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The Benign Course of Postnatal Zika Infection

Amesh A. Adalja, MD, FACP, FACEP, FIDSA, October 7, 2016

The major focus with Zika virus has been on its effect on a developing fetus, since it can result in a spectrum of conditions that include microcephaly. Preventing congenital Zika syndrome has become a major priority, as it has a major developmental impact on the children who are affected. However, it has been unclear what the impact of postnatal acquired infection is on children. A new study published in the Centers for Disease Control and Prevention’s(CDC) Morbidity and Mortality Weekly Report (MMWR) details the clinical spectrum of childhood Zika infections.


158 Children with Zika, Mostly Benign Course

The study, which took place between January 2015 and July 2016, included 158 children with confirmed or probable Zika infection. The median age was 14 years, with a range of 1 month to 17 years. Females comprised 56% of cases. Pregnant females, aged 16-17, accounted for 3% of included cases. All cases were travel-related, with Florida, New York, and California accounting for the highest number of reported cases. Travel to the Dominican Republic was reported by one quarter of study subjects.

Symptoms were as expected with Zika: rash was present in 82%, 55% were febrile, 29% had conjunctivitis, and 28% had arthralgias. Only 2 (1%) of the children were hospitalized, and no child developed Guillain-Barré syndrome (which is rare in children). Meningitis and encephalitis also did not occur in this cohort. Hospitalizations were for poor oral intake in one case in a 4-year-old and for cough and rash in another child who was 1 year of age.


Important Evidence Confirming Zika’s Main Impact

The study is significant because it provides further evidence regarding the clinical consequences of Zika. For children, as with adults, a benign case is the rule; this is reassuring and reinforces the fact that preventing congenital Zika syndrome should be the top priority with respect to this outbreak. However, more information on the clinical spectrum of illness caused by Zika, especially delineating the risk factors for severe manifestations from postnatal infections, is still needed.



Goodman AB, Dziuban EJ, Powell K, et al. Characteristics of children aged <18 years with Zika virus disease acquired postnatally—U.S. states, January 2015-July 2016. MMWR 2016; Accessed October 6, 2016.