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August 13, 2018

Just how risky is Zika exposure? About 14% of children exposed as fetuses developed health conditions, CDC says

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    An estimated one in seven children who were exposed to the Zika virus while they were fetuses developed one or more health conditions that might have been caused by the virus by the time they were one year old, according to a CDC Vital Signs report published Tuesday. 

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    For the report, CDC researchers reviewed data from the U.S. Zika Pregnancy and Infant Registry on 1,450 children who were at least one year old as of February 2018 and had some reported follow-up care. According to MedPage Today, the analysis is the largest to date that examines the longer-term outcomes among babies born to women who had laboratory-confirmed Zika infection while pregnant.

    Margaret Honein of CDC's Division of Congenital and Developmental Disorders said, "What makes this report unique is that we're looking at the health of these babies beyond what was observed at birth." She added, "Based on what we've learned about other congenital infections, we suspect these health issues will continue to emerge as these children age."


    The researchers found that 6% of the 1,450 infants reviewed for the report had at least one health condition associated with Zika at birth. Further, the researchers found that:

    • 9% of the infants at birth had at least one neurodevelopmental abnormality—including motor disabilities, seizures, and swallowing problems—that potentially is associated with congenital Zika infection; and
    • 1% of the infants at birth had both a Zika-associated condition and at least one neurodevelopmental abnormality possibly associated with Zika.

    Further, the researchers found that 14% of the infants had developed at least one health condition associated with Zika or one health condition possibly associated with Zika by the time they were one year old. The researchers wrote that "[s]ome of these problems were not apparent at birth and were identified as the babies grew older." For instance, they noted that 20 of the infants did not have detected microcephaly at birth, but had developed the condition by the time they were one year old. Honein said, "That happened because their brain was not growing and developing properly."

    Overall, Honein said the rate of birth defects was 30 times higher among infants who had been exposed to Zika as fetuses than it was among infants who were not.

    The researchers also found that some babies exposed to Zika while they were fetuses did not receive some screenings for health conditions associated with the virus. The report stated that, of the 1,450 children reviewed:

    • 95% received at least one physical examination during their first two weeks of life;
    • 76% received the recommended developmental evaluation;
    • 60% received recommended neuroimaging;
    • 48% had at least one recommended hearing screening; and
    • 36% had the recommended ophthalmologic evaluation.

    According to the researchers, of the 96% of the children who did not have detected microcephaly—a condition associated with congenital Zika infection—at birth, 12% had at least one brain anomaly that was identified via neuroimaging after delivery. In addition, the researchers found that 2% of the 494 children who received an ophthalmologic evaluation after delivery had at least one eye anomaly.

    Honein said, "Parents and doctors need to work together to make sure all babies are evaluated, even babies that look healthy at birth."

    In addition, the CDC researchers wrote that the "full range of long-term health problems caused by Zika will remain unknown until these babies mature" and, as such, Honein said physicians should continue to screen children who were infected with Zika as fetuses for any possible associated health conditions. "We are still in the early stages of learning about Zika. So we don't yet know what sort of problems might emerge when the children are two years old or three years old or when they reach school age," she said.

    Further, Honein cautioned that women who are or who might become pregnant should remain aware of Zika, because although there currently is not any reported instances of locally transmitted Zika virus in the continental United States, many areas throughout the world still are seeing local Zika transmission. According to the Los Angeles Times, U.S. officials have reported about 74 cases of local mosquito-borne Zika transmission in Puerto Rico so far this year (George, MedPage Today, 8/7; CDC report, August 2018; Stein, "Shots," NPR, 8/7; Healy, "Science Now," Los Angeles Times, 8/7).

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