CDC offers new Zika resource for pediatricians in
MelissaJenco, News Content Editor
The Centers for Disease Control and Prevention (CDC) has compiled its research and
recommendations on Zika virus in a new Pediatrics article released today.
“We wanted to have a place where busy pediatric health care providers could have information
in one place that would give them what they needed to counsel women who might be considering
traveling to places where there might be ongoing transmission as well as providing
care for kids and their families that are concerned about Zika virus infections,”
said Sonja A. Rasmussen, M.D., M.S., FAAP, co-author of the article “Zika Virus Disease:
A CDC Update for Pediatric Health Care Providers” (Karwowski MP, et al. Pediatrics. March 21, 2016, http://pediatrics.aappublications.org/content/early/2016/03/22/peds.2016-0621).
Zika, a mosquito-borne Flavivirus, dates back to 1947, but it wasn’t until last year
that it started spreading to the Americas. The introduction of the virus coincided
with increasing numbers of microcephaly cases in Brazil. More than 5,000 suspected microcephaly cases were reported there
from October 2015 through February 2016, according to the CDC. The number far surpasses
Brazil’s average of 150-200 cases per year.
Researchers now are studying associations between the virus in pregnant women and
these cases of microcephaly as well as other neurological disorders in their babies,
although a causal link has not yet been proven.
“I think every week we become more concerned and have more information suggesting
that link is real,” said Dr. Rasmussen, one of the leaders of the CDC’s Pregnancy and Birth Defects Task Force.
World Health Organization (WHO) Director-General Margaret Chan, M.D., M.Sc. expressed
similar sentiments in a March 22 press briefing.
“Though the associations are not yet scientifically proven … there is now scientific
consensus that Zika virus is implicated in these neurological disorders,” Dr. Chan
said. “The kind of urgent action called for by this public health emergency should
not wait for definitive proof.”
Zika now is being spread in more than 38 countries and territories in Latin America
and the Caribbean, according to the WHO.
As summer gets closer, officials say it likely will spread to the continental U.S.,
particularly in areas that are home to the primary vectors, the Aedes aegypti mosquitoes and possibly Aedes albopictus mosquitoes. In rare cases, Zika also may be spread through sexual contact.
For the 20% of those infected who display symptoms, the illness is mild and may include
fever, rash, joint pain and conjunctivitis. The top concern, Dr. Rasmussen said, is
for babies born to mothers who may have contracted Zika during their pregnancy. The
CDC in collaboration with the Academy released guidance on identifying infants and
children who may have become infected.
Infants should be tested for Zika if they are born with microcephaly or intracranial
calcifications and their mother spent time in an affected area while pregnant or had
sexual contact with a male partner who traveled to such areas.
Infants should be tested for Zika if their mother had a positive or inconclusive test
for Zika even if birth defects are not detected prenatally or at birth.
Infants whose mother tested negative for Zika or was not tested and who are not born
with microcephaly or intracranial calcifications should receive routine well-child
Zika should be suspected in infants with two of the aforementioned symptoms in their
first two weeks of life if their mother traveled to one of the affected areas within
two weeks of delivery.
Zika should be suspected in children who display at least two symptoms within two
weeks of traveling to an affected area. Adolescents also may be exposed through sexual
contact with a male who spent time in an affected area.
The virus is a nationally notifiable disease and should be reported to local, state
or territorial health departments to facilitate testing. CDC leaders say they are
working to improve the availability of diagnostic tests, but none are available commercially.
For infants and children who contract Zika through mosquitoes, the disease typically
is mild just as it is for adults, and treatment involves supportive care, according
to the CDC. Two teen deaths tentatively have been associated with the virus, but at
least one teen had a pre-existing condition. Researchers also are exploring possible
associations between Zika and Guillain-Barré syndrome.
Zika RNA has been found in breast milk, but no infant cases of the virus related to
breastfeeding have been reported. The CDC recommends mothers diagnosed with Zika who
live in an area where the virus is spreading continue to breastfeed.
“We don’t have any evidence of transmission (through breast milk), and we know there
are so many benefits to breastfeeding,” Dr. Rasmussen said.