Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017

Adebanjo, Tolulope; Godfred‐Cato, Shana; Viens, Laura; Fischer, Marc; Staples, J. Erin; Kuhnert-Tallman, Wendi; Walke, Henry; Oduyebo, Titilope; Polen, Kara; Peacock, Georgina; Meaney‐Delman, Dana; Honein, Margaret A.; Rasmussen, Sonja A.; Moore, Cynthia A.; Alleyne, Edna; Badell, Martina; Bale, James F.; Barfield, Wanda D.; Beigi, Richard H.; Berrocal, Audina M.; Blackmore, Carina; Blank, Eric; Pitre, Jennifer Bolden; Boyle, Coleen; Conners, Erin E.; Curry, Christine; Danila, Richard; Vega, Alberto De la; DeBiasi, Roberta L.; Demmler-Harrison, Gail J.; Dolan, Siobhan M.; Driggers, Rita W.; Dziuban, Eric J.; Eichwald, John; Eppes, Catherine; Fehrenbach, Nicole; Fisher, Meg; Fortner, Kimberly B.; Garbarczyk, Elizabeth; García, Francisco José Ferraro; Gaw, Stephanie L.; Godoshian, Valerie; González, Iván; Green, Caitlin; Griffin, Dixie D.; Hall, Manda; Houtrow, Amy J.; Hudak, Mark L.; Hunter, Lisa L.; Kimberlin, David W.; Lawrence, Linda; Lee, Ellen H.; Leeb, Rebecca T.; Levine, Deborah; Malave, Claritsa; Maldonado, Yvonne; Mofenson, Lynne M.; Mulkey, Sarah B.; Muñoz, Flor M.; Needle, Scott; Oram, Chloe; Pasley, Cassandra G.; Carlos, Maria P.; Pensirikul, Alyssa; Petersen, Emily E.; Platt, Lawrence D.; Prakalapakorn, S. Grace; Reagan‐Steiner, Sarah; Rodriguez, Jeannie; Rosenblum, Elizabeth; Sánchez, Pablo J.; Cortés, Magdalena Sanz; Schonfeld, David J.; Shapiro-Mendoza, Carrie K.; Sidelinger, Dean E.; Tait, V. Fan; Valencia‐Prado, Miguel; Waddell, Lisa F.; Warren, Michael D.; Wiley, Susan; Yamada, Eileen G.; Yeargin‐Allsopp, Marshalyn; Ysern, Fernando; Zahn, Christopher M.

doi:10.15585/mmwr.mm6641a1

Cited by 164 publications

(179 citation statements)

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“…The guidance was based largely on existing guidelines for pediatric health promotion and care ( 14 ); expert opinion was incorporated from clinicians and researchers with knowledge of congenital infections and of clinical care of infants with birth defects as described in early reports ( 15 – 18 ). Recommendations for the care and management of infants with possible congenital Zika virus exposure and infants with one or more clinical findings consistent with congenital Zika virus syndrome have remained largely unchanged through subsequent updates ( 19 ). Standard evaluation* at birth and during each well-child visit is recommended for all infants and young children with possible prenatal Zika virus exposure ( 13 , 19 ).…”

Section: Introductionmentioning

confidence: 99%

“…Recommendations for the care and management of infants with possible congenital Zika virus exposure and infants with one or more clinical findings consistent with congenital Zika virus syndrome have remained largely unchanged through subsequent updates ( 19 ). Standard evaluation* at birth and during each well-child visit is recommended for all infants and young children with possible prenatal Zika virus exposure ( 13 , 19 ). Laboratory testing for Zika virus is recommended for infants born to mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and for infants with one or more clinical findings consistent with congenital Zika syndrome born to mothers with possible Zika virus exposure, regardless of maternal testing results.…”

Section: Introductionmentioning

confidence: 99%

“…Laboratory testing for Zika virus is recommended for infants born to mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and for infants with one or more clinical findings consistent with congenital Zika syndrome born to mothers with possible Zika virus exposure, regardless of maternal testing results. In addition to a standard evaluation, infants born to mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy should have a cranial ultrasound or other brain imaging and a comprehensive ophthalmologic evaluation performed by age 1 month to detect subclinical brain and eye findings ( 19 ). …”

Section: Introductionmentioning

confidence: 99%

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Vital Signs:Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018

Rice¹,

Galang²,

Roth³

et al. 2018

MMWR Morb. Mortal. Wkly. Rep.

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IntroductionZika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning.MethodsPregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection.ResultsAmong 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both.ConclusionOne in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Vital Signs:Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018

Rice¹,

Galang²,

Roth³

et al. 2018

MMWR Morb. Mortal. Wkly. Rep.

Self Cite

190

237

View full text Add to dashboard Cite

show abstract

“…13 Initial USZPIR data showed that most infants with possible congenital ZIKV infection (ie, those who are born to women with [possible or confirmed] laboratory evidence of ZIKV infection) are not receiving CDC-recommended postnatal neuroimaging or ZIKV testing at birth. 13,30 Adherence to recommended evaluation and management procedures for infants with possible congenital ZIKV infection is essential to characterize the full spectrum of CZS. The CDC has produced a pocket guide summarizing pediatric guidance on initial evaluation and outpatient management.…”

Section: Public Health Approachmentioning

confidence: 99%

Public Health Approach to Addressing the Needs of Children Affected by Congenital Zika Syndrome

et al. 2018

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We have learned much about the short-term sequelae of congenital Zika virus (ZIKV) infection since the Centers for Disease Control and Prevention activated its ZIKV emergency response in January 2016. Nevertheless, gaps remain in our understanding of the full spectrum of adverse health outcomes related to congenital ZIKV infection and how to optimize health in those who are affected. To address the remaining knowledge gaps, support affected children so they can reach their full potential, and make the best use of available resources, a carefully planned public health approach in partnership with pediatric health care providers is needed. An essential step is to use population-based data captured through surveillance systems to describe congenital Zika syndrome. Another key step is using collected data to investigate why some children exhibit certain sequelae during infancy and beyond, whereas others do not, and to describe the clustering of anomalies and the timing of when these anomalies occur, among other research questions. The final critical step in the public health framework for congenital Zika syndrome is an intervention strategy with evidence-based best practices for longer-term monitoring and care. Adherence to recommended evaluation and management procedures for infants with possible congenital ZIKV infection, including for those with less obvious developmental and medical needs at birth, is essential. It will take many years to fully understand the effects of ZIKV on those who are congenitally infected; however, the lifetime medical and educational costs as well as the emotional impact on affected children and families are likely to be substantial.

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“…8 In the U.S. reports and in the French territories, some brain abnormalities may have been missed among babies whose mothers had confirmed infection, because not all fetuses or infants underwent the recommended brain imaging; continued efforts are needed to increase the proportion of infants who receive all recommended evaluations if their mothers have had evidence of ZIKV infection during pregnancy. 9 …”

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confidence: 99%

Recognizing the Global Impact of Zika Virus Infection during Pregnancy

Honein

2018

N Engl J Med

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Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017

Cited by 164 publications

References 46 publications

Vital Signs:Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018

Vital Signs:Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018

Public Health Approach to Addressing the Needs of Children Affected by Congenital Zika Syndrome

Recognizing the Global Impact of Zika Virus Infection during Pregnancy

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