The U.S. Centres for Disease Control and Prevention (CDC) has released interim guidelines for the treatment and management of pregnant women during a Zika virus outbreak (MMWR. 2016 Jan 19;65[Early Release]:1-4). One key symptom of the infection that may be observed clinically is maculopapular rash.
The guidelines recommend that health care providers should ask all pregnant women about recent travel and should have pregnant women tested for Zika virus if they have two or more symptoms consistent with the virus, which include maculopapular rash, acute onset of fever, arthralgia, or conjunctivitis. Women should also been tested if they have ultrasound findings of fetal microcephaly or intracranial calcifications.
Zika virus is a mosquito-borne virus transmitted primarily by Aedes aegypti mosquitoes. An estimated 80% of persons infected with Zika virus are asymptomatic. Symptomatic disease is generally mild and symptoms usually last from several days to one week, according to the CDC.
The CDC has issued a travel alert for 14 countries and territories in Central American, South America, and the Carribean. “This alert follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant,” said the CDC in a media statement.
“Zika virus infections have been confirmed in infants with microcephaly, and in the current outbreak in Brazil, a marked increase in the number of infants born with microcephaly has been reported,” state the authors of the guidelines. “The full spectrum of outcomes that might be associated with Zika virus infections during pregnancy is unknown and requires further investigation.”
Currently, as there is neither a vaccine nor prophylatic medications available to prevent Zika virus infection, the CDC recommends that pregnant women consider postponing travel to areas where Zika virus transmission is ongoing.
“If a pregnant woman travels to an area with Zika virus transmission, she should be advised to strictly follow steps to avoid mosquito bites,” said the investigators. “Mosquito prevention strategies include wearing long-sleeved shirts and long pants, using . . . insect repellents, using permethrin-treated clothing and gear, and staying and sleeping in screened-in or air-conditioned rooms. When used as directed on the product label, insect repellents containing DEET, picaridin, and IR3535 are safe for pregnant women.”
Treatment of Zika virus disease is supportive, note the CDC, and include rest, fluids, and use of analgesics and antipyretics; and fever should be treated with acetaminophen. The CDC recommends that in a pregnant woman with laboratory evidence of Zika virus should receive ultrasounds every three to four weeks to closely monitor fetal anatomy and growth.
In a travel health notice, The Public Heath Agency of Canada note that there have been travel-related cases of Zika virus reported in Canada in returned travellers from countries where the virus is known to circulate. “There have been no reported cases of locally acquired Zika virus in Canada.”