Zika Outcomes and Development in Infants and Children Investigation

Brazil with two states highlighted

In 2017, CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD), in partnership with the Brazilian Ministry of Health, conducted the Zika Outcomes and Development in Infants and Children (ZODIAC) investigation. Researchers collected and analyzed information from Paraíba and Ceará, two states in northeastern Brazil that were heavily affected by the 2015–2016 Zika outbreak.

ZODIAC aimed to describe the health and developmental challenges faced by Brazilian children exposed to the Zika virus infection before birth. The investigation studied children born during the 2015–2016 Zika virus outbreak:

  • Who were between the ages of 15 and 26 months old when the investigation began in 2017;
  • Whose mothers became pregnant and resided in the study area for at least 80% of the pregnancy, as well as after the delivery; and
  • Who had laboratory evidence or clinical indicators of Zika virus infection before birth.
Hispanic mom sitting in a chair holding her toddler

Investigation Overview

Zika virus infection before birth may not be recognized right away. This can happen if the mother’s infection during pregnancy was mild, she did not get tested for Zika virus infection during pregnancy, and/or the child was born without noticeable birth defects. ZODIAC was designed to look carefully at these children to pick up the health outcomes and challenges that were less obvious at birth or that progressed over time.

ZODIAC scientists examined the children seen at the Brazilian clinics from August–October 2017, interviewed caregivers, and reviewed medical records to gather information on the following child health outcomes and challenges:

  • Physical growth;
  • Birth defects;
  • Vision and hearing loss; and
  • Cognitive, social, language, and motor development.

In addition, scientists interviewed primary caregivers about their family’s wellbeing and healthcare needs.

How Will CDC Use the Information?

Boy sitting with book and juice

ZODIAC data are being used to

  • Understand the health problems experienced by and emphasize the need for continued monitoring of children exposed to Zika virus infection before birth;
  • Educate parents and healthcare providers about how to watch for and find these problems early; and
  • Understand the needs of families affected by Zika virus.

Research results might be most helpful for families, and healthcare and social service providers in Brazil, the United States, and other countries affected by the Zika virus.

ZODIAC: Collaboration and Support

The research from ZODIAC was made possible with the support and collaboration of the Ministério da Saúde do Brasil (Ministry of Health of Brazil), the State Health Secretariats of Paraíba and Ceará, and CDC’s NCBDDD, Center for Global Health, country office in Brazil, and National Center for Emerging and Zoonotic Infectious Disease.

ZODIAC Publications and Resources

  • Satterfield-Nash A, Kotzky K, Allen J, et al. Health and development at age 19–24 months of 19 children who were born with microcephaly and laboratory evidence of congenital Zika virus infection during the 2015 Zika virus outbreak — Brazil, 2017. MMWR Morb Mortal Wkly Rep. 2017;66:1347–1351.
    Read the MMWR.
  • Kotzky K, Allen JE, Robinson LR, et al. Depressive symptoms and care demands among primary caregivers of young children with evidence of congenital Zika virus infection in Brazil. J Dev Behav Pediatr. 2019 MarJun 26 [Epub ahead of print] 40(5):344-353. doi: 10.1097/DBP.0000000000000666
    Read the articleexternal icon. Watch video abstractexternal icon.
  • Ornelas Pereira I, Santelli ACFS, Leite PL, Attell J, Bertolli J, Kotzky K, Araújo WN, Peacock G. Parental Stress in Primary Caregivers of Children with Evidence of Congenital Zika Virus Infection in Northeastern Brazil. Matern Child Health J. 2021 Mar;25(3):360-367. doi: 10.1007/s10995-020-03053-8. Epub 2020 Nov 27.
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  • Attell, J., Rose, C., Bertolli, J., Kotzky, K., Squires, J., Krishna, N., Satterfield-Nash, A., Peacock, G., Ornelas Pereira, I., Faria E Silva Santellia, A., Smith, C. (2020). Adapting the Ages and Stages Questionnaire to Identify and Quantify Development Among Children with Evidence of Zika Infection. Infants & Young Children, 33(2), 95­­—107. doi: 10.1097/IYC.0000000000000161.
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  • Bertolli J, Attell JE, Rose C, Moore CA, Melo F, Staples JE, Kotzky K, Krishna N, Satterfield-Nash A, Pereira IO, Pessoa A, Smith DC, Santelli ACFES, Boyle CA, Peacock G. Functional Outcomes among a Cohort of Children in Northeastern Brazil Meeting Criteria for Follow-Up of Congenital Zika Virus Infection. Am J Trop Med Hyg. 2020 May;102(5):955-963. doi: 10.4269/ajtmh.19-0961. PMID: 32228785; PMCID: PMC7204564.
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  • Rose CE, Bertolli J, Attell JE, Moore CA, Melo F, Kotzky K, Krishna N, Satterfield-Nash A, Pereira IO, Pessoa A, Smith DC, Santelli ACFES, Peacock G. Early Growth Parameters as Predictors of Developmental Delay Among Children Conceived During the 2015-2016 Zika Virus Outbreak in Northeastern Brazil. Trop Med Infect Dis. 2020 Oct 1;5(4):155. doi: 10.3390/tropicalmed5040155. PMID: 33019699; PMCID: PMC7709658.
    Read the articleexternal icon.

Visit cdc.gov/Zika for the latest Zika-related updates.

ZODIAC was made possible through support provided by the Office of Infectious Diseases, Bureau of Global Health, United States Agency for International Development.