The Texas Medical Association and the Texas Association of Obstetricians and Gynecologists have prepared the following information on Zika virus and pregnant patients.
Serious birth defects including congenital microcephaly have been reported in babies of mothers who were infected with Zika virus while pregnant. Information on these outcomes related to Zika is evolving, but until more is known, the Centers for Disease Control and Prevention (CDC) recommends special precautions for pregnant women and women who are trying to become pregnant.
Discuss travel. Zika is transmitted primarily through the bite of infected Aedes aegypti mosquitoes, the same mosquitoes that spread chikungunya and dengue. Anyone living in or traveling to an area where Zika virus is found is at risk for infection. (See the list of affected areas below.) Perinatal, sexual, and transfusion transmission events also have been reported.
Ask all pregnant women about recent travel and about recent or planned travel by their sexual partners.
Screen. About one in five people infected with Zika will get sick. For people who get sick, the illness is usually mild. For this reason, many people might not realize they have been infected.
The most common symptoms of Zika virus disease are fever, rash, joint pain, or conjunctivitis (red eyes). Symptoms typically begin two to seven days after being bitten by an infected mosquito.
Urge your sick patients to stay indoors to help prevent others from getting sick. Encourage them to stay home from work or school to avoid mosquito bites for seven days from the onset of symptoms.
Physicians should report suspected Zika virus disease cases to their regional or local health department to facilitate diagnosis and mitigate the risk of local transmission.
If your patient screens positive: At this time, polymerase chain reaction (PCR) and serologic testing in Texas is referred to CDC. To discuss, contact your local or regional public health office:
Test these patients who meet epidemiological testing criteria:
- Asymptomatic pregnant women who traveled to an area with ongoing Zika virus transmission, within two to 12 weeks after returning from travel;
- Any patient with two or more symptoms compatible with Zika virus infection, within two weeks of travel to area with Zika virus transmission;
- Patients with symptoms of Guillain-Barre syndrome, within one month of travel to an area with Zika virus transmission;
- Infants born to women with positive or inconclusive test results for Zika virus infection; and
- Infants with microcephaly or intracranial calcification born to women who have traveled to an area with Zika virus transmission while pregnant.
Patients with compatible illness who do not meet above testing criteria, but for whom there may be concern for alternate modes of transmission should be discussed for case-by-case evaluation.
If your patient tests positive: No specific antiviral treatment is available for Zika virus disease.
Fetal evaluation is recommended in all exposed women with symptoms regardless of maternal testing results.
Because of the similar geographic distribution and clinical presentation of Zika, dengue, and chikungunya virus infection, patients with symptoms consistent with Zika virus disease also should be evaluated for dengue and chikungunya virus infection, in accordance with existing guidelines.
Discuss prevention: Post a sign to remind patients to discuss travel plans with the physician. CDC recommends that all pregnant women consider postponing travel to areas where Zika virus transmission is ongoing:
Commonwealth of Puerto Rico
U.S. Virgin Islands
This virus can spread through sexual contact, so it is important that patients AND PARTNERS attempt to reduce risk of infection.
For men and pregnant partners: CDC recommends that men who live in or have traveled to an area with Zika virus transmission abstain from sexual activity or consistently and correctly use condoms during sex.
For men with nonpregnant partners: Men who reside in or have traveled to an area of active Zika virus transmission and are concerned about sexual transmission of Zika virus should consider abstaining from sexual activity or using condoms consistently and correctly during sex. After infection, Zika virus might persist in semen when it is no longer detectable in blood.
Mosquito bite prevention is always a good idea to protect from this and other viruses. DEET is safe for women to use during pregnancy. Help your patients and their family understand all the safe ways to protect themselves — including the use of DEET.
- U.S. Centers for Disease Control and Prevention at cdc.gov/zika
- Texas Department of State Health Services at texaszika.org
- Signage for office settings:
Questions? Contact the TMA Knowledge Center at (800) 880-7955 or knowledge[at]texmed[dot]org.
A. Tomas Garcia III, MD
Texas Medical Association
Kimberly Carter, MD
Texas Association of Obstetricians and Gynecologists
 CDC interim guidelines for pregnant women during a Zika virus outbreak — United States, 2016. www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm.
 CDC. Update: Interim Guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure — United States, 2016. www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er.htm_w.
 CDC. http://www.cdc.gov/zika/geo/index.html.
 ACOG, SMFM. Interim Guidance. www.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-Patients-During-a-Zika-Virus-Outbreak.
 CDC. CDC. Update: Interim Guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika virus exposure — United States, 2016. http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er.htm_w.
 CDC interim guidelines for prevention of sexual transmission of Zika virus— United States, 2016. www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_w.htm.