Ask about possible maternal Zika virus exposure

Possible Zika virus exposure

If no maternal Zika virus exposure is identified, routine pediatric care is recommended.

Initial evaluation:

Standard evaluation^*
Zika virus NAT and IgM testing
Consider Zika virus NAT and IgM testing on CSF
Head ultrasound by age 1 month
Comprehensive ophthalmologic exam by age 1 month
Automated ABR by age 1 month
Evaluate for other causes of congenital anomalies

Refer to developmental specialist and early intervention services
Provide family support services
Consider additional consultations with:

Infectious disease specialist
Clinical geneticist
Neurologist
Other clinical specialists based on clinical findings of infant

End

^* All infants should receive a standard evaluation at birth and at each subsequent well-child visit by their health care providers including (1) comprehensive physical examination, including growth parameters and (2) age-appropriate vision screening and developmental monitoring and screening using validated tools. Infants should receive a standard newborn hearing screen at birth, preferably using auditory brainstem response.

^† Automated ABR by age 1 month if newborn hearing screen passed but performed with otoacoustic emission methodology.

^§ Laboratory evidence of possible Zika virus infection during pregnancy is defined as (1) Zika virus infection detected by a Zika virus RNA NAT on any maternal, placental, or fetal specimen (referred to as NAT-confirmed); or (2) diagnosis of Zika virus infection, timing of infection cannot be determined or unspecified flavivirus infection, timing of infection cannot be determined by serologic tests on a maternal specimen (i.e., positive/equivocal Zika virus IgM and Zika virus PRNT titer ≥10, regardless of dengue virus PRNT value; or negative Zika virus IgM, and positive or equivocal dengue virus IgM, and Zika virus PRNT titer ≥10, regardless of dengue virus PRNT titer). The use of PRNT for confirmation of Zika virus infection, including in pregnant women, is not routinely recommended in Puerto Rico (https://www.cdc.gov/zika/laboratories/lab-guidance.html).

^¶ This group includes women who were never tested during pregnancy as well as those whose test result was negative because of issues related to timing or sensitivity and specificity of the test. Because the latter issues are not easily discerned, all mothers with possible exposure to Zika virus during pregnancy who do not have laboratory evidence of possible Zika virus infection, including those who tested negative with currently available technology, should be considered in this group.

^** Laboratory testing of infants for Zika virus should be performed as early as possible, preferably within the first few days after birth, and includes concurrent Zika virus NAT in infant serum and urine, and Zika virus IgM testing in serum. If CSF is obtained for other purposes, Zika virus NAT and Zika virus IgM testing should be performed on CSF.

^†† Laboratory evidence of congenital Zika virus infection includes a positive Zika virus NAT or a nonnegative Zika virus IgM with confirmatory neutralizing antibody testing, if PRNT confirmation is performed.

Initial evaluation:

Standard evaluation^*
Zika virus NAT and IgM testing
Head ultrasound by age 1 month
Comprehensive ophthalmologic exam by age 1 month
Automated ABR by age 1 month

Testing and clinical evaluation for congenital Zika virus infection beyond a standard evaluation^* is not routinely recommended.
If findings suggestive of CZS are identified at any time, refer to appropriate specialists and evaluate for congenital Zika virus infection.

Is there laboratory evidence of possible maternal Zika virus infection during pregnancy?

Laboratory evidence of possible maternal Zika virus infection during pregnancy

No laboratory evidence of possible maternal Zika virus infection during pregnancy

Is initial evaluation normal?

Yes

No

Congenital Zika virus infection is unlikely
Infant should continue to receive routine care, and health care providers should remain alert for any new findings of congenital Zika virus infection

Is there laboratory evidence of congenital Zika virus infection?

Laboratory evidence of congenital Zika virus infection

No laboratory evidence of congenital Zika virus infection

Does infant have findings consistent with CZS?

Yes

No