Notes from the Field: Follow-Up on 11 Infants Born to Women with Evidence of Zika Virus Infection During Pregnancy — Los Angeles County, 2016
Weekly / December 14, 2018 / 67(49);1372–1373
Curtis Croker, MPH1; Amy Marutani, MPH1; Marita Santos1; Susan Hathaway, MPH1; Bessie Hwang, MD1 (View author affiliations)View suggested citation
Views equals page views plus PDF downloads
- pdf icon [PDF]
Microcephaly and other birth defects have been identified among infants born to women with Zika virus infection during pregnancy (1–4). In accordance with CDC recommendations (5), the Los Angeles County (LAC) Department of Public Health implemented surveillance to assess the health of infants born to women with evidence of Zika virus infection during pregnancy at birth and at ages 2, 6, and 12 months. These recommendations included testing all such infants at birth for Zika virus.
During 2016, 11 infants were born to women in LAC who met the Council of State and Territorial Epidemiologists case definition (6) for confirmed (four infants) or probable (seven infants) Zika virus infection (Table). Follow-up through age 12 months was completed for nine infants; two infants (numbers 3 and 5) were evaluated at birth, and their parents declined to participate after delivery. All infants appeared healthy and normal at the last available assessment, with normal head circumference measurements. Zika virus immunoglobulin M (IgM) testing of serum was completed on eight infants at birth; all test results were negative. Three of these eight infants were also tested for Zika virus RNA in urine and in serum; all test results were negative.
Although no infant had clinical or laboratory evidence of Zika virus infection, there were instances when laboratory or clinical information raised concern for possible Zika-associated birth defects. Zika virus RNA was isolated from the umbilical cord at the time of delivery of infant number 1 (Table); this infant had a negative Zika IgM test and was found to be healthy and normal at birth and at all follow-up visits. A fetal cranial ultrasound obtained for infant number 4 indicated “poor fetal brain development”; however, the mother’s amniotic fluid tested negative for Zika virus RNA, the infant tested negative for Zika virus at birth (serum IgM and RNA and urine RNA), and was healthy and normal at all follow-up visits.
The head circumferences at birth of infant number 6 (30 cm) and infant number 8 (31 cm) were below the third percentile for gestational age and sex. Zika virus test results (serum IgM and RNA and urine RNA) were all negative for infant number 6 at birth; the infant received a diagnosis of microcephaly at age 1 week, but head circumference was normal at ages 2, 6, and 12 months, and a cranial ultrasound at age 3 months was unremarkable. A pediatrician classified the infant as normal at age 12 months. Infant number 8 was born at 38 weeks gestation, weighing 2.2 kg. Zika virus test results (serum IgM and RNA and urine RNA) at birth were negative. The infant received a diagnosis of symmetric growth retardation and was admitted to the neonatal intensive care unit for respiratory distress but was discharged home in good health at age 4 days. A pediatrician found this infant to be healthy and with normal head circumference at age 12 months.
Among 11 infants born to women in LAC with evidence of confirmed or probable Zika virus infection during pregnancy, the nine who participated in follow-up through age 12 months had no apparent adverse health effects at that time. Subtler health effects, or health effects occurring later in life, would not be captured with this surveillance activity. In addition, mothers with Zika virus infection who did not seek medical care, as well as those who chose not to participate in, or did not complete, the surveillance, limited the generalizability of these findings. Ongoing assessment of the health of infants born to women with evidence of Zika virus infection during pregnancy is important to assess the public health impact of Zika virus and to guide interventions.
Martha E. Garcia, Monica Molina, Elizabeth Traub, Acute Communicable Disease Control Program, Department of Health, Los Angeles County, California; Children’s Medical Services Program, County Department of Health, Los Angeles County, California; Maternal Child and Adolescent Health Program, Department of Public Health, Los Angeles County, California; staff members, Public Health Laboratory, Department of Public Health, Los Angeles County, California.
Corresponding author: Curtis Croker, firstname.lastname@example.org, 213-240-7941.
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
- de Araújo TVB, Rodrigues LC, de Alencar Ximenes RA, et al. ; Investigators from the Microcephaly Epidemic Research Group; Brazilian Ministry of Health; Pan American Health Organization; Instituto de Medicina Integral Professor Fernando Figueira; State Health Department of Pernambuco. Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study. Lancet Infect Dis 2016;16:1356–63. CrossRefexternal icon PubMedexternal icon
- Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika virus and birth defects—reviewing the evidence for causality. N Engl J Med 2016;374:1981–7. CrossRefexternal icon PubMedexternal icon
- Kleber de Oliveira W, Cortez-Escalante J, De Oliveira WT, et al. Increase in reported prevalence of microcephaly in infants born to women living in areas with confirmed Zika virus transmission during the first trimester of pregnancy—Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65:242–7. CrossRefexternal icon PubMedexternal icon
- Cauchemez S, Besnard M, Bompard P, et al. Association between Zika virus and microcephaly in French Polynesia, 2013–15: a retrospective study. Lancet 2016;387:2125–32. CrossRefexternal icon PubMedexternal icon
- Adebanjo T, Godfred-Cato S, Viens L, et al. ; Contributors. Update: interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection—United States, October 2017. MMWR Morb Mortal Wkly Rep 2017;66:1089–99. CrossRefexternal icon PubMedexternal icon
- CDC. Zika virus 2016 case definitions. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://wwwn.cdc.gov/nndss/conditions/zika
Suggested citation for this article: Croker C, Marutani A, Santos M, Hathaway S, Hwang B. Notes from the Field: Follow-Up on 11 Infants Born to Women with Evidence of Zika Virus Infection During Pregnancy — Los Angeles County, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1372–1373. DOI: http://dx.doi.org/10.15585/mmwr.mm6749a5external icon.
MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.
All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.
Questions or messages regarding errors in formatting should be addressed to email@example.com.