Obstetrics

ATLANTA – Contrary to conventional wisdom and standard obstetrical practice, opiate-addicted women can safely undergo detoxification during pregnancy, findings in more than 300 women suggest.

Over a 5-year period, 301 women with opiate addiction were detoxed during pregnancy with no adverse fetal outcomes related to the detox identified, Dr. Jennifer Bell reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.

©thegoodphoto/Thinkstock

Of the women studied, 108 were acutely detoxed while incarcerated, 100 went through inpatient detox, and 93 went through slow outpatient Subutex detox over 6-12 weeks. Relapse rates in those groups were 19%, 71%, and 15%, respectively.

However, among 23 women in the inpatient detox group who had close outpatient follow-up management, the relapse rate was 17% versus the 71% overall relapse rate with inpatient detox, said Dr. Bell, a third-year resident at the University of Tennessee Medical Center, Knoxville.

No cases of intrauterine fetal demise (IUFD) occurred during the course of the study, and the rate of preterm delivery did not differ between detox groups, Dr. Bell noted.

The rate of preterm delivery was 17% overall (51 patients), but 28 of the patients were induced for suspected intrauterine growth restriction. Only 16 had the condition.

Detox was slightly more expensive than drug maintenance in this study, but was cost saving when considered against the cost of treating one newborn with neonatal abstinence syndrome – $63,000 on average nationally.

Standard practice is to not detoxify opiate-addicted pregnant women, based primarily on two case reports from the 1970s that suggested fetal harm from detox. However, in the current study and five other studies published since that time, a total of 684 patients have been detoxed with no cases of IUFD, suggesting that detox is not harmful during pregnancy. And though relapse rates are high, this is typically among women who do not have continual follow-up management, according to Dr. Bell.

Once a patient is drug free, intense patient behavioral health follow-up is needed for success, Dr. Craig V. Towers, the lead author on the study, said in an interview. Such follow-up is costly, but not nearly as costly as caring for infants with neonatal abstinence syndrome, he said.

In Tennessee alone, where approximately 1,000 cases of neonatal abstinence syndrome occur each year, a 50% reduction in these cases could save more than $30 million per year, said Dr. Towers, also of the University of Tennessee Medical Center.

The framework for follow-up management programs for women who undergo detox could be paid for with a portion of those savings, said Dr. Towers, who is currently working with the state health department on developing a plan for such an approach to the problems of opiate addiction in pregnancy.

The current findings represent the first step toward an improved system, as many women who become pregnant while addicted to opiate drugs desire to detox, but aren’t given the option, he said. “We need to get rid of this argument that [detox] is harmful to the baby.”

The researchers reported having no financial disclosures.

[email protected]

ATLANTA – Contrary to conventional wisdom and standard obstetrical practice, opiate-addicted women can safely undergo detoxification during pregnancy, findings in more than 300 women suggest.

Over a 5-year period, 301 women with opiate addiction were detoxed during pregnancy with no adverse fetal outcomes related to the detox identified, Dr. Jennifer Bell reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.

©thegoodphoto/Thinkstock

Of the women studied, 108 were acutely detoxed while incarcerated, 100 went through inpatient detox, and 93 went through slow outpatient Subutex detox over 6-12 weeks. Relapse rates in those groups were 19%, 71%, and 15%, respectively.

However, among 23 women in the inpatient detox group who had close outpatient follow-up management, the relapse rate was 17% versus the 71% overall relapse rate with inpatient detox, said Dr. Bell, a third-year resident at the University of Tennessee Medical Center, Knoxville.

No cases of intrauterine fetal demise (IUFD) occurred during the course of the study, and the rate of preterm delivery did not differ between detox groups, Dr. Bell noted.

The rate of preterm delivery was 17% overall (51 patients), but 28 of the patients were induced for suspected intrauterine growth restriction. Only 16 had the condition.

Detox was slightly more expensive than drug maintenance in this study, but was cost saving when considered against the cost of treating one newborn with neonatal abstinence syndrome – $63,000 on average nationally.

Standard practice is to not detoxify opiate-addicted pregnant women, based primarily on two case reports from the 1970s that suggested fetal harm from detox. However, in the current study and five other studies published since that time, a total of 684 patients have been detoxed with no cases of IUFD, suggesting that detox is not harmful during pregnancy. And though relapse rates are high, this is typically among women who do not have continual follow-up management, according to Dr. Bell.

Once a patient is drug free, intense patient behavioral health follow-up is needed for success, Dr. Craig V. Towers, the lead author on the study, said in an interview. Such follow-up is costly, but not nearly as costly as caring for infants with neonatal abstinence syndrome, he said.

In Tennessee alone, where approximately 1,000 cases of neonatal abstinence syndrome occur each year, a 50% reduction in these cases could save more than $30 million per year, said Dr. Towers, also of the University of Tennessee Medical Center.

The framework for follow-up management programs for women who undergo detox could be paid for with a portion of those savings, said Dr. Towers, who is currently working with the state health department on developing a plan for such an approach to the problems of opiate addiction in pregnancy.

The current findings represent the first step toward an improved system, as many women who become pregnant while addicted to opiate drugs desire to detox, but aren’t given the option, he said. “We need to get rid of this argument that [detox] is harmful to the baby.”

The researchers reported having no financial disclosures.

[email protected]

ATLANTA – Contrary to conventional wisdom and standard obstetrical practice, opiate-addicted women can safely undergo detoxification during pregnancy, findings in more than 300 women suggest.

Over a 5-year period, 301 women with opiate addiction were detoxed during pregnancy with no adverse fetal outcomes related to the detox identified, Dr. Jennifer Bell reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine.

©thegoodphoto/Thinkstock

Of the women studied, 108 were acutely detoxed while incarcerated, 100 went through inpatient detox, and 93 went through slow outpatient Subutex detox over 6-12 weeks. Relapse rates in those groups were 19%, 71%, and 15%, respectively.

However, among 23 women in the inpatient detox group who had close outpatient follow-up management, the relapse rate was 17% versus the 71% overall relapse rate with inpatient detox, said Dr. Bell, a third-year resident at the University of Tennessee Medical Center, Knoxville.

No cases of intrauterine fetal demise (IUFD) occurred during the course of the study, and the rate of preterm delivery did not differ between detox groups, Dr. Bell noted.

The rate of preterm delivery was 17% overall (51 patients), but 28 of the patients were induced for suspected intrauterine growth restriction. Only 16 had the condition.

Detox was slightly more expensive than drug maintenance in this study, but was cost saving when considered against the cost of treating one newborn with neonatal abstinence syndrome – $63,000 on average nationally.

Standard practice is to not detoxify opiate-addicted pregnant women, based primarily on two case reports from the 1970s that suggested fetal harm from detox. However, in the current study and five other studies published since that time, a total of 684 patients have been detoxed with no cases of IUFD, suggesting that detox is not harmful during pregnancy. And though relapse rates are high, this is typically among women who do not have continual follow-up management, according to Dr. Bell.

Once a patient is drug free, intense patient behavioral health follow-up is needed for success, Dr. Craig V. Towers, the lead author on the study, said in an interview. Such follow-up is costly, but not nearly as costly as caring for infants with neonatal abstinence syndrome, he said.

In Tennessee alone, where approximately 1,000 cases of neonatal abstinence syndrome occur each year, a 50% reduction in these cases could save more than $30 million per year, said Dr. Towers, also of the University of Tennessee Medical Center.

The framework for follow-up management programs for women who undergo detox could be paid for with a portion of those savings, said Dr. Towers, who is currently working with the state health department on developing a plan for such an approach to the problems of opiate addiction in pregnancy.

The current findings represent the first step toward an improved system, as many women who become pregnant while addicted to opiate drugs desire to detox, but aren’t given the option, he said. “We need to get rid of this argument that [detox] is harmful to the baby.”

The researchers reported having no financial disclosures.

[email protected]

The Centers for Disease Control and Prevention has updated its interim guidelines on treatment of infants born to mothers who may have been exposed to Zika virus during pregnancy, adding new protocols and expanding the scope of its guidance to include all children under age 18 years.

The updated guidelines, which were released Feb. 19, call for “routine care” for infants whose mothers traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, provided that the infant has a normal head circumference, normal prenatal and postnatal ultrasounds, and a normal physical examination (Morb Mortal Wkly Rep. 2016;65[early release]:1-6).

If an infant’s mother has traveled to a Zika-endemic area, the first step is screening the infant for microcephaly or intracranial calcifications, either prenatally or at birth. If such defects are found, a complete physical examination and Zika virus tests should be performed on the infant.

If tests are positive or inconclusive for Zika virus infection, an additional clinical evaluation is warranted, as well as an assessment for possible long-term sequelae.

Even if no microcephaly or intracranial calcification is detected in the infant, the guidelines state that the mother should still undergo testing for Zika virus infection. If test results are negative, then “routine care” of the infant can proceed; however, positive or inconclusive results should be followed by a physical examination of the infant.

For laboratory testing of congenital Zika virus infection, infant serum should be tested for Zika virus RNA, immunoglobulin M (IgM), dengue virus IgM, and related neutralizing antibodies. If testing on a placenta or umbilical cord sample, use Zika virus immunohistochemical staining, while reverse transcription–polymerase chain reaction (RT-PCR) should be used on fixed or frozen tissue.

Acute Zika virus infections should be tested via RT-PCR for Zika virus RNA of either the serum or cerebrospinal fluid in children who have been symptomatic for less than 7 days. If symptoms have been present for 4 or more days, but Zika virus RNA has not been detected, then the serum or cerebrospinal fluid should be tested for Zika virus IgM and dengue virus IgM, along with related neutralizing antibodies.

All children under age 18 years should be considered likely for Zika infection if they have traveled to or resided in a Zika-endemic area within the previous 2 weeks and have at least two of the following known symptoms of Zika virus infection: fever, rash, conjunctivitis, and arthralgia. The same criteria apply to infants during the first 2 weeks of life if the mother has been to an area where Zika is endemic and if the infant exhibits any two symptoms of the virus.

“Arthralgia can be difficult to detect in infants and young children, and can manifest as irritability, walking with a limp (for ambulatory children), difficulty moving or refusing to move an extremity, pain on palpation, or pain with active or passive movement of the affected joint,” according to the guidelines.

NSAIDs should not be used to treat potential Zika virus infections until dengue virus infection has been definitively ruled out as the cause of illness, because of “the potential for hemorrhagic complications of dengue fever.” Further, no child under age 6 months should be prescribed NSAIDs, and no children of any age who present with acute viral illness should be given aspirin, because of associations with Reye syndrome.

Although Zika virus RNA has been isolated in breast milk, there have been no reported cases of the virus being transmitted via breastfeeding. The CDC considers breastfeeding by mothers with Zika virus infections to be safe, saying that “the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission through breast milk.”

For infants and children, the best way to avoid Zika virus infection is to avoid getting bitten by mosquitoes. The most effective ways to prevent mosquito bites are by “using air conditioning or window and door screens when indoors, wearing long-sleeved shirts and long pants, using permethrin-treated clothing and gear, and using insect repellents.” The CDC also warns against using oil of lemon eucalyptus on children under age 3 years.

“Persons with Zika virus infection should take steps to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission,” the updated guidelines state.

Information on areas where Zika virus is currently prevalent, and what precautions to take when traveling to these areas, can be found on the CDC website.

[email protected]

The Centers for Disease Control and Prevention has updated its interim guidelines on treatment of infants born to mothers who may have been exposed to Zika virus during pregnancy, adding new protocols and expanding the scope of its guidance to include all children under age 18 years.

The updated guidelines, which were released Feb. 19, call for “routine care” for infants whose mothers traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, provided that the infant has a normal head circumference, normal prenatal and postnatal ultrasounds, and a normal physical examination (Morb Mortal Wkly Rep. 2016;65[early release]:1-6).

If an infant’s mother has traveled to a Zika-endemic area, the first step is screening the infant for microcephaly or intracranial calcifications, either prenatally or at birth. If such defects are found, a complete physical examination and Zika virus tests should be performed on the infant.

If tests are positive or inconclusive for Zika virus infection, an additional clinical evaluation is warranted, as well as an assessment for possible long-term sequelae.

Even if no microcephaly or intracranial calcification is detected in the infant, the guidelines state that the mother should still undergo testing for Zika virus infection. If test results are negative, then “routine care” of the infant can proceed; however, positive or inconclusive results should be followed by a physical examination of the infant.

For laboratory testing of congenital Zika virus infection, infant serum should be tested for Zika virus RNA, immunoglobulin M (IgM), dengue virus IgM, and related neutralizing antibodies. If testing on a placenta or umbilical cord sample, use Zika virus immunohistochemical staining, while reverse transcription–polymerase chain reaction (RT-PCR) should be used on fixed or frozen tissue.

Acute Zika virus infections should be tested via RT-PCR for Zika virus RNA of either the serum or cerebrospinal fluid in children who have been symptomatic for less than 7 days. If symptoms have been present for 4 or more days, but Zika virus RNA has not been detected, then the serum or cerebrospinal fluid should be tested for Zika virus IgM and dengue virus IgM, along with related neutralizing antibodies.

All children under age 18 years should be considered likely for Zika infection if they have traveled to or resided in a Zika-endemic area within the previous 2 weeks and have at least two of the following known symptoms of Zika virus infection: fever, rash, conjunctivitis, and arthralgia. The same criteria apply to infants during the first 2 weeks of life if the mother has been to an area where Zika is endemic and if the infant exhibits any two symptoms of the virus.

“Arthralgia can be difficult to detect in infants and young children, and can manifest as irritability, walking with a limp (for ambulatory children), difficulty moving or refusing to move an extremity, pain on palpation, or pain with active or passive movement of the affected joint,” according to the guidelines.

NSAIDs should not be used to treat potential Zika virus infections until dengue virus infection has been definitively ruled out as the cause of illness, because of “the potential for hemorrhagic complications of dengue fever.” Further, no child under age 6 months should be prescribed NSAIDs, and no children of any age who present with acute viral illness should be given aspirin, because of associations with Reye syndrome.

Although Zika virus RNA has been isolated in breast milk, there have been no reported cases of the virus being transmitted via breastfeeding. The CDC considers breastfeeding by mothers with Zika virus infections to be safe, saying that “the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission through breast milk.”

For infants and children, the best way to avoid Zika virus infection is to avoid getting bitten by mosquitoes. The most effective ways to prevent mosquito bites are by “using air conditioning or window and door screens when indoors, wearing long-sleeved shirts and long pants, using permethrin-treated clothing and gear, and using insect repellents.” The CDC also warns against using oil of lemon eucalyptus on children under age 3 years.

“Persons with Zika virus infection should take steps to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission,” the updated guidelines state.

Information on areas where Zika virus is currently prevalent, and what precautions to take when traveling to these areas, can be found on the CDC website.

[email protected]

The Centers for Disease Control and Prevention has updated its interim guidelines on treatment of infants born to mothers who may have been exposed to Zika virus during pregnancy, adding new protocols and expanding the scope of its guidance to include all children under age 18 years.

The updated guidelines, which were released Feb. 19, call for “routine care” for infants whose mothers traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, provided that the infant has a normal head circumference, normal prenatal and postnatal ultrasounds, and a normal physical examination (Morb Mortal Wkly Rep. 2016;65[early release]:1-6).

If an infant’s mother has traveled to a Zika-endemic area, the first step is screening the infant for microcephaly or intracranial calcifications, either prenatally or at birth. If such defects are found, a complete physical examination and Zika virus tests should be performed on the infant.

If tests are positive or inconclusive for Zika virus infection, an additional clinical evaluation is warranted, as well as an assessment for possible long-term sequelae.

Even if no microcephaly or intracranial calcification is detected in the infant, the guidelines state that the mother should still undergo testing for Zika virus infection. If test results are negative, then “routine care” of the infant can proceed; however, positive or inconclusive results should be followed by a physical examination of the infant.

For laboratory testing of congenital Zika virus infection, infant serum should be tested for Zika virus RNA, immunoglobulin M (IgM), dengue virus IgM, and related neutralizing antibodies. If testing on a placenta or umbilical cord sample, use Zika virus immunohistochemical staining, while reverse transcription–polymerase chain reaction (RT-PCR) should be used on fixed or frozen tissue.

Acute Zika virus infections should be tested via RT-PCR for Zika virus RNA of either the serum or cerebrospinal fluid in children who have been symptomatic for less than 7 days. If symptoms have been present for 4 or more days, but Zika virus RNA has not been detected, then the serum or cerebrospinal fluid should be tested for Zika virus IgM and dengue virus IgM, along with related neutralizing antibodies.

All children under age 18 years should be considered likely for Zika infection if they have traveled to or resided in a Zika-endemic area within the previous 2 weeks and have at least two of the following known symptoms of Zika virus infection: fever, rash, conjunctivitis, and arthralgia. The same criteria apply to infants during the first 2 weeks of life if the mother has been to an area where Zika is endemic and if the infant exhibits any two symptoms of the virus.

“Arthralgia can be difficult to detect in infants and young children, and can manifest as irritability, walking with a limp (for ambulatory children), difficulty moving or refusing to move an extremity, pain on palpation, or pain with active or passive movement of the affected joint,” according to the guidelines.

NSAIDs should not be used to treat potential Zika virus infections until dengue virus infection has been definitively ruled out as the cause of illness, because of “the potential for hemorrhagic complications of dengue fever.” Further, no child under age 6 months should be prescribed NSAIDs, and no children of any age who present with acute viral illness should be given aspirin, because of associations with Reye syndrome.

Although Zika virus RNA has been isolated in breast milk, there have been no reported cases of the virus being transmitted via breastfeeding. The CDC considers breastfeeding by mothers with Zika virus infections to be safe, saying that “the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission through breast milk.”

For infants and children, the best way to avoid Zika virus infection is to avoid getting bitten by mosquitoes. The most effective ways to prevent mosquito bites are by “using air conditioning or window and door screens when indoors, wearing long-sleeved shirts and long pants, using permethrin-treated clothing and gear, and using insect repellents.” The CDC also warns against using oil of lemon eucalyptus on children under age 3 years.

“Persons with Zika virus infection should take steps to prevent mosquito bites for at least the first week of illness to decrease the risk for human-to-mosquito-to-human transmission,” the updated guidelines state.

Information on areas where Zika virus is currently prevalent, and what precautions to take when traveling to these areas, can be found on the CDC website.

[email protected]

WASHINGTON – Once again, the United States is ill-prepared to handle the threat of a global pandemic entering its borders and must commit resources to the development of a Zika virus vaccine, said Dr. Victor J. Dzau, president of the National Academy of Medicine.

Dr. Dzau issued this call to action on Feb. 16 at a workshop centered around the recent Zika virus outbreak and how to combat it. The workshop was convened at the request of the Health and Human Services department.

Deepak Chitnis/Frontline Medical News

Calling Zika virus “a new threat to global health,” Dr. Dzau said the best course of action is for the U.S. and health authorities around the world is to create a “global health risk framework” that would actively work to identify new and emerging public health threats and prevent them from becoming outbreaks. This framework would consist of a global architecture to reduce risk and mitigate the next global health crisis, identification of key resources and applications before an outbreak occurs, successful containment of future outbreaks, and coordinated responses “informed by good planning and evidence, not fear or politics,” he said.

“Global leaders need to step up,” said Dr. Dzau. “They need to step up investments to improve their response and also their preparedness for pandemics and infectious outbreaks.”

One of the most serious concerns about Zika virus has been its effects on pregnant women, as infected mothers have been bearing children with microcephaly in Central and South America. Dr. Laura E. Riley of Massachusetts General Hospital spoke about the gaps in what ob.gyns. currently know about the virus and the best way to treat pregnant women who may have been exposed.

Testing for Zika immunoglobulin M (IgM) antibodies is the “first step” in treating any pregnant woman who has traveled and may have been exposed to the virus, she said. However, Dr. Riley noted that the test is relatively new and “we’re putting a lot of stock into this test that we don’t have a lot of information about.”

Citing a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention in February, Dr. Riley said that evidence of the link between Zika virus infections and microcephaly is stronger than ever, but there is still doubt as to exactly how microcephaly is caused, and at what point during the pregnancy symptoms begin to present in the fetus.

Serial ultrasounds have shown the slowing of fetal development over the course of a pregnancy – specifically in two Brazilian women examined for the report – but data is still sparse. “The causal relationship between Zika virus and other adverse pregnancy outcomes” is also of critical importance, said Dr. Riley. “I think we have pretty well established the association with microcephaly [but] there may be other neurologic abnormalities that we should be aware of and looking for.”

These other conditions include lissencephaly and intracranial calcification, Dr. Riley said.

“We don’t know what the infection rate is, but more importantly, the incidence of internal fetal transmission by trimester is particularly important as well, and what are the factors that influence that transmission?” asked Dr. Riley. “Is it the severity of internal infection? Is it the maternal immune response? We don’t know. We have information that we can glean from other infections.”

For now, said Dr. Riley is relying largely on the CDC guidance in advising patients.

“I’m taking the CDC guidance and I’m taking my own knowledge of [cytomegalovirus] and rubella and I’m trying to put it all together for Zika virus, for which I know very little,” she said.

Dr. Dzau and Dr. Riley did not report having any relevant financial disclosures.

[email protected]

WASHINGTON – Once again, the United States is ill-prepared to handle the threat of a global pandemic entering its borders and must commit resources to the development of a Zika virus vaccine, said Dr. Victor J. Dzau, president of the National Academy of Medicine.

Dr. Dzau issued this call to action on Feb. 16 at a workshop centered around the recent Zika virus outbreak and how to combat it. The workshop was convened at the request of the Health and Human Services department.

Deepak Chitnis/Frontline Medical News

Calling Zika virus “a new threat to global health,” Dr. Dzau said the best course of action is for the U.S. and health authorities around the world is to create a “global health risk framework” that would actively work to identify new and emerging public health threats and prevent them from becoming outbreaks. This framework would consist of a global architecture to reduce risk and mitigate the next global health crisis, identification of key resources and applications before an outbreak occurs, successful containment of future outbreaks, and coordinated responses “informed by good planning and evidence, not fear or politics,” he said.

“Global leaders need to step up,” said Dr. Dzau. “They need to step up investments to improve their response and also their preparedness for pandemics and infectious outbreaks.”

One of the most serious concerns about Zika virus has been its effects on pregnant women, as infected mothers have been bearing children with microcephaly in Central and South America. Dr. Laura E. Riley of Massachusetts General Hospital spoke about the gaps in what ob.gyns. currently know about the virus and the best way to treat pregnant women who may have been exposed.

Testing for Zika immunoglobulin M (IgM) antibodies is the “first step” in treating any pregnant woman who has traveled and may have been exposed to the virus, she said. However, Dr. Riley noted that the test is relatively new and “we’re putting a lot of stock into this test that we don’t have a lot of information about.”

Citing a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention in February, Dr. Riley said that evidence of the link between Zika virus infections and microcephaly is stronger than ever, but there is still doubt as to exactly how microcephaly is caused, and at what point during the pregnancy symptoms begin to present in the fetus.

Serial ultrasounds have shown the slowing of fetal development over the course of a pregnancy – specifically in two Brazilian women examined for the report – but data is still sparse. “The causal relationship between Zika virus and other adverse pregnancy outcomes” is also of critical importance, said Dr. Riley. “I think we have pretty well established the association with microcephaly [but] there may be other neurologic abnormalities that we should be aware of and looking for.”

These other conditions include lissencephaly and intracranial calcification, Dr. Riley said.

“We don’t know what the infection rate is, but more importantly, the incidence of internal fetal transmission by trimester is particularly important as well, and what are the factors that influence that transmission?” asked Dr. Riley. “Is it the severity of internal infection? Is it the maternal immune response? We don’t know. We have information that we can glean from other infections.”

For now, said Dr. Riley is relying largely on the CDC guidance in advising patients.

“I’m taking the CDC guidance and I’m taking my own knowledge of [cytomegalovirus] and rubella and I’m trying to put it all together for Zika virus, for which I know very little,” she said.

Dr. Dzau and Dr. Riley did not report having any relevant financial disclosures.

[email protected]

WASHINGTON – Once again, the United States is ill-prepared to handle the threat of a global pandemic entering its borders and must commit resources to the development of a Zika virus vaccine, said Dr. Victor J. Dzau, president of the National Academy of Medicine.

Dr. Dzau issued this call to action on Feb. 16 at a workshop centered around the recent Zika virus outbreak and how to combat it. The workshop was convened at the request of the Health and Human Services department.

Deepak Chitnis/Frontline Medical News

Calling Zika virus “a new threat to global health,” Dr. Dzau said the best course of action is for the U.S. and health authorities around the world is to create a “global health risk framework” that would actively work to identify new and emerging public health threats and prevent them from becoming outbreaks. This framework would consist of a global architecture to reduce risk and mitigate the next global health crisis, identification of key resources and applications before an outbreak occurs, successful containment of future outbreaks, and coordinated responses “informed by good planning and evidence, not fear or politics,” he said.

“Global leaders need to step up,” said Dr. Dzau. “They need to step up investments to improve their response and also their preparedness for pandemics and infectious outbreaks.”

One of the most serious concerns about Zika virus has been its effects on pregnant women, as infected mothers have been bearing children with microcephaly in Central and South America. Dr. Laura E. Riley of Massachusetts General Hospital spoke about the gaps in what ob.gyns. currently know about the virus and the best way to treat pregnant women who may have been exposed.

Testing for Zika immunoglobulin M (IgM) antibodies is the “first step” in treating any pregnant woman who has traveled and may have been exposed to the virus, she said. However, Dr. Riley noted that the test is relatively new and “we’re putting a lot of stock into this test that we don’t have a lot of information about.”

Citing a Morbidity and Mortality Weekly Report released by the Centers for Disease Control and Prevention in February, Dr. Riley said that evidence of the link between Zika virus infections and microcephaly is stronger than ever, but there is still doubt as to exactly how microcephaly is caused, and at what point during the pregnancy symptoms begin to present in the fetus.

Serial ultrasounds have shown the slowing of fetal development over the course of a pregnancy – specifically in two Brazilian women examined for the report – but data is still sparse. “The causal relationship between Zika virus and other adverse pregnancy outcomes” is also of critical importance, said Dr. Riley. “I think we have pretty well established the association with microcephaly [but] there may be other neurologic abnormalities that we should be aware of and looking for.”

These other conditions include lissencephaly and intracranial calcification, Dr. Riley said.

“We don’t know what the infection rate is, but more importantly, the incidence of internal fetal transmission by trimester is particularly important as well, and what are the factors that influence that transmission?” asked Dr. Riley. “Is it the severity of internal infection? Is it the maternal immune response? We don’t know. We have information that we can glean from other infections.”

For now, said Dr. Riley is relying largely on the CDC guidance in advising patients.

“I’m taking the CDC guidance and I’m taking my own knowledge of [cytomegalovirus] and rubella and I’m trying to put it all together for Zika virus, for which I know very little,” she said.

Dr. Dzau and Dr. Riley did not report having any relevant financial disclosures.

[email protected]

A case study conducted in Brazil revealed the presence of Zika virus in the amniotic fluid of two pregnant women, suggesting that the virus can cross the placental barrier and potentially infect the developing fetus.

Both women in the study had their amniotic fluid samples taken at 28 weeks, and later gave birth to babies with microcephaly.

The finding, published online Feb 17 in The Lancet Infectious Diseases (Lancet Infect Dis. 2016 Feb 17. doi: 10.1016/S1473-3099[16]00095-5), does not prove that Zika virus infection causes microcephaly but does suggest the biological plausibility of such a link.

In the same study, the researchers, led by Dr. Ana de Filippis of Oswaldo Cruz Institute in Rio de Janeiro, applied reverse transcription polymerase chain reaction and viral metagenomic sequencing to the viral samples, allowing them to establish that the virus was very closely related to the Zika virus that caused an outbreak in French Polynesia in 2013, and was not a recombinant strain.

©Oswaldo Cruz Institute

The women in the study, age 27 and 35, were from the Brazilian state of Paraíba. Neither woman reported smoking, using recreational drugs or alcohol, or taking medications known to affect fetal development.

Zika virus was not found in the blood or urine of either woman when the amniotic samples were taken, though both had reported earlier symptoms consistent with Zika infection. Other infections, including HIV, dengue, chikungunya, rubella, and herpes viruses, were ruled out.

The results provide important insight into the origin of the Zika virus circulating in Brazil, the researchers wrote in their analysis. Moreover, “our group is the first, to our knowledge, to isolate the whole genome of Zika virus directly from the amniotic fluid of a pregnant woman before delivery, supporting the hypothesis that Zika virus infection could occur through transplacental transmission,” wrote Dr. de Filippis and her colleagues.

Still, little is known about the effects of Zika on the developing central nervous system, the researchers wrote. A connection between Zika virus infections and poor CNS outcomes “remains presumptive, and is based on a temporal association. New studies should be done to investigate whether the Zika virus can infect either neurological precursor cells or final differentiated cells.”

The researchers cautioned that congenital microcephaly has been associated with genetic disorders, chemical exposures, brain injury and uterine infections. Other possible contributors to the current high rate of microcephaly in Brazil, which last year was 20 times higher than in previous years, need to be investigated, they wrote.

Agencies within Brazil’s national government and the city of Rio de Janeiro funded the study, and investigators disclosed no conflicts of interest.

A case study conducted in Brazil revealed the presence of Zika virus in the amniotic fluid of two pregnant women, suggesting that the virus can cross the placental barrier and potentially infect the developing fetus.

Both women in the study had their amniotic fluid samples taken at 28 weeks, and later gave birth to babies with microcephaly.

The finding, published online Feb 17 in The Lancet Infectious Diseases (Lancet Infect Dis. 2016 Feb 17. doi: 10.1016/S1473-3099[16]00095-5), does not prove that Zika virus infection causes microcephaly but does suggest the biological plausibility of such a link.

In the same study, the researchers, led by Dr. Ana de Filippis of Oswaldo Cruz Institute in Rio de Janeiro, applied reverse transcription polymerase chain reaction and viral metagenomic sequencing to the viral samples, allowing them to establish that the virus was very closely related to the Zika virus that caused an outbreak in French Polynesia in 2013, and was not a recombinant strain.

©Oswaldo Cruz Institute

The women in the study, age 27 and 35, were from the Brazilian state of Paraíba. Neither woman reported smoking, using recreational drugs or alcohol, or taking medications known to affect fetal development.

Zika virus was not found in the blood or urine of either woman when the amniotic samples were taken, though both had reported earlier symptoms consistent with Zika infection. Other infections, including HIV, dengue, chikungunya, rubella, and herpes viruses, were ruled out.

The results provide important insight into the origin of the Zika virus circulating in Brazil, the researchers wrote in their analysis. Moreover, “our group is the first, to our knowledge, to isolate the whole genome of Zika virus directly from the amniotic fluid of a pregnant woman before delivery, supporting the hypothesis that Zika virus infection could occur through transplacental transmission,” wrote Dr. de Filippis and her colleagues.

Still, little is known about the effects of Zika on the developing central nervous system, the researchers wrote. A connection between Zika virus infections and poor CNS outcomes “remains presumptive, and is based on a temporal association. New studies should be done to investigate whether the Zika virus can infect either neurological precursor cells or final differentiated cells.”

The researchers cautioned that congenital microcephaly has been associated with genetic disorders, chemical exposures, brain injury and uterine infections. Other possible contributors to the current high rate of microcephaly in Brazil, which last year was 20 times higher than in previous years, need to be investigated, they wrote.

Agencies within Brazil’s national government and the city of Rio de Janeiro funded the study, and investigators disclosed no conflicts of interest.

A case study conducted in Brazil revealed the presence of Zika virus in the amniotic fluid of two pregnant women, suggesting that the virus can cross the placental barrier and potentially infect the developing fetus.

Both women in the study had their amniotic fluid samples taken at 28 weeks, and later gave birth to babies with microcephaly.

The finding, published online Feb 17 in The Lancet Infectious Diseases (Lancet Infect Dis. 2016 Feb 17. doi: 10.1016/S1473-3099[16]00095-5), does not prove that Zika virus infection causes microcephaly but does suggest the biological plausibility of such a link.

In the same study, the researchers, led by Dr. Ana de Filippis of Oswaldo Cruz Institute in Rio de Janeiro, applied reverse transcription polymerase chain reaction and viral metagenomic sequencing to the viral samples, allowing them to establish that the virus was very closely related to the Zika virus that caused an outbreak in French Polynesia in 2013, and was not a recombinant strain.

©Oswaldo Cruz Institute

The women in the study, age 27 and 35, were from the Brazilian state of Paraíba. Neither woman reported smoking, using recreational drugs or alcohol, or taking medications known to affect fetal development.

Zika virus was not found in the blood or urine of either woman when the amniotic samples were taken, though both had reported earlier symptoms consistent with Zika infection. Other infections, including HIV, dengue, chikungunya, rubella, and herpes viruses, were ruled out.

The results provide important insight into the origin of the Zika virus circulating in Brazil, the researchers wrote in their analysis. Moreover, “our group is the first, to our knowledge, to isolate the whole genome of Zika virus directly from the amniotic fluid of a pregnant woman before delivery, supporting the hypothesis that Zika virus infection could occur through transplacental transmission,” wrote Dr. de Filippis and her colleagues.

Still, little is known about the effects of Zika on the developing central nervous system, the researchers wrote. A connection between Zika virus infections and poor CNS outcomes “remains presumptive, and is based on a temporal association. New studies should be done to investigate whether the Zika virus can infect either neurological precursor cells or final differentiated cells.”

The researchers cautioned that congenital microcephaly has been associated with genetic disorders, chemical exposures, brain injury and uterine infections. Other possible contributors to the current high rate of microcephaly in Brazil, which last year was 20 times higher than in previous years, need to be investigated, they wrote.

Agencies within Brazil’s national government and the city of Rio de Janeiro funded the study, and investigators disclosed no conflicts of interest.

ATLANTA – The decision of whether to screen a pregnancy for genetic anomalies should not be taken lightly, especially in light of the invasive procedures required. But what if a simple maternal blood test could provide everything we needed to know about a fetus’ genetic health?

At the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, Dr. Ronald J. Wapner of Columbia University, New York, said that time is quickly approaching, and that cell-free fetal DNA testing should – and will – become a routine part of prenatal care.

Watch an interview with Dr. Wapner here.

[email protected]

ATLANTA – The decision of whether to screen a pregnancy for genetic anomalies should not be taken lightly, especially in light of the invasive procedures required. But what if a simple maternal blood test could provide everything we needed to know about a fetus’ genetic health?

At the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, Dr. Ronald J. Wapner of Columbia University, New York, said that time is quickly approaching, and that cell-free fetal DNA testing should – and will – become a routine part of prenatal care.

Watch an interview with Dr. Wapner here.

[email protected]

ATLANTA – The decision of whether to screen a pregnancy for genetic anomalies should not be taken lightly, especially in light of the invasive procedures required. But what if a simple maternal blood test could provide everything we needed to know about a fetus’ genetic health?

At the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, Dr. Ronald J. Wapner of Columbia University, New York, said that time is quickly approaching, and that cell-free fetal DNA testing should – and will – become a routine part of prenatal care.

Watch an interview with Dr. Wapner here.

[email protected]

ATLANTA – Oral health – whether poor or good – seems to run in families. Is it behavior, biology, or both?

At the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, Dr. Renee Samelson, a maternal-fetal medicine specialist with a certification in preventive medicine, said that taking care of moms’ teeth and gums, even before pregnancy, gives children the best shot at maintaining a healthy mouth from infancy to old age.

Watch an interview with Dr. Samelson here.

[email protected]

ATLANTA – Oral health – whether poor or good – seems to run in families. Is it behavior, biology, or both?

At the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, Dr. Renee Samelson, a maternal-fetal medicine specialist with a certification in preventive medicine, said that taking care of moms’ teeth and gums, even before pregnancy, gives children the best shot at maintaining a healthy mouth from infancy to old age.

Watch an interview with Dr. Samelson here.

[email protected]

ATLANTA – Oral health – whether poor or good – seems to run in families. Is it behavior, biology, or both?

At the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine, Dr. Renee Samelson, a maternal-fetal medicine specialist with a certification in preventive medicine, said that taking care of moms’ teeth and gums, even before pregnancy, gives children the best shot at maintaining a healthy mouth from infancy to old age.

Watch an interview with Dr. Samelson here.

[email protected]

Updated Zika virus figures from the U.S. territory of Puerto Rico show that more than two dozen locally acquired cases have occurred since December 2015, and more can be expected, according to the Centers for Disease Control and Prevention.

In a Feb. 12 report published in the Morbidity and Mortality Weekly Report, CDC officials said, “Because the most common mosquito vector of Zika virus, Aedes aegypti, is present throughout Puerto Rico, Zika virus is expected to continue to spread throughout the island.”

During the period of Nov. 23, 2015, to Jan. 28, 2016, the Puerto Rico Department of Health (PRDH) reported a total of 30 laboratory-confirmed cases of Zika virus. The first locally acquired case of Zika virus in Puerto Rico was reported on Dec. 31, 2015, in a patient from the southeastern region (Morb Mortal Wkly Rep. 2016 Feb;65[early release]:1-6. doi: http://dx.doi.org/10.15585/mmwr.mm6506e2er.).

The PRDH is using passive and enhanced surveillance to track the spread of the mosquito-borne Flavivirus, a disease that in humans has a generally benign course but that has a suspected association with microcephaly in infants born to Zika-infected mothers. Investigators are also tracking a suspected association with Guillain-Barré syndrome.

Patients, who mainly resided in metropolitan San Juan or areas of eastern Puerto Rico, had mostly mild illness. Patients most frequently experienced rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three patients were hospitalized.

One case of Guillain-Barré syndrome in a Zika-infected individual was reported to the PRDH, but the department saw no cases of microcephaly that were suspected of being associated with Zika virus.

The CDC is coordinating with the PRDH in ongoing surveillance efforts and response to the Zika virus. All clinicians in Puerto Rico are urged to report cases of Guillain-Barré syndrome, microcephaly, and suspected Zika infection to the PRDH. Residents of Puerto Rico should use strict mosquito avoidance and bite prevention measures, including the use of window screens, protective clothing, and an effective insect repellent.

[email protected]

On Twitter @karioakes

Updated Zika virus figures from the U.S. territory of Puerto Rico show that more than two dozen locally acquired cases have occurred since December 2015, and more can be expected, according to the Centers for Disease Control and Prevention.

In a Feb. 12 report published in the Morbidity and Mortality Weekly Report, CDC officials said, “Because the most common mosquito vector of Zika virus, Aedes aegypti, is present throughout Puerto Rico, Zika virus is expected to continue to spread throughout the island.”

During the period of Nov. 23, 2015, to Jan. 28, 2016, the Puerto Rico Department of Health (PRDH) reported a total of 30 laboratory-confirmed cases of Zika virus. The first locally acquired case of Zika virus in Puerto Rico was reported on Dec. 31, 2015, in a patient from the southeastern region (Morb Mortal Wkly Rep. 2016 Feb;65[early release]:1-6. doi: http://dx.doi.org/10.15585/mmwr.mm6506e2er.).

The PRDH is using passive and enhanced surveillance to track the spread of the mosquito-borne Flavivirus, a disease that in humans has a generally benign course but that has a suspected association with microcephaly in infants born to Zika-infected mothers. Investigators are also tracking a suspected association with Guillain-Barré syndrome.

Patients, who mainly resided in metropolitan San Juan or areas of eastern Puerto Rico, had mostly mild illness. Patients most frequently experienced rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three patients were hospitalized.

One case of Guillain-Barré syndrome in a Zika-infected individual was reported to the PRDH, but the department saw no cases of microcephaly that were suspected of being associated with Zika virus.

The CDC is coordinating with the PRDH in ongoing surveillance efforts and response to the Zika virus. All clinicians in Puerto Rico are urged to report cases of Guillain-Barré syndrome, microcephaly, and suspected Zika infection to the PRDH. Residents of Puerto Rico should use strict mosquito avoidance and bite prevention measures, including the use of window screens, protective clothing, and an effective insect repellent.

[email protected]

On Twitter @karioakes

Updated Zika virus figures from the U.S. territory of Puerto Rico show that more than two dozen locally acquired cases have occurred since December 2015, and more can be expected, according to the Centers for Disease Control and Prevention.

In a Feb. 12 report published in the Morbidity and Mortality Weekly Report, CDC officials said, “Because the most common mosquito vector of Zika virus, Aedes aegypti, is present throughout Puerto Rico, Zika virus is expected to continue to spread throughout the island.”

During the period of Nov. 23, 2015, to Jan. 28, 2016, the Puerto Rico Department of Health (PRDH) reported a total of 30 laboratory-confirmed cases of Zika virus. The first locally acquired case of Zika virus in Puerto Rico was reported on Dec. 31, 2015, in a patient from the southeastern region (Morb Mortal Wkly Rep. 2016 Feb;65[early release]:1-6. doi: http://dx.doi.org/10.15585/mmwr.mm6506e2er.).

The PRDH is using passive and enhanced surveillance to track the spread of the mosquito-borne Flavivirus, a disease that in humans has a generally benign course but that has a suspected association with microcephaly in infants born to Zika-infected mothers. Investigators are also tracking a suspected association with Guillain-Barré syndrome.

Patients, who mainly resided in metropolitan San Juan or areas of eastern Puerto Rico, had mostly mild illness. Patients most frequently experienced rash (77%), myalgia (77%), arthralgia (73%), and fever (73%). Three patients were hospitalized.

One case of Guillain-Barré syndrome in a Zika-infected individual was reported to the PRDH, but the department saw no cases of microcephaly that were suspected of being associated with Zika virus.

The CDC is coordinating with the PRDH in ongoing surveillance efforts and response to the Zika virus. All clinicians in Puerto Rico are urged to report cases of Guillain-Barré syndrome, microcephaly, and suspected Zika infection to the PRDH. Residents of Puerto Rico should use strict mosquito avoidance and bite prevention measures, including the use of window screens, protective clothing, and an effective insect repellent.

[email protected]

On Twitter @karioakes