In the JournalsPerspective

Postnatal Zika infection symptoms mirror common childhood illnesses

Children in the United States with Zika virus infection are often infected while traveling abroad and present with symptoms similar to those of other diseases, according to research published in Clinical Infectious Diseases.

Nicole P. Lindsey, MS, a CDC epidemiologist, told Infectious Diseases in Children that Zika virus (ZIKV) infection is generally mild in children. Although the clinical presentation and severity of diseases can often differ between children and adults, they found that the symptoms and severity ZIKV was similar.

The researchers assessed data from children who met the case definition for confirmed or probable ZIKV infection with symptom onset beginning between 2016 and 2017. All children (n = 141) were aged younger than 18 years and resided in California, Indiana, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Texas or Virginia.

Most children infected were aged 12 to 17 years (64%), followed by children aged 5 to 11 years (30%) and children aged 1 to 4 years (5%). One child was aged younger than 1 year. Nearly all children (99%) were infected with ZIKV while traveling to a country or territory outside the contiguous U.S. Lindsey and colleagues said Mexico (n = 28), the Dominican Republic (n = 26) and Puerto Rico (n = 22) were the most commonly travel destinations. Two children were infected in Texas by mosquito transmission, they said.

According to the researchers, 89% (n = 125) of children had lab-confirmed ZIKV infection.

The researchers observed no neurologic signs or symptoms of ZIKV infection in children. The most commonly reported clinical signs and symptoms were rash (94%), fever (74%), arthralgia (48%) and conjunctivitis (51%). The rashes were most often maculopapular, and about half were pruritic.

Most children (87%) had two or more signs or symptoms, with 70% reporting fever and rash. More than half of the children had three or more signs and symptoms, and 18% had four. 

In addition, 27% of children also presented with gastrointestinal symptoms, including nausea, vomiting, diarrhea and abdominal pain, and 26% presented with respiratory symptoms, such as sore throat and cough.

The researchers wrote that the signs and symptoms associated with ZIKV infection are similar to the those observed with other diseases, such as chikungunya, dengue, measles, parvovirus, adenovirus, enterovirus, leptospirosis, rickettsiosis and group A streptococcal infection. However, they suggested that some clinical features may be more prominent with diseases that would be in the differential for an ill child who was exposed to mosquitoes in an area where ZIKV is circulating.

According to the CDC, no local mosquito-borne Zika virus transmission was reported in the contiguous U.S. in 2018, and no transmission has been reported thus far in 2019. The organization recommends taking travel precautions for international trips to areas where Aedes aegypti is present, where there is current or past transmission risk, or where an outbreak is occurring. Detailed information can be found on the agency’s website, at www.cdc.gov/zika.

“Health care providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia or conjunctivitis, who reside in or have recently traveled to an area where Zika virus transmission is occurring,” Lindsey said. “Because chikungunya and dengue virus infections share a similar geographic distribution and symptoms with ZIKV, children with suspected ZIKV should be evaluated and managed for possible dengue or chikungunya virus infection until laboratory testing is completed.” – by Katherine Bortz

Reference:

Lindsey NP, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz195.

Disclosure: Lindsey reports no relevant financial disclosures.

Children in the United States with Zika virus infection are often infected while traveling abroad and present with symptoms similar to those of other diseases, according to research published in Clinical Infectious Diseases.

Nicole P. Lindsey, MS, a CDC epidemiologist, told Infectious Diseases in Children that Zika virus (ZIKV) infection is generally mild in children. Although the clinical presentation and severity of diseases can often differ between children and adults, they found that the symptoms and severity ZIKV was similar.

The researchers assessed data from children who met the case definition for confirmed or probable ZIKV infection with symptom onset beginning between 2016 and 2017. All children (n = 141) were aged younger than 18 years and resided in California, Indiana, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Texas or Virginia.

Most children infected were aged 12 to 17 years (64%), followed by children aged 5 to 11 years (30%) and children aged 1 to 4 years (5%). One child was aged younger than 1 year. Nearly all children (99%) were infected with ZIKV while traveling to a country or territory outside the contiguous U.S. Lindsey and colleagues said Mexico (n = 28), the Dominican Republic (n = 26) and Puerto Rico (n = 22) were the most commonly travel destinations. Two children were infected in Texas by mosquito transmission, they said.

According to the researchers, 89% (n = 125) of children had lab-confirmed ZIKV infection.

The researchers observed no neurologic signs or symptoms of ZIKV infection in children. The most commonly reported clinical signs and symptoms were rash (94%), fever (74%), arthralgia (48%) and conjunctivitis (51%). The rashes were most often maculopapular, and about half were pruritic.

Most children (87%) had two or more signs or symptoms, with 70% reporting fever and rash. More than half of the children had three or more signs and symptoms, and 18% had four. 

In addition, 27% of children also presented with gastrointestinal symptoms, including nausea, vomiting, diarrhea and abdominal pain, and 26% presented with respiratory symptoms, such as sore throat and cough.

The researchers wrote that the signs and symptoms associated with ZIKV infection are similar to the those observed with other diseases, such as chikungunya, dengue, measles, parvovirus, adenovirus, enterovirus, leptospirosis, rickettsiosis and group A streptococcal infection. However, they suggested that some clinical features may be more prominent with diseases that would be in the differential for an ill child who was exposed to mosquitoes in an area where ZIKV is circulating.

According to the CDC, no local mosquito-borne Zika virus transmission was reported in the contiguous U.S. in 2018, and no transmission has been reported thus far in 2019. The organization recommends taking travel precautions for international trips to areas where Aedes aegypti is present, where there is current or past transmission risk, or where an outbreak is occurring. Detailed information can be found on the agency’s website, at www.cdc.gov/zika.

“Health care providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia or conjunctivitis, who reside in or have recently traveled to an area where Zika virus transmission is occurring,” Lindsey said. “Because chikungunya and dengue virus infections share a similar geographic distribution and symptoms with ZIKV, children with suspected ZIKV should be evaluated and managed for possible dengue or chikungunya virus infection until laboratory testing is completed.” – by Katherine Bortz

Reference:

Lindsey NP, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz195.

Disclosure: Lindsey reports no relevant financial disclosures.

    Perspective

    Photo of W. Christopher Golden 
    W. Christopher Golden
    Photo of Anna C. Sick-Samuels 
    Anna Sick-Samuels

    In this study, researchers reviewed 141 cases of acute Zika virus infection among children aged 11 months to 17 years from 10 U.S. states. Similar to adults with acute Zika virus infection, participants most commonly manifested symptoms of rash, fever, headache, arthralgia, myalgia and conjunctivitis. The illness was self-limited without report of death or neurologic sequelae (including Guillain-Barré syndrome or meningoencephalitis), verifying prior studies on acute pediatric Zika infections in the U.S.

    At this time, Zika virus remains a reportable condition, and children who present to care with symptoms, travel history and lab findings consistent with an acute Zika infection still should be reported to local health departments. Further investigation is needed to identify the clinical presentation in children aged younger than 1 year, particularly to identify any neurodevelopmental risks of acute Zika infection in infancy.

    W. Christopher Golden, MD

    Medical director, newborn nursery

    Johns Hopkins Hospital

    Professor of pediatrics

    Johns Hopkins University School of Medicine

     

    Anna Sick-Samuels, MD, MPH

    Pediatric infectious disease fellow

    Johns Hopkins University School of Medicine

    Disclosures: Golden and Sick-Samuels report no relevant financial disclosures.

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