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Clinical Guidance for Healthcare Providers Caring for Infants & Children

Summary

Infants and children can acquire Zika virus congenitally and postnatally. Guidance is available on testing, clinical management and prevention of Zika for children under the age of 18.

Key Points on Evaluation and Management of Infants with Possible Congenital Zika Virus Infection

  • Testing of infants with possible congenital Zika virus infection should be guided by
    • Whether the infant has abnormalities consistent with congenital Zika syndrome (e.g., microcephaly, intracranial calcifications, or other brain or eye abnormalities).
    • The mother’s Zika virus testing results.
  • Congenital Zika virus infection can be diagnosed by RNA NAT (nucleic acid testing).

Key Points on Evaluation and Management of Infants and Children with Possible Postnatal Zika Virus Infection

  • Guidance for testing and clinical management of infants and children with postnatal Zika virus infection is in line with testing and clinical management recommendations for adults.
  • Postnatal Zika virus disease should be suspected in an infant or child <18 years old who
    • Has traveled to or lived in an area with active Zika virus transmission in the last 2 weeks.
    • Has one or more symptoms of Zika: fever, rash, conjunctivitis, or arthralgia.
    • Has another possible exposure to Zika (sexual contact with a person who lives in or traveled to an area with Zika or an association in time and place with a confirmed or probable case).
  • Perinatal Zika virus disease should also be suspected in an infant in the first 2 weeks of life if
    • The mother traveled to or resided in an affected area within 2 weeks of delivery.
    • The infant has one or more of the following manifestations: fever, rash, conjunctivitis, or arthralgia.
  • For diagnosing postnatal Zika virus infection, RNA NAT testing is recommended during the first two weeks after symptom onset. Serologic testing is recommended 2-12 weeks after symptom onset.
  • Symptomatic treatment and supportive care are appropriate and usually sufficient to treat Zika. Special considerations to treat children with Zika include
    • Aspirin should never be used to treat children with symptoms of acute viral illness because of the risk of Reye’s syndrome.
    • All non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided in children <6 months.
  • No cases of Zika virus infection associated with breastfeeding have been reported. Current evidence suggests that the benefits of breastfeeding outweigh the theoretical risks of Zika virus transmission through breast milk. CDC and the World Health Organization recommend that infants born to women with suspected, probable, or confirmed Zika virus infection, or who live in or have traveled to areas with Zika, should be fed according to established infant feeding guidelines. [PDF - 37 pages]
  • Protecting children from mosquito bites is the primary way to prevent Zika virus infection. Adolescents that live in or traveled to an area with active Zika transmission should be counseled on the risks of sexual transmission and prevention methods.

Health Care for Infants

 

	Assessment of Infant Hearing: For infants testing positive for Zika virus infection thumbnail

Assessment of Infant Hearing

	What to know if your doctor suspects microcephaly during pregnancy fact sheet thumbnail

What to know: If your doctor suspects microcephaly during pregnancy

 

	What to know if your baby was born with congenital Zika syndrome fact sheet thumbnail

What to know: If your baby was born with congenital Zika syndrome

	What to Know if your baby may have been affected by Zika but has no related health conditions at birth fact sheet thumbnail

What to know: If your baby may have been affected by Zika but has no related health conditions at birth

Testing Algorithm

For Infants Whose Mothers Traveled to or Resided in an Area with Zika During Pregnancy

Interim guidlines for the evaluation and testing of infants whose mothers traveled to or resided in an area with ongoing Zika virus transmission during pregnancy infographic thumbnail

Instructional Video

Measuring Infant Head Circumference: An instructional video for healthcare providers
This video demonstrates how to measure the head circumference of an infant. Measuring head circumference is a primary way to determine the presence of microcephaly, which is important during this Zika outbreak. It is intended to help clinicians evaluate babies born to mothers infected with Zika virus.
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