From: Pennsylvania Health Alert Network
Re: 394 - 12/18/17 - ADV - Updated Guidance for the Evaluation and Management of Pregnant Women and Infants with Possible Zika Virus Exposure

PDF Document:  2017-PAHAN-394-12-18-ADV_Zika_Update.pdf

Message:

Beginning January 1, 2018, the Pennsylvania Department of Health (DOH) does NOT recommend routine Zika virus testing for:
 

• Asymptomatic pregnant women with recent* possible Zika virus exposure (i.e., through travel or sexual exposure) but without ongoing** possible exposure.

 

• Infants without clinical findings consistent with Congenital Zika Syndrome (https://www.cdc.gov/zika/hc-providers/infants-children/zika-syndrome-birth-defects.html) born to mothers with possible Zika virus exposure in pregnancy but without laboratory evidence of possible Zika virus infection.

 
Pregnant Women
On July 24, 2017, CDC released updated Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure – United States and U.S. Territories (https://www.cdc.gov/mmwr/volumes/66/wr/mm6629e1.htm). These recommendations updated prior CDC guidance in response to two developments in the Zika outbreak. First, the number of people with Zika virus infection in the Americas continues to decrease. A lower incidence of disease may lead to a higher proportion of false-positive test results. Second, emerging data show that Zika virus IgM antibodies can persist for months in some pregnant women, making it difficult for healthcare providers to use Zika IgM test results to determine whether an infection occurred during or before the current pregnancy. Due to these developments, Zika virus testing is no longer routinely recommended for asymptomatic pregnant women with recent possible Zika virus exposure, but without ongoing exposure. Testing is still recommended for symptomatic pregnant women with possible Zika virus exposure. 
 
*For the purposes of this guidance, recent possible Zika virus exposure is defined as a possible exposure during the current pregnancy or periconceptional period (i.e., 8 weeks before conception or 6 weeks before the last menstrual period).
 
**Persons with ongoing possible Zika virus exposure include those who reside in or frequently travel (e.g., daily or weekly) to an area with risk for Zika virus transmission. This may also include those who do not travel, but have a sex partner who lives in or travels frequently to an area with risk for Zika virus transmission.
 
Possible exposures include traveling to areas with local mosquito-borne transmission of Zika virus (https://www.cdc.gov/zika/geo/index.html) and sexual contact with a person infected with Zika virus. For testing to be useful, exposure to Zika virus should have occurred within the past 12 weeks from the testing date.
 
Infants
On October 20, 2017, CDC released updated Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection— United States, October 2017
(https://www.cdc.gov/mmwr/volumes/66/wr/mm6641a1.htm).
 

• For infants with clinical findings consistent with congenital Zika syndrome regardless of maternal testing results, recommendations include:

     ~Zika virus testing
     ~Cranial ultrasound
     ~Comprehensive ophthalmologic exam by age 1 month
     ~Automated auditory brainstem response exam by age 1 month
     ~Consider referrals to Early Intervention and additional multi-disciplinary specialists
 
 

• For infants without clinical findings consistent with congenital Zika syndrome who were born to mothers with laboratory evidence of possible Zika virus infection, recommendations include:

     ~Zika virus testing
     ~Cranial ultrasound
     ~Comprehensive ophthalmologic exam by age 1 month
     ~Automated auditory brainstem response exam by age 1 month
 
 

• For infants without clinical findings consistent with congenital Zika syndrome who were born to mothers without laboratory evidence of possible Zika virus infection:

     ~Zika virus testing is not routinely recommended
 
 
Further guidance for the evaluation and management for infants with possible congenital Zika infection can be found here: https://www.cdc.gov/zika/pdfs/pediatric-evaluation-follow-up-tool.pdf 
 
Zika virus testing is available through commercial laboratories and the DOH Bureau of Laboratories (the state public health laboratory). For assistance with testing and other Zika virus-related questions, contact your local health department or DOH at 1-877-PA-HEALTH. Reminder that submission of specimens for testing at DOH requires approval by your local health department.
  Agency ID: 2.16.840.1.114222.4.3.2.2.3.657.1
Alert Title: 394 - 12/18/17 - ADV - Updated Guidance for the Evaluation and Management of Pregnant Women and Infants with Possible Zika Virus Exposure
Agency Name: Pennsylvania Department of Health
Agency Abbreviation: PA
Alert Program: Pennsylvania Health Alert Network
Alert Identifier: 394
Send Time: UTC
Severity: Moderate
Acknowledge: Yes
Delivery Time: Within 15 minutes
Sensitive: No
Status: Actual
Message Type: Alert
Reference Alert:
Jurisdiction: 42
Jurisdiction Level: State
Role: HAN Coordinator ****
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Thank you,
Pennsylvania Health Alert Network