As the Zika virus spreads at home and abroad, new research reveals the risk is greater than previously believed — even for those who were not born with microcephaly, the birth defect associated with Zika, or other signs of impairment.
This possibility will require better tracking of babies’ development and well-being if they were at risk of exposure to Zika while in utero, experts say.
Scientists at the Centers for Disease Control and Prevention have concluded that Zika virus is a cause of microcephaly and other severe fetal brain defects.
Scientists in Brazil reported last week on an infant whose mother contracted the virus late in pregnancy, which has typically been considered a less vulnerable time. Two months after birth, the infant didn’t show signs of developmental problems but still had Zika in his urine, saliva and serum. By six months, the child showed signs of brain impairment — suggesting the virus lingers longer in babies’ systems and causes health problems later than researchers had thought possible.
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The report only describes one case, which limits what scientists can reasonably conclude. But it underscores a need for better counseling, more-thorough monitoring of children who were potentially exposed and increased research on how Zika may affect child development, doctors said.
“There’s not that much long-term follow-up with the Zika infection. This provides insight into the fact that risk doesn’t disappear with delivery,” said Martha Rac, a maternal-fetal medicine specialist at Texas Children’s Pavilion for Women and Baylor College of Medicine in Houston. “It changes how we need to counsel mothers.”
There’s not that much long-term follow-up with the Zika infection.
Martha Rac, a maternal-fetal medicine specialist
The new development validates some of what public health experts have suspected, and supports the notion of monitoring at-risk children to make sure they develop normally, said Scott Needle, chief medical officer at Healthcare Network of Southwest Florida, in Naples, and a member of the American Academy of Pediatrics’ Disaster Preparedness Advisory Council.
In a clinical guidance published before the Brazil report, the Centers for Disease Control and Prevention called for regular assessments of children who may have been exposed in utero. Practically, that means tracking things like head size and how babies progress in terms of vision and hearing as well as their ability to feed. It emphasizes the importance of regular well-child visits and thorough communication between doctors and parents. Though the guidance predated the Brazil case, the resulting information adds to its significance, said Needle, who was involved in helping craft the CDC standards.
Surveillance of babies who might have been born with Zika is critical, added Mohan Pammi, medical director of the neonatal intensive care unit at Texas Children’s Pavilion for Women.
Doctors and parents alike, Needle added, need to be informed. What may look like a bad bout of colic could in fact indicate a more fundamental problem with brain development.
“Once the baby is born, [we need to] have them be monitored and followed, even if there’s no microcephaly,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, and an expert on the virus.
40 Percentage of children on Medicaid who had less than six wellness visits in first 15 months of life.
That points to another challenge. Many public health experts argue that lower-income people — who are less likely to have air conditioning, or live in well-screened housing that keeps mosquitoes out — are at greater risk of coming into contact with Zika-bearing mosquitoes.
Many of those families with children rely on Medicaid, the federal-state insurance plan for low-income people that provides coverage for 40 percent of kids nationwide. Adults have a harder time qualifying for the program, Needle noted. And regular preventive medicine, which could be leveraged to do those screenings and assessments, is still no guarantee.
Take well-child visits. Doctors recommend children receive nine such visits in their first 15 months of life. But on average, about 40 percent of the children covered by Medicaid had fewer than six wellness visits in that time frame, according to 2015 data from the U.S. Department of Health and Human Services. That builds on other reports suggesting that low-income children are less likely to receive preventive screenings and services.
“It’s not always easy for parents. There are always going to be opportunities for improvement,” Needle said. Gaps in access certainly persist, he added.
Pediatric specialists and experts who might know how to better navigate the disease and undermine its potential consequences aren’t always available, noted Nassim Zecavati, an assistant professor of pediatrics and neurology at Georgetown University School of Medicine in Washington, D.C.
“Those children, as they get older, are going to need a lot of services: rehab, early intervention, speech therapy,” she said. “It depends on where you live — what part of the country you live in — and how well served that population is.”
That matters. There’s no vaccine or treatment for Zika, and researchers still don’t fully understand all the ways it affects the brain. But, experts said, identifying brain problems early and addressing them as soon as possible can make a huge difference for children.
“You’re going to reduce the risk they get worse,” Needle said.
Those children, as they get older, are going to need a lot of services.
Nassim Zecavati, Georgetown University professor
Without that focus, the potential consequences could be severe, he said. Treating neurological disorders can get expensive. And depending on the severity, the price tag and emotional labor of caring for a child can take a toll on a family’s health, too.
Given the high number of children covered by public insurance programs, some of the long-term costs could end up being shouldered by taxpayers, straining state budgets, he added.
Meanwhile, Zika still is a moving target. As understanding of the virus evolves, so do views about its threats, and the right kind of interventions.
“The more we learn about this virus, the more we learn about how it affects the brain, and how it lingers,” Zecavati said. “It helps us know more about the virus, and how to treat the virus, and how to treat the children who are affected. Those children who have been affected are going to have significant long-term needs.”
Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.