Zika Virus Disease: A CDC Update for Pediatric Health Care Providers

Abstract

Zika virus is a mosquito-borne flavivirus discovered in Africa in 1947. Most persons with Zika virus infection are asymptomatic; symptoms when present are generally mild and include fever, maculopapular rash, arthralgia, and conjunctivitis. Since early 2015, Zika virus has spread rapidly through the Americas, with local transmission identified in 31 countries and territories as of February 29, 2016, including several US territories. All age groups are susceptible to Zika virus infection, including children. Maternal–fetal transmission of Zika virus has been documented; evidence suggests that congenital Zika virus infection is associated with microcephaly and other adverse pregnancy and infant outcomes. Perinatal transmission has been reported in 2 cases; 1 was asymptomatic, and the other had thrombocytopenia and a rash. Based on limited information, Zika virus infection in children is mild, similar to that in adults. The long-term sequelae of congenital, perinatal, and pediatric Zika virus infection are largely unknown. No vaccine to prevent Zika virus infection is available, and treatment is supportive. The primary means of preventing Zika virus infection is prevention of mosquito bites in areas with local Zika virus transmission. Given the possibility of limited local transmission of Zika virus in the continental United States and frequent travel from affected countries to the United States, US pediatric health care providers need to be familiar with Zika virus infection. This article reviews the Zika virus, its epidemiologic characteristics, clinical presentation, laboratory testing, treatment, and prevention to assist providers in the evaluation and management of children with possible Zika virus infection.

Characteristics of Children Aged <18 Years with Zika Virus Disease Acquired Postnatally — U.S. States, January 2015–July 2016

“…This series of 158 children with postnatally acquired Zika virus disease corroborates previously published reports suggesting that the clinical course of Zika virus disease is typically mild in children, as it is in adults (2,7). In this case series, only two children were hospitalized, and no deaths occurred.…”

“…All nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in children aged <6 months. NSAIDs also should be avoided in all other age groups until infection with dengue virus is ruled out, to avoid the potential for hemorrhagic complications of dengue fever (7).…”

“…Guillain-Barré syndrome (an autoimmune disorder of the peripheral nervous system), other neurologic manifestations, and thrombocytopenia have been reported following Zika virus infections in adults (5,6). However, there are few published data on the clinical findings and outcomes of postnatally acquired Zika virus disease among children (7). This case series describes the epidemiology, clinical findings, and outcomes in 158 U.S. children with confirmed or probable postnatally acquired Zika virus disease.…”

Global epidemiology of Zika and Chikungunya virus human infections

“…No difference between ages was shown. Reports of child infection are limited, but they seems similar to that of adults with asymptomatic or mild symptomatic cases (60). Zika virus infections are mainly asymptomatic (75-80%); the symptomatic infection is similar to other arboviral infections (i.e.…”

Insect Repellants During Pregnancy in the Era of the Zika Virus

“…2,3 Recommendations for use of insect repellants on infants and young children may differ from those for adults and pregnant women, so health care providers and parents should consult the pediatric guidelines for the appropriate use of insect repellants in children. 4 The biology of the primary mosquito vector transmitting Zika virus, Aedes aegypti, has implications for vector control. 5 Importantly, Aedes aegypti mosquitoes are quite adaptable to human settings and can bite both indoors and outdoors, with a preference for indoor biting.…”