July 14, 2016
Dear Virginia Labor and Delivery Care Team Members:
Thank you for the work you have done and will continue to do with families concerned about Zika virus disease. Physicians and nurses who provide perinatal care to women and their infants are at the forefront of the Zika virus response and we greatly appreciate your efforts.
Because we share, as a top priority, ensuring the proper evaluation of all infants born to mothers with possible Zika virus exposure, I am providing some critical updates for your clinical practice.
The following are three key points for your awareness:
- VDH recommends that labor and delivery care teams develop protocols to identify mothers potentially infected with Zika virus during pregnancy, and ensure that relevant clinical information is passed on to all team members, including your pediatric providers.
- For infants born to mothers with Zika positive or inconclusive lab results, we request that the labor and delivery nursing team and clinicians work together to ensure that Zika Virus rRT‑PCR and IgM serology testing is performed on serum specimens collected within two days of birth from the umbilical cord or directly from the infant.
- Infants diagnosed with a birth defect, such as those associated with Zika virus exposure, are eligible to receive care coordination and child development services through the VDH’s Children and Youth with Special Health Care Needs (CYSHCN) programs.
Identification of Zika-Impacted Pregnancies
It is recommended that labor and delivery team members develop protocols to ascertain the Zika testing status for all mothers presenting for delivery. Clearly record in the medical record of the patient and explicitly communicate to the full labor and delivery team and all covering clinicians, those women identified as having positive or inconclusive test results for Zika virus.
In addition, transfer appropriate clinical records to clinician team members in a timely way (ideally immediately before or upon birth of the infant) in order to ensure appropriate clinical evaluation of the infant at birth. Assure access, by both pediatric and obstetric providers, to previous prenatal ultrasounds and other relevant test results.
Zika Testing of Infants
The Centers for Disease Control and Prevention has developed recommendations for health care providers caring for infants born to mothers who were potentially exposed to Zika virus during pregnancy. Zika virus testing is currently recommended for:
- Infants with microcephaly, intracranial calcifications, or other brain or eye abnormalities consistent with Zika virus disease detected prenatally or at birth and born to women with possible Zika virus exposure while pregnant; or
- Infants born to mothers with positive or inconclusive test results for Zika virus infection, regardless of the presence or absence of congenital abnormalities.
Perform Zika testing of these infants by rRT-PCR and IgM serology within two days of birth on serum specimens collected from the umbilical cord or directly from the infant. Such testing can be provided by the Division of Consolidated Laboratory Services (DCLS), Virginia’s state public health laboratory. Please contact your local health department to arrange for Zika virus testing, disease reporting, help with test interpretation, and other questions you may have regarding testing.
Coordination of Care for Infants Born with Birth Defects
Infants born to pregnant women included in the CDC Zika Pregnancy Registry or who exhibit laboratory evidence of Zika virus will be included in registry data collection efforts. Information will be collected from the infant’s pediatrician at delivery and at different intervals throughout the first year of life.
If an infant has been diagnosed with a birth defect, such as those associated with Zika virus exposure, these infants and their families are eligible to receive care coordination and child development services through the VDH’s Children and Youth with Special Health Care Needs (CYSHCN) programs.
Care Connection for Children is a network of six regional centers that provides care coordination, medical insurance evaluation, family-to-family support, and referral to other related services.
Child Development Centers are located across five regions and provide diagnostic assessment, care planning, follow-up care coordination, and referral to those children and youth suspected of having development disorders associated with sensory or physical disabilities.
For more information about any of the topics listed above, please visit the VDH Zika Virus Disease Information website or the CDC Zika Pregnancy Registry website.
Thank you again for all you do for mothers, babies and their families day in and day out. Thank you also for transferring your commitment to quality care to the Zika threat. Working collaboratively we can continue to assure the best possible start for all infants born in Virginia.
Sincerely,
Marissa J. Levine, MD, MPH, FAAFP
State Health Commissioner