CDC Updates Guidance on Zika Virus Infection in Infants

October 24, 2017 04:17 pm News Staff
[Infant being examined by health care professional]

Although there have been far fewer cases of Zika virus infection in 2017 to date compared with this time last year, the CDC said the virus continues to pose an international public health threat to pregnant women and their infants.

With this in mind, the CDC released new interim clinical guidance in Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) for health care professionals who care for infants born to mothers with possible Zika virus infection during pregnancy. The Oct. 20 MMWR article updates the agency's August 2016 guidance on this topic.

The revised recommendations stress the need for health care professionals who care for these infants to

  • assess the risk of congenital Zika virus infection;
  • communicate closely with obstetrical health care professionals; and
  • remain alert for problems that can arise in infants born to mothers with possible Zika virus exposure during pregnancy who don't initially display any birth defects.
Story highlights
  • On Oct. 20, the CDC released updated interim clinical guidance for health care professionals who care for infants born to mothers with possible Zika virus infection during pregnancy.
  • For newborns who exhibit birth defects consistent with congenital Zika syndrome, family physicians should monitor for an expanded list of problems, including hydrocephaly and difficulty breathing and swallowing.
  • Infants born to mothers with laboratory evidence of possible Zika virus infection during pregnancy who do not appear to have birth defects consistent with congenital Zika syndrome should receive an ophthalmologic examination by age 1 month to detect subclinical brain and eye findings.

"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," said CDC Director Brenda Fitzgerald, M.D., in an Oct. 19 news release.(www.cdc.gov) "Learning how best to support them will require a team approach between health care providers and families."

To update these recommendations, the CDC convened clinical experts from a number of health care organizations, including AAFP member Elizabeth Rosenblum, M.D., of San Diego. This group reviewed emerging evidence that the agency then combined with individual expert input regarding the diagnosis, evaluation and management of infants with possible congenital Zika virus infection.

During their discussions, these experts defined three groups of infants born to mothers with possible exposure to the virus during pregnancy on which to focus, tailoring their recommendations to each group:

  1. infants with birth defects consistent with congenital Zika syndrome, regardless of the mother's Zika virus test results;
  2. infants without birth defects consistent with congenital Zika syndrome born to mothers with laboratory evidence of possible Zika virus infection during pregnancy; and
  3. infants without birth defects consistent with congenital Zika syndrome born to mothers without laboratory evidence of possible Zika virus infection during pregnancy.

First, for infants with birth defects consistent with congenital Zika syndrome, family physicians should monitor for an expanded list of problems, including hydrocephaly and difficulty breathing and swallowing. These infants should receive a head ultrasound, as well as a comprehensive ophthalmologic exam performed no later than age 1 month by an ophthalmologist experienced in assessing and managing infants. Infectious disease, clinical genetics and neurology consultations also should be considered for these infants, along with other specialty consultations based on clinical findings.

In a change to guidance regarding care for infants with laboratory evidence of congenital Zika virus infection, a diagnostic auditory brainstem response (ABR) at age 4-6 months or behavioral audiology at age 9 months is no longer recommended if the initial hearing screen was passed by automated ABR, because there is no evidence of delayed-onset hearing loss in infants with congenital Zika virus infection.

Next, infants without birth defects consistent with congenital Zika syndrome who were born to mothers with laboratory evidence of possible Zika virus infection during pregnancy also should receive a head ultrasound, along with an ophthalmologic examination by age 1 month to detect subclinical brain and eye findings. Zika virus testing is recommended for these infants to inform the need for further monitoring and possible management.

And finally, for infants without birth defects consistent with congenital Zika syndrome born to mothers with exposure to Zika virus but no laboratory evidence, Zika testing and clinical evaluation beyond the standard evaluation and routine preventive care are not routinely recommended.

Because the types of services needed to care for infants with congenital Zika syndrome are complex, the CDC recommended coordinated care by a multidisciplinary team in an established medical home setting. The agency also noted that families need to be reminded to monitor their children for early identification of any developmental delays.

The CDC said it will continue to update its recommendations as new evidence becomes available.

Related AAFP News Coverage
CDC Updates Guidance on Zika Testing for Pregnant Women
Agency No Longer Advises Routine Testing in Asymptomatic Women Without Ongoing Exposure
(7/31/2017)

AAFP Webinar Offers Members Latest Zika Virus Updates
Discussing Zika With All Patients Is Key to Prevention
(7/10/2017)

Birth Defects Seen in One in 10 Zika-infected Pregnancies
CDC Officials Call for Physicians to Remain Vigilant
(4/5/2017)

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