CDC urges vigilance for Zika following hurricanes, updates guidance
MelissaJenco, News Content Editor
In the wake of recent hurricanes, pediatricians may see displaced families from areas
with significant Zika outbreaks who need additional care.
The Centers for Disease Control and Prevention (CDC) is urging physicians to be vigilant
for these women and children from Puerto Rico and the U.S. Virgin Islands. It also
has updated its guidance on caring for infants who may have been exposed to Zika regardless
of their hometown.
“There’s a lot we still don’t know about Zika, so it’s very important for us to keep
a close eye on these babies as they develop,” CDC Director Brenda Fitzgerald, M.D.,
said in a news release. “Learning how best to support them will require a team approach
between healthcare providers and families.”
The CDC’s revised recommendations were drafted with input with the Academy and other experts and are in response to changes in testing
recommendations for pregnant women as well as new health issues in infants related
In July, the CDC said asymptomatic pregnant women with limited exposure to Zika through travel or sex would
not be tested routinely, although testing may be appropriate after discussing risks,
benefits and limitations of tests with their doctor. It cited limitations of the available
tests and decreasing prevalence of Zika cases, leading to false positives.
The probability of fewer women being tested routinely contributed to the updated guidelines
on caring for infants. If a pregnant woman may have been exposed to Zika virus, her
infant should receive a standard evaluation at birth and during each well-child visit,
according to the CDC. That evaluation includes a comprehensive physical exam, vision screening, developmental monitoring and screening, and a newborn hearing screen at birth, preferably using auditory brainstem response
(ABR) methodology, according to the CDC.
The need for additional testing is based on the infant’s clinical findings and mother’s
Zika tests. Updates to the guidance are listed below.
Infants with clinical findings consistent with Zika virus can receive their clinical evaluations before or after hospital discharge. They should
be sent to a hospital with subspecialty care only if “there is an urgent clinical
need,” the CDC said. However, health care providers need to be vigilant about additional
Zika-related issues that have been identified in recent months, including diaphragmatic
paralysis and postnatal hydrocephalus.
Infants in this group no longer need thyroid testing unless clinical symptoms indicate
an issue and no longer need a diagnostic ABR test at 4-6 months if they passed a newborn
screening using automated ABR.
Infants without clinical findings consistent with Zika born to mothers with laboratory
evidence of infection during pregnancy should receive a comprehensive eye exam by an ophthalmologist by 1 month, the same
as infants with indications of Zika.
Infants without clinical findings consistent with Zika born to mothers without laboratory
evidence of infection need standard evaluations at birth and at well-child visits and no additional evaluations
unless abnormalities are detected.
Since 2015, 98 babies in U.S. states and 137 babies in U.S. territories have been
born with Zika-related birth defects, according to the CDC. Research has found about 5% of women with possible Zika infection had a baby with Zika-related
Pediatricians should report suspected congenital Zika virus cases to their local health
department and provide information to the CDC’s Zika Pregnancy and Infant Registry. The report to the registry should include information about a child’s relocation
from another jurisdiction if applicable.