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Postnatal Care

Zika virus testing is recommended for infants born to women with laboratory evidence of confirmed or probable Zika virus infection regardless of the presence or absence of phenotypic abnormalities.

Pathologic evaluation of fetal tissue specimens (e.g., placenta and umbilical cord), is another important diagnostic tool to establish the presence of maternal or congenital Zika virus infection and can provide a definitive diagnosis of Zika virus infection among pregnant women whose serology results indicate recent unspecified flavivirus infection. In addition, findings from pathologic evaluation might also be helpful in evaluating pregnant women who seek care >12 weeks after symptom onset or possible exposure.

Clinical Management of Pregnant Women with Possible Zika Virus Infection

Interpretation of laboratory results* Postnatal management
  • Recent Zika virus infection
  • Recent flavivirus infection; specific virus cannot be identified

Live births: Infant serum and urine should be tested for Zika virus by RNA NAT, and for Zika IgM and dengue virus IgM antibodies. If CSF is obtained for other reasons, it can also be tested. Zika virus RNA NAT and IHC staining of umbilical cord and placenta are recommended.

Fetal losses: Zika virus RNA NAT and IHC staining of fetal tissues are recommended.

  • Presumptive recent Zika virus infection**
  • Presumptive recent flavivirus infection**

Live births: Infant serum and urine should be tested for Zika virus by RNA NAT, and for Zika virus IgM and dengue virus IgM antibodies. If CSF is obtained for other reasons, it can also be tested. Zika virus RNA NAT and IHC staining of umbilical cord and placenta should be considered.

Fetal losses: Zika virus RNA NAT and IHC staining of fetal tissues should be considered.

  • Recent dengue virus infection
Clinical management in accordance with existing guidelines.
  • No evidence of Zika virus or dengue virus infection

Prenatal ultrasound to evaluate for fetal abnormalities consistent with congenital Zika virus syndrome.††

Fetal abnormalities present: repeat Zika virus RNA NAT and IgM test; base clinical management on corresponding laboratory results.

Fetal abnormalities absent: base obstetric care on the ongoing risk for Zika virus exposure risk to the pregnant woman.

Abbreviations: CSF = cerebrospinal fluid; IgM = immunoglobulin M; IHC = immunohistochemical; PRNT = plaque reduction neutralization test; RNA NAT = RNA nucleic acid testing

Footnotes

* Refer to the previously published guidance for testing interpretation.

** rRT-PCR or PRNT should be performed for positive or equivocal IgM results as indicated. PRNT results that indicate recent flavivirus infection should be interpreted in the context of the currently circulating flaviviruses. Refer to the laboratory guidance for updated testing recommendations. Because of the overlap of symptoms and areas where other viral illnesses are endemic, evaluate for possible dengue or chikungunya virus infection.

Refer to pathology guidance for collection and submission of fetal tissues for Zika virus testing for detailed information on recommended specimen types.

http://apps.who.int/iris/bitstream/10665/44188/1/9789241547871_eng.pdf [PDF - 1.5 MB].

†† Fetal abnormalities consistent with congenital Zika virus syndrome include microcephaly, intracranial calcifications, and brain and eye abnormalities.

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