Evaluation of Pregnant Women, Fetuses and Infants with Zika Virus Exposure and Infection: Lessons Learned from the Congenital Zika Program at Children’s National

Abstract

BackgroundZikaVirus (ZIKV) infection during pregnancy has severe potential consequence to the fetus. Despite limited endemic transmission in the continental US, travel/ sexual exposurein the periconception/pregnancy period requires experienced multidisciplinary care to assess potential infection and effects in the fetus.MethodsThe Congenital Zika Program at Children’s National (CZPCN) was developed to meet need for pre- and post-natal consultation in the setting of Zika exposure/infection during pregnancy. CZPCR includes multidisciplinary expertise in fetal imaging, pediatric infectious diseases, fetal and pediatric neurology. Services include a hotline, facilitation of ZIKV testing and interpretation, detailed fetal MRI/US, delivery instructions to faciliate postnatal evaluation of ZIKV exposed/infected fetuses and educational outreach to providers regarding ZIKV.ResultsBetween Jan 2016 and May 2017, 36 women/fetuses were evaulated atby CZPCN for possible ZIKV infection during pregnancy (32 US residents who traveled, 2 with partner who traveled, 2 emigrees). An additional 14 women/infant pairs were evaluated following postnatal referral to our program. Exposure route included direct arboviral (89 %) and/or potential sexual exposure (48%). Symptoms occurred in only 6/50 (12%). Exposure occurred in the preconceptual period in 10/50 (20%), first trimester in 23/50 (46%), second trimester in 13/50 (26%), and third trimester 4/50 (8%). Nearly 50% (24/50) of women presented outside the 12 week window of exposure and could not have infection excluded. ZIKV was confirmed in 22% (11/50) or suspected due to unspecified flavivirus infection in 28% (14/50). Only 7/50 (14%) had negative PCR/IgM testing in appropriate window to exclude infection. Two fetuses with severe involement were not carried to term, 1 was carried to term but died immediately after birth and 1 died within the first year of life.ConclusionCZPCN fills a critical need within our region to faciliate evaluation of exposed/infected pregnant women/fetuses/infants including neurodevelopmental followup of affected suriving infants. . Lessons learned are instructive to other centers developing programs, needed as the range of endemic Zika transmission expands.Disclosures All authors: No reported disclosures.