Congenital Zika
From IDWiki
Background
- Infection with Zika virus
- Mostly transmitted by mosquitoes (mainly Aedes aegypti), but can be sexually transmitted
- Present in most of South and Central America including the Caribbean, sub-Saharan Africa, the Indian subcontinent, southeast Asia, and the Pacific islands
- Transmission
- Detectable in serum of pregnant women for 10 weeks after symptom onset
- Detectable in semen for up to 188 days after symptom onset (but only 69 days for replication-competent virus)
- Longest documented duration from symptom onset to sexual transmission is 32 to 41 days
| Trimester | Congenital Anomaly |
|---|---|
| first | 8-13% |
| second | 3-5% |
| third | 3-5% |
| overall | 5-10% |
Clinical Manifestations
- Cranial morphology due to a disruption in the fetal brain sequence
- Severe microcephaly
- Overlapping cranial sutures
- Prominent occipital bone
- Redundant scalp skin
- Brain anomalies
- Diffuse CNS calcifications, primarily subcortical
- Ventriculomegaly
- Polymicrogyria with cortical thinning
- Hypoplasia of the corpus callosum
- Decreased myelination
- Hypoplasia of the cerebellar vermis
- Ocular anomalies (25 to 55%)
- Chorioretinal atrophy or scarring
- Focal pigmentary retinal mottling
- Optic nerve atrophy
- Microphthalmia, cataracts, and intraocular calcifications
- Congenital contractures (5 to 15%)
- Arthrogryposis
- Club foot
- Congenital hip dislocation
- Other contractures, usually bilateral
Diagnosis
- Testing is only indicated for returned travellers with compatible symptoms
- CATMAT recommends against routine testing of asymptomatic pregnant women
- Molecular testing is the mainstay of diagnosis
- Serology also possible
Prevention
- For asymptomatic men and women: no recommendations
- For women who have confirmed infection: wait 2 months after returning from the risk area before trying to conceive
- For men who have confirmed infection: wait 3 months after returning from the risk area before trying to conceive
- For men with compatible symptoms or confirmed infection and a pregnant partner: use barrier protection for the duration of pregnancy
