CDC Guidance Update for Possible Congenital Zika Infection

This updated interim guidance is based on current, limited data about Zika virus infection, and reflects the information available as of September 2017.

Guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection has been updated and was recently published in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

Laboratory testing and clinical evaluation recommendations were updated for 3 clinical scenarios based on clinical findings for congenital Zika syndrome in infants during standard evaluations at birth and laboratory test results of mothers for Zika infection. The updated scenarios are: 1) infants with clinical findings regardless of maternal laboratory results, 2) infants without clinical findings born to mothers with positive results, 3) infants without clinical findings and mothers with negative results. Infants in scenario 3 are not recommended for further evaluation; however, healthcare providers should remain vigilant for abnormalities like postnatal-onset microcephaly and eye abnormalities in all 3 scenarios.

Additional laboratory testing for infection is recommend for infants in scenario 1 and 2, specifically testing of the cerebrospinal fluid for Zika RNA and immunoglobulin M antibodies if serum and urine tests are negative. Head ultrasound and comprehensive ophthalmologic evaluations should also be performed by age 1 month, along with an auditory brainstem response (ABR) test if not previously done at birth. A diagnostic ABR when the child is 4 to 6 months of age or behavioral audiology at 9 months is no longer recommended if the initial ABR test is passed.

Consultation with a developmental specialist and use of early intervention programs are also recommended for infants with clinical findings, in addition to tests such as neurologic examination, clinical genetics assessment, and evaluation for other congenital infections.

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Adebanjo T, Godfred-Cato S, Viens L, et al. Update: interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection – United States, October 2017. MMWR Morb Mortal Wkly Rep. 2017;66:1089-1099.