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

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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

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。

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