Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants With Possible Congenital Zika Virus Infection — United States, October 2017

Tolulope Adebanjo, MD; Shana Godfred-Cato, DO; Laura Viens, MD; Marc Fischer, MD; J. Erin Staples, MD, PhD; Wendi Kuhnert-Tallman, PhD; Henry Walke, MD; Titilope Oduyebo, MD; Kara Polen, MPH; Georgina Peacock, MD; Dana Meaney-Delman, MD; Margaret A. Honein, PhD; Sonja A. Rasmussen, MD; Cynthia A. Moore, MD, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2017;66(41):1089-1099. 

In This Article

Abstract and Introduction

Introduction

CDC has updated its interim guidance for U.S. health care providers caring for infants with possible congenital Zika virus infection[1] in response to recently published updated guidance for health care providers caring for pregnant women with possible Zika virus exposure,[2] unknown sensitivity and specificity of currently available diagnostic tests for congenital Zika virus infection, and recognition of additional clinical findings associated with congenital Zika virus infection. All infants born to mothers with possible Zika virus exposure* during pregnancy should receive a standard evaluation at birth and at each subsequent well-child visit including a comprehensive physical examination, age-appropriate vision screening and developmental monitoring and screening using validated tools,[3–5] and newborn hearing screen at birth, preferably using auditory brainstem response (ABR) methodology.[6] Specific guidance for laboratory testing and clinical evaluation are provided for three clinical scenarios in the setting of possible maternal Zika virus exposure: 1) infants with clinical findings consistent with congenital Zika syndrome regardless of maternal testing results, 2) infants without clinical findings consistent with congenital Zika syndrome who were born to mothers with laboratory evidence of possible Zika virus infection, and 3) infants without clinical findings consistent with congenital Zika syndrome who were born to mothers without laboratory evidence of possible Zika virus infection. Infants in the first two scenarios should receive further testing and evaluation for Zika virus, whereas for the third group, further testing and clinical evaluation for Zika virus are not recommended. Health care providers should remain alert for abnormal findings (e.g., postnatal-onset microcephaly and eye abnormalities without microcephaly) in infants with possible congenital Zika virus exposure without apparent abnormalities at birth.

* Possible Zika virus exposure includes travel to, or residence in an area with mosquitoborne Zika virus transmission or sex without the use of condoms with a partner who has traveled to or resides in an area with mosquitoborne Zika virus transmission.
† Laboratory evidence of possible Zika virus infection during pregnancy is defined as 1) Zika virus infection detected by a Zika virus RNA nucleic acid test (NAT) on any maternal, placental, or fetal specimen (referred to as NAT-confirmed), or 2) diagnosis of Zika virus infection, timing of infection cannot be determined or unspecified flavivirus infection, timing of infection cannot be determined by serologic tests on a maternal specimen (i.e., positive/equivocal Zika virus immunoglobulin M [IgM] and Zika virus plaque reduction neutralization test [PRNT] titer ≥ 10, regardless of dengue virus PRNT value; or negative Zika virus IgM, and positive or equivocal dengue virus IgM, and Zika virus PRNT titer ≥ 10, regardless of dengue virus PRNT titer). The use of PRNT for confirmation of Zika virus infection, including in pregnant women, is not routinely recommended in Puerto Rico (https://www.cdc.gov/zika/laboratories/lab-guidance.html).
§ Assessment of visual acuity (if able, responses to teller or grating tests), pupillary response, external examination, anterior segment examination, intraocular pressure measurement if indicated, and dilated fundus examination. After 3–4 months of age, also assess ocular motility, cycloplegia refraction and accommodation by dynamic retinoscopy. If physical abnormalities are present, recommend photo documentation if resources are available. (https://www.aao.org/preferred-practice-pattern/pediatric-eye-evaluations-ppp--september-2012#sectionII.comprehensiveophthamalicexamination).

 

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