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 The new guidelines, first reported by Reuters, lay out
recommendations for doctors whose pregnant patients have traveled to
areas with Zika virus transmission.
They follow a travel advisory issued by the CDC on Friday warning
pregnant women to avoid travel to 14 countries and territories in
the Caribbean and Latin America affected by the virus.
In Brazil, Zika has been linked to a rising number of cases of
microcephaly, a condition associated with small head size and brain
damage. Tourism officials in that country have tried to play down
the risks as the country gears up for Carnivale and the 2016
Olympics, the first in South America.
On Saturday, health officials confirmed the birth of the first baby
born with microcephaly in the United States attributed to the virus.
The child was born in Hawaii to a mother who had become ill with
Zika virus while living in Brazil last May.
There is no vaccine or treatment for Zika, which causes mild fever
and rash. An estimated 80 percent of people infected with the virus
have no symptoms at all, making it difficult for pregnant women to
know whether they have been infected.
In its latest to doctors, the CDC urges providers to ask pregnant
women about their travel history. Women who have traveled to regions
in which Zika is active and who report symptoms during or within two
weeks of travel should be offered a test for Zika virus infection.
Those who test positive should be offered an ultrasound to check the
fetus's head size or check for calcium deposits in the brain, two
indicators of microcephaly. These women should also be offered a
test of their amniotic fluid called amniocentesis to confirm the
presence of Zika virus.
Pregnant women who traveled in areas where Zika is active but have
no clinical symptoms should also be offered an ultrasound, and women
whose fetus shows signs of microcephaly should also be offered
amniocentesis. Those with no positive findings should be offered
frequent ultrasounds to check for changes in the baby's head size.
Pregnant women with laboratory-confirmed evidence of Zika infection
should be offered ultrasounds every three to four weeks to monitor
fetal anatomy or growth. The CDC recommends that these women be
referred to a maternal-fetal medicine or infectious disease expert
with expertise in managing high-risk pregnancies.
EARLY DETECTION
While there is no treatment for microcephaly, early detection might
offer some women the option of terminating their pregnancies or to
have specialists on hand at delivery, said Dr. Laura Riley,
president of the Society for Maternal-Fetal Medicine, who has been
working with the CDC on the guidelines.
Riley, an expert in high-risk pregnancies who practices at
Massachusetts General Hospital in Boston, said she is writing
practice guidelines for the Society for Maternal-Fetal Medicine,
which will be released in partnership with The American College of
Obstetricians and Gynecologists. Riley said the guidelines could be
released as early as Wednesday.
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"We're going to be recommending people get an ultrasound. If that is
normal, great, but it needs to be followed up," Riley said.
Since the CDC issued its travel advisory, Riley said she has had
several calls to her practice from families asking whether they
should cancel their travel plans.
She also has had calls from worried patients who have already
traveled to countries with Zika outbreaks.
The guidelines will give doctors like her some answers for those
patients. Even so, there are many unknowns, Riley said.
For example, it is not clear how accurate a test of amniotic fluid
would be in detecting Zika infections, especially those that might
have occurred earlier during the pregnancy. In addition, even though
a child might show signs suggesting a smaller head size on an
ultrasound, that does not give doctors a clear picture of whether
the child will have extensive brain damage, Riley said.
And testing could be an issue. Currently, there are no commercially
available diagnostic tests for Zika infection. Tests to confirm Zika
will require advanced laboratory capabilities beyond what is
available in most local hospitals.
According to the guidelines, testing for Zika virus will be
performed by the CDC and several state health departments. Doctors
are urged to contact their state or local health department to
arrange for testing or to interpret results.
Despite the advice, experts admit there is still much about Zika
infections that is unknown.
"People are making educated guesses," said Paul Roepe, co-director
of the Center for Infectious Disease at Georgetown University
Medical Center.
For example, he said it is not clear how common Zika infection is in
pregnant women, or when during a pregnancy a woman is most at risk
of transmitting the virus to her fetus.
"Does it happen in first few weeks for the first trimester?I'm not
sure anybody really knows," he said.
(Reporting by Julie Steenhuysen; Editing by G Crosse and Jonathan
Oatis)
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