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

Abstract

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.

Age-dependent manifestations and case definitions of paediatric Zika: a prospective cohort study

“…12,13 Because Zika manifests differentially across childhood, and standard case definitions include clinical findings rarely observed in our large paediatric population, symptomatic ZIKV infection could manifest differently across the lifespan. This hypothesis is supported by the age-varying prevalence of various Zika clinical findings, observed in comparisons of younger children with older children (in our study and others) 8,9 and in comparisons of children with adults. 9 A comparison of Zika clinical findings in paediatric and general population studies provides further evidence in support of this hypothesis (appendix pp 28-30).…”

“…This hypothesis is supported by the age-varying prevalence of various Zika clinical findings, observed in comparisons of younger children with older children (in our study and others) 8,9 and in comparisons of children with adults. 9 A comparison of Zika clinical findings in paediatric and general population studies provides further evidence in support of this hypothesis (appendix pp 28-30). Specifically, general population Zika studies report a higher prevalence of arthralgia, myalgia, conjunctival involve ment, headache, periarticular oedema, and gastrointestinal and respiratory clinical findings than do studies of paediatric Zika.…”

“…The increasing prevalence of arthralgia, rash, and fever across paediatric age has been previously noted. 8,9 The WHO and PAHO case definitions are likely based on adult data, as mostly adult data from Yap Island 26 and French Polynesia 27 were available when the case definitions were created 1 and updated. 12,13 Because Zika manifests differentially across childhood, and standard case definitions include clinical findings rarely observed in our large paediatric population, symptomatic ZIKV infection could manifest differently across the lifespan.…”

“…Most of what is known about Zika derives from adult studies. Clinical studies of paediatric Zika are relatively scarce and feature modest sample sizes, [6][7][8][9][10] precluding a full understanding of the disease in children. Using the largest clinical dataset of laboratory-confirmed paediatric Zika cases to date, 11 this study characterises the acute clinical profile of Zika and assesses the diagnostic performance of the WHO 12 and PAHO 13 case definitions in children.…”

Zika Virus Disease Comparing Children and Adults in a Dengue-Endemic Setting

“…17,18 Previous studies found that rash and fever were the two most common symptoms in pediatric ZIKV cases. 19,20 However, rash was the only symptom that was significantly more common in children with ZIKV than those without ZIKV in our study. All pediatric ZIKV cases in our study had lower peak temperature than pediatric non-ZIKV cases.…”