CDC Zika Health Advisory: Prolonged IgM response and Testing Results in Pregnancy
On May 5, 2017, the CDC released an urgent public health advisory regarding prolonged IgM response and subsequent consequences related to Zika testing in pregnancy. Based on emerging data, it appears that IgM may remain in the system > 12 weeks, therefore complicating estimates as to when infection may have occurred, particularly in asymptomatic individuals
Promptly test any pregnant women with concurrent NAT and serologic testing as soon as possible through 12 weeks after symptom onset if they become symptomatic during their pregnancy or if a sexual partner tests positive for Zika virus infection
Asymptomatic pregnant women living in or frequently traveling to areas with Zika virus transmission
Consider Zika NAT testing at least once per trimester in addition to IgM testing as previously recommended
Consider Zika NAT testing if performing amniocentesis
Consider IgM testing to determine baseline Zika virus IgM levels as part of preconception counseling
Counsel pregnant women each trimester on the limitations of IgM and NAT testing
Interpreting Zika NAT results:
Positive – may indicate recent infection
Negative – does not rule out recent infection as viral RNA declines over time
The CDC has not changed guidance for symptomatic individuals at this time. The Advisory states:
Although IgM persistence could affect IgM test interpretation for all infected people, it would have the greatest effect on clinical management of pregnant women with a history of living in or traveling to areas with Zika virus transmission before conception. Pregnant women who test positive for IgM antibody may have been infected with Zika virus and developed an IgM response before conception.
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