NEW YORK (Reuters Health) – Most children presenting with Zika virus infection have only two of the four main symptoms that characterize the illness, according to an epidemiological study.
The four main symptoms are maculopapular rash, fever, conjunctivitis, and arthralgia – but as many as 80% of Zika virus infections are asymptomatic. All four symptoms can be found in other common childhood illnesses, further complicating Zika diagnoses in children.
Isabel Griffin from the Florida Department of Health, in Miami-Dade County, and colleagues report the features of 33 confirmed Zika virus cases in children: 27 were travel-associated, and six were acquired within Miami-Dade County.
Of the six locally acquired infections, three were identified during household cluster investigations, and two patients lived in active Zika virus transmission zones at the time of onset, according to the November 1 Pediatrics online report.
Two of the 33 total cases were asymptomatic, but only three (9.6%) of the 31 symptomatic children had all four main symptoms.
Eight symptomatic children (25.8%) reported three of the four symptoms, 16 (51.6%) reported two of the four, and four (12.9%) reported just one main symptom. In all, 25 of the 31 (80.6%) had both fever and rash.
All patients with only two of four symptoms had travel-associated infections, whereas none of the children with travel-associated infection were asymptomatic. Five children (18.5%) with travel-associated infections also reported diarrhea.
There were no Zika-related hospitalizations, reported instances of Guillain-Barre syndrome, or Zika-linked deaths.
Dr. Debbie-Ann Shirley from the University of Virginia School of Medicine, in Charlottesville, who recently reviewed Zika virus infection, told Reuters Health by email, “The overwhelming clinical significance of Zika virus is that in utero exposure may result in microcephaly and other congenital anomalies of the central nervous system. Healthcare providers should consider a diagnosis of Zika virus infection in children who have an epidemiologic risk and compatible symptoms, and should report suspected cases to state and local health authorities to facilitate diagnosis and mitigate the risk of local transmission, especially to pregnant women.”
“Protecting children from mosquito bites is the best method currently available to prevent Zika virus infection in children,” she said. “Sexually active adolescents may also require counseling on the risk of Zika infection through sexual transmission.” She advised healthcare providers to visit the CDC website for guidance on preventing Zika infection, appropriate testing of blood and urine specimens in suspected cases, and caring for affected children. (http://bit.ly/2j8aBrQ)
Dr. Stefan Hagmann from Steven and Alexandra Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York, recently detailed the clinical impact of non-congenital Zika virus infection in children. He told Reuters Health by email, “Of note is that diarrhea was reported in almost 20% of travel-associated cases. Further, the identification of household clusters is noteworthy.”
“As a result of those findings, I think one could say that children returning from Zika-affected areas with diarrhea may also need to be evaluated for Zika virus infection in the context of a febrile illness,” he said. “And further, that in areas with active Zika transmission, children of household members with symptomatic Zika virus infection may need to be considered for Zika testing.”
Griffin did not respond to a request for comment.
SOURCE: http://bit.ly/2ymvwlW
Pediatrics 2017.
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