CDC Issues Interim Guidance on Congenital Zika Virus Infection

Megan Brooks

Disclosures

January 26, 2016

The US Centers for Disease Control and Prevention (CDC) has issued interim guidelines for the evaluation, testing, and management of infants with possible congenital Zika virus infection.

Developed in conjunction with the American Academy of Pediatrics, the guidelines address the care of infants with microcephaly or intracranial calcifications detected prenatally or at birth, as well as infants without these findings whose risk is based on maternal exposure and testing for Zika virus infection.

The guidelines are published in the January 26 early-release issue of the Morbidity and Mortality Weekly Report.

The CDC advises pediatric healthcare providers to work with obstetric providers to identify infants whose mothers were potentially infected with Zika virus during pregnancy (based on travel to or residence in an area with Zika virus transmission) and to review fetal ultrasounds and maternal testing for Zika virus infection.

The guidelines recommend Zika virus testing for infants with microcephaly or intracranial calcifications who were born to women who traveled to or resided in an area with Zika virus transmission while pregnant and for infants born to mothers with positive or inconclusive test results for Zika virus infection. In these situations, the CDC recommends:

  • Testing infant serum for Zika virus RNA, Zika virus immunoglobulin M (IgM) and neutralizing antibodies, and dengue virus IgM and neutralizing antibodies. The initial sample should be collected either from the umbilical cord or directly from the infant within 2 days of birth, if possible.

  • If cerebrospinal fluid is obtained for other studies, it should also be tested for Zika virus RNA, Zika virus IgM and neutralizing antibodies, and dengue virus IgM and neutralizing antibodies.

  • Histopathologic evaluation of the placenta and umbilical cord with Zika virus immunohistochemical staining on fixed tissue and Zika virus reverse transcription-polymerase chain reaction on fixed and frozen tissue may also be considered.

  • If not already performed during pregnancy, test mother's serum for Zika virus IgM and neutralizing antibodies and dengue virus IgM and neutralizing antibodies.

For infants with possible congenital Zika virus infection, the CDC recommends:

  • Comprehensive physical examination, including careful measurement of the occipitofrontal circumference, length, weight, and assessment of gestational age.

  • Evaluation for neurologic abnormalities, dysmorphic features, splenomegaly, hepatomegaly, and rash or other skin lesions. Full-body photographs and any rash, skin lesions, or dysmorphic features should be documented. If an abnormality is noted, consult with an appropriate specialist.

  • Cranial ultrasound, unless prenatal ultrasound results from third trimester demonstrated no abnormalities of the brain.

  • Evaluation of hearing by evoked otoacoustic emissions testing or auditory brainstem response testing, before hospital discharge or within 1 month after birth. Refer infants with abnormal initial hearing screens to an audiologist.

  • Ophthalmologic evaluation, including examination of the retina, before hospital discharge or within 1 month after birth. Refer infants with abnormal initial eye evaluation to a pediatric ophthalmologist.

  • Other evaluations specific to the infant's clinical presentation.

For infants with microcephaly or intracranial calcifications, the CDC recommends the following additional actions:

  • Consultation with a clinical geneticist or dysmorphologist.

  • Consultation with a pediatric neurologist to determine appropriate brain imaging and additional evaluation.

  • Testing for other congenital infections such as syphilis, toxoplasmosis, rubella, cytomegalovirus infection, lymphocytic choriomeningitis virus infection, and herpes simplex virus infections. Consider consulting a pediatric infectious disease specialist.

  • Complete blood count, platelet count, and liver function and enzyme tests, including alanine aminotransferase, aspartate aminotransferase, and bilirubin.

  • Consideration of genetic and other teratogenic causes based on additional congenital anomalies that are identified through clinical examination and imaging studies.

The CDC also recommends long-term follow-up for infants with possible congenital Zika virus infection:

  • Conduct additional hearing screen at age 6 months, plus any appropriate follow-up of hearing abnormalities detected through newborn hearing screening.

  • Carefully evaluate occipitofrontal circumference and developmental characteristics and milestones throughout the first year of life, with use of appropriate consultations with medical specialists (eg, pediatric neurology, developmental and behavioral pediatrics, physical and speech therapy).

The CDC encourages health providers to report cases of possible congenital Zika virus infection to their state, territorial or local health departments, and monitor for additional guidance as it is released. "As an arboviral disease, Zika virus disease is a nationally notifiable condition," they note.

"No specific antiviral treatment is available for Zika virus infections and no vaccine against Zika virus is available," the CDC notes. "Treatment of congenital Zika virus infection is supportive and should address specific medical and neurodevelopmental issues for the infant's particular needs; investigations are ongoing to better understand what services will be most effective for these children as they grow," they add.

More on Zika virus can be found on the CDC's website.

Morb Mortal Wkly Rep. Published online January 26, 2016. Full text

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