All pregnant woman with a history of travel during pregnancy to an area with active Zika virus transmission who reports clinical illness that raises suspicion of Zika virus disease, during or within 2 weeks of travel, and who is currently symptomatic, should be tested for Zika virus infection and have a baseline fetal ultrasound scan in a local antenatal ultrasound service. However, clinicians should consider investigations for other travel-associated infections such as malaria, dengue fever and chikungunya.
There is no specific antiviral treatment for Zika virus infection. Symptomatic management is recommended if symptoms are troublesome.
Women with a positive (or inconclusive) ZIKV PCR result should have a baseline fetal ultrasound (if not done already), serial fetal growth ultrasound scans at four-weekly intervals and a referral to fetal medicine service for further evaluation and follow up. Fetal MRI and amniocentesis for ZIKV PCR may be considered after careful counselling.
When a significant brain abnormality or microcephaly is confirmed, the option of termination of pregnancy should be discussed with the woman, regardless of gestation.
For asymptomatic pregnant women or women previously symptomatic with negative ZIKV PCR results, who have travelled to an area with active Zika virus transmission during pregnancy should be offered a baseline fetal ultrasound scan. If the ultrasound scan is normal, considerations for repeat fetal growth ultrasound scans every four weeks throughout pregnancy should be taken.
Following a live birth where there has been laboratory confirmation of maternal or fetal Zika virus infection, the following tests are recommended:
- histopathological examination of the placenta and umbilical cord
- testing of placental tissue and cord tissue for Zika virus RNA
- testing of cord blood and neonatal urine for Zika virus and other flaviviruses.
The case should be discussed with RIPL prior to delivery.
When congenital infection is confirmed, the baby should be followed up into childhood for signs of any adverse sequelae
Pregnant women with fetal loss who have recently travelled to an area with active Zika virus transmission and who had symptoms suggestive of Zika virus infection or fetal microcephaly, should be discussed with RIPL.
An interim algorithm for assessing pregnant women with a history of travel during pregnancy to areas with active ZIKV transmission can be found here.