Vital Signs: Update on Zika Virus–Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure — U.S. Zika Pregnancy Registry, 2016

Early Release / April 4, 2017 / 66

Megan R. Reynolds, MPH1; Abbey M. Jones, MPH1; Emily E. Petersen, MD2; Ellen H. Lee, MD3; Marion E. Rice, MPH1,4; Andrea Bingham, PhD5; Sascha R. Ellington, MSPH2; Nicole Evert, MS6; Sarah Reagan-Steiner, MD7; Titilope Oduyebo, MD2; Catherine M. Brown, DVM8; Stacey Martin, MSc9; Nina Ahmad, MD10; Julu Bhatnagar, PhD7; Jennifer Macdonald, MPH11; Carolyn Gould, MD9; Anne D. Fine, MD3; Kara D. Polen, MPH1; Heather Lake-Burger, MPH5; Christina L. Hillard, MA1; Noemi Hall, PhD6,12; Mahsa M. Yazdy, PhD8; Karnesha Slaughter, MPH1; Jamie N. Sommer, MS10; Alys Adamski, PhD1; Meghan Raycraft, MPH1; Shannon Fleck-Derderian, MPH4,13; Jyoti Gupta, MPH11; Kimberly Newsome, MPH1; Madelyn Baez-Santiago, PhD1; Sally Slavinski, DVM3; Jennifer L. White, MPH10; Cynthia A. Moore, MD, PhD1; Carrie K. Shapiro-Mendoza, PhD2; Lyle Petersen, MD9; Coleen Boyle, PhD14; Denise J. Jamieson, MD2; Dana Meaney-Delman, MD13; Margaret A. Honein, PhD1; U.S. Zika Pregnancy Registry Collaboration (View author affiliations)

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Key Points

• In 2016, a total of 1,297 pregnancies with possible recent Zika virus infection were reported to the U.S. Zika Pregnancy Registry from 44 states.

• Approximately one in 10 pregnancies with laboratory-confirmed Zika virus infection resulted in a fetus or infant with Zika virus–associated birth defects.

• The proportion of fetuses and infants with Zika virus–associated birth defects was highest among those with first trimester Zika virus infections.

• Only 25% of infants from pregnancies with possible recent Zika virus infection reported receiving postnatal neuroimaging.

• Identification and follow-up care of infants born to mothers with laboratory evidence of possible recent Zika virus infection during pregnancy and infants with congenital Zika virus infection can ensure that appropriate intervention services are available to affected infants.

• Additional information is available at https://www.cdc.gov/vitalsigns/.

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Abstract

Background: In collaboration with state, tribal, local, and territorial health departments, CDC established the U.S. Zika Pregnancy Registry (USZPR) in early 2016 to monitor pregnant women with laboratory evidence of possible recent Zika virus infection and their infants.

Methods: This report includes an analysis of completed pregnancies (which include live births and pregnancy losses, regardless of gestational age) in the 50 U.S. states and the District of Columbia (DC) with laboratory evidence of possible recent Zika virus infection reported to the USZPR from January 15 to December 27, 2016. Birth defects potentially associated with Zika virus infection during pregnancy include brain abnormalities and/or microcephaly, eye abnormalities, other consequences of central nervous system dysfunction, and neural tube defects and other early brain malformations.

Results: During the analysis period, 1,297 pregnant women in 44 states were reported to the USZPR. Zika virus–associated birth defects were reported for 51 (5%) of the 972 fetuses/infants from completed pregnancies with laboratory evidence of possible recent Zika virus infection (95% confidence interval [CI] = 4%–7%); the proportion was higher when restricted to pregnancies with laboratory-confirmed Zika virus infection (24/250 completed pregnancies [10%, 95% CI = 7%–14%]). Birth defects were reported in 15% (95% CI = 8%–26%) of fetuses/infants of completed pregnancies with confirmed Zika virus infection in the first trimester. Among 895 liveborn infants from pregnancies with possible recent Zika virus infection, postnatal neuroimaging was reported for 221 (25%), and Zika virus testing of at least one infant specimen was reported for 585 (65%).

Conclusions and Implications for Public Health Practice: These findings highlight why pregnant women should avoid Zika virus exposure. Because the full clinical spectrum of congenital Zika virus infection is not yet known, all infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy should receive postnatal neuroimaging and Zika virus testing in addition to a comprehensive newborn physical exam and hearing screen. Identification and follow-up care of infants born to women with laboratory evidence of possible recent Zika virus infection during pregnancy and infants with possible congenital Zika virus infection can ensure that appropriate clinical services are available.