Abstract
BackgroundRecent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. However, little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence.MethodsWe conducted a systematic review on the clinical presentation and complications of children and adolescents aged 0 to 18 years with a robust diagnosis of ZIKV infection. We searched PubMed, Web of Science, LILACs, and EMBASE until 13 February 2020 and screened reference lists of eligible articles. We assessed the studies’ risk of bias using pre-specified criteria.FindingsOur review collated the evidence from 2543 pediatric ZIKV cases representing 17 countries and territories, identified in 1 cohort study, 9 case series and 22 case reports. The most commonly observed signs and symptoms of ZIKV infection in children and adolescents were mild and included fever, rash, conjunctivitis and arthralgia. The frequency of neurological complications was reported only in the largest case series (identified in 1.0% of cases) and in an additional 14 children identified from hospital-based surveillance studies and case reports. ZIKV-related mortality was primarily accompanied by co-morbidity and was reported in one case series (<0.5% of cases) and three case reports. One death was attributed to complications of Guillain-Barré Syndrome secondary to ZIKV infection.Conclusions and relevanceBased on the current evidence, the clinical presentation of ZIKV infection in children and adolescents appears to be primarily mild and similar to the presentation in adults, with rare instances of severe complications and/or mortality. However, reliable estimation of the risks of ZIKV complications in these age groups is limited by the scarcity and quality of published data. Additional prospective studies are needed to improve understanding of the relative frequency of the signs, symptoms, and complications associated with pediatric ZIKV infections and to investigate any potential effects of early life ZIKV exposure on neurodevelopment.
Highlights
Following the introduction of the arthropod-borne flavivirus Zika (ZIKV) into Brazil in 2013 [1], Zika virus (ZIKV) spread rapidly across the Americas, facilitated by global air travel [2], and autochthonous transmission of ZIKV has been reported in 84 countries and territories worldwide [3]
Evidence has shown that ZIKV is neurotropic, with approximately 5–10% of congenital ZIKV infections leading to neurologic anomalies in neonates [18,19,20,21,22,23,24]
We identified one additional full text article from the reference review of eligible articles. This resulted in 32 final full text articles included in the systematic review (i.e., 1 cohort, 9 case series and 22 case reports)
Summary
Following the introduction of the arthropod-borne flavivirus Zika (ZIKV) into Brazil in 2013 [1], ZIKV spread rapidly across the Americas, facilitated by global air travel [2], and autochthonous transmission of ZIKV has been reported in 84 countries and territories worldwide [3]. The definition includes five unique features (i.e., severe microcephaly, subcortical calcifications, macular scarring and pigmentary retinal mottling, congenital contractures, and early hypertonia), which are used to distinguish congenital ZIKV infection from other congenital infections [25, 26]. Another severe neurological complication which has been linked with ZIKV infection is the severe autoimmune polyneuropathy known as Guillain-Barre Syndrome (GBS) [27, 28]. Recent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. Little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence
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