Most reported Zika-associated microcephaly cases are from intrauterine first trimester infection. Among perinatal, specifically third trimester and immediate post-birth, Zika cases, there are only a few case reports of brain development issues.
Reported Outcomes Of Perinatal Zika Infection
Though a mouse model of Zika infection (1), where embryos were infected in utero at embryonic age 14.5 days (mouse gestation is ~21 days), reported post-natal microcephaly, only a handful of human perinatally infected Zika-associated brain development or neurologic issues have been reported in the biomedical literature so far.
- Reported Brain And/Or Neurologic Abnormalities
- Two infants with laboratory-confirmed Zika infection from third trimester exposure during the 2016-16 Brazil Zika outbreak showed not microcephaly but other brain abnormalities such as subependymal cysts in both and lenticulostriate vasculopathy in one (2).
- Paraguay reported in one child after post-natal Zika in 2016 (3).
- No Reported Brain And/Or Neurologic Abnormalities
- Of two cases of perinatal Zika transmission from mothers infected close to delivery during the 2013-14 French Polynesia Zika outbreak, one infant remained asymptomatic while the other was diagnosed with and diffuse rash but not microcephaly ( ).
- A study ( ) of 1501 live births of Zika-infected mothers during the 2015-16 Brazil Zika outbreak found first trimester infection to be most severely affected, based on head circumference z score.
- Similarly, no apparent anomalies were reported ( ) among children born to 1850 pregnant women in Colombia, >90% of them reportedly Zika infected during the third trimester.
Reported Outcomes Of Postnatal Zika Infection In Infants & Children
- The CDC collated and analyzed ( ) previously published data ( , , , , , ) on ten 3 to 16 year old Zika-infected children from Africa, Asia, South America and the Pacific. Though none of them developed rash, all had fever, 2 each had conjunctivitis, vomiting or diarrhea while 3 had joint pain ( ). No microcephaly.
- All eight cases of travel-related Zika cases among American children as of February 2016 ( ) had rash with at least one other symptom (fever, arthralgia, nonpurulent conjunctivitis). Again no microcephaly.
- The 2007 Yap Island, Micronesia Zika virus outbreak included several infants and children. While their symptoms were similar to those in adults, namely, fever, maculopapular rash, arthralgia, , 0 to 19 year olds had fewer probable and confirmed cases of Zika compared to 20 to 59 year olds ( ). No microcephaly.
- No single case of microcephaly reported to CDC from US states among 150 probable or confirmed Zika cases among children <18 years of age (
). Ranging from 1 month to 17 years in age with median age of 14 years, all infections were travel-associated.
- 129 (82%) had rash.
- 87 (55%) had fever.
- 45 (29%) had conjunctivitis.
- 44 (28%) had arthralgia.
1. Shao, Qiang, et al. “Zika virus infection disrupts neurovascular development and results in postnatal microcephaly with brain damage.” Development 143.22 (2016): 4127-4136.
2. de Souza, Antonio Soares, et al. “Fetal infection by Zika virus in the third trimester: report of 2 cases.” Clinical Infectious Diseases 63.12 (2016): 1622-1625.
3. Lovera, Dolores, et al. “Neurologic syndrome associated with Zika postnatal acquisition. With regard to the first case in Paraguay.” Revista del Instituto de Medicina Tropical 11.2 (2016): 36-41.
4. Besnard, M., et al. “Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014.” Euro surveill 19.13 (2014): 20751.
5. França, Giovanny VA, et al. “Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation.” The Lancet 388.10047 (2016): 891-897.
6. Pacheco, Oscar, et al. “Zika virus disease in Colombia—preliminary report.” New England Journal of Medicine (2016).
7. Fleming-Dutra, Katherine E. “Update: interim guidelines for health care providers caring for infants and children with possible Zika virus infection—United States, February 2016.” MMWR. Morbidity and mortality weekly report 65 (2016).
8. Macnamara, F. N. “Zika virus: a report on three cases of human infection during an epidemic of jaundice in Nigeria.” Transactions of the royal society of tropical medicine and hygiene 48.2 (1954): 139-145.
9. Olson, J. G., and T. G. Ksiazek. “Zika virus, a cause of fever in Central Java, Indonesia.” Transactions of the Royal Society of Tropical Medicine and Hygiene 75.3 (1981): 389-393.
10. Heang, Vireak. “Zika Virus Infection, Cambodia, 2010-Volume 18, Number 2—February 2012-Emerging Infectious Disease journal-CDC.” (2012).
11. Alera, Maria Theresa, et al. “Zika virus infection, Philippines, 2012.” Emerging infectious diseases 21.4 (2015): 722.
12. Dupont-Rouzeyrol, Myrielle. “Co-infection with Zika and Dengue Viruses in 2 Patients, New Caledonia, 2014-Volume 21, Number 2—February 2015-Emerging Infectious Disease journal-CDC.” (2015).
13. Arzuza-Ortega, Laura, et al. “Fatal sickle cell disease and Zika virus infection in girl from Colombia.” Emerging infectious diseases 22.5 (2016): 925.
14. Duffy, Mark R., et al. “Zika virus outbreak on Yap Island, federated states of Micronesia.” N Engl J Med 2009.360 (2009): 2536-2543.
15. Goodman, Alyson B. “Characteristics of Children Aged< 18 Years with Zika Virus Disease Acquired Postnatally—US States, January 2015–July 2016.” MMWR. Morbidity and Mortality Weekly Report 65 (2016).