Epidemiologic Surveillance and Research Activities to Address Zika Virus and Pregnancy: An Update from the U.S. Centers for Disease Control and Prevention

Abstract

The emergence of Zika virus in the Americas with its untoward impact on the developing fetus is resulting in a rapid response by the scientific and public health communities. The U.S. Centers for Disease Control and Prevention (CDC) responded by activating its Emergency Operations Center on January 22, 2016. Given the paucity of data specific to how the virus impacts the fetus, CDC has a launched a number of surveillance and research projects in the U.S. and with collaborators in other countries. On the domestic front, CDC has implemented the U.S. Zika Pregnancy Registry, an active surveillance network to prospectively enroll and follow pregnant women and their infants; a complementary registry has also been implemented in the Commonwealth of Puerto Rico. Both systems enroll pregnant women and infants with laboratory evidence of Zika virus infection, and prenatally and perinatally exposed infants. Individuals are enrolled into the registry by health departments or directly from health care providers. In Puerto Rico active surveillance is underway based on medical record abstraction. Data on the pregnant women will be collected at a number of points in pregnancy and on the infants at birth and at 2, 6, and 12 months of age, with follow-up to age 3 years in Puerto Rico. Clinical information will include attributes of the mother’s health and Zika virus testing during pregnancy, results of fetal and newborn evaluations, and medical and developmental information on the infant. Emerging data from the registries will be used to inform clinical recommendations and public health actions. CDC is also enhancing its ongoing state-based birth defects surveillance programs to identify, in a real-time manner, any infant born with microcephaly or other Zika-related birth defects. In the international arena, CDC is engaged in several research and surveillance activities in Central and South America. Most notably, we are collaborating with the Secretary of Health of Paraiba state, Brazil and the Brazilian Ministry of Health on a case-control study of microcephaly to further characterize the association with Zika virus infection and the clinical phenotype of fetal Zika infection. We are also collaborating with the Instituto Nacional de Salud in Colombia to enhance their national surveillance of Zika virus disease among pregnant women and to implement in-depth monitoring of pregnant women in selected regions of Colombia with high reported incidence of Zika virus disease. A description of CDC activities and collaborations will be presented, including current status and anticipated outcomes.