Can I Get Tested for Zika Before Getting Pregnant
Want a Zika Test? It's Non Easy
MIAMI — After returning from a honeymoon in the Dominican Democracy, Jamie Palmeroni-Lavis asked to be tested for the Zika virus. Ms. Palmeroni-Lavis, 28, a publicist in Rochester, N.Y., wants to get pregnant, merely not before she knows her body is Zika free.
But she and other would-exist parents are chop-chop learning that getting a Zika test isn't easy.
As worries about the spread of the virus in the United States go along to mount, public health section labs in Florida and New York City are running at or close to capacity, while private commercial labs have won emergency blessing to run Zika tests and have ramped up their testing chapters.
Only that doesn't mean that merely anybody tin can get a test. Even people like Ms. Palmeroni-Lavis, who accept compelling reasons to be tested for a virus known to cause devastating brain defects in the fetus, can't walk into a local health department and become tested on need.
That's because the Centers for Disease Control and Prevention has issued strict guidelines about who should be tested, giving priority to meaning women with possible exposure to Zika and people with Zika-like symptoms. Already public health officials in Florida say they face up a backlog of tests for pregnant women, some of whom may be waiting to make decisions about whether to have abortions if they test positive. But the C.D.C.'southward testing policy largely ignores a sizable subgroup of women and men too at risk — those who are trying to conceive just fear they take been exposed to Zika. The C.D.C. recommends women contemplating pregnancy avoid travel to areas where Zika transmission is occurring and, if they have traveled, says they should wait at to the lowest degree 8 weeks before trying to conceive. But it does not recommend testing.
Guidance for men is inconsistent. Although the virus can persist in sperm for months after exposure, the C.D.C. recommends that men who may have been exposed to the virus have protected sex for at to the lowest degree eight weeks after potential exposure unless they have symptoms. The World Health Organization just changed its recommendation to 6 months of protected sex for men and women. Neither grouping recommends testing.
The restrictions are aimed at preventing an onslaught of requests for Zika tests that could clog the system and prevent public health officials from identifying new cases apace. They besides shape medical practice and influence insurance coverage, making doctors reluctant to order tests and insurers unwilling to cover the costs — between $229 and $800 on the individual marketplace — if patients don't fit the C.D.C.'south testing criteria.
In the case of Ms. Palmeroni-Lavis and her husband, her obstetrician and primary care doctors declined to refer her for testing because she didn't meet the criteria.
"If I have to wait a year, I will, because you want a healthy infant," said Ms. Palmeroni-Lavis, who booked her trip to the Dominican Republic almost a year agone, long earlier Zika had emerged every bit a threat. She and her husband already take a ii½-yr-old son and desire to conceive now and then the children are close in historic period. "If I could conceive sooner rather than later, that would be good for our family," she said.
Public health experts say the restrictions are necessary to ensure that people most at chance have access to testing.
"We aren't interested in stimulating the testing of simply anxious people," Dr. William Schaffner, an infectious diseases specialist and the caput of preventive medicine at Vanderbilt University Medical Center. "We want wellness care providers to provide the appropriate counseling and to be selective in the use of this examination, as they are in the use of whatever other test."
Laboratories and public health agencies say they are inundated with requests for tests, but declined to provide specifics. Julie Kliegl, the president of Viracor-IBT Laboratories, a commercial lab in Lee's Summit, Mo., said the demand for Zika testing had doubled between July and Baronial.
Clarissa Bradstock, the chief executive of Any Lab Test Now, a franchise company with headquarters in Alpharetta, Ga., said its fundamental call centre had been getting dozens of calls a solar day from people asking near Zika testing. The lab briefly offered on-demand testing, in disobedience of C.D.C. guidelines, but last calendar week stopped the practise after one of the company'southward testing partners raised concerns.
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"Nosotros're just trying to respond to customers' demands," she said. "We don't desire to add together to the hype, but nosotros're getting many people who want to excogitate or are concerned about themselves or their partners being infected."
One problem with private testing, health officials say, is that about commercial labs can't offer all the tests needed to determine conclusively if a person has been exposed to the virus.
Testing for Zika is surprisingly circuitous, and may require iii tests to be sure of a result. One type is called a polymerase concatenation reaction, or P.C.R., designed to observe the agile virus in blood and urine. The test is similar to those used for more mutual viruses like Due west Nile and influenza.
Just the P.C.R. test is reliable only if information technology's used within a week or two of exposure. Since most people don't have symptoms for Zika, many can't pinpoint the engagement of exposure. While a positive P.C.R. test shows definitively that a person has Zika, a negative test does not hateful a person is Zika costless.
If a P.C.R. examination is negative, the adjacent step is to test the blood sample for Zika antibodies. Antibiotic tests are not widely bachelor and tin can besides produce equivocal results.
A negative antibody examination means a person wasn't exposed to Zika. But a positive result requires a tertiary examination to be sure the detected antibodies aren't other viruses, such as dengue or chikungunya, both of which cause flulike symptoms and are present in Latin and South American countries.
The tertiary blazon, the plaque reduction neutralization test, or P.R.N.T., determines conclusively if a person was exposed to Zika. Only the examination is now done only past the C.D.C. and a limited number of local health department labs.
For men, the story is even more complicated. Infected men tin can behave Zika in their semen for upwardly to six months, only in that location is no approved test for screening semen.
"Unfortunately, telling someone 'you do not have Zika and never had Zika' can be challenging. There are limitations to the all-time available tests," said Dr. Jay M. Varma, the deputy commissioner for disease control at New York Metropolis'south Section of Health and Mental Hygiene. "There are situations in which we have to tell people, 'Nosotros don't know for sure whether or not you've been infected. Nosotros tin can't conclusively say you lot were infected, and nosotros can't conclusively say you weren't infected.' That's the limitation of the applied science."
For Elizabeth Agraz-Sanchez, 33, of Los Angeles, the lack of reliable testing for women who want to conceive has been disappointing. Ms. Agraz-Sanchez had her dream wedding in May on a beach in Puerto Rico, an active zone of musquito-borne Zika transmission, and didn't realize the touch on it would take on her path to pregnancy.
A cancer survivor, she consulted a fertility specialist after returning home to Los Angeles to talk about getting pregnant. "My doctor just said, 'No, yous tin can't. No, you have to expect,'" Ms. Agraz-Sanchez said. "It was kind of heartbreaking."
Some medical groups are pushing back against the C.D.C. guidelines. On Thursday, the American Social club of Reproductive Medicine, a membership arrangement that represents fertility experts, recommended that men and women who may have been exposed to Zika consider being tested and embark on fertility treatments just if tests are negative.
Only while the new guidelines comprise the option of testing, Dr. Kristin Bendikson, an assistant professor of obstetrics and gynecology at the Keck School of Medicine at the Academy of Southern California, said, "If you aren't sure, your best option is to wait two months."
Source: https://www.nytimes.com/2016/09/20/well/live/want-a-zika-test-its-not-easy.html
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