title: 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.
authors.forename: Titilope
authors.initials: T
authors.lastname: Oduyebo
authors.forename: Irogue
authors.initials: I
authors.lastname: Igbinosa
authors.forename: Emily E
authors.initials: EE
authors.lastname: Petersen
authors.forename: Kara N D
authors.initials: KN
authors.lastname: Polen
authors.forename: Satish K
authors.initials: SK
authors.lastname: Pillai
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ailes
authors.forename: Julie M
authors.initials: JM
authors.lastname: Villanueva
authors.forename: Kim
authors.initials: K
authors.lastname: Newsome
authors.forename: Marc
authors.initials: M
authors.lastname: Fischer
authors.forename: Priya M
authors.initials: PM
authors.lastname: Gupta
authors.forename: Ann M
authors.initials: AM
authors.lastname: Powers
authors.forename: Margaret
authors.initials: M
authors.lastname: Lampe
authors.forename: Susan
authors.initials: S
authors.lastname: Hills
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Arnold
authors.forename: Laura E
authors.initials: LE
authors.lastname: Rose
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Shapiro-Mendoza
authors.forename: Charles B
authors.initials: CB
authors.lastname: Beard
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Muñoz
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Rao
authors.forename: Dana
authors.initials: D
authors.lastname: Meaney-Delman
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Honein
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D003955:Diagnostic Tests, Routine / Q000592:standards*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D012367:RNA, Viral / Q000097:blood; D012111:Residence Characteristics / Q000706:statistics & numerical data; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014195:Travel / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D000071243:Zika Virus Infection / Q000517:prevention & control* / Q000635:transmission
chemical_list: D007075:Immunoglobulin M; D012367:RNA, Viral