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Updated Zika Guidance

ACOG and SMFM have revised sections of their Practice Advisory on Zika Virus

Critical updates include:

  • Obstetric health care providers should continue to consult CDC’s World Map of Areas with Risk of Zika when assessing patients. In many countries the epidemic is over, however Zika is still likely to be endemic in various regions of the Americas.
  • New data on currently available IgM tests shows that IgM antibodies persist at least four months following acute infection, thus making it difficult to determine if IgM detected during pregnancy represents an infection that is recent (during pregnancy) or one that occurred before pregnancy. IgM can also persist for a prolonged period of time potentially making timing of infection with subsequent pregnancies difficult to determine.
  • The number of false positive Zika tests has risen as the prevalence of Zika has decreased, and this compounds some of the limitations of the IgM test.
  • CDC no longer recommends routine Zika virus testing for asymptomatic pregnant women withpossible Zika exposure that is not ongoing*. However, testing of asymptomatic pregnant women without ongoing* possible exposure should be considered using shared decision making. See more in the Assessment and Testing section.
  • Some jurisdictions (e.g. those at increased risk for local transmission) will continue to recommend Zika testing for asymptomatic pregnant women due to increased risks of transmission. Therefore, obstetric providers should check regularly with their state and local health departments for information on testing asymptomatic pregnant women without ongoing* possible exposure.
  • The CDC now recommends concurrent IgM and NAT testing for symptomatic pregnant women with possible Zika exposure up to 12 weeks after symptom onset. Ideally, testing should be performed as soon as possible after symptoms begin. Revised testing Figure 1 & Figure 2 can be found in theAssessment and Testing module.

*Ongoing exposure is defined as currently living in or frequent travel (e.g. daily or weekly) to areas with Zika virus transmission
Regardless of location, providers should evaluate all pregnant women in the United States for possible Zika virus exposure during each prenatal care visit. This evaluation should include an assessment of signs and symptoms of Zika virus disease, a travel history, and a woman’s sexual partner’s potential exposure.
More Information

Obstetrician-gynecologists and other obstetric providers are encouraged to visit the following resources for detailed guidance and information regarding Zika, including breaking developments: