Zika Virus

Summary:

• The largest Zika virus outbreak to date is presently ongoing in the Americas (Brazil is defined as a High Risk country)
• In Brazil there are 16,447 cases of either confirmed or suspected cases of Zika virus infection in pregnant women (as of 2 November 2016)
• The vast majority of confirmed Zika cases are in Brazil (2,143 cases as of 17 November)
• To prevent transmission during pregnancy:

• advise pregnant women to avoid travel to regions with active transmission
• recommend that pregnant women with sexual partners who have traveled to or live in an area with active transmission use condoms to prevent congenital infection or abstain from sex during pregnancy
• Sexual transmission is possible and concern may be highest in pregnancy
• women who live in or cannot avoid travel to an area with active transmission should be educated on mosquito avoidance measures including:
  • wearing protective clothing
  • use of bed nets and insecticides
  • use of N,N-Diethyl-3-methylbenzamide (DEET)-based repellants are considered safe during pregnancy
• congenital anomalies described in association with maternal Zika virus infection include:
  • microcephaly and other brain defects
  • ocular lesions
  • miscarriage and stillbirth
• overall risk for congenital anomalies with maternal Zika virus infection is not known
  • specific risk for microcephaly with first trimester infection is estimated at 1%-13%
  •  congenital Zika virus infection is associated with microcephaly in infants
  • risk of congenital anomalies appears to be highest when infection is acquired in the first trimester
• travel-related cases of maternal infection reported from other countries:
  • 1 case with severe neurologic congenital anomalies in Canadian woman (timing and site of Zika virus infection not reported) (PAHO Zika Update 2016 Aug 11)
  • 1 case in 17-week pregnant woman with serologically confirmed recent Zika virus infection who traveled to Spain from Venezuela, where she had reported generalized skin rash at 11 weeks gestation (Euro Surveill 2016 Jun 16;21(24) early online full-text)
  • 1 case in 33-year-old Finnish woman who acquired symptomatic Zika virus infection after traveling to endemic areas (Mexico and Central America) at 11 weeks gestation (N Engl J Med 2016 Jun 2;374(22):2142)
  • 1 case in 25-year-old woman in Slovenia who acquired symptomatic Zika virus infection at 13 weeks of gestation while residing in Brazil (N Engl J Med 2016 Mar 10;374(10):951), editorial can be found in N Engl J Med 2016 Mar 10;374(10):984Source: DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 910450, Zika virus in pregnancy and congenital Zika syndrome; [updated 2016 Nov 01, cited 18/11/2016]; [about 23 screens]. Available from http://search.ebscohost.com/login.aspx?direct=true&db=dnh&AN=910450&site=dynamed-live&scope=site . Registration and login required.

    Other useful Sources:

• Public Health England – Zika and Pregnancy
• The RCOG has a Q&A page on Zika and Pregnancy
• National Travel and Health Network and Centre (NaTHNaC) advice for pregnant women
• NHS Choices advice for pregnant wome