CDC: Caring for Infants, Kids With Possible Zika Infection

Megan Brooks

February 19, 2016

The Centers for Disease Control and Prevention (CDC) today updated its interim guidelines on caring for infants and children born to mothers with possible Zika virus exposure during pregnancy and expanded guidelines to include infants and children with possible acute Zika virus disease.

"This update contains a new recommendation for routine care for infants born to mothers who traveled to or resided in areas with Zika virus transmission during pregnancy but did not receive Zika virus testing, when the infant has a normal head circumference, normal prenatal and postnatal ultrasounds (if performed), and normal physical examination," the CDC explains in the Morbidity and Mortality Weekly Report (MMWR).

Infants without microcephaly or intracranial calcifications whose mothers have negative Zika virus test results or who were not tested for Zika virus should receive routine care, the CDC says.

"Because information on the effects of congenital Zika virus infection is limited, health care providers should exercise clinical judgment in the assessment of newborns with abnormalities other than microcephaly or intracranial calcifications who were born to mothers who traveled to or resided in an area with active Zika virus transmission during pregnancy. For these infants, health care providers should consider testing the mother before testing the infant," the CDC advises.

The updated recommendations also advise health providers to suspect acute Zika virus disease in any infant or child aged younger than 18 years who has traveled to or resided in an affected area within the past 2 weeks and has two or more of the following manifestations: fever, rash, conjunctivitis, or arthralgia.

Acute Zika virus disease should also be suspected in any infant during the first 2 weeks of life whose mother traveled to or resided in an affected area within 2 weeks of delivery and who has two or more of the manifestations of fever, rash, conjunctivitis, or arthralgia, the CDC says.

"Evidence suggests that Zika virus illness in children is usually mild," the CDC notes.

Test for Infection

They advise that infants whose mothers reported illness consistent with Zika virus disease around the time of delivery should be monitored for signs and symptoms of Zika virus disease. "If an infant shows signs and symptoms of acute Zika virus disease within the first 2 weeks of life, both the mother and infant should be tested for Zika virus infection," the CDC says.

In evaluating infants and children for acute Zika virus infection (symptom onset within the past 7 days), the CDC advises testing of serum and, if obtained for other reasons, cerebrospinal fluid (CSF) specimens for evidence of Zika virus RNA using RT-PCR. If Zika virus RNA is not detected and symptoms have been present for 4 days or more, serum may be tested for Zika virus immunoglobulin M (IgM) and neutralizing antibodies, and dengue virus IgM and neutralizing antibodies, the CDC says.

"Laboratory evidence of Zika virus infection in an infant or child would include, in any clinical specimen, detectable Zika virus in culture, Zika virus RNA or antigen, or a clinical specimen positive for Zika virus IgM with confirmatory neutralizing antibody titers ≥ 4-fold higher than dengue virus neutralizing antibody titers," they say. Test results for Zika virus are considered inconclusive if Zika virus antibody titers are < 4-fold higher than dengue virus neutralizing antibody titers, they note.

The CDC has more information on laboratory testing for Zika virus here.

The CDC will update these guidelines as more information becomes available.

The CDC says guidance on evaluating infants with microcephaly or intracranial calcifications, or infants whose mothers have positive or inconclusive test results for Zika virus infection, remains the same as described in recommendations issued January 26.

The CDC asks healthcare providers to notify their local, state, or territorial health department of suspected Zika cases to arrange testing and so that action can be taken to decrease the risk for local transmission in areas with Aedes species mosquitoes.

MMWR. Published online February 19, 2016. Full text


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