65, no. 29, 2016, pp. 739-44.
    Oduyebo T, Igbinosa I, Petersen EE, et al. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016. MMWR Morb Mortal Wkly Rep. 2016;65(29):739-44.
    Oduyebo, T., Igbinosa, I., Petersen, E. E., Polen, K. N., Pillai, S. K., Ailes, E. C., ... Honein, M. A. (2016). Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016. MMWR. Morbidity and Mortality Weekly Report, 65(29), pp. 739-44. doi:10.15585/mmwr.mm6529e1.
    Oduyebo T, et al. Update: Interim Guidance for Health Care Providers Caring for Pregnant Women With Possible Zika Virus Exposure - United States, July 2016. MMWR Morb Mortal Wkly Rep. 2016 Jul 25;65(29):739-44. PubMed PMID: 27467820.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016. AU - Oduyebo,Titilope, AU - Igbinosa,Irogue, AU - Petersen,Emily E, AU - Polen,Kara N D, AU - Pillai,Satish K, AU - Ailes,Elizabeth C, AU - Villanueva,Julie M, AU - Newsome,Kim, AU - Fischer,Marc, AU - Gupta,Priya M, AU - Powers,Ann M, AU - Lampe,Margaret, AU - Hills,Susan, AU - Arnold,Kathryn E, AU - Rose,Laura E, AU - Shapiro-Mendoza,Carrie K, AU - Beard,Charles B, AU - Muñoz,Jorge L, AU - Rao,Carol Y, AU - Meaney-Delman,Dana, AU - Jamieson,Denise J, AU - Honein,Margaret A, Y1 - 2016/07/25/ PY - 2016/7/29/entrez PY - 2016/7/29/pubmed PY - 2016/12/23/medline SP - 739 EP - 44 JF - MMWR. Morbidity and mortality weekly report JO - MMWR Morb. Mortal. Wkly. Rep. VL - 65 IS - 29 N2 - CDC has updated its interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure, to include the emerging data indicating that Zika virus RNA can be detected for prolonged periods in some pregnant women. To increase the proportion of pregnant women with Zika virus infection who receive a definitive diagnosis, CDC recommends expanding real-time reverse transcription-polymerase chain reaction (rRT-PCR) testing. Possible exposures to Zika virus include travel to or residence in an area with active Zika virus transmission, or sex* with a partner who has traveled to or resides in an area with active Zika virus transmission without using condoms or other barrier methods to prevent infection.(†) Testing recommendations for pregnant women with possible Zika virus exposure who report clinical illness consistent with Zika virus disease(§) (symptomatic pregnant women) are the same, regardless of their level of exposure (i.e., women with ongoing risk for possible exposure, including residence in or frequent travel to an area with active Zika virus transmission, as well as women living in areas without Zika virus transmission who travel to an area with active Zika virus transmission, or have unprotected sex with a partner who traveled to or resides in an area with active Zika virus transmission). Symptomatic pregnant women who are evaluated <2 weeks after symptom onset should receive serum and urine Zika virus rRT-PCR testing. Symptomatic pregnant women who are evaluated 2-12 weeks after symptom onset should first receive a Zika virus immunoglobulin (IgM) antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR testing should be performed. Testing recommendations for pregnant women with possible Zika virus exposure who do not report clinical illness consistent with Zika virus disease (asymptomatic pregnant women) differ based on the circumstances of possible exposure. For asymptomatic pregnant women who live in areas without active Zika virus transmission and who are evaluated <2 weeks after last possible exposure, rRT-PCR testing should be performed. If the rRT-PCR result is negative, a Zika virus IgM antibody test should be performed 2-12 weeks after the exposure. Asymptomatic pregnant women who do not live in an area with active Zika virus transmission, who are first evaluated 2-12 weeks after their last possible exposure should first receive a Zika virus IgM antibody test; if the IgM antibody test result is positive or equivocal, serum and urine rRT-PCR should be performed. Asymptomatic pregnant women with ongoing risk for exposure to Zika virus should receive Zika virus IgM antibody testing as part of routine obstetric care during the first and second trimesters; immediate rRT-PCR testing should be performed when IgM antibody test results are positive or equivocal. This guidance also provides updated recommendations for the clinical management of pregnant women with confirmed or possible Zika virus infection. These recommendations will be updated when additional data become available. SN - 1545-861X UR - https://www.unboundmedicine.com/medline/citation/27467820/Update:_Interim_Guidance_for_Health_Care_Providers_Caring_for_Pregnant_Women_with_Possible_Zika_Virus_Exposure___United_States_July_2016_ L2 - https://dx.doi.org/10.15585/mmwr.mm6529e1 DB - PRIME DP - Unbound Medicine ER -