Zika Virus screened-in or air-conditioned facilities. When used properly, insect repellents containing DEET, picaridin, and IR3535 are considered safe for pregnant women.(193) The approach to Zika virus identification in maternal serum involves reverse transcription-polymerase chain reaction (RT-PCR) testing for symptomatic patients with onset of symptoms within a one week period-of-time. Immunoglobulin M (IgM) and neutralizing antibody testing should also be performed on specimens collected > 4 days after onset of symptoms. Antibody cross-reactivity with related flaviviruses (e.g., dengue or yellow fever) is common, and may result in diagnostic uncertainty. Given the similar geographic distributions and clinical presentations, selective consideration should be given to a concomitant evaluation for dengue and chikungunya infections. Testing of asymptomatic pregnant women is not recommended in the absence of ultrasoundidentified fetal microcephaly or other related intracranial abnormalities.(194) Preliminary data suggests Zika virus RT-PCR testing can be performed on amniotic fluid samples. However, the sensitivity and specificity for establishing a congenital infection diagnosis has not yet been determined. Similarly, it is at present undetermined if a positive result is predictive of a subsequent fetal abnormality, or what proportion of neonates born after infection will have symptomatic disease.(194) The CDC recommends that for a live birth with evidence of maternal or fetal Zika virus infection, the following tests be undertaken: 路 histopathologic examination of the placenta and umbilical cord; 路 testing of frozen placental tissue or cord tissue for Zika virus RNA; 路 testing of cord blood for Zika and dengue virus IgM and neutralizing antibodies. Since most commercial laboratories do not routinely run these studies, coordinated efforts should be undertaken with governmental health agencies. If a pregnancy results in a fetal loss in a symptomatic women with a travel history to an endemic area during or within 2 weeks of travel, or there is a finding of fetal microcephaly, Zika virus RTPCR and immunohistochemical staining should be performed on fetal tissues, umbilical cord and placenta.(194) No specific antiviral therapy is available for Zika virus infection. Treatment is generally supportive and can include rest, fluids, and use of analgesics and antipyretics. In a pregnant woman with laboratory evidence of Zika virus in serum or amniotic fluid, serial ultrasound scans should be considered to monitor fetal anatomy and growth through the remainder of the pregnancy.(194) Weblink: wwwnc.cdc.gov/travel/notices
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