Zika in Infants & Children

Congenital and Perinatal Transmission

Zika virus can be transmitted from a pregnant person to their fetus during pregnancy (congenital transmission) or around the time of birth (perinatal transmission).

Congenital or intrauterine (in utero)  transmission of Zika virus occurs when a pregnant person is infected with Zika virus before delivery, and the virus passes to the fetus.

Perinatal transmission of Zika virus occurs when a pregnant person is infected with the Zika virus within approximately 2 weeks of delivery, and the virus passes to the infant at or around the time of delivery. When an infant acquires Zika virus infection perinatally, the infant may develop symptoms such as maculopapular rash, conjunctivitis, arthralgia, and fever. We do not know how often perinatal Zika transmission occurs.

Information on perinatal transmission is limited. An asymptomatic case and a symptomatic case (with thrombocytopenia and a diffuse rash) have been reported. The spectrum of clinical features that might be observed in infants who acquire Zika virus during the perinatal period is currently unknown.

Postnatal Transmission

Infants and children can acquire Zika virus postnatally via other routes of transmission, such as mosquito bites. Information on long-term outcomes among infants and children with postnatal Zika virus disease is limited. Most children infected with Zika virus are asymptomatic or have mild illness, similar to the findings seen in adults with Zika virus infection. Until more evidence is available to inform recommendations, routine pediatric care is advised for these infants and children. Treatment is supportive; this includes rest and fluids to prevent dehydration. Non-steroidal anti-inflammatory drugs (NSAIDS) should not be used until dengue is ruled out as a cause of illness and should be avoided in children aged <6 months. Aspirin is not recommended for use with postnatal viral illnesses because of the risk of Reye’s syndrome.

Breastfeeding

Zika virus has been found in breast milk.^1,2 Possible Zika virus infections have been identified in breastfeeding babies, but Zika virus transmission through breast milk has not been confirmed.^1,2 Because current evidence suggests that the benefits of breastfeeding outweigh the risk of Zika virus spreading through breast milk, CDC continues to encourage mothers to breastfeed, even if they were infected or lived in or traveled to an area with risk of Zika. CDC continues to study Zika virus and the ways it can spread and will update recommendations as new information becomes available.

Guillain-Barré Syndrome

In general, the risk for GBS from any cause appears to increase with increasing age. GBS has been reported following Zika virus infection, although a causal link has not been established. It is unclear how often GBS following Zika virus infection has occurred in children; one report from Brazil refers to 6 patients, aged 2–57 years, with neurologic syndromes (4 with GBS and 2 with acute disseminated encephalomyelitis) after laboratory-confirmed Zika virus infection. Deaths due to Zika virus infection appear to be rare at all ages.

References

1. Blohm GM, Lednicky JA, Márquez M, et. al. Evidence for Mother-to-Child Transmission of Zika Virus Through Breast Milk. Clin Infect Dis. 2018;55:1120–1. https://doi.org/10.1093/cid/cix968external icon
2. Colt S, Garcia-Casal MN, Peña-Rosas JP, et. al. Transmission of Zika virus through breast milk and other breastfeeding-related bodily fluids: A systematic review. PLOS Negl Trop Dis. 2017;11: e0005528. https://doi.org/10.1371/journal.pntd.0005528external icon