Leaders of Congenital Zika Virus Program at Childrens National share lessons learned with peers
Zika-affected pregnancies from near and far referred to Children's National for multidisciplinary consultations
SAN DIEGO—During their lifetimes, the tainted Aedes mosquitoes that spread Zika virus only fly a few hundred feet from where they hatch. And Zika hotspots—Texas and Florida domestically and dozens of nations around the world—all lie a fair distance from the nation’s capital. Still, the Congenital Zika Virus Program at Children’s National Health System evaluated 36 women and their fetuses from January 2016 through May 2017. Another 14 women and their infants were referred to the Zika program for postnatal consultations during that time.
“As the days grow shorter and temperatures drop, we continue to receive referrals to our Zika program, and this is a testament to the critical need it fulfills in the greater metropolitan D.C. region,” says Roberta L. DeBiasi, M.D., M.S., chief of the Division of and co-leader of the program. “Our multidisciplinary team now has consulted on 90 dyads (mothers and their Zika-affected fetuses/infants). The lessons we learned about when and how these women were infected and how their offspring were affected by Zika may be instructive to institutions considering launching their own programs.”
Dr. DeBiasi will outline lessons learned during a pediatric virology workshop at IDWeek2017, one of three such Zika presentations led by Children’s National research-clinicians during this year’s meeting of pediatric infectious disease specialists.
“The Zika virus continues to circulate in dozens of nations, from Angola to the U.S. Virgin Islands. Clinicians considering a strategic approach to managing pregnancies complicated by Zika may consider enlisting an array of specialists to attend to infants’ complex care needs, including experts in fetal imaging, pediatric infectious disease, physical therapists, audiologists, ophthalmologists and radiologists skilled at reading serial magnetic resonance images as well as ultrasounds,” Dr. DeBiasi says. “At Children’s we have a devoted Zika hotline to triage patient and family concerns. We provide detailed instructions for referring institutions explaining protocols before and after childbirth, and we provide continuing education for health care professionals.”
Of the 36 pregnant women possibly exposed to Zika during pregnancy seen in the program’s first year, 32 lived in the United States and traveled to countries where Zika virus was circulating. Two women had partners who traveled to Zika hot zones. And two moved to the Washington region from places where Zika is endemic. Including the postnatal cases, 89 percent of patients had been bitten by Zika-tainted mosquitoes, while 48 percent of women could have been exposed to Zika via sex with an infected partner.
Twenty percent of the women were exposed before conception; 46 percent were exposed to Zika in the first trimester of pregnancy; 26 percent were exposed in the second trimester; and 8 percent were exposed in the final trimester. In only six of 50 cases (12 percent) did the Zika-infected individual experience symptoms.
Zika infection can be confirmed by detecting viral fragments but only if the test occurs shortly after infection. Twenty-four of the 50 women (nearly 50 percent) arrived for a Zika consultation outside that 12-week testing window. Eleven women (22 percent) had confirmed Zika infection and another 28 percent tested positive for the broader family of flavivirus infections that includes Zika. Another detection method picks up antibodies that the body produces to neutralize Zika virus. For seven women (14 percent), Zika infection was ruled out by either testing method.
“Tragically, four fetuses had severe Zika-related birth defects,” Dr. DeBiasi says. “Due to the gravity of those abnormalities, two pregnancies were not carried to term. The third pregnancy was carried to term, but the infant died immediately after birth. The fourth pregnancy was carried to term, but that infant survived less than one year.”
IDWeek 2017 presentations:
Saturday, Oct. 7, 2017
- “Zika A to Z” session moderated by Roberta L. DeBiasi, M.D., M.S.
8:30 a.m. to 10 a.m.(PT)
- “Differential neuronal susceptibility and apoptosis in congenital Zika virus infection.”
9:15 a.m. (PT)
Cheng-Ying Ho, M.D., Ph.D.; Heather Ames, M.D., Ph.D.; Ashley Tipton, B.S.; Gilbert Vezina, M.D.; Judy Liu, M.D., Ph.D.; Joseph Scafidi, D.O.; Masaaki Torii, Ph.D.; Fausto Rodriguez, M.D.; Adré J. du Plessis, M.B.Ch.B., M.P.H.; and Roberta L. DeBiasi, M.D., M.S.
- “Evaluation of pregnant women, fetuses and infants with Zika virus exposure and infection: Lessons learned from the Congenital Zika Virus Program at Children’s National.”
12:30 pm. to 2 p.m. (PT)
Roberta L. DeBiasi, M.D., M.S.; Sarah B. Mulkey, M.D., Ph.D.; Caitlin Cristante, B.S.; Lindsay Pesacreta, R.N.; Gilbert Vezina, M.D.; Dorothy I. Bulas, M.D.; and Adré J. du Plessis, M.B.Ch.B., M.P.H.
Contact: Diedtra Henderson | Children’s National Health System | c: 443-610-9826/o: 202-476-4500 | [email protected]
About Children’s National Health System
Children’s National Health System, based in Washington, D.C., has been serving the nation’s children since 1870. Children’s National is #1 for babies and ranked in every specialty evaluated by U.S. News & World Report including placement in the top 10 for: Cancer (#7), Neurology and Neurosurgery (#9) Orthopedics (#9) and Nephrology (#10). Children’s National has been designated two times as a Magnet®hospital, a designation given to hospitals that demonstrate the highest standards of nursing and patient care delivery. This pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty outpatient centers. Home to the Children’s Research Institute and the Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National is one of the nation’s top NIH-funded pediatric institutions. Children’s National is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels. For more information, visit ChildrensNational.org , or follow us on Facebook and Twitter.
IDWeek is the combined annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. With the theme, “Advancing science, improving care,” IDWeek2017 features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment and epidemiology of infectious diseases, including HIV, across the lifespan. For information, visit IDWeek2017