Vector-Borne Illnesses and Pregnancy
This resource provides guidance for both healthcare providers and patients on vector-borne illnesses during pregnancy. It was developed by the Society for Maternal-Fetal Medicine (SMFM) Committee on Infectious Diseases and Emerging Threats in collaboration with the CDC.
Overview
Vector-borne illnesses are caused by a pathogen, such as a virus or bacteria, that is transmitted by an insect carrier. Emerging threats include, but are not limited to, Chikungunya, Dengue, Oropouche, and Zika viruses. Because many of these diseases have no cure and treatment is largely supportive, prevention is critical. Prevention strategies are largely focused on the insect vector. With climate change, increasing temperatures allow disease-carrying insects to thrive and survive in new regions and put vulnerable populations at greater risk, especially pregnant people.
Risks in Pregnancy
Perinatal infection can lead to preterm delivery, low birth weight, congenital malformations, and increased maternal, fetal, and neonatal mortality.
Assessment
Include travel history, sick contacts, and activities with exposure risk. Symptoms often mimic viral syndromes but may have distinguishing features, e.g., severe arthralgia (Chikungunya), mucosal bleeding (Dengue), scleral injection (Zika), or retro-orbital pain (Oropouche).
Diagnosis
Use PCR for acute infection, serology for past exposure, and follow CDC clinical testing guidelines.
Recommended Testing & Reporting
| Illness | ≤7 days after onset | >7 days after onset | Surveillance |
|---|---|---|---|
| Chikungunya | RT-PCR; confirm with NAT if positive | IgG/IgM detection | Report to state health department |
| Dengue | NAAT & IgM OR NS1 ELISA & IgM | IgM ELISA | Report to state health department |
| Oropouche | RT-PCR; confirm negative with PRNT | PRNT | Report to state health department |
| Zika | NAAT; IgM with PRNT if negative | NAAT; IgM with PRNT if negative | Report to state health department |
Vaccines
At this time, there are no currently available vaccines against Oropouche and Zika viruses. The vaccine against Dengue virus is not available in most jurisdictions of the United States, though it is available in Puerto Rico. There are two vaccines available in the United States to protect against chikungunya: a live-attenuated (LA) vaccine (called IXCHIQ) and a virus-like particle (VLP) vaccine (called VIMKUNYA). In pregnant patients, the CDC recommends deferring vaccination with IXCHIQ (CHIK-LA) until after delivery.
Treatment
Supportive care only; monitor closely for complications like dengue shock.
Prevention Counseling
Advise avoiding nonessential travel to high-risk areas, using EPA-approved repellents, protective clothing, and environmental control measures.
Pregnancy-Safe Repellents
DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol.
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