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Zika Virus Diagnosis and Management During Pregnancy and In Infancy

Pregnancy Outcomes After Maternal Zika Virus Infection During Pregnancy - U.S. Territories, January 1, 2016 - April 25, 2017

1. In 2016, the CDC recommended all of the following, except:

A. Routine testing for Zika virus infection of asymptomatic pregnant women living in areas with ongoing local Zika virus transmission at the first prenatal care visit.

B. Retesting during the second trimester for women who initially test negative.

C. Retesting during the third trimester for women who tested negative in either the first or second trimester.

D. Testing of pregnant women with signs or symptoms consistent with Zika virus disease at any time during pregnancy.


2. All of the following are signs and symptoms consistent with Zika virus disease, except for:

A. Hyperemesis gravidarum

B. Rash

C. Arthralgia

D. Conjunctivitis


3. Among completed pregnancies with laboratory evidence of recent possible maternal Zika virus infection in the U.S. territories, about one in twelve fetuses or infants had a possible Zika-associated birth defect.

A. True

B. False


4. The risk for birth defects is higher when infection occurs early in pregnancy.

A. True

B. False


5. Possible Zika-associated birth defects were identified in pregnancies with symptoms or laboratory evidence of recent possible maternal Zika virus infection in which trimester of pregnancy?

A. First

B. Second

C. Third

D. Zika-associated birth defects were identified in each trimester of pregnancy


6. The highest risk of severe central nervous system sequelae (hearing loss, seizures, or chorioretinitis), have been reported of congenital cytomegalovirus infection following which trimester?

A. First

B. Second

C. Third

D. There is equal risk for all trimesters


7. The birth defects caused by the Zika virus are commonly also seen with the dengue virus.

A. True

B. False


Evaluation of Placental and Fetal Tissue Specimens for Zika Virus Infection - 50 States and District of Columbia, January - December, 2016

8. Zika virus reverse transcription - polymerase chain reaction testing of tissue specimens can provide a confirmed diagnosis of recent maternal Zika virus infection.

A. True

B. False


9. A positive Zika virus RT-PCR test result on placental tissue is evidence of maternal Zika virus infection.

A. True

B. False


10. A positive placental tissue RT-PCR can distinguish between maternal and congenital infection.

A. True

B. False


11. Which factor could lead to false-negative results?

A. Levels of viral RNA below the limit of assay detection.

B. Variability in tissue sampling.

C. Degradation of viral RNA because of insufficient tissue fixation or prolonged formalin-fixation.

D. Levels of viral RNA below the limit of assay detection, variability in tissue sampling, and degradation of viral RNA because of insufficient tissue fixation or prolonged formalin-fixation could all lead to false-negative results.


Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States (Including U.S. Territories), July 2017

12. Emerging epidemiological and laboratory data indicate that Zika virus IgM antibodies can persist beyond _____ after infection.

A. 6 weeks

B. 12 weeks

C. 18 weeks

D. 24 weeks


13. All pregnant women in the United States and U.S. territories should be asked about possible Zika virus exposure before and during the current pregnancy, at every prenatal care visit.

A. True

B. False


14. How many times should asymptomatic pregnant women with ongoing possible Zika virus exposure be offered Zika virus NAT testing during pregnancy?

A. Once

B. Twice

C. Three times

D. At every visit


15. IgM antibody testing is routinely recommended because it can reliably determine whether an infection occurred during the current pregnancy.

A. True

B. False


16. Even without ongoing possible exposure, asymptomatic pregnant women who have recent possible Zika virus exposure through travel or sexual exposure are routinely recommended to have Zika virus testing.

A. True

B. False


17. To assist in establishing the etiology of the birth defects, which of the following testing methods should be used for pregnant women who have recent possible Zika virus exposure and who have a fetus with prenatal ultrasound findings consistent with congenital Zika virus syndrome?

A. NAT

B. IgM

C. Both NAT and IgM

D. PRNT is the only test that can determine the etiology of the birth defects


18. Zika virus IgM testing is recommended as part of preconception counseling to establish baseline IgM results for nonpregnant women with ongoing possible Zika virus exposure.

A. True

B. False


19. Zika virus is a mosquito-borne flavivirus that is closely related to all of the following, except:

A. Dengue

B. Malaria

C. West Nile

D. Yellow fever


20. Zika virus is present in body fluids only transiently, which makes confirming the presence of the virus difficult.

A. True

B. False


21. Zika virus IgM antibodies typically become detectable within the first _____ after symptom onset.

A. 24 hours

B. 4 days

C. 2 weeks

D. Month


22. Consistent with what is known about other flaviviruses, data from this study indicate a median of ____ to the first negative Zika Virus IgM result.

A. One month

B. Two months

C. Three months

D. Four months


23. Based on experience with other flaviviruses, previous Zika virus infection is likely to confer prolonged, possibly lifelong, immunity.

A. True

B. False


24. In primary flavivirus infections, the plaque reduction neutralization test can do all of the following, except:

A. Discriminate between anti-Zika virus antibodies and cross-reacting antibodies in persons who have been previously infected with or vaccinated against a related flavivirus.

B. Identify the infecting virus.

C. Assist in identifying false-positive IgM.

D. PRNT can discriminate between anti-Zika and cross-reacting antibodies from those previously infected or vaccinated, identify the infecting virus, and also assist in identifying false-positive IgM results.


25. Testing for Zika virus infection is recommended for pregnant women with symptoms of Zika virus disease and possible Zika virus exposure, with the main goal of establishing a diagnosis that accounts for their symptoms, or ruling out Zika virus infection so that an alternative diagnosis can be considered.

A. True

B. False


26. Although a negative result does not rule out an infection during pregnancy because IgM levels decline over time, Zika virus IgM testing might be considered for women who seek care _____ weeks after symptom onset.

A. 6

B. 12

C. 18

D. 24


27. For pregnant women who have received a diagnosis of laboratory-confirmed Zika virus infection any time before or during the current pregnancy, additional Zika virus testing is recommended.

A. True

B. False


28. Adverse outcomes have been associated with infections diagnosed in the first and second trimesters, but not in the third trimester.

A. True

B. False


29. Zika virus testing is not recommended to determine timing of conception or pregnancy for couples in which one or both partners has had possible Zika virus exposure.

A. True

B. False


30. Which of the following is true with regard to amniotic fluid testing?

A. Detection of Zika virus RNA in amniocentesis specimens from pregnancies with a fetus with Zika virus-associated birth defects indicates fetal infection.

B. Detection of Zika virus RNA in amniotic fluid could be transient.

C. Zika virus RNA might not always be detectable in amniotic fluid after fetal infection.

D. Detection of Zika virus RNA in amniocentesis specimens from pregnancies with a fetus with Zika virus-associated birth defects indicate fetal infection, detection of Zika virus RNA in amniotic fluid could be transient, and Zika virus RNA might not always be detectable in amniotic fluid after fetal infection.


31. For pregnant women with laboratory evidence of possible Zika virus infection, serial fetal ultrasounds every 3 to 4 weeks should be considered to assess fetal anatomy, particularly fetal neuroanatomy, and to monitor growth.

A. True

B. False


32. Given the length of time for the detection of prenatal microcephaly, prenatal ultrasounds should carefully evaluate the fetal anatomy, particularly the neuroanatomy, to identify brain or structural abnormalities that might occur before microcephaly.

A. True

B. False


33. Which statement about Zika virus RNA in the amniotic fluid is correct?

A. The presence of Zika virus RNA in the amniotic fluid might indicate fetal infection.

B. A negative result of Zika virus RNA in the amniotic fluid excludes congenital Zika virus infection.

C. The presence of Zika virus RNA in the amniotic fluid might indicate fetal infection but a negative result of Zika virus RNA in the amniotic fluid excludes congenital Zika virus infection.

D. The presence of Zika virus RNA in the amniotic fluid indicates 100% certainty of fetal infection but a negative result of Zika virus RNA in the amniotic fluid excludes congenital Zika virus infection.


34. It is critical that pediatric health care providers inquire about possible maternal and congenital Zika virus exposure for every newborn.

A. True

B. False


35. Recommendations for outpatient management during the first _____ of life include monitoring of head circumference and development.

A. 6 months

B. 12 months

C. 24 months

D. 36 months


Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection - United States, October 2017

36. Further testing and clinical evaluation for Zika virus are not recommended for which of the following?

A. Infants with clinical findings consistent with congenital Zika syndrome regardless of maternal testing results.

B. Infants without clinical findings consistent with congenital Zika syndrome who were born to mothers with laboratory evidence of possible Zika virus infection.

C. Infants without clinical findings consistent with congenital Zika syndrome who were born to mothers without laboratory evidence of possible Zika virus infection.

D. Further testing and evaluation for Zika virus is recommended for all infants.


37. All of the following are characteristic findings in the brain and spinal cord among infants with congenital Zika virus infection, except:

A. Thick cerebral cortices with shrunken ventricles and decreased extra-axial fluid collections.

B. Intracranial calcifications particularly between the cortex and subcortex.

C. Absent or hypoplastic corpus callosum.

D. Hypoplasia of the cerebellum or cerebellar vermis.


38. Currently, there is no evidence suggesting that delayed-onset hearing loss occurs following congenital Zika virus infection.

A. True

B. False


39. Negative results to which of the following tests rule out infection?

A. Nucleic acid testing

B. Immunoglobulin M serologic testing

C. Negative results to either nucleic acid testing or immunoglobulin M serologic testing will rule out infection

D. Negative results to neither nucleic acid testing nor immunoglobulin M serologic testing rule out infection


40. Which of the following should be offered as part of routine obstetric care to asymptomatic pregnant women with ongoing possible Zika virus exposure?

A. NAT testing

B. Serologic testing

C. Both NAT and serologic testing

D. Neither NAT nor serologic testing


41. Testing of _____ is not recommended because it can yield false-positive and false-negative test results.

A. Serum

B. Cord blood

C. Urine

D. Cerebrospinal fluid


42. The plaque reduction neutralization test, which measures virus-specific neutralizing antibodies, can be used to help identify false-negative results?

A. True

B. False


43. PRNT can be used for:

A. Distinguishing between maternal and infant antibodies in specimens collected from infants at or near birth.

B. Determining timing of infection.

C. PRNT can be used for distinguishing between maternal and infant antibodies in specimens collected from infants at or near birth and determining timing of infection.

D. PRNT cannot be used for distinguishing between maternal and infant antibodies in specimens collected from infants at or near birth nor determining timing of infection.


44. Zika virus testing is recommended for infants with clinical findings consistent with congenital Zika syndrome and possible maternal Zika virus exposure during pregnancy, regardless of maternal testing results.

A. True

B. False


45. Referral to the appropriate specialist should be made if which of the following findings is identified at any time?

A. Impaired visual acuity / function

B. Hearing problems

C. Developmental delay

D. Impaired visual acuity / function, hearing problems, developmental delay, or delay in head growth


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