Ocular Findings and Visual Function in Children Examined during the Zika Health Brigade in the US Virgin Islands, March 2018.

S Grace Prakalapakorn,Linda Lawrence,Megan R Reynolds,Cosme Harrison,Leah De Wilde,Esther M Ellis,Shana Godfred-Cato,Richard D House,Daniel Lattin,Braeanna Hillman,Nicola Kim,Nicole Fehrenbach,Lucas Bonafede

doi:10.3390/tropicalmed6020066

Abstract

Among children born with laboratory-confirmed Zika virus (ZIKV) infection, visual impairment (VI) can occur despite normal ocular structure. The objective of this report is to describe ocular findings and visual function among children examined during the Department of Health Zika Health Brigade (ZHB) in the United States Virgin Islands in March 2018. This analysis is based on a retrospective chart review of children eligible to participate in the ZHB (i.e., part of the US Zika Pregnancy and Infant Registry) and who were examined by ophthalmologists. Eighty-eight children attended the ZHB. This report includes 81 children [48 (59.3%) males] whose charts were located [average gestational age = 37.6 weeks (range: 27.6–41.3) and average adjusted age at examination = 9.1 months (range: 0.9–21.9)]. Of those examined, 5/81 (6.2%) had microcephaly at birth, 2/81 (2.5%) had a structural eye abnormality, and 19/72 (26.4%) had VI. Among children with normal ocular structure and neurologic examination, 13/51 (25.5%) had VI. Despite a low incidence of abnormal ocular structure and microcephaly, about a quarter of children examined had VI. Our findings emphasize that ophthalmological examinations should be performed in all children with suspicion for antenatal ZIKV infection, even children with normal ocular structure and neurologic examination.

Highlights

United States Zika Pregnancy and Infant Registry (USZPIR) eligibility criteria included children born between 1 December 2015 and 31 March 2018 in the US Virgin Islands (USVI), to mothers with confirmed or possible recent zika virus (ZIKV) infection as defined by (1) ZIKV infection detected by Zika ribonucleic acid nucleic acid amplification test (NAAT) on any maternal, placental, fetal, or infant specimen or (2) ZIKV or flavivirus infection detected by serologic tests of maternal, fetal, or infant specimen [14]
USZPIR eligibility criteria included children born between 1 December 2015 and 31 March 2018 in the United States Virgin Islands, to mothers with confirmed or possible recent zika virus (ZIKV) infection as defined by (1) recent ZIKV infection detected by Zika ribonucleic acid nucleic acid amplification test (NAAT) on any maternal, placental, fetal, or infant specimen or (2) recent ZIKV or flavivirus infection detected by serologic tests of maternal, fetal, or infant specimen [14]. b Confirmed ZIKV infection was defined as either: (1) positive NAAT or (2) positive or equivocal
Among children born in the USVI to women who met USZPIR eligibility criteria of confirmed or possible recent ZIKV infection during pregnancy, were examined during the Zika Health Brigade (ZHB), and had complete charts available for review, 2.5% had structural ocular abnormalities and 26% had visual impairment

Summary

Introduction

First isolated in Uganda in 1947, Zika virus (ZIKV), a single-stranded ribonucleic acid flavivirus, is primarily transmitted by the Aedes mosquito, but can be transmitted sexually, intrauterine (mother-to-fetus during pregnancy), and perinatally (mother-toinfant at delivery) [1,2]. While most people infected with ZIKV are asymptomatic or only have mild symptoms of fever, maculopapular rash, conjunctivitis, or arthralgias, in. 2013–2014 ZIKV was first noted to be associated with Guillain-Barre syndrome [1]. In. 2017, it was reported that infection with ZIKV during pregnancy can cause a recognizable pattern of structural anomalies and functional disabilities known as Congenital Zika syndrome (CZS) [3]. The most recent ZIKV outbreak identified in the Americas in 2015 has had a wide geographic distribution, being reported in 86 countries and territories [4]

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Conclusion