What should midwives know about Zika virus infection?

On 1 February 2016, the Director General of the World Health Organization (WHO) declared the recent outbreak of cases of fetal microcephaly linked to Zika in South America an international public health emergency (WHO, 2016a). As it is likely that some practising midwives in the UK will encounter women who are pregnant or planning to conceive and may have been exposed to Zika, it is important for midwives to be prepared for properly assessing and informing women with the infection. This article offers some insight into Zika and addresses the known effects of Zika during pregnancy, clinical management of women who are pregnant or planning pregnancy, and the implications of Zika for practising midwives in the UK.

Zika virus disease is a mosquito-borne infection caused by Zika virus (ZIKV), a member of the Flavivirus genus. ZIKV was first observed in a monkey in the Zika forest in Uganda in 1947, and it was found a few years later in humans, animals and mosquitoes throughout Africa and Asia. In the past 9 years, large outbreaks have been reported in Micronesia, French Polynesia and other parts of the Pacific, typically accompanied by mild illness (Centers for Disease Control and Prevention (CDC), 2016a). In May 2015, the first case of local ZIKV transmission was reported in Brazil. Since then, ZIKV has spread rapidly across 40 countries, particularly affecting South America, Central America and the Caribbean (Pan American Health Organization (PAHO) and WHO, 2016). By October 2015, Brazil reported an association between ZIKV infection with both fetal microcephaly—small head for gestational age—and Guillain-Barré syndrome. Pacific Islands and Cape Verde have also reported active ZIKV transmission, and more recently, small outbreaks have also been reported in Southeast Asia and Florida, USA (CDC, 2016a; European Centre for Disease Prevention and Control, 2016) (Figure 1).