一般財団法人 国際医学情報センター 信頼できる医学・薬学・医療情報を適切に提供することによって健康社会に貢献します。

一般財団法人 国際医学情報センター

IMICライブラリ IMIC Library

ホームIMICライブラリMMWR抄訳2017年(Vol.66)最新情報:先天性ジカウイルス感染症の可能性のある乳・・・

MMWR抄訳

rss

2017/10/20Vol. 66 / No. 41

MMWR66(41):1089-1099
Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017

最新情報:先天性ジカウイルス感染症の可能性のある乳児の診断、評価および管理に関する暫定ガイドライン― アメリカ、2017年10月

CDCは先天性ジカウイルス感染症の可能性のある乳児に対するケアに関する医療従事者に対する暫定ガイドラインの改訂を行った。母親が妊娠中にジカウイルスに曝露した可能性がある場合、乳児は出生時および定期的な健康診断時に標準的評価を受けるべきであり、臨床検査および臨床評価に関するガイドラインは、1)母親の検査結果にかかわらず先天性ジカ症候群に一致する臨床所見を認める乳児、2)先天性ジカ症候群の臨床所見は認めないが、母親にジカウイルス感染症のエビデンスを認める乳児、3)先天性ジカ症候群の臨床所見を認めず、母親にジカウイルス感染症のエビデンスを認めない乳児を対象とし、3)の場合はさらなる試験と臨床評価は推奨されない。ジカウイルス曝露の可能性のある妊婦の検査に関するガイドラインは、ジカウイルス感染症の発症率低下を受けて2017年7月24日に最新の版が公表された。ジカウイルス核酸増幅検査(NAT)は曝露の可能性が持続する場合、無症候性の妊婦に対し定期的産科ケアの一部として行われるべきであり、血清学的検査は定期的に行うことは推奨されない。母体曝露に関しては感染した小児の同定が遅れる可能性があるため、産科と小児科間の情報提供が重要であり、また、家族に対する心理社会的支援も重要である。先天性ジカ症候群の臨床所見を認める乳児に関するガイドラインでは、臨床検査は血清および尿検査陰性の場合、ジカウイルスRNAおよびIgM抗体のCSF検査を推奨している。臨床評価および管理に関しては、標準的評価に加え生後1カ月までに眼科医による頭部超音波検査と眼科検査を行い、新生児聴覚スクリーニング検査が耳音響放射法のみで行われた場合は、生後1カ月までに聴性脳幹反応(ARB)を行う。また、発達遅延および発達障害のリスクがあるため、専門医および早期介入サービスプログラムの紹介が推奨され、同時に家族支援サービスが提供されるべきである。さらに小頭症または先天性異常の原因の検査や神経学的検査が考慮されるべきであり、包括的、定期的追跡評価が推奨される。先天性ジカ症候群の臨床所見を認めない乳児に関しては、母親に感染のエビデンスを認める場合に臨床検査を行い、標準的評価に加え生後1ヵ月までに頭部超音波検査と眼科検査およびARBを行う。プラーク減少中和試験(PRNT)確認が行われた場合、NAT陽性またはジカウイルスIgM非陰性によりジカウイルス感染の検査所見を認めた場合は臨床的に明らかな異常がなくとも臨床所見を示す乳児と同様に評価されるべきである。前回のガイドラインからの変更点として、最初のABRによる聴覚スクリーニングをパスした場合、生後4~6カ月の診断的ABRまたは9カ月の聴覚検査の実施は推奨されない。また、出生前診断に関しては超音波検査または羊水穿刺にて行われる。胎児の解剖学的構造の評価は妊娠18~22週のすべての妊婦に推奨されるが、先天性ジカウイルス感染症に関連する異常の検出は不明であり、また、羊水穿刺による検出に関してもその有用性は不明であり、検査の実施に関しては個別に判断される。

References

  • Russell K, Oliver SE, Lewis L, et al.; Contributors. Update: interim guidance for the evaluation and management of infants with possible congenital Zika virus infection—United States, August 2016. MMWR Morb Mortal Wkly Rep 2016;65:870–8. <https://doi.org/10.15585/mmwr.mm6533e2>
  • Oduyebo T, Polen KD, Walke HT, et al. Update: interim guidance for health care providers caring for pregnant women with possible Zika virus exposure—United States (including U.S. territories), July 2017. MMWR Morb Mortal Wkly Rep 2017;66:781–93. <https://doi.org/10.15585/mmwr.mm6629e1>
  • American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, Section on Ophthalmology, American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Visual system assessment in infants, children, and young adults by pediatricians. Pediatrics 2016;137:e20153596. <https://doi.org/10.1542/peds.2015-3596>
  • Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev 2016;37:25–37. <https://doi.org/10.1542/pir.2014-0103>
  • Council on Children With Disabilities; Section on Developmental Behavioral Pediatrics; Bright Futures Steering Committee; Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics 2006;118:405–20. <https://doi.org/10.1542/peds.2006-1231>
  • American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics 2007;120:898–921. <https://doi.org/10.1542/peds.2007-2333>
  • Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med 2016;374:1981–7. <https://doi.org/10.1056/NEJMsr1604338>
  • Hazin AN, Poretti A, Di Cavalcanti Souza Cruz D, et al.; Microcephaly Epidemic Research Group. Computed tomographic findings in microcephaly associated with Zika virus. N Engl J Med 2016;374:2193–5. <https://doi.org/10.1056/NEJMc1603617>
  • de Fatima Vasco Aragao M, van der Linden V, Brainer-Lima AM, et al. Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study. BMJ 2016;353:i1901. <https://doi.org/10.1136/bmj.i1901>
  • Soares de Oliveira-Szejnfeld P, Levine D, Melo AS, et al. Congenital brain abnormalities and Zika virus: what the radiologist can expect to see prenatally and postnatally. Radiology 2016;281:203–18. <https://doi.org/10.1148/radiol.2016161584>
  • de Paula Freitas B, de Oliveira Dias JR, Prazeres J, et al. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol 2016;134:529–35. <https://doi.org/10.1001/jamaophthalmol.2016.0267>
  • Ventura CV, Maia M, Ventura BV, et al. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol 2016;79:1–3.
  • Verçosa I, Carneiro P, Verçosa R, et al. The visual system in infants with microcephaly related to presumed congenital Zika syndrome. J AAPOS 2017;21:300–304.e1. <https://doi.org/10.1016/j.jaapos.2017.05.024>
  • Moore CA, Staples JE, Dobyns WB, et al. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr 2017;171:288–95. <https://doi.org/10.1001/jamapediatrics.2016.3982>
  • Leal MC, Muniz LF, Ferreira TS, et al. Hearing loss in infants with microcephaly and evidence of congenital Zika virus infection—Brazil, November 2015–May 2016. MMWR Morb Mortal Wkly Rep 2016;65:917–9. <https://doi.org/10.15585/mmwr.mm6534e3>
  • Zin AA, Tsui I, Rossetto J, et al. Screening criteria for ophthalmic manifestations of congenital Zika virus infection. JAMA Pediatr 2017;171:847–54. <https://doi.org/10.1001/jamapediatrics.2017.1474>
  • van der Linden V, Pessoa A, Dobyns W, et al. Description of 13 infants born during October 2015–January 2016 with congenital Zika virus infection without microcephaly at birth— Brazil. MMWR Morb Mortal Wkly Rep 2016;65:1343–8. <https://doi.org/10.15585/mmwr.mm6547e2>
  • van der Linden V, Filho ELR, van der Linden A. Congenital Zika syndrome: clinical aspects. In: Vasco Aragão M, ed. Zika in focus. Postnatal clinical, laboratorial and radiological Aspects. Cham, Switzerland: Springer International Publishing AG; 2017:33–46.
  • Carvalho MD, Miranda-Filho DB, van der Linden V, et al. Sleep EEG patterns in infants with congenital Zika virus syndrome. Clin Neurophysiol 2017;128:204–14. <https://doi.org/10.1016/j.clinph.2016.11.004>
  • Melo AS, Aguiar RS, Amorim MM, et al. Congenital Zika virus infection: beyond neonatal microcephaly. JAMA Neurol 2016;73:1407–16. <https://doi.org/10.1001/jamaneurol.2016.3720>
  • Meneses JDA, Ishigami AC, de Mello LM, et al. Lessons learned at the epicenter of Brazil’s congenital Zika epidemic: evidence from 87 confirmed cases. Clin Infect Dis 2017;64:1302–8. <https://doi.org/10.1093/cid/cix166>
  • Souza ASR, Cordeiro MT, Meneses JA, et al. Clinical and laboratory diagnosis of congenital Zika virus syndrome and diaphragmatic unilateral palsy: case report. Rev Bras Saude Mater Infant 2016;16:467–73. <https://doi.org/10.1590/1806-93042016000400007>
  • Rabe IB, Staples JE, Villanueva J, et al.; MTS. Interim guidance for interpretation of Zika virus antibody test results. MMWR Morb Mortal Wkly Rep 2016;65:543–6. <https://doi.org/10.15585/mmwr.mm6521e1>
  • Calisher CH, Karabatsos N, Dalrymple JM, et al. Antigenic relationships between flaviviruses as determined by cross-neutralization tests with polyclonal antisera. J Gen Virol 1989;70:37–43. <https://doi.org/10.1099/0022-1317-70-1-37>
  • Food and Drug Administration. Zika virus response updates from FDA. Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2017 <https://www.fda.gov/EmergencyPreparedness/Counterterrorism/MedicalCountermeasures/MCMIssues/ucm485199.htm>
  • de Araújo TVB, Rodrigues LC, de Alencar Ximenes RA, et al.; Investigators from the Microcephaly Epidemic Research Group; Brazilian Ministry of Health; Pan American Health Organization; Instituto de Medicina Integral Professor Fernando Figueira; State Health Department of Pernambuco. Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study. Lancet Infect Dis 2016;16:1356–63. <https://doi.org/10.1016/S1473-3099(16)30318-8>
  • Masuzaki H, Miura K, Miura S, et al. Labor increases maternal DNA contamination in cord blood. Clin Chem 2004;50:1709–11. <https://doi.org/10.1373/clinchem.2004.036517>
  • Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-03).
  • Oliveira DB, Almeida FJ, Durigon EL, et al. Prolonged shedding of Zika virus associated with congenital infection. N Engl J Med 2016;375:1202–4. <https://doi.org/10.1056/NEJMc1607583>
  • Villamil-Gómez WE, Guijarro E, Castellanos J, Rodríguez-Morales AJ. Congenital Zika syndrome with prolonged detection of Zika virus RNA. J Clin Virol 2017;95:52–4. <https://doi.org/10.1016/j.jcv.2017.08.010>
  • World Health Organization. WHO recommendations on the diagnosis of HIV infection in infants and children. Geneva, Switzerland: World Health Organization; 2010. <http://apps.who.int/iris/bitstream/10665/44275/1/9789241599085_eng.pdf>
  • Arvedson JC. Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev 2008;14:118–27. <https://doi.org/10.1002/ddrr.17>
  • Leal MC, van der Linden V, Bezerra TP, et al. Characteristics of dysphagia in infants with microcephaly caused by congenital Zika virus infection, Brazil, 2015. Emerg Infect Dis 2017;23:1253–9. <https://doi.org/10.3201/eid2308.170354>
  • Kuo DZ, Houtrow AJ, Arango P, Kuhlthau KA, Simmons JM, Neff JM. Family-centered care: current applications and future directions in pediatric health care. Matern Child Health J 2012;16:297–305. <https://doi.org/10.1007/s10995-011-0751-7>
  • Committee on Practice and Ambulatory Medicine; Bright Futures Periodicity Schedule Workgroup. 2017 recommendations for preventive pediatric health care. Pediatrics 2017;139:e20170254. <https://doi.org/10.1542/peds.2017-0254>
  • Committee on Practice Bulletins—Obstetrics and the American Institute of Ultrasound in Medicine. Practice bulletin no. 175: ultrasound in pregnancy. Obstet Gynecol 2016;128:e241–56. <https://doi.org/10.1097/AOG.0000000000001815>
  • Vouga M, Baud D. Imaging of congenital Zika virus infection: the route to identification of prognostic factors. Prenat Diagn 2016;36:799–811. <https://doi.org/10.1002/pd.4880>
  • Chibueze EC, Parsons AJQ, Lopes KDS, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017;7:2310. <https://doi.org/10.1038/s41598-017-01991-y>
  • Brasil P, Pereira JP Jr, Moreira ME, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016;375:2321–34. <https://doi.org/10.1056/NEJMoa1602412>
  • Sarno M, Aquino M, Pimentel K, et al. Progressive lesions of central nervous system in microcephalic fetuses with suspected congenital Zika virus syndrome. Ultrasound Obstet Gynecol 2016. <https://doi.org/10.1002/uog.17303>
  • Parra-Saavedra M, Reefhuis J, Piraquive JP, et al. Serial head and brain imaging of 17 fetuses with confirmed Zika virus infection in Colombia, South America. Obstet Gynecol 2017;130:207–12. <https://doi.org/10.1097/AOG.0000000000002105>
  • Besnard M, Eyrolle-Guignot D, Guillemette-Artur P, et al. Congenital cerebral malformations and dysfunction in fetuses and newborns following the 2013 to 2014 Zika virus epidemic in French Polynesia. Euro Surveill 2016;21:30181 <https://doi.org/10.2807/1560-7917.ES.2016.21.13.30181.>
  • Carvalho FH, Cordeiro KM, Peixoto AB, et al. Associated ultrasonographic findings in fetuses with microcephaly because of suspected Zika virus (ZIKV) infection during pregnancy. Prenat Diagn 2016;36:882–7. <https://doi.org/10.1002/pd.4882>
  • Schaub B, Gueneret M, Jolivet E, et al. Ultrasound imaging for identification of cerebral damage in congenital Zika virus syndrome: a case series. Lancet Child Adolesc Health 2017;1:45–55. <https://doi.org/10.1016/S2352-4642(17)30001-9>
  • Schaub B, Vouga M, Najioullah F, et al. Analysis of blood from Zika virus-infected fetuses: a prospective case series. Lancet Infect Dis 2017;17:520–7. <https://doi.org/10.1016/S1473-3099(17)30102-0>
  • Herrera K, Bernasko J, Garry D, Vahanian S, Kaplan C. Vertical transmission of Zika virus (ZIKV) in early pregnancy: two cases, two different courses. Case Reports in Perinatal Medicine 2016;5:131–3. <https://doi.org/10.1515/crpm-2016-0027>
  • Grimes DA, Schulz KF. Uses and abuses of screening tests. Lancet 2002;359:881–4. <https://doi.org/10.1016/S0140-6736(02)07948-5>

このコンテンツに「いいね」する

ページトップへ

一般財団法人 国際医学情報センター

〒160-0016 
東京都新宿区信濃町35番地 信濃町煉瓦館
TEL:03-5361-7080 (総務課)

WEBからのお問い合わせ

財団や各種サービスについてのお問い合わせ、お見積もりのご依頼、
サービスへのお申し込みはこちらをご覧ください。

お問い合わせ