OGSS > For Professionals > Zika Virus and Pregnancy

Dear OGSS Members,

The "explosive" propagation of the Zika virus has very much been in the recent news. OGSS has prepared a short background and a list of useful sites where more information can be obtained. We hope you find this useful.

Best Regards

OGSS

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The Zika virus is a mosquito-borne single-stranded RNA virus related to Dengue virus. Significantly increasing  transmission has been noted in South and Central America over the past few months.

The virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito. Once infected, the incubation period for the virus is approximately 3-12 days.

Symptoms of the Zika virus disease are non-specific but may include fever, rash, arthralgia, and conjunctivitis. It is not currently known if pregnant woman are at greater risk of infection than non-pregnant individuals. However, it is possible that when contracted in pregnancy, the virus may lead to fetal microcephaly, although it is not yet clear whether this association is causal (although emerging evidence suggests that they may be) or whether additional factors are involved. In November 2015, the Brazilian Ministry of Health declared a public health emergency following reports of a 20-fold increase in the number of babies born with microcephaly, suggesting a potential link with the ongoing outbreak of the Zika virus infection in the region.

The Centers for Disease Control and Prevention (CDC) now recommend that all pregnant women should consider postponing travel to areas where the Zika virus transmission is ongoing, and this recommendation has been issued by a number of other countries including Singapore's Ministry of Health. If travel to affected areas cannot be avoided, one should undertake strict precautions against mosquito bites, and monitor their health on return to Singapore for the next 14 days and consult a doctor if symptoms of Zika are present.

As there have been increasing number of confirmed cases of sexual transmission of the Zika virus from infected men to their female partners, various health organisations have produced interim guidelines on how to reduce the risk of this particular mode of transmission. The RCOG's interim clinical guidelines recommend that if a woman's partner has travelled to a country with active Zika virus transmission, effective contraception is advised to avoid pregnancy (and the use of condoms could be considered to prevent against infection acquisition):

          - for 28 days after his return home if he had no Zika virus symptoms, either whilst abroad or within 2 weeks of his leaving the affected country

          - for 6 months following recovery if he did experience Zika virus symptoms during that period

In addition, with regards to ongoing pregnancies, CDC's interim guidelines have also recommended that men who reside in or have traveled to an area of ongoing Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex with their pregnant partner for the duration of the pregnancy.

While no cases of Zika virus infection have been detected in Singapore thus far, the possibility that there may be undetected cases cannot be ruled out as most infected persons may display mild or no symptoms. It is therefore important to stay vigilant against possible suspect cases, and consider the diagnosis of Zika virus infection among individuals returning from South or Central America, the Carribean, or the Pacific region who developed a fever and/or other symptoms suggestive of Zika virus infection while abroad or within 2 weeks of returning to Singapore.

Below are links to existing interim guidelines and health advisories released by various medical bodies internationally. Please refer to these, in particular the MOH links as it provides details on testing if the need arises. Do refer to these links regularly for updates.

Information for healthcare providers:

1. MOH Singapore Health Advisory on Zika Virus
https://www.moh.gov.sg/content/moh_web/home/pressRoom/Current_Issues/2016/zika-virus.html

2. MOH Singapore FAQs on Zika Virus
https://www.moh.gov.sg/content/moh_web/home/pressRoom/Current_Issues/2016/zika-virus/faqs.html

3. MOH Singapore Circular on Zika Virus (details on testing included) 

Zika Virus Infection
Zika Virus Infection Form

4. CDC's Questions and Answers for Obstetrical Healthcare Providers: Pregnant Women and Zika Virus Infection
http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html 

5. CDC's Interim Guidelines for Pregnant Women during a Zika Virus Outbreak
http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm

6. WHO Zika Virus disease; Q&A (released on 20th Jan 2016)
http://www.who.int/features/qa/zika/en/

7. RCOG's Interim Clinical Guidelines on Zika Virus infection and pregnancy
https://www.rcog.org.uk/globalassets/documents/news/zika-virus-interim-guidelines.pdf

8. ACOG and Society for Maternal-Fetal Medicine's Practice Advisory: Interim Guidance for Care of Obstetric Patients During a Zika Virus Outbreak
https://m.acog.org/About-ACOG/News-Room/Practice-Advisories/Practice-Advisory-Interim-Guidance-for-Care-of-Obstetric-Patients-During-a-Zika-Virus-Outbreak?IsMobileSet=true>

9. Travel Advice (Public Health England)
https://www.gov.uk/government/news/zika-virus-travel-advice-for-pregnant-women

10. CDC's Interim Guidelines for Prevention of Sexual Transmission of Zika virus
http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1.htm?s_cid=mm6505e1.htm_w


Information for patients:

1. MOH Singapore Frequently Asked Questions on Zika virus and Microcephaly
Interim Clinical Guidance On Zika Virus Infection and Pregnancy

2. NHS patient information on Zika virus
http://www.nhs.uk/news/2016/01January/Pages/Zika-virus-your-questions-answered.aspx

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