Testing - Pregnant Women

Transcription

1 Testing - Pregnant Women 81% of women approved for testing in NJ were pregnant In 2017, nearly 95% of pregnant women tested were asymptomatic

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3 CDC Updated Testing Recommendations for Asymptomatic Pregnant Women Recent exposure ono routine recommendation for testing o Testing can be considered based on patient preferences, clinical judgment, and a balanced assessment of risks and expected outcomes Ongoing exposure o NAT (PCR) testing 3x during pregnancy o Serology no longer recommended

4 Updated Testing Recommendations for Symptomatic Pregnant Women Testing is recommended as soon as possible and within 12 weeks after onset NAT (PCR) and IgM should be performed concurrently and up to 12 weeks after onset

5 Additional Updates Criteria for evaluating travel exposure for asymptomatic pregnant women = all areas with any risk of Zika transmission Interpretation of lab test results o Take PCR (serum and urine) and serological testing together o Discordant PCR (serum / urine) with negative IgM may require second specimen o Serology timing of infection can not be determined

6 CDC COCA call today 2pm: gov/coca/calls/2017/cal linfo_ asp

7 Zika Testing Approval Rules of Thumb Specimen collection must be within 12 weeks of last exposure (travel or unprotected sexual) o Applies to everyone requesting Zika testing Symptomatic o Onset symptoms within 2 weeks of last exposure AND o Specimens collected within 12 weeks

8 Testing Approval Rules of Thumb Sexual exposure = unprotected sexual contact with a partner who had a Zika exposure o For men, semen is potentially infectious for 6 months o If a male partner returned from the DR on Jan 1st, the semen would be considered potentially infectious through June 30 th Need dates & location of the sexual partner s travel Need first & last dates of unprotected sexual contact If location and dates are not in CDRSS and SRD-1 form, the specimen may be rejected

9 Example: John traveled to the DR 1/15-1/30 with his pregnant wife Jane. Jane developed fever & rash on 5/29 6/1 Jane s OB requests Zika testing Travel > 12 weeks. Jane reports ongoing unprotected sexual contact POLL Unprotected sexual contact with John from 1/15 5/25 John s semen would be considered potentially infectious through 7/30 POLL Jane had sexual contact on 5/25 = sexual exposure; symptom onset (5/29) is <2 wks from last sexual exposure (5/25) and date of test request (6/1) is < 12 wks from last sexual exposure - testing is approved

10 Zika Case Investigation Select a subgroup! o Zika virus disease, congenital; Zika virus infection, congenital; Zika virus disease, non-congenital; Zika virus infection, non-congenital o Signs/symptoms and risk factors are tailored to subgroup Rationale for timely investigation o Identify source of exposure o Determine pregnancy status enroll into US Zika Pregnancy Registry o Provide patient education

11 Zika Case Investigation Zika Patient Information Worksheet contains most information needed Patient interview needed o Patient education: Prevent mosquito bites for 3 weeks after return from travel Protect against sexual transmission particularly during pregnancy o Ask if household members are ill with Zika symptoms Determine travel/sexual exposure history Refer to healthcare provider for Zika testing If no travel/sexual exposure identified, notify CDS o Re-interview patient days after symptom onset (or return from travel) to confirm status of household members

12 Dates are important Travel enter country in attribute field and 2 dates Relocation to US enter country in attribute field and an arrival date only Sexual exposure o Select Sexual Transmission dates of first/last unprotected sexual contact ongoing can t be used to determine testing eligibility ask physician/patient to estimate date if needed o Also select Sexual Partner s Travel enter country and dates of partner travel Pregnancy CDRSS Risk Factors o Enter pregnancy status on Clinical Info Tab with EDD and current pregnancy ALSO select Exposed during Pregnancy risk factor

13 Additional CDC Indicators Date the LHD initiated the case investigation Date control measures were implemented and a description, for example: o Spoke with/ faxed healthcare provider to request that they inform patient to: 1) avoid getting mosquito bites for 3 weeks following return from travel; 2) take steps to reduce mosquitos in and around their home; 3) if pregnant and partner traveled to an area with known Zika transmission, to use condoms for the duration of pregnancy Include in case comments

14 Zika Resources NJDOH Zika Testing Guidelines and Algorithm Zika Patient Information Worksheet NJDOH Delivery Packet Track when You re Back patient education flyer Communicable Disease Investigation Chapter!

15 DENGUE

16 New Dengue Subgroups Dengue: fever AND 1 of the following: o nausea/vomiting, rash, tourniquet test positive, aches and pains, leukopenia, or any warning sign for severe dengue (persistent vomiting, abdominal pain, extravascular fluid accumulation, mucosal bleeding, liver enlargement, or increasing hematocrit concurrent with a rapid decrease in platelet count Dengue-like illness: fever Severe dengue: dengue with 1 of the following: o hypovolemic shock caused by serious plasma leakage, severe bleeding, severe organ involvement (including elevated liver enzymes, impaired level of consciousness)

17 New Possible Dengue Case Status CONFIRMED and PROBABLE cases meet clinical criteria for a subgroup and have acceptable lab results POSSIBLE cases meet the clinical criteria for a subgroup and have a epidemiologic linkage (travel, close contact), but do not have acceptable laboratory results Updated Investigation Chapter and Worksheet:

18 Positive Zika IgM results are sent for PRNT o Neutralizing antibodies for both Zika and dengue Positive PRNT results for dengue create a dengue case in CDRSS o If confirmed/probable Zika case dengue will be closed as Not a Case o If not Zika case Dengue and Zika If clinical criteria is met for a dengue subgroup classified as POSSIBLE If asymptomatic, classified as NAC Note: POSSIBLE = SUSPECT cases and are not reported to CDC