Zika Virus Infection: Perspectives as a Specialist of Pediatric Infectious Diseases

Ki Wook Yun

doi:10.14776/piv.2016.23.1.1

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Yun: Zika Virus Infection: Perspectives as a Specialist of Pediatric Infectious Diseases

Review Article

Pediatr Infect Vaccine 2016;23(1):1-9.

Published online: 21 January 2016

DOI: https://doi.org/10.14776/piv.2016.23.1.1

Zika Virus Infection: Perspectives as a Specialist of Pediatric Infectious Diseases

Ki Wook Yun

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea

Tel: 02)2072-4909, Fax: 02)743-3455 E-mail: pedwilly@gmail.com

Received 14 March 201623 March 2016 Accepted 24 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The Zika virus, a flavivirus related to dengue and Japanese encephalitis was discovered in the Zika forest in Uganda, 1947. Since Zika virus was first reported in Brazil in May 2015, infections have occurred in at least 40 countries, especially in the Americas. Zika virus infection usually is asymptomatic or causes mild illness, but may be related to severe clinical manifestations, particularly microcephaly and Guillain-Barré syndrome. Although the possibility of autochthonous Zika virus transmission in South Korea is low, the imported cases and Zika virus-transmitting mosquito should be adequately monitored and promptly managed. In addition, enhancing preparedness for Zika virus infection are needed.

Keywords: Zika virus, Mosquito, Congenital infection, Microcephaly, Guillain-Barré syndrome

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Fig. 1.

Guidelines for the evaluation and testing of neonates and infants with possible congenital Zika virus infection. ∗Follow the recommendations of Korean Centers for Disease Control and Prevention (http://www.cdc.go.kr) for Zika virus testing in mother who traveled to or resided in an area with Zika virus transmission during pregnancy.

Table 1.

Recommended Laboratory Testing for Neonates and Infants with Possible Congenital Zika Virus Infection

Indications	Neonate or infant with microcephaly or intracranial calcifications born to a woman who traveled to or resided in an area with Zika virus transmission while she was pregnant
Indications	Neonate or infant born to a mother with a positive or inconclusive test result for Zika virus infection
Testing	In serum∗ or CSF^†
	-RT-PCR for Zika virus RNA
	-IgM and neutralizina antibodies for Zika virus and denaue virus
	Consider histopathologic evaluation of the placenta and umbilical cord
	-Zika virus immunohistochemical staining on fixed tissue
	-Zika virus RT-PCR on fixed and frozen tissue
Diagnosis	Detectable Zika virus RNA, or Zika virus antigen in any clinical sample
	Positive Zika virus IgM with confirmatory neutralizing antibody titers that are >4-fold higher than dengue virus neutralizing antibody titers in serum or CSF
	-Testing would be considered inconclusive if Zika virus neutralizing antibody titers are <4-fold higher than dengue virus neutralizing antibodv titers.

^∗ The initial sample should be collected either from the umbilical cord or directly from the infant within 2 days of birth, if possible.

^† If cerebrospinal fluid is obtained for other studies. Abbreviations: CSF, cerebrospinal fluid; RT-PCR, reverse transcription-polymerase Chain reaction.

Table 2.

Recommended Clinical Evaluation and Longterm Follow-up for Infants with Possible Congenital Zika Virus Infection

Clinical evaluation	1. Comprehensive physical examination, includinq careful measurement of occipitofrontal circumference, Iength, weight, and assessment of gestational age.
	2. Evaluation for neurologic abnormalities, dysmorphic features, splenomegaly, hepatomegaly, and rash or other skin lesions.
	3. Cranial ultrasound.
	4. Evaluation of hearing and vision. either before discharge from the hospital or within 1 month after birth.
	5. For infants with microcephaly∗ or intracranial calcifications, additional evaluation includes the following:
	-Complete blood count with platelet count and liver function and enzyme tests.
	-Testing for other congenital infections such as syphilis, toxoplasmosis, rubella, cytomegalovirus infection, lymphocytic choriomeningitis virus infection, and herpes simplex virus infections.
	-Consultation with a pediatric infectious disease specialist to determine appropriate brain imaging and additional evaluation.
Longterm follow—up	1. Consider conducting additional hearing screen at age 6 months.
	2. Refer any child with developmental delay for an audiologic evaluation.
	3. Ensure that appropriate follow - up of abnormal newborn hearing screening has occurred.
	4. Carefully evaluate occipitofrontal circumference and developmental characteristics and milestones throughout the first year of life.

^∗ Microcephaly is defined as occipitofrontal circumference less than the third percentile, based on WHO growth curves for sex, age, and gestational age at birth. For a diagnosis of microcephaly to be made, the occipitofrontal circumference should be disproportionately small in comparison with the length of the infant and not explained by other etic logies. If an infant's occipitofrontal circumference is equal to or greater than the third percentile but is notably disproportionate to the length of the infant, or if the infant has deficit that are related to the central nervous system. additional evaluation for Zika virus infection miaht be considered.

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