Outcomes up to age 36 months after congenital Zika virus infection-U.S. states

Varsha Neelam, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA. pju4@cdc.gov.
Kate R. Woodworth, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Daniel J. Chang, Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
Nicole M. Roth, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Megan R. Reynolds, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Amanda Akosa, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Christopher P. Carr, Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
Kayla N. Anderson, Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Sarah B. Mulkey, Children's National Hospital, Washington, D. C., USA.
Roberta L. DeBiasi, Children's National Hospital, Washington, D. C., USA.
Cara Biddle, Children's National Hospital, Washington, D. C., USA.
Ellen H. Lee, New York City Department of Health & Mental Hygiene, New York City, NY, USA.
Amanda L. Elmore, Florida Department of Health, Tampa, FL, USA.
Sarah J. Scotland, Massachusetts Department of Public Health, Boston, MA, USA.
Similoluwa Sowunmi, California Department of Public Health, Sacramento, CA, USA.
Nicole D. Longcore, New York State Department of Health, Albany, NY, USA.
Muhammad Ahmed, New Jersey Department of Health, Trenton, NJ, USA.
Peter H. Langlois, Texas Department of State Health Services, Austin, TX, USA.
Salma Khuwaja, Houston Health Department, Houston, TX, USA.
Shea Elizabeth Browne, Virginia Department of Health, Richmond, VA, USA.
Leah Lind, Pennsylvania Department of Health, Pittsburgh, PA, USA.
Kyoo Shim, Dallas County Health and Human Services, Dallas, TX, USA.
Michael Gosciminski, Rhode Island Department of Health, Providence, RI, USA.
Rachel Blumenfeld, Philadelphia Department of Public Health, Philadelphia, PA, USA.
Shreya Khuntia, District of Columbia Department of Health, Washington, D. C, USA.
Umme-Aiman Halai, Los Angeles County Department of Public Health, Los Angeles, CA, USA.
Autumn Locklear, North Carolina Department of Health and Human Services, Chapel Hill, NC, USA.
Mary Chan, Washington State Department of Health, Seattle, WA, USA.
Teri' Willabus, Georgia Department of Public Health, Atlanta, GA, USA.
Julius Tonzel, Louisiana Department of Health, New Orleans, LA, USA.
Natalie S. Marzec, Colorado Department of Public Health and Environment, Denver, CO, USA.
Nianest Alers Barreto, Hawaii Department of Health, Honolulu, HI, USA.

Document Type

Journal Article

Publication Date

9-1-2023

Journal

Pediatric research

DOI

10.1038/s41390-023-02787-9

Abstract

BACKGROUND: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS: Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT: We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.

Department

Neurology

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