First Neonatal Demise with Travel-Associated Zika Virus Infection in the United States of America

Abstract

Zika virus is increasingly recognized as a fetal pathogen worldwide. We describe the first case of neonatal demise with travel-associated Zika virus infection in the United States of America, including a novel prenatal ultrasound finding. A young Latina presented to our health care system in Southeast Texas for prenatal care at 23 weeks of gestation. Fetal Dandy–Walker malformation, asymmetric cerebral ventriculomegaly, single umbilical artery, hypoechoic fetal knee, dorsal foot edema, and mild polyhydramnios were noted upon initial screening prenatal sonography at 26 weeks. A growth-restricted, microcephalic, and arthrogrypotic infant was delivered alive at 36 weeks but died within an hour despite resuscitation. The neonatal karyotype was normal. Flavivirus IgM antibodies were identified in the serum of the puerpera, once she disclosed that she had traveled from El Salvador to Texas in the early second trimester. Zika virus was identified in the umbilical cord and neonatal brain. Fetal arthritis may precede congenital arthrogryposis in cases of Zika virus infection and may be detectable by prenatal sonography. Physician and health care system vigilance is required to optimally address the significant and enduring Zika virus global health threat.

Association Between Neonatal Neuroimaging and Clinical Outcomes in Zika-Exposed Infants From Rio de Janeiro, Brazil

“…Dandy-Walker malformation has been reported previously in other congenital infections, especially congenital rubella, 21 and observed in several other ZIKV radiology reports. 5,10,22,23…”

Consensus and conflict among ecological forecasts of Zika virus outbreaks in the United States

“… Carlson Messina Samy Mordecai (97.5% min) Mordecai (2.5% max) n points 242 323 168 NA NA n predictors 15 6 15 NA NA AUC 0.970 0.829 NA NA NA Counties Predicted 13 465 1616 1937 3108 Accuracy 99.6% 85.2% 48.2% 37.8% 0.2% County Population at Risk 19,653,445 95,359,408 270,249,781 218,444,263 320,957,062 Mean Outbreak Size 12,871,005 63,622,367 181,290,371 37,598,099 198,910,979 Median Outbreak Size 14,552,250 64,038,273 181,732,629 37,312,233 197,731,918 Four different methods, each performing well based on sufficient data and predictors, produce highly contrasting results. Out of a total of 3108 counties in the continental U.S., only five have experienced outbreaks (Cameron County, TX with 6 cases of local transmission in 2016; Miami-Dade, FL with 241; Palm Beach, FL with 8; Broward County, FL with 5; and Pinellas County, FL with 1) 39 , 69 . Accuracy values were calculated from the confusion matrix of observed outbreaks against predicted suitability.…”

“… Four different methods, each performing well based on sufficient data and predictors, produce highly contrasting results. Out of a total of 3108 counties in the continental U.S., only five have experienced outbreaks (Cameron County, TX with 6 cases of local transmission in 2016; Miami-Dade, FL with 241; Palm Beach, FL with 8; Broward County, FL with 5; and Pinellas County, FL with 1) 39 , 69 . Accuracy values were calculated from the confusion matrix of observed outbreaks against predicted suitability.…”

Consensus and conflict among ecological forecasts of Zika virus outbreaks in the United States

“…This, in itself, adds another layer of neutral assumptions (populations are treated as having a uniform distribution within counties) but might also produce less drastic differences between outbreak trajectories. The results of that analysis are given in Table 3 33,62 . Accuracy values were calculated from the confusion matrix of observed outbreaks against predicted suitability.…”