Guidance for Health Care Providers Caring for Women of Reproductive Age with Possible Zika Virus Exposure

Table of Content

Introduction

Interim guidance for U.S. health care providers caring for women of reproductive age with possible Zika virus exposure has been updated by CDC. These guidelines include recommendations on preconception counselling for men and women, testing of men and women attempting conception, for women undergoing fertility treatment and for testing of pregnant women.

Preconception Counselling for Men and Women with Possible Exposure to Zika Virus who do not Reside in an Area with Active Zika Virus Transmission

Preconception counselling should be provided by the health care providers to men and women with possible Zika virus exposure. Until the risk for sexual transmission is believed to be minimal, men and their female partners should wait to attempt conception. Health care providers should discuss the signs and symptoms of Zika virus disease and the potential adverse outcomes associated with Zika virus infection in pregnancy. Women with Zika virus disease should wait until at least 8 weeks after symptom onset before attempting conception and men should wait at least 6 months after symptom onset. Asymptomatic men and women with possible exposure of Zika virus should wait for at least 8 weeks after the last date of exposure before attempting conception. Strategies to prevent unintended pregnancy with the use of effective contraceptive methods and correct and consistent use of condoms should be informed by the health care providers.

Preconception Counselling for Men and Women Residing in Areas with Active Zika Virus Transmission

It is advisable that women with Zika virus disease should wait for at least 8 weeks from symptoms onset and men should wait at least 6 months from symptoms onset before attempting conception. Women and their partners should plan their pregnancies and should talk to their health care providers about the same. Risk for active Zika virus transmission, reproductive life plan of the patient, timing of pregnancy, fertility, age, reproductive history should be discussed with the health care provider. Strategies to prevent unintended pregnancy with the use of effective contraceptive methods and correct and consistent use of condoms should be informed by the health care providers.

Testing of Persons Attempting Conception

If the following signs or symptoms develop within 2 weeks of possible exposure to Zika virus, testing of serum should be performed: acute onset of fever, rash, arthralgia or conjunctivitis. In men and women who are attempting conception who have possible Zika virus exposure but no clinical illness, routing testing is not currently recommended.

Special Considerations for Women Undergoing Fertility Treatment

No instance of transmission of Zika virus during fertility treatment has been documented. Timing of pregnancy should be taken into consideration in couples who are using their own gametes and embryos. Guidance for donated tissues including donated sperm, oocytes and embryos has been developed by the Food and Drug Administration, which states the following –

  • Living donors will be deemed ineligible for anonymous donation if they have any of the following risk factors:
  • medical diagnosis of Zika virus infection in the past 6 months;
  • residence in or travel to an area with active Zika virus transmission within the past 6 months; or within the past 6 months had sex with a male partner who, during the 6 months before this sexual contact, received a diagnosis of or experienced an illness consistent with Zika virus disease, or had traveled to an area of active Zika virus transmission

Directed (or known) donors must undergo the same evaluation and eligibility determination as anonymous donors. If the tissue is properly labelled to indicate potential increased risk, all participating parties are aware of and willing to incur the risk, and physicians are aware of the status of gametes or embryos, then  gametes or embryos from directed donors who are ineligible may be used, as per FDA guidance. Recipients should be informed and counselled about the potential risks before use of donated tissue, as per the recommendations.

Testing of Pregnant Women with Possible Zika Virus Exposure

Zika virus RNA can be detected for prolonged periods in some pregnant women. These recommendations extend the timeframe for rRT-PCT testing of serum and include rRT-PCR testing for some asymptomatic pregnant women. It also recommends that all pregnant women in the United States and U.S. territories should be assessed for possible Zika virus exposure at each prenatal care visit.

Symptomatic & Asymptomatic Pregnant Women

If the signs or symptoms consistent with Zika virus disease (acute onset of fever, rash, arthralgia, conjunctivitis) are reported by pregnant women, then they should be tested for Zika virus infection.

PRNT – plaque reduction neutralization test; IgM – immunoglobulin; rRT-PCR – real-time reverse transcription polymerase chain reaction

Prenatal Management of Pregnant Women with Laboratory Evidence of Confirmed or Possible Zika Virus Infection

Serial foetal ultrasounds should be considered every 3-4 weeks. Consideration for amniocentesis should be individualized.

Postnatal Management of Pregnant Women with Laboratory Evidence of Confirmed or Possible Zika Virus Infection

Cord blood testing, pathological evaluation of foetal tissue specimens (placenta and umbilical cord), Zika virus RNA in tissue specimens including placenta and foetal brain can be performed. A positive rRT-PCR or immunohistochemical staining on the placenta indicates the presence of maternal infection.

http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_w.htmLast accessed on 17-08-2016

http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e . Last accessed on 17-08-2016