Outcomes Up to Age 36 Months after Congenital Zika Virus Infection – U.S. States

Abstract

Background: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. Methods: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥ 1 follow-up exam after 14 days of age or with ≥ 1 visit with development reported, respectively. Results: Among 2,248 infants, 9.9% were born preterm, and 10.0% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1,881 children ≥ 1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥ 1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. Conclusion: Understanding the prevalence of developmental delays and healthcare needs these children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families.

Continuing development of vaccines and monoclonal antibodies against Zika virus

“…Among pregnancies with confirmed ZIKV infection, 6.2% of infants had a ZBD. In areas with widespread local transmission of the virus, ZBDs were 9 times higher than in areas without local transmission [4][5][6] . A limitation of findings from the USZPIR is a lack of a control group of pregnant persons who were not exposed to ZIKV during pregnancy.…”

“…The Zika virus (ZIKV) was brought to global attention in 2016 when scientists discovered that ZIKV infections were linked to microcephaly and Guillain-Barre syndrome (GBS) [1][2][3] . ZIKV infection during pregnancy was later appreciated to cause a range of other congenital malformations [4][5][6] . ZIKV infection is also linked to Guillain-Barré syndrome, neuropathy, and myelitis in both children and adults.…”

Does Intra-Uterine Exposure to the Zika Virus Increase Risks of Cognitive Delay at Preschool Ages? Findings from a Zika-Exposed Cohort from Grenada, West Indies

“…Moreover, a cohort study from French Polynesia found that maternal ZIKV infection was not associated with an excess burden of developmental delay during early childhood [ 33 ]. Data from the U.S. Zika Pregnancy and Infant Registry show that among children with confirmed prenatal Zika-exposure but without Zika-associated birth defects, the rate of confirmed or possible NDD was 7.4% up to 36 months of age, which is considered to be within the expected general population rate [unpublished personal data] [ 34 ]. Nevertheless, developmental delays, particularly in cognitive and language domains, have been previously reported in normocephalic ZIKV-exposed children [ 34 , 35 , 36 , 37 ] and authors have cautioned against normocephaly being used as a proxy marker for reassurance of typical neurodevelopment [ 12 ].…”

“…Data from the U.S. Zika Pregnancy and Infant Registry show that among children with confirmed prenatal Zika-exposure but without Zika-associated birth defects, the rate of confirmed or possible NDD was 7.4% up to 36 months of age, which is considered to be within the expected general population rate [unpublished personal data] [ 34 ]. Nevertheless, developmental delays, particularly in cognitive and language domains, have been previously reported in normocephalic ZIKV-exposed children [ 34 , 35 , 36 , 37 ] and authors have cautioned against normocephaly being used as a proxy marker for reassurance of typical neurodevelopment [ 12 ]. In one Brazilian study, lower head circumference for age was found to be a predictor of neurodevelopmental delay in normocephalic ZIKV-exposed children at 6 months [ 38 ].…”