Zika Virus UPDATE
March 4th, 2016.
Department of Obstetrics and Gynaecology - University of Toronto. Version #3
Zika virus information and screening recommendations
Zika virus is a mosquito-borne flavivirus. Fetuses exposed to Zika are believed to be at risk of congenital abnormalities, specifically intracranial calcifications and microcephaly.
Symptoms of Zika may develop between 3 and 12 days following bites from infected mosquitoes and include fever, rash, joint pains and conjunctivitis. However, 80% of infections are asymptomatic. Individuals mount an immune response, first IgM antibodies, approximately 4-14 days following exposure and then IgG antibodies.
Most people exposed to Zika develop immunity without further sequelae, however it appears that 1-5 in 10,000 go on to develop Guillain-Barré syndrome.
Countries at risk and where CDC has issued a travel advisory currently include: Barbados, Bolivia, Brazil, Colombia, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, St. Martine, Suriname, Venezuela and Puerto Rico. This list is being frequently updated.
Testing Recommendations:
- Serologic testing for all pregnant individuals (symptomatic or not) who have traveled to a Zika affected area within the last 12 weeks.
- PCR testing (whole blood & urine) and serology testing for acutely ill pregnant individuals who have or have had symptoms (fever, rash, joint pains, conjunctivitis) compatible with Zika virus infection within 2 weeks of travel to an endemic area and within 2 weeks of the symptoms.
- Consider amniocentesis for individuals who test positive for Zika virus and/or for those with travel history and whose fetus demonstrates signs of fetal infection (intracranial calcifications, microcephaly).
Recommendations:
- Pregnant individuals who test positive for Zika virus should be referred to a Maternal Fetal Medicine Specialist or Reproductive Infectious Disease Specialist.
- For pregnant individuals, who have traveled to a Zika affected area and test negative for Zika virus, consideration should be given for an ultrasound assessment between 28-32 weeks and 34-36 weeks.
- Male partners of pregnant women who have traveled to a Zika affected area should use condoms with sexual activity for the remainder of the pregnancy.
Travel Recommendations:
- Pregnant individuals should AVOID travel to Zika affected areas. Currently there is NO treatment.
- If pregnant, avoid mosquito bites. Wear long sleeved shirts, pants and bug repellent with DEET in mosquito infested areas.
References: