A 31-year-old woman (gravida 1 para 0) presents at 12 weeks’ gestation to her obstetrician in New York. Her husband returned about 1 month ago from a business trip to Texas. Although he does not recall any specific symptoms over the past month, he experienced mosquito bites during the trip. They have had unprotected vaginal sex since his return.
A 1-day-old male infant in Florida, following an uncomplicated pregnancy and vaginal delivery at 39 weeks’ gestation, has a head circumference in the third percentile for age and gender. There is no family history of genetic abnormalities, known infection during pregnancy, or in utero drug/toxin exposure. The mother reports spending 3 weeks in the Caribbean during her second trimester.
Approximately 80% of people infected with Zika virus are asymptomatic.  In those who are symptomatic, patients generally present with a mild, self-limited illness including fever, maculopapular (sometimes morbilliform) rash, arthralgia/myalgia, and conjunctivitis. Less common symptoms include vomiting/diarrhea, abdominal pain, anorexia, edema of the lower limbs, and retro-orbital pain.  There have been case reports of sepsis and rapid disease progression in patients with comorbidities.  Atypical presentations (e.g., patients have presented with generalized rash or fever only) have been reported.  Zika-related microcephaly has been reported in both fetuses in a monochorionic diamniotic twin pregnancy. 
People may ask about whether to proceed with planned travel to endemic areas and/or preventive measures for avoidance of mosquito bites. Women of childbearing age may ask about whether to proceed with or to defer a planned pregnancy. People may ask about safe sexual practice, including before or during pregnancy. Pregnant women who have possibly been exposed to Zika virus through travel or sexual contact may inquire about Zika virus testing and fetal monitoring.
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