The CDC sets up a registry to document the disease in pregnancy and infants. Plus: A look at Zika, HIV infection. Also, Zika care standards updated.
CDC Pregnancy Registry documents Zika in pregnancy, infants
The Centers for Disease Control and Prevention (CDC) is collaborating with health departments and officials around the country to create the US Zika Pregnancy Registry, a vehicle to collect and analyze information about pregnancy and infant outcomes following laboratory evidence of Zika virus infection during pregnancy.
The Registry is based on tools developed and used in Puerto Rico to track Zika and its impact on pregnant women and their children. It is open to pregnant women in the United States, territories, and freely-associated states. The women may be symptomatic or asymptomatic, but they must have positive or equivocal test results for Zika virus infection and infants who have been periconceptionally, prenatally, or perinatally exposed to the virus. The Registry is also open to infants with laboratory evidence of congenital Zika infection, either symptomatic or asymptomatic, and their mothers.
Healthcare providers can play an active role in the Pregnancy Registry by collecting pertinent clinical information from pregnant patients and reporting that information to the state, tribal, local, or territorial health offices or to the CDC.
· Identify pregnant women who may have been exposed to Zika virus. Ask about travel to infected areas or sexual contact with men who live in or who have traveled to infected areas. For patients with a positive history, arrange laboratory testing for Zika virus infection (Figures 1 and 2).
· Use the Pregnancy and Zika Virus Disease Surveillance forms from the Pregnancy Registry to report women who display laboratory evidence of Zika virus or infants with laboratory evidence of congenital Zika virus infection.
· Collect follow-up information about the women, their pregnancies, and the infants, including infants who appear to be healthy at birth – short- and long-term effects of in utero Zika exposure are part of the study.
· Notify the health department or the Registry of adverse events such as spontaneous abortion, fetal death, or the presence of birth defects.
According to the standards of the US Zika Pregnancy Registry, laboratory evidence of possible Zika virus infection includes:
· Detection of recent Zika virus infection by ZIKA RNA nucleic acid test (NAT) on any maternal or fetal/infant clinical specimen.
· Detection of recent Zika virus or flavivirus infection by serologic tests of maternal or infant serum or cerebrospinal fluid.
· Confirmation of Zika virus infection in any test of maternal or fetal/infant clinical specimen.
The CDC evaluates all data received and updates statistics for the Pregnancy Registry on a weekly basis. The data will be used as a source to improve measures to prevent Zika infection during pregnancy and to update clinical guidelines for patient care. Providing services and support for the pregnant women and families affected by Zika virus is also a priority.
1. US Zika Pregnancy Registry. CDC website. https://www.cdc.gov/zika/reporting/registry.html. Accessed July 28, 2017
Study: Zika, HIV coinfection
The National Institutes of Health (NIH) has launched a prospective study to determine if coinfection with Zika virus and human immunodeficiency virus (HIV) in pregnant women increases the risk of mother-to-child transmission (MTCT) or exacerbates the effects of either disease on the child. This study was inspired by past research showing women with coinfections of syphilis and herpes simplex virus 2 (HSV-2) also demonstrated an increase in the number of fetal infections of HSV-2.
Researchers from the Eunice Kennedy Shriver National Institute of Child Health and Human Development are concerned that treatment for Zika virus may interfere with the effectiveness of medications normally given to pregnant women to decrease the chance of MTCT. They also hope to document if coinfection increases risk of damage to the fetal brain, as seen with Zika.
The study will consist of pregnant women infected with HIV or Zika virus alone or in combination, and women not infected with either virus. All women will be monitored throughout their pregnancies and for 6 months after birth. Their infants will be monitored for 1 year.
Researchers hope that the results of their study will help guide patient care standards, especially in those areas where HIV infection is widespread. In addition, they hope to obtain information sufficient to determine whether other infections such as Dengue Fever or other flaviviruses may also potentiate the impact of Zika virus.
The entire project is expected to run from 4 to 6 years and include 2000 women in the United States and Brazil.
1. NIH launches prospective study of Zika and HIV co-infection during pregnancy. Eunice Kennedy Shriver National Institute of Child Health and Human Development website.
2. Castles, T. NIH to Study Zika and HIV in Pregnant Women. Contagion Live, Infectious Diseases Today website. July 12, 2017.
Update to Zika care standards
The Centers for Disease Control and Prevention (CDC) have issued updated guidelines for the care of pregnant women with possible Zika virus exposure. These updates were recently published due to a noted decrease in the incidence of Zika virus disease in the Americas, evidence that the IgM antibodies persist in the body over 12 weeks after Zika infection and a high false positive rate of IgM assays.
HIGHLIGHTS OF THE UPDATES INCLUDE:
1. All pregnant women should be asked at every prenatal visit about possible exposure to Zika virus that may have occurred before or during the current pregnancy.
2. All pregnant women with recent possible Zika virus exposure and symptoms of infection should be tested with both Zika virus nucleic acid test (NAT) and serologic studies to determine a diagnosis.
3. Asymptomatic pregnant women with ongoing Zika virus exposure should be offered nucleic acid testing (NAT testing) 3 times during pregnancy.
4. Routine testing is not recommended for asymptomatic patients with recent, but not ongoing, exposure to Zika virus (ie, through travel or sexual exposure), although testing should be considered using a shared patient-provider decision-making model
5. Pregnant women with possible Zika virus exposure and a fetus with ultrasound fi ndings that are consistent with congenital Zika virus syndrome should be tested for Zika virus with both NAT and serologies.
6. Preconception testing to determine baseline IgM levels in patients with possible ongoing exposure to Zika virus is not necessary.
Full information on the updated guidelines can be found at the CDC website - https://www.cdc.gov/mmwr/volumes/66/wr/mm6629e1.htm?s_cid=mm6629e1_w