Epidemiology of Pediatric Zika Virus Infection in the United States

Majority of children presented with only 2 of 4 main symptoms (fever, maculopapular rash, conjunctivitis, and/or arthralgia).

The first report of pediatric epidemiology of Zika virus infections in the United States, published in Pediatrics, revealed that the majority of infected children from the 2016 Miami-Dade County outbreak had 2 of 4 main symptoms and were associated with symptomatic household members.

In 2016, the first recorded outbreak of Zika virus in the continental United States occurred. Zika virus has spread across the South Pacific and Americas in the last years; however, very little is known about the epidemiology of pediatric Zika virus infection.

Between October 1, 2015, and March 29, 2017, 478 cases of Zika virus in Miami-Dade County were confirmed; 33 of these (6.9%) were children age 1 to 17 years (median age 11.1). 

Seventeen of the children (51.5%) were male, and 23 (69.7%) were Hispanic. The disease was travel associated in 27 of the children (81.8%) and locally acquired in 6 (18.2%). Of the 27 travel-associated cases, 6 (22.2%) occurred in 3 pairs of siblings within households. All 31 symptomatic children reported rash, 25 (80.6%) reported fever, 9 (29.0%) reported conjunctivitis, and 7 (22.5%) reported arthralgia. Three (9.6%) reported all 4 main symptoms, 8 (25.8%) reported 3 of 4, 16 (51.6%) reported 2 of 4, and 4 (12.9%) reported 1 of 4.

The percentage of pediatric Zika virus infection cases in Miami-Dade County was lower than in concurrent outbreaks in both Brazil and Puerto Rico. The majority of these patients reported only fever and rash and there were no hospitalizations, occurrences of Guillain-Barré syndrome, or deaths reported. 

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Although specific risk factors could not be calculated because of the unavailability of negative test results, the presence of sibling clusters highlights, “the need for families to take mosquito bite prevention measures when traveling to areas of active Zika virus transmission,” and to seek medical attention if a household member has symptoms of the virus. 


Griffin I, Zhang G, Fernandez D, et al. Epidemiology of pediatric Zika virus infections. Pediatrics. 2017;140: e20172044.