Fever, Rash, Conjunctival Hyperemia Common Symptoms of Pediatric Zika Virus Infection

Zika virus
Zika virus
Symptomatic pediatric patients infected with Zika virus generally have a mild, often nonspecific symptoms not requiring hospitalization.

For children infected with Zika virus, most have symptoms of fever, rash, and conjunctival hyperemia, with viral loads decreasing as the number of days since symptom onset increases, according to results published in JAMA Pediatrics.

The study included participants younger than 18 years who were infected with Zika virus and enrolled in the Sentinel Enhanced Dengue and Acute Febrile Illness Surveillance System (n=351).

Participants included 25 infants, 69 children age 1 to 4 years, 95 children age 5 to 9 years, and 162 children age 10 to 17 years.

Of the 351 participants, 260 were seen for evaluation of Zika virus infection at ≤3 days after the onset of symptoms.

At evaluation, 96.9% (n=340) were discharged following examination, 99.4% (n=349) had fever, 79.8% (n=280) had a rash, 69.2% (n=243) had facial/neck erythema, 66.7% (n=234) had fatigue, 63.5% (n=223) had headache, 60.4% (n=212) had chills, 58.7% (n=206) had pruritus, and 58.1% (n=204) had conjunctival hyperemia.

The researchers collected 317 serum specimens and 163 urine specimens from 349 participants. When a single serum sample from each of 317 patients was analyzed, there were no statistically significant differences in median viral loads according to age, sex, or disposition.

However, the median serum viral load varied significantly according to the number of days after the onset of symptoms (0 days, 106,778 [interquartile ratio [IQR]: 9772-1,571,718] copies/mL; 1 day, 46,299 [IQR: 10,663-255,030] copies/mL; 2 days, 20,678 [IQR: 8763-42,458] copies/mL; and 3 days, 15,901 [IQR: 5135-49,248] copies/mL; P =.001).

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“Although several signs and symptoms occurred, 4 signs experienced by most children included fever, facial or neck erythema, conjunctival hyperemia, and a maculopapular rash that was often pruritic,” the authors noted.


Read JS, Torres-Velasquez B, Lorenzi O, et al. Symptomatic Zika virus infection in infants, children, and adolescents living in Puerto Rico [published online May 29, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.0870