Robert R. Redfield
A report issued by the CDC shows that approximately 14% of infants — or one in seven — infected with Zika virus in utero within U.S. territories have one or more health issues at 1 year of age.
The organization notes that some of these issues, including brain and eye damage, seizures and vision and hearing problems, are not always evident at birth.
“We are still learning about the effects of Zika, and it might be years before we fully understand the full spectrum of the health outcomes related to Zika infection during pregnancy,” Robert R. Redfield, MD, director of the CDC, said. “We do know some babies may appear healthy at birth but can develop long-term health problems as they grow. That is why continued monitoring and follow-up evaluations are so crucial, and health care providers play a key role in these efforts.”
This report included data collected between 2016 and 2018 on 4,800 pregnancies. All mothers had lab-confirmed or possible Zika virus infection. Follow-up was conducted for 1,450 infants, and all were aged 1 year by February 2018. Infants were located in American territories, including American Samoa, the Federated States of Micronesia, Puerto Rico, the Republic of Marshall Islands and the U.S. Virgin Islands.
Of the 1,450 babies included in the analysis who had received some form of follow-up, 6% had one or more Zika-related birth defects that were identified and reported to the surveillance network. Peggy Honein, PhD, MPH, director of the CDC’s division of congenital and developmental disorders, said that this rate is more than 30% higher than the baseline for these types of brain and eye defects in the absence of Zika during pregnancy.
“Although this report focuses on babies born in U.S. territories, it is important to remember that almost 2,500 pregnancies in the U.S. also had laboratory evidence of Zika during the same time frame,” Redfield said. “Nearly all of these cases happen when pregnant women travel to Zika-affected areas.”
The CDC continues to recommend that pregnant women should not travel to areas with risk of Zika.
Additionally, about 9% of infants had at least one Zika-related nervous system problem identified and reported, including seizures, problems with swallowing and moving, hearing loss or developmental delay based on standardized testing.
“Based on what we have learned about other congenital infections, we suspect that health issues will continue to emerge as these children age,” Honein said. “This is why it is so absolutely critical that these babies receive care to identify issues as soon as possible.”
The report highlights high rates of follow-up among exposed children, including the 95% who received at least one physical exam after the first 2 weeks of life. Additionally, about 76% had a developmental evaluation, and about 60% received the recommended brain imaging after birth; however, room for improvement exists. Honein said that only about one-half of infants had undergone recommended hearing evaluations, and only about one-third received an eye exam from a specialist.
“Pediatricians can ask every mother of a new baby about Zika exposure during pregnancy,” Honein said. “If possible, when Zika exposure during pregnancy is identified through these questions, extra monitoring is recommended for the baby. Some health problems can easily go undetected, which is why it is so important that these babies receive all the recommended care and evaluation, even if they appear healthy.”
Additionally, the CDC has updated guidance for those who are planning to conceive following Zika virus exposure to prevent the sexual transmission of Zika virus. Men with possible exposure or known Zika virus infection who are planning to conceive should wait 3 months after they develop symptoms or after their last exposure before doing so. This guidance shortens the suggested waiting period, which was previously 6 months. All other guidance remains the same.
“Zika is now established and continues to circulate in places around the world, including the U.S.,” Honein said. “Together, we can take steps to prevent Zika infection during pregnancy and support families who have been affected by Zika. The Zika story is not over, especially for the children and families who have been directly affected.” – by Katherine Bortz
Disclosures: Infectious Diseases in Children was unable to confirm relevant financial disclosures prior to publication.