Around this time last year, the Zika epidemic was covered by every major news outlet across the country and ACOG issued a statement reaffirming the latest warning from the U.S. Centers for Disease Control and Prevention (CDC) advising pregnant women not to travel to a specific area in Miami, Florida. We had recently learned that it was possible for the virus to be transmitted during all trimesters of pregnancy and ob-gyns were actively advising pregnant patients and their partners who had lived or traveled to Zika-affected areas to use contraception or abstain from sex for the duration of the pregnancy. While it was critical to get information out as soon as possible, we acknowledged that there were still many unknowns regarding transmission and the various harmful birth defects that can result from an infected fetus. During that time, we joined the CDC in recommending that all pregnant women be assessed for possible exposure at each prenatal care visit and that pregnant women with exposure be tested regardless of symptom status.
Since that time, the amount of data we have on Zika has increased and the realities regarding transmission of the virus have changed. For one, we’ve learned that the Zika virus antibodies can persist for months in some pregnant women, which makes it difficult for providers to know with certainty whether infection occurred before or during pregnancy. And, overall, the number of people infected with the virus in the United States and U.S. territories such as Puerto Rico has declined since 2016, making false-positives more likely when there is a lower occurrence of the disease. Therefore, the CDC, working with ACOG, announced at the end of July new guidance for pregnant women with possible Zika exposure. One of the significant changes is that we no longer recommend routine testing of pregnant women who are not experiencing symptoms and do not have ongoing exposure. In addition, to help address known issues with available Zika tests, pregnant women who are tested should receive concurrent IgM and NAT testing. ACOG continues to update a Practice Advisory, which further explains these changes and several others, as well as the new focus on shared decision-making when it comes to screening and testing patients, particularly those who are not experiencing symptoms.
While these new recommendations reflect the best data available on the virus to date, educating providers in a climate with rapidly changing recommendations remains challenging. It is certainly good news that the spread of the virus is on the decline in some areas, but Zika still poses a very real threat and we must remain vigilant. There is already a lot to cover at each prenatal care visit, but screening for Zika virus must continue to be a priority. Additionally, education about family planning for women who do not wish to become pregnant and condom use for pregnant women and their partners at risk of exposure are still essential. We can’t forget that contraception is an important tool in our fight against birth defects caused by Zika.
Also, adequate funding for needed resources to better understand and combat Zika are still a necessity. We need to be able to continue to track the virus through tools like the U.S. Zika Pregnancy Registry, deepen our understanding of its impact on pregnant women and fetuses, simplify and improve Zika virus testing and develop an effective vaccine. We must also remember that continued funding for Medicaid expansion and coverage of essential health benefits increases access to maternity, preventive and primary care for women at risk for the virus.
So, while Zika headlines might not be as prevalent anymore, we have a responsibility as physicians to keep it top-of-mind because there is still much work to be done.
To access ACOG’s Zika resources, visit https://www.acog.org/About-ACOG/ACOG-Departments/Zika-Virus.