CDC issues Zika virus update for pediatric health care providers

As Zika virus infections continue, the CDC offers clinicians information on evaluating and managing suspected cases.
As Zika virus infections continue, the CDC offers clinicians information on evaluating and managing suspected cases.

Pediatric health care providers should be prepared to clinically evaluate, test, and manage infants and children suspected to be infected with Zika virus, according to a report from the Centers for Disease Control and Prevention (CDC) published in the March issue of Pediatrics.1

Since early 2015, Aedes aegypti mosquitoes have spread the Flavivirus widely throughout the Americas, including several US territories. “Local transmission was reported in 31 countries and territories in the Americas as of February 29, 2016, including some US territories,” wrote lead author Mateusz P. Karwowski, MD, MPH, of the CDC. “Based on the distributions of its primary mosquito vector, Aedes aegypti, and another possible vector, Aedes albopictus, local Zika virus transmission is possible in the continental United States.”

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Zika virus is spread primarily via mosquitoes, although sexual transmission has also been documented. Additionally, maternal-fetal transmission during pregnancy, intrapartum transmission, and perinatal transmission have all been reported.

Acute Zika virus infection should be suspected in infants and children who meet the following criteria: 2

  • Infants whose mothers traveled to or resided in a Zika-endemic area (http://wwwnc.cdc.gov/travel/notices) within 2 weeks of delivery;
  • children who have traveled to or resided in a Zika-endemic area within the past 2 weeks;
  • and patients who have at least 2 of the following symptoms: fever, rash, conjunctivitis, or arthralgia.

Mothers and adolescents who may have had sexual contact with an infected partner should also be tested.3

Most patients infected with Zika virus are asymptomatic. When symptoms do present, they generally include maculopapular rash, fever, arthralgia, and nonpurulent conjunctivitis, and last for up to 1 week. In infants and young children, arthralgia may manifest as irritability, walking with a limp, difficulty moving or refusing to move an extremity, pain on palpitation, or pain with active or passive movement of an affected joint.

Laboratory testing can confirm a clinical diagnosis by testing serum or plasma to detect virus, viral nucleic acid, or virus-specific immunoglobulin M and neutralizing antibodies.

No treatment specific to Zika virus is available. Fluids, rest, acetaminophen for fever, antihistamines for pruritis can be beneficial. Precautions should be taken to prevent mosquito bites during the first week of illness. Aspirin should be avoided in children and nonsteroidal anti-inflammatory drugs should be prescribed cautiously in children and avoided in infants less than 6 months of age.

In addition, the authors suggested that pregnant women postpone travel to Zika-endemic areas and that pregnant women or adolescents with male partners who have traveled to areas of active Zika virus transmission either abstain from sexual activity or use condoms.

References

  1. Karwowski MP, Nelson JM, Staples JE, et al. Zika virus disease: A CDC update for pediatric health care providers. Pediatrics. 2016; 137(5):e20160621.
  2. Fleming-Dutra KE, Nelson JM, Fischer M, et al. Update: Interim guidelines for health care providers caring for infants and children with possible Zika virus infection – United States, February 2016. MMWR Morb Mortal Wkly Rep. 2016;65(7):182-187.
  3. Oster AM, Brooks JT, Stryker JE, et al. Interim guidelines for prevention of sexual transmission of Zika virus – United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(5):120-121.
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