The Nurse Practitioner's Guide to Zika + Pregnancy

One of the few new stories to make headlines amidst political coverage over the past few weeks has been that of the Zika virus ravaging Central and South America. While the few cases of Zika identified in the United States have been acquired abroad, the virus is projected to arrive in the United States in the coming weeks or months. For most, Zika results only in mild illness. For pregnant women, however, catching the virus carries significant implications. 

Nurse practitioners can expect questions about the Zika virus from patients, especially those who are pregnant or thinking about becoming pregnant. Here's what NPs need to know about diagnosis, treatment, and monitoring for Zika in these patients. 

What is the Zika virus, anyway?

The Zika virus is a mosquito-transmitted infection related to dengue, yellow fever and West Nile virus. The virus was discovered in 1947 in monkeys living in the Zika Forest in Uganda. Outbreaks of Zika have occurred in humans in the South Pacific islands and Africa intermittently since the discovery of the virus. In 2015, an outbreak of Zika appeared in Brazil. Over the past few months, transmission of the virus has been reported in multiple countries in South and Central America. Models predict that transmission of the Zika virus within the United States is likely. 

What's the problem with Zika?

The majority of individuals infected with the virus have no symptoms at all. About one out of five people infected experience mild symptoms including rash, fever, joint pain, and conjunctivitis. Symptoms appear two to seven days after been bitten by an infected mosquito. Treatment is supportive. The problem with Zika arises in that the virus has been associated with microcephaly in infants born to mothers infected with the virus. Data on the incidence of microcephaly in infants born to mothers who contract the virus is limited. So, women of child bearing age must take precautions to protect themselves in areas with active Zika transmission. 

Microcephaly and Zika

We do not yet know if the Zika virus can lead to acquired microcephaly, or microcephaly developing after birth. So far, all documented reports of microcephaly occurring with Zika infection have been congenital, occurring before birth. Microcephaly is diagnosed when an infant's head is smaller than expected as compared to infants of the same sex and gestational age. Brain size typically correlates with head size, the underdeveloped brain leading to long-term neurologic complications such as seizures, vision or hearing problems, and other developmental abnormalities. 

Do you need to test pregnant patients for Zika?

At this time, routine testing for Zika in pregnant women who have traveled to an area with known transmission is not recommended. False-positive results may occur with Zika testing due to the presence of antibodies against other related viruses causing undue concern. Availability of testing is also limited. Commercial testing is not available so testing must be coordinated with local health departments and the CDC. Testing for the Zika virus is recommended in pregnant women with clinical illness consistent with Zika virus during or within two weeks of travel to an area with Zika transmission. 

How should pregnant patients with possible Zika exposure be monitored?

Given that most patients infected with Zika display no symptoms at all, pregnant patients returning from an area with active Zika transmission should be monitored for the possibility of fetal complications. New CDC guidelines recommend fetal ultrasound to detect microcephaly or intracranial calcifications in all pregnant women with a history of travel to an area with Zika transmission. If findings are present, testing for the Zika virus is recommended. If findings are not present on the initial ultrasound, routine prenatal care should commence. 

The following monitoring algorithm provided by the CDC outlines these guidelines (updated 2/5/16). 

 

Can patients with a history of travel to an area of Zika transmission breastfeed?

The Zika virus has been detected in breast milk, however transmission of Zika from mother to infant through breast milk has not been documented. Based on current evidence, the CDC currently believes that the benefits of breastfeeding outweigh risk to the infant. Patients should be carefully counseled regarding the amount of knowledge related to Zika and breastfeeding.

Zika, Pregnancy, and Sexual Contact

Sexual transmission of the Zika virus from male to female partners has been documented. So, men with a pregnant partner who reside in or have traveled to an area with Zika transmission should consistently and correctly use protection or abstain from sexual contact with pregnant partners to avoid the possibility of transmission of the virus. Precautions should be taken throughout the entire course of the pregnancy. 

How can pregnant women protect themselves from the Zika virus?

Prevention from mosquito bites is the best form of Zika protection. Pregnant women should avoid travel to areas with active Zika transmission. If travel cannot be avoided, or, as Zika arrives in the United States, wearing pants and long sleeves can help protect from mosquito bites. Applying and reapplying insect repellant as recommended also helps protect pregnant patients. 

Guidelines for prevention of and monitoring for the Zika virus in pregnant patients is constantly developing as more information about the virus is gathered. Nurse practitioners must keep up to date with these changes to provide proper care for pregnant patients with potential exposure to the Zika virus. 

*Source: Centers for Disease Control and Prevention

 

Comments

How long is the Zika virus active in the body? Does it become dormant or does it resolve like someone with the flu?

Colette Greer Daniel