Population-Based Surveillance for Birth Defects Potentially Related to Zika Virus Infection — 22 States and Territories, January 2016–June 2017

Smoots, Ashley N.; Olson, Samantha M; Cragan, Janet D.; Delaney, Augustina; Roth, Nicole; Godfred‐Cato, Shana; Jones, Abbey M.; Nahabedian, John F.; Fornoff, Jane; Sandidge, Theresa; Yazdy, Mahsa M.; Higgins, Cathleen A.; Olney, Richard S.; Eckert, Valorie; Forkner, Allison; Fox, Deborah; Stolz, Amanda; Crawford, Katherine; Cho, Sook Ja; Knapp, Mary; Ahmed, Muhammad Farooq; Lake-Burger, Heather; Elmore, Amanda L.; Langlois, Peter H.; Breidenbach, Rebecca; Nance, Amy; Denson, Lindsay; Caton, Lisa; Forestieri, Nina; Bergman, Kristin; Humphries, Brian K.; Leedom, Vinita; Tran, Tri; Johnston, Julie; Valencia‐Prado, Miguel; Pérez-Gonzalez, Stephany I; Romitti, Paul A.; Fall, Carrie; Bryan, Jacqueline; Barton, Jerusha; Arias, William; John, Kristen St.; Mann, Sylvia; Kimura, Jonathan; Orantes, Lucia C.; Martin, Brennan; Wilde, Leah de; Ellis, Esther M.; Song, Ziwei; Akosa, Amanda; Goodroe, Caroline; Ellington, Sascha; Tong, Van T.; Gilboa, Suzanne M.; Moore, Cynthia A.; Honein, Margaret A.

doi:10.15585/mmwr.mm6903a3

Cited by 20 publications

(29 citation statements)

References 8 publications

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“…Birth prevalence of microcephaly, which was monitored before the ZIKV outbreak in Costa Rica, increased by almost 4-fold after the ZIKV outbreak, from 4.2 cases/10,000 live births to 15.5 cases/10,000 live births. Although we recognize that the birth prevalence of this defect may be underreported during non–ZIKV-epidemic times, these data are consistent with the experience in other countries, where the prevalence of microcephaly increased >4-fold (Colombia, French Polynesia, United States) ( 7 , 24 , 25 ) and up to 9-fold (Brazil) ( 30 , 31 ). Heightened awareness of the possible association between congenital ZIKV infection and microcephaly, as well as country-specific protocols to improve identification of this traditionally underascertained birth defect, probably contributed to increased prevalence estimates ( 32 ).…”

Section: Discussionsupporting

confidence: 88%

“…In Costa Rica, most infants with ZBD were born ≈1 year after the onset of autochthonous circulation of ZIKV and 6 months after peak incidence of ZIKV infection among pregnant women. Similar findings have been observed in Brazil, Colombia, and the United States, where the peak incidence was observed ≈6 months after the ZIKV epidemic, corroborating a temporal link between ZIKV infection and associated birth defects ( 7 , 23 , 24 ). Most infants with ZBD were born to mothers who reported symptoms in the first and second trimesters of pregnancy (64%), consistent with other reports ( 25 – 29 ); however, because 36% were born to mothers who were asymptomatic, the proportion of infections in early to mid-pregnancy is probably greater.…”

Section: Discussionsupporting

confidence: 86%

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Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018

Benavides‐Lara¹,

Barboza-Argüello²,

González-Elizondo³

et al. 2021

Emerg. Infect. Dis.

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In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/eid; and (4) view/print certificate. For CME questions, see page XXX.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 86%

Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018

Benavides‐Lara¹,

Barboza-Argüello²,

González-Elizondo³

et al. 2021

Emerg. Infect. Dis.

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“…Infants from approximately 7,500 completed pregnancies are monitored in this system. Second, the Zika Birth Defects Surveillance (ZBDS) is a population‐based surveillance system that collected data on 3,359 infants and fetuses who had a birth defect potentially related to ZIKV infection, regardless of ZIKV laboratory findings, in 22 U.S. states and territories from January 2016 to June 2017 (Olson et al, 2019; Smoots et al, 2020). Infants captured in both surveillance systems were matched to increase data completeness.…”

Section: Methodsmentioning

confidence: 99%

Clinical phenotype in infants with negative Zika virus immunoglobulin M testing born to mothers with confirmed Zika virus infection during pregnancy

Godfred‐Cato

Newton²,

Adams

et al. 2021

Birth Defects Research

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Background Recommended testing for both infants with Zika‐associated birth defects (i.e., microcephaly and selected brain or eye anomalies) and infants without birth defects whose mothers had laboratory evidence of possible Zika virus (ZIKV) infection during pregnancy includes nucleic acid amplification testing (NAAT) and immunoglobulin M (IgM) testing within days after birth. Brain and eye defects highly specific for congenital ZIKV infection have been described; sporadic reports have documented negative ZIKV testing in such infants. Methods Infants from the U.S. Zika Pregnancy and Infant Registry and Zika Birth Defects Surveillance with Zika‐associated birth defects and maternal and infant laboratory testing for ZIKV and two congenital infections (i.e., cytomegalovirus [CMV] and toxoplasmosis) were reviewed for phenotype and laboratory results. Infants with at least one defect considered highly specific for congenital ZIKV infection were designated as having congenital Zika syndrome (CZS) clinical phenotype for this study. Results Of 325 liveborn infants with Zika‐associated birth defects and laboratory evidence of maternal ZIKV infection, 33 (10%) had CZS clinical phenotype; 172 (53%) had ZIKV IgM testing with negative or no ZIKV NAAT. ZIKV IgM was negative in the remaining 121 infants, and for 90%, testing for CMV and toxoplasmosis was missing/incomplete. Among 11 infants testing negative for ZIKV IgM, CMV, and toxoplasmosis, 2 infants had CZS clinical phenotype. Conclusions These data add support to previous reports of negative ZIKV IgM testing in infants with clear maternal and phenotypic evidence of congenital ZIKV infection. Follow‐up care consistent with the diagnosis is recommended regardless of infant ZIKV test results.

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“…However, a substantial proportion of pregnancies with in-utero ZIKV exposure result in babies without apparent defects. Only an estimated 5-15% of infants have ZIKV-related birth defects (1–3). Importantly, infants who are born apparently healthy can manifest developmental and neurocognitive deficits months to years after birth (4–7), even if maternal exposure resulted in asymptomatic infection (8).…”

Section: Introductionmentioning

confidence: 99%

Zika virus infection of pregnant Ifnar1^−/− mice triggers strain-specific differences in fetal outcomes

Bohm¹,

Vangorder-Braid²,

Jaeger³

et al. 2021

Preprint

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Zika virus (ZIKV) is a flavivirus that causes a constellation of adverse fetal outcomes collectively termed Congenital Zika Syndrome (CZS). However, not all pregnancies exposed to ZIKV result in an infant with apparent defects. During the 2015-2016 American outbreak of ZIKV, CZS rates varied by geographic location. The underlying mechanisms responsible for this heterogeneity in outcomes have not been well defined. Therefore, we sought to characterize and compare the pathogenic potential of multiple Asian/American-lineage ZIKV strains in an established Ifnar1 pregnant mouse model. Here, we show significant differences in the rate of fetal demise following maternal inoculation with ZIKV strains from Puerto Rico, Panama, Mexico, Brazil, and Cambodia. Rates of fetal demise broadly correlated with maternal viremia but were independent of fetus and placenta virus titer, indicating that additional underlying factors contribute to fetus outcome. Our results, in concert with those from other studies, suggest that subtle differences in ZIKV strains may have important phenotypic impacts. With ZIKV now endemic in the Americas, greater emphasis needs to be placed on elucidating and understanding the underlying mechanisms that contribute to fetal outcome.

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Population-Based Surveillance for Birth Defects Potentially Related to Zika Virus Infection — 22 States and Territories, January 2016–June 2017

Cited by 20 publications

References 8 publications

Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018

Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018

Clinical phenotype in infants with negative Zika virus immunoglobulin M testing born to mothers with confirmed Zika virus infection during pregnancy

Zika virus infection of pregnant Ifnar1^−/− mice triggers strain-specific differences in fetal outcomes

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Population-Based Surveillance for Birth Defects Potentially Related to Zika Virus Infection — 22 States and Territories, January 2016–June 2017

Cited by 20 publications

References 8 publications

Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018

Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018

Clinical phenotype in infants with negative Zika virus immunoglobulin M testing born to mothers with confirmed Zika virus infection during pregnancy

Zika virus infection of pregnant Ifnar1−/− mice triggers strain-specific differences in fetal outcomes

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Product

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Zika virus infection of pregnant Ifnar1^−/− mice triggers strain-specific differences in fetal outcomes