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  • Screening for Congenital Zika Virus Infection

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD
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    Journal Highlights

    JAMA Pediatrics
    Published online July 17, 2017

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    According to current guidelines, screening eye exams are recommend­ed for infants with microcephaly or laboratory-confirmed infection with the Zika virus (ZIKV) but not for all infants potentially exposed to the virus in utero. To assess the adequacy of this recommendation, Zin et al. examined ophthalmic findings of infants whose mothers were infected with ZIKV during pregnancy. They found that eye abnormalities may occur in the absence of microcephaly and may be the sole initial sign of congenital ZIKV infection.

    For this descriptive case series, the researchers examined 112 mothers and their infants at a facility for high-risk pregnancies in Brazil. During gesta­tion, the mothers were confirmed to be infected with the virus by real-time polymerase chain reaction (PCR) test­ing. The infants were evaluated from birth to 1 year of age by a multidisci­plinary team. Median age at the first eye exam was 31 days (range, 0-305 days). Eye abnormalities were documented, and their relationship to microcephaly, central nervous system (CNS) findings, and the timing of maternal infection was explored.

    Ocular defects were observed in 24 (21.4%) of the 112 infants born to ZIKV-infected mothers, with abnor­malities of the retina and optic nerve the most common findings. Of these 24 infants, 10 (41.7%) did not have mi­crocephaly, and 8 (33.3%) had normal CNS findings.

    With regard to the timing of mater­nal infection, 14 of the 24 infants with an eye abnormality (58.3%) were born to mothers who contracted ZIKV in their first trimester, 8 (33.3%) to those infected during the second trimester, and 2 (8.3%) to those infected in the third trimester.

    As eye abnormalities may be the only initial indicator of congenital ZIKV infection, the authors recom­mended that screening eye exams be given to all infants potentially exposed to the virus at any point during ges­tation, regardless of CNS findings or laboratory confirmation of infection.

    The original article can be found here.