Zika virus: What does a physician caring for children in Canada need to know?

Abstract

Zika virus (ZIKV) was recently recognized to be teratogenic. The diagnosis of congenital ZIKV syndrome should be considered in children with unexplained microcephaly, intracranial calcifications, ventriculomegaly or major structural central nervous system abnormalities. Management is evolving but suggestions are provided for children with findings compatible with congenital infection and for those born to women with potential exposure during pregnancy.

Figure 1.

Investigating infants or children with features suggestive of congenital Zika syndrome. ¹Negative maternal ZIKV serology more than 4 weeks after exposure rules out ZIKV infection and congenital ZIKV infection. However, since one may wait weeks for results, sending specimens for PCR and testing the child simultaneously is advised. Assuming that the child has not travelled to a ZIKV-endemic country, they should only have positive ZIKV serology if the mother tests positive. Discuss with an ID physician or microbiologist if results are positive only from the child. CMV cytomegalovirus; CNS central nervous system; CSF cerebrospinal fluid; ID infectious diseases; IgM Immune globulin; LCMV lymphocytic choriomeningitis virus; MRI magnetic resonance imaging; PCR polymerase chain reaction; PRNT plaque reduction neutralization test; U/S ultrasound; ZIKV Zika virus.

Figure 2.

Management of infants born to women with potential exposure to ZIKV during pregnancy. ¹Travel to a ZIKV-endemic country during pregnancy or sexual contact during pregnancy with a male who travelled to a ZIKV-endemic country in the preceding 6 months. CMV cytomegalovirus; ID infectious diseases; IgM immune globulin; MRI magnetic resonance imaging; PCR polymerase chain reaction; ZIKV Zika virus.