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Pregnant Women Living in Areas with Active Zika Virus Transmission

Why is testing recommended for all pregnant women in areas with active Zika virus transmission?

Pregnant women living in areas with active Zika virus transmission are at risk of Zika virus infection throughout their pregnancy. Pregnant women should be tested for Zika virus infection if symptoms develop. For asymptomatic pregnant living in areas with active Zika virus transmission, testing is recommended as part of routine obstetric care during the first and second trimesters. Local health officials should determine when to implement testing of asymptomatic pregnant women on the basis of information about levels of Zika virus transmission and laboratory capacity.

When should pregnant women living in areas with active Zika virus transmission be tested if they have symptoms consistent with Zika virus infection?

  • For pregnant women with at least one symptom consistent with Zika virus disease (symptomatic), RNA NAT (nucleic acid testing) of serum and urine is recommended up to 2 weeks after symptom onset.
  • Symptomatic pregnant women who seek care 2-12 weeks after symptom onset should have Zika virus and dengue virus IgM testing performed with RNA NAT testing if IgM is positive, followed by PRNT if indicated.

Does a prior negative Zika virus test result obviate repeat testing if new symptoms consistent with Zika virus develop later on?

No. If new symptoms develop, a prior negative test for Zika virus does not rule out current infection. If new symptoms develop, a pregnant woman should be retested.

  • Up to 2 weeks after symptom onset, viral RNA can be identified in serum and urine, and RNA NAT is the preferred test.
  • Because of the decline in the level of viremia over time and possible inaccuracy in reporting of dates of illness onset, a negative RNA NAT on specimens collected during this testing window does not exclude Zika virus infection. Serologic (IgM) testing should be performed with PRNT if indicated.
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