Congenital Zika

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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 Any Microcephaly Congenital Zika Syndrome
first 10% 7%
second 3% 1%
third 4% 1%
overall 6% 3%

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
  • 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%)

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

Further Reading