Federal health officials are calling on pediatricians to monitor and report congenital Zika infections in infants, which can cause microcephaly and other brain abnormalities.
“One of the most important things they can do as pediatricians is to be vigilant, so recognizing a child who may be at risk for Zika infection, and that’s both your congenital or your primary infections; helping facilitate the testing process with the local and state health authorities; and then work to make sure information about children affected by Zika is included in the registries and reporting tools,” said Eric Dziuban, M.D., D.T.M., FAAP, team lead for the Centers for Disease Control and Prevention’s (CDC’s) Children’s Preparedness Unit.
There have been 310 pregnant women infected with Zika in the United States and its territories — 168 in states and 142 in territories, according to the CDC. There have been no documented cases of mosquito transmission of the virus in the states, but experts say that may change this summer in some areas.
Officials recently updated the way they report the figures to include pregnant women who have laboratory evidence of possible Zika infection but do not show symptoms. Doing so “will provide a more comprehensive picture of the effects of Zika in the U.S. states and territories,” according to Margaret Honein, Ph.D., M.P.H., chief of the Birth Defects Branch of the CDC’s National Center on Birth Defects and Developmental Disabilities.
Data come from the U.S. Zika Pregnancy Registry and the Puerto Rico Zika Active Pregnancy Surveillance System. The CDC is asking pediatricians to contribute to the registries by reporting suspected congenital Zika cases to state, tribal, local or territorial health departments to facilitate testing. AAP members can find state-specific contact information at https://www.aap.org/en-us/my-aap/resources/Pages/Dept-Health-Contacts.aspx.
The CDC recently released recommendations for using real-time reverse transcription-polymerase chain reaction testing of urine in conjunction with serum. Urine samples should be collected within 14 days of symptom onset.
The pregnancy registries also will include follow-up data on infants who may have contracted congenital Zika virus. Pediatricians should provide clinical information on the infants at birth, 2, 6 and 12 months of age.
“We want to have all the best available data to know what the needs for these children are, and pediatricians can play a key role in that,” Dr. Dziuban said.
Pediatricians can discuss suspected congenital Zika cases in newborns with the CDC Emergency Operations Center. Dr. Dziuban is leading the Children’s Health Team that is providing additional support to the center. The center can be reached at 770-488-7100 or ZikaPregnancy@cdc.gov.
In addition, the CDC has improved access to its guidance on assessing and caring for infants who may be infected. It has compiled its algorithms into a new tool available at http://www.cdc.gov/zika/pdfs/pediatric-evaluation-follow-up-tool.pdf.
“We just want to make sure we’re hitting every possible way to get that information to pediatricians, make it easy to access,” Dr. Dziuban said.
Long-term, the CDC calls for additional hearing screenings, evaluation of children’s development and consultation with specialists, if needed.
Among the types of care that pediatricians and specialists may need to provide is psychological counseling to families, according to David J. Schonfeld, M.D., FAAP, a member of the AAP Disaster Preparedness Advisory Council.
Families expecting a baby who may have contracted Zika may be dealing with greater anxiety than normal. Those who deliver a baby with disabilities also may need special guidance on issues like child care, returning to work, communicating with other family members and parenting other children.
“There’s a lot of issues that the families are going to struggle with that go even beyond the typical concerns that families have when they have a child, particularly a first child,” Dr. Schonfeld said.