Monday, May 20, 2024
| Zika-related outcomes | Any laboratory evidence of confirmed or possible Zika virus infection during pregnancy (n = 1,450)† No. (%) | Pregnancies with nucleic acid test-confirmed Zika virus infection (n = 943)§ No. (%) |
|---|---|---|
| Zika-associated birth defect¶ | 87 (6) | 62 (7) |
| Neurodevelopmental abnormality possibly associated with congenital Zika virus infection** | 136 (9) | 99 (10) |
| Zika-associated birth defect and neurodevelopmental abnormality possibly associated with congenital Zika virus infection | 20 (1) | 17 (2) |
| Total with Zika-associated birth defect, neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both | 203 (14) | 144 (15) |
| Microcephaly | ||
| Microcephaly at birth†† | 64 (4) | 44 (5) |
| Postnatal-onset microcephaly only§§ | 20 (1) | 12 (1) |
| Total with microcephaly | 84 (6) | 56 (6) |
Outcomes among children aged ≥1 year from pregnancies with any laboratory evidence of confirmed or possible Zika virus infection (n = 1,450) and with nucleic acid test-confirmed Zika virus infection (n = 943) and with reported follow-up care* — U.S. Zika Pregnancy and Infant Registry (USZPIR), U.S. territories and freely associated states, February 1, 2017-June 1, 2018
* Any clinical care at age >14 days reported to the USZPIR.
† Includes maternal, placental, or infant laboratory evidence of confirmed or possible Zika virus infection during pregnancy
based on presence of Zika virus RNA by a positive nucleic acid test (e.g., reverse transcription-polymerase chain reaction
[RT-PCR]), serologic evidence of a Zika virus infection, or serologic evidence of an unspecified flavivirus infection.
§ Includes maternal, placental, or infant laboratory evidence of confirmed Zika virus infection during pregnancy based on presence
of Zika virus RNA by a positive nucleic acid test (e.g., RT-PCR).
¶ Includes Zika-associated birth defect detected from birth to age 2 years with or without neurodevelopmental abnormality possibly
associated with congenital Zika virus infection. Zika-associated birth defects include selected congenital brain anomalies
(intracranial calcifications; cerebral atrophy; abnormal cortical formation; corpus callosum abnormalities; cerebellar abnormalities;
porencephaly; hydranencephaly; ventriculomegaly/hydrocephaly); selected congenital eye anomalies (microphthalmia or anophthalmia;
coloboma; cataract; intraocular calcifications; chorioretinal anomalies involving the macula, excluding retinopathy of prematurity;
and optic nerve atrophy, pallor, and other optic nerve abnormalities); and/or microcephaly at birth (birth head circumference
<3rd percentile for infant sex and gestational age based on INTERGROWTH-21st online percentile calculator (http://intergrowth21.ndog.ox.ac.uk/)).
** Includes neurodevelopmental abnormality possibly associated with congenital Zika virus infection detected from birth to
age 2 years, with or without Zika-associated birth defect. Neurodevelopmental abnormalities possibly associated with congenital
Zika virus infection include hearing abnormalities; congenital contractures; seizures; body tone abnormalities; movement abnormalities;
swallowing abnormalities; possible developmental delay; possible visual impairment; and/or postnatal-onset microcephaly (two
most recent head circumference measurements reported from follow-up care <3rd percentile for child's sex and age based on
World Health Organization child growth standards; downward trajectory of head circumference percentiles with most recent <3rd
percentile. Age at measurement was adjusted for gestational age in infants born at <40 weeks' gestational age, through age
24 months chronological age).
†† Microcephaly at birth is a subset of Zika-associated birth defects and was defined as birth head circumference <3rd percentile
for infant sex and gestational age based on INTERGROWTH-21st online percentile calculator (http://intergrowth21.ndog.ox.ac.uk/)).
§§ Postnatal-onset microcephaly is a subset of neurodevelopmental abnormalities possibly associated with congenital Zika virus
infection and was defined as two most recent head circumference measurements reported from follow-up care <3rd percentile
for child's sex and age based on World Health Organization child growth standards; downward trajectory of head circumference
percentiles with most recent <3rd percentile. Age at measurement was adjusted for gestational age in infants born at <40 weeks'
gestational age, through age 24 months chronological age).
Zika-associated birth defects: Selected structural anomalies of the brain or eyes present at birth (congenital) and detected from birth to age 2 years.
Microcephaly at birth, with or without low birthweight, was included as a structural anomaly.
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Surveillance case classification — children, neonate to 2 years of age, born to mothers with any evidence of Zika virus infection during pregnancy
This activity is intended for obstetricians/ gynecologists, infectious disease clinicians, neurologists, nurses, pediatricians, psychiatrists, public health officials, and other clinicians caring for children born to mothers exposed to Zika virus during pregnancy.
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Introduction: Zika 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.
Methods: Pregnancies 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.
Results: Among 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.
Conclusion: One 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.
Zika virus infection during pregnancy can cause serious birth defects, including structural abnormalities of the brain and eye.[1-7] As infants with congenital Zika virus infection get older, problems such as epilepsy, vision loss, and developmental delays have been increasingly recognized.[8] Early identification of and intervention for adverse neurodevelopmental outcomes have been determined to improve cognitive, social, and behavioral functioning and to be cost effective to society in general.[9-12]
The most critical time to intervene and promote optimal brain development is during the first 3 years of life.[9] To facilitate early identification and intervention, CDC released clinical guidance for the evaluation and management of infants with possible congenital Zika virus infection in January 2016.[13] 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] 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]
To better understand the effects of Zika virus infection during pregnancy on mothers and children from a national surveillance perspective, CDC collaborated with state, territorial, and local health departments on the U.S. Zika Pregnancy and Infant Registry (USZPIR)† to monitor pregnancy and infant/child outcomes among pregnancies with laboratory evidence of confirmed or possible Zika virus infection (www.cdc.gov/pregnancy/zika/research/registry.html). The USZPIR currently monitors outcomes of approximately 7,300 pregnancies, over 4,800 of which are reported from the U.S. territories and freely associated states§ (https://www.cdc.gov/pregnancy/zika/data/pregwomen-uscases.html). This report is the first to provide data on Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection identified during infancy and early childhood among children aged ≥1 year who were born in the U.S. territories and freely associated states.§
