Epidemiology of Pediatric Zika Virus Infections

Griffin, Isabel; Zhang, Guoyan; Fernández, Danielle; Cordero, Christina; Logue, Teresa C.; White, Stephen; Llau, Anthoni; Thomas, Lakisha; Moore, Emily; Noya-Chaveco, Pedro; Etienne, Marie O.; Rojas, Mercedes; Goldberg, Cynthia C.; Rodriguez, Genevie; Mejia-Echeverry, Alvaro; Rico, Edhelene; Gillis, Leah D; Cone, Marshall; Jean, Reynald; Rivera, Lillian

doi:10.1542/peds.2017-2044

Cited by 6 publications

(8 citation statements)

References 11 publications

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“…Finally, the data presented here are from 10 states and may not be representative of all cases nationally; however, they represent roughly 35% of the 411 pediatric cases reported in the continental United States during the study period (CDC unpublished). Furthermore, a previous case series of all cases reported nationally and a series of cases identified in Florida reported similar findings among children suggesting these data may be fairly representative [16].…”

Section: Discussionsupporting

confidence: 71%

Postnatally Acquired Zika Virus Disease Among Children, United States, 2016–2017

Lindsey

Porse

Potts

et al. 2019

Clinical Infectious Diseases

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Background The clinical findings among children with postnatally acquired Zika virus disease are not well characterized. We describe and compare clinical signs and symptoms for children aged <18 years. Methods Zika virus disease cases were included if they met the national surveillance case definition, had illness onset in 2016 or 2017, resided in a participating state, and were reported to the Centers for Disease Control and Prevention. Pediatric cases were aged <18 years; congenital and perinatal infections were excluded. Pediatric cases were matched to adult cases (18‒49 years). Clinical information was compared between younger and older pediatric cases and between children and adults. Results A total of 141 pediatric Zika virus disease cases were identified; none experienced neurologic disease. Overall, 28 (20%) were treated in an emergency department, 1 (<1%) was hospitalized; none died. Of the 4 primary clinical signs and symptoms associated with Zika virus disease, 133 (94%) children had rash, 104 (74%) fever, 67 (48%) arthralgia, and 51 (36%) conjunctivitis. Fever, arthralgia, and myalgia were more common in older children (12‒17 years) than younger children (1‒11 years). Arthralgia, arthritis, edema, and myalgia were more common in adults compared to children. Conclusions This report supports previous findings that Zika virus disease is generally mild in children. The most common symptoms are similar to other childhood infections, and clinical findings and outcomes are similar to those in adults. Healthcare providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia, or conjunctivitis, who reside in or have traveled to an area where Zika virus transmission is occurring.

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Section: Discussionsupporting

confidence: 71%

Postnatally Acquired Zika Virus Disease Among Children, United States, 2016–2017

Lindsey

Porse

Potts

et al. 2019

Clinical Infectious Diseases

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“…Among 31 children aged 1 to 17 years with symptomatic ZIKV infection in Florida, all of the children reported a rash and 81% of them reported fever; only 29% had conjunctivitis, and 22% had arthralgia. 29 Finally, of 158 children younger than 18 years with confirmed or probable ZIKV disease reported to the CDC from US states, 30 fever and a rash were reported by most children, with conjunctivitis and arthralgia reported only in a minority of children.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Zika Virus Infection in Infants, Children, and Adolescents Living in Puerto Rico

et al. 2018

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IMPORTANCE Little information is available regarding Zika virus (ZIKV) infection in children. OBJECTIVE To describe patients younger than 18 years who were infected with ZIKV and were enrolled in the Sentinel Enhanced Dengue and Acute Febrile Illness Surveillance System (SEDSS). DESIGN, SETTING, AND PARTICIPANTS Children infected with ZIKV with 7 or fewer days of fever or emancipated minors aged 14 to 17 years with a generalized maculopapular rash, arthritis or arthralgia, or nonpurulent conjunctivitis were eligible for enrollment on or before December 31, 2016, in Puerto Rico. Patients were evaluated using ZIKV polymerase chain reaction testing at 7 or fewer days after the onset of symptoms. Available ZIKV polymerase chain reaction-positive specimens were evaluated to determine viral loads. EXPOSURES Confirmed polymerase chain reaction-positive ZIKV infection. MAIN OUTCOMES AND MEASURES Clinical characteristics and viral loads of symptomatic children with confirmed ZIKV infection. RESULTS Of 7191 children enrolled in SEDSS on or before December 31, 2016, only those with confirmed ZIKV infection (351 participants) were included in this study. Participants who had confirmed ZIKV infection included 25 infants (7.1%), 69 children (19.7%) aged 1 to 4 years, 95 (27.1%) aged 5 to 9 years, and 162 (46.1%) aged 10 to 17 years. Among these, 260 patients (74.1%) presented for evaluation of ZIKV infection at fewer than 3 days after the onset of symptoms, 340 (96.9%) were discharged to home after evaluation, and 349 (99.4%) had fever, 280 (79.8%) had a rash, 243 (69.2%) had facial or neck erythema, 234 (66.7%) had fatigue, 223 (63.5%) had headache, 212 (60.4%) had chills, 206 (58.7%) had pruritus, and 204 (58.1%) had conjunctival hyperemia. Of 480 specimens collected (317 serum and 163 urine specimens) from 349 children, the median number of days after the onset of symptoms was lower for children who had serum specimens (1 day [interquartile range (IQR), 1-2 days]) than for children who had urine specimens (2 [1-3] days) (P < .001). Of 131 children who had both serum and urine specimens collected on the same day, the median viral load was higher in serum than in urine (median [IQR], 23 098 [8784-88 242] copies/mL for serum vs 9966 [2815-52 774] copies/mL for urine; P = .02). When a single serum sample from each of 317 patients was analyzed, there were no statistically significant differences in median viral loads according to age, sex, or disposition. However, the median serum viral load varied significantly according to the number of days after the onset of symptoms (0 days, 106 778 [IQR, 9772-1 571 718] copies/mL; 1 day, 46 299 [10 663-255 030] copies/mL; 2 days, 20 678 [8763-42 458] copies/mL; and Ն3 days, 15 901 [5135-49 248] copies/mL; P = .001). CONCLUSIONS AND RELEVANCE This study represents the largest study to date of ZIKV infection in the pediatric population. Most children infected with ZIKV had fever, rash, and conjunctival hyperemia. The children usually presented for evaluation at fewer than 3 days after the on...

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“…Most case studies of symptomatic pediatric ZIKV infection have shown a typically mild disease (172)(173)(174), similar to that observed in adult infection. However, complications associated with infection in newborns have rarely been reported (18), as well as ZIKV-related Guillain-Barré syndrome in adolescents (175).…”

Section: Postnatal Zikv Infectionmentioning

confidence: 62%

Maternal-Fetal Interplay in Zika Virus Infection and Adverse Perinatal Outcomes

et al. 2020

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During pregnancy, the organization of complex tolerance mechanisms occurs to assure non-rejection of the semiallogeneic fetus. Pregnancy is a period of vulnerability to some viral infections, mainly during the first and second trimesters, that may cause congenital damage to the fetus. Recently, Zika virus (ZIKV) infection has gained great notoriety due to the occurrence of congenital ZIKV syndrome, characterized by fetal microcephaly, which results from the ability of ZIKV to infect placental cells and neural precursors in the fetus. Importantly, in addition to the congenital effects, studies have shown that perinatal ZIKV infection causes a number of disorders, including maculopapular rash, conjunctivitis, and arthralgia. In this paper, we contextualize the immunological aspects involved in the maternal-fetal interface and vulnerability to ZIKV infection, especially the alterations resulting in perinatal outcomes. This highlights the need to develop protective maternal vaccine strategies or interventions that are capable of preventing fetal or even neonatal infection.

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Epidemiology of Pediatric Zika Virus Infections

Abstract: This report found that the majority of children identified during the 2016 ZIKV outbreak only presented with 2 of the 4 main symptoms. In addition, pediatric ZIKV cases were frequently associated with symptomatic household members.

Cited by 6 publications

References 11 publications

Postnatally Acquired Zika Virus Disease Among Children, United States, 2016–2017

Postnatally Acquired Zika Virus Disease Among Children, United States, 2016–2017

Symptomatic Zika Virus Infection in Infants, Children, and Adolescents Living in Puerto Rico

Maternal-Fetal Interplay in Zika Virus Infection and Adverse Perinatal Outcomes

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