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INTRODUCTION: Zika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning. METHODS: Pregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection. RESULTS: Among 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both. CONCLUSION: One in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.
Assuntos
Anormalidades Congênitas/virologia , Transtornos do Neurodesenvolvimento/virologia , Vigilância da População , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/congênito , Samoa Americana/epidemiologia , Pré-Escolar , Anormalidades Congênitas/epidemiologia , District of Columbia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Microcefalia/epidemiologia , Microcefalia/virologia , Micronésia/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Porto Rico/epidemiologia , Sistema de Registros , Estados Unidos/epidemiologia , Ilhas Virgens Americanas/epidemiologia , Zika virus/isolamento & purificaçãoRESUMO
INTRODUCTION: Vectorborne diseases are major causes of death and illness worldwide. In the United States, the most common vectorborne pathogens are transmitted by ticks or mosquitoes, including those causing Lyme disease; Rocky Mountain spotted fever; and West Nile, dengue, and Zika virus diseases. This report examines trends in occurrence of nationally reportable vectorborne diseases during 2004-2016. METHODS: Data reported to the National Notifiable Diseases Surveillance System for 16 notifiable vectorborne diseases during 2004-2016 were analyzed; findings were tabulated by disease, vector type, location, and year. RESULTS: A total 642,602 cases were reported. The number of annual reports of tickborne bacterial and protozoan diseases more than doubled during this period, from >22,000 in 2004 to >48,000 in 2016. Lyme disease accounted for 82% of all tickborne disease reports during 2004-2016. The occurrence of mosquitoborne diseases was marked by virus epidemics. Transmission in Puerto Rico, the U.S. Virgin Islands, and American Samoa accounted for most reports of dengue, chikungunya, and Zika virus diseases; West Nile virus was endemic, and periodically epidemic, in the continental United States. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Vectorborne diseases are a large and growing public health problem in the United States, characterized by geographic specificity and frequent pathogen emergence and introduction. Differences in distribution and transmission dynamics of tickborne and mosquitoborne diseases are often rooted in biologic differences of the vectors. To effectively reduce transmission and respond to outbreaks will require major national improvement of surveillance, diagnostics, reporting, and vector control, as well as new tools, including vaccines.
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Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Doença de Lyme/epidemiologia , Vigilância da População , Febre Maculosa das Montanhas Rochosas/epidemiologia , Febre do Nilo Ocidental/epidemiologia , Infecção por Zika virus/epidemiologia , Samoa Americana/epidemiologia , Animais , Culicidae , Humanos , Incidência , Insetos Vetores , Porto Rico/epidemiologia , Carrapatos , Estados Unidos/epidemiologia , Ilhas Virgens Americanas/epidemiologiaRESUMO
Cross-reactivity within flavivirus antibody assays, produced by shared epitopes in the envelope proteins, can complicate the serological diagnosis of Zika virus (ZIKAV) infection. We assessed the utility of the plaque reduction neutralization test (PRNT) to confirm recent ZIKAV infections and rule out misleading positive immunoglobulin M (IgM) results in areas with various levels of past dengue virus (DENV) infection incidence. We reviewed PRNT results of sera collected for diagnosis of ZIKAV infection from 1 January through 31 August 2016 with positive ZIKAV IgM results, and ZIKAV and DENV PRNTs were performed. PRNT result interpretations included ZIKAV, unspecified flavivirus, DENV infection, or negative. For this analysis, ZIKAV IgM was considered false positive for samples interpreted as a DENV infection or negative. In U.S. states, 208 (27%) of 759 IgM-positive results were confirmed to be ZIKAV compared to 11 (21%) of 52 in the U.S. Virgin Islands (USVI), 15 (15%) of 103 in American Samoa, and 13 (11%) of 123 in Puerto Rico. In American Samoa and Puerto Rico, more than 80% of IgM-positive results were unspecified flavivirus infections. The false-positivity rate was 27% in U.S. states, 18% in the USVI, 2% in American Samoa, and 6% in Puerto Rico. In U.S. states, the PRNT provided a virus-specific diagnosis or ruled out infection in the majority of IgM-positive samples. Almost a third of ZIKAV IgM-positive results were not confirmed; therefore, providers and patients must understand that IgM results are preliminary. In territories with historically higher rates of DENV transmission, the PRNT usually could not differentiate between ZIKAV and DENV infections.
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Anticorpos Antivirais/sangue , Vírus da Dengue/imunologia , Dengue/epidemiologia , Imunoglobulina M/sangue , Infecção por Zika virus/diagnóstico , Zika virus/imunologia , Samoa Americana/epidemiologia , Reações Cruzadas , Reações Falso-Positivas , Feminino , Flavivirus/imunologia , Humanos , Incidência , Masculino , Testes de Neutralização , Porto Rico/epidemiologia , Estados Unidos/epidemiologia , Ilhas Virgens Americanas/epidemiologia , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologiaRESUMO
This study compares findings from research projects involving different genetic, environmental, and cultural contexts: a study of lifestyle and health from American Samoa (ASLS) and the Bolivian project. Reproduction and Ecology in Provincia Aroma (REPA). This paper presents analyses of varying economic strategies and their association with nutritional status indicators in each population. The ASLS sample includes 66 Samoan women and the REPA sample includes 210 Aymara women. Principle components analysis of household economic resources within each sample extracted two significant factors: one represents modernizing influences including education and occupational status, and the other represents ethnographically salient traditional economic behavior. The traditional pattern includes adding household members in Samoa and selling agricultural products in Bolivia. This analysis places each woman along two continua, traditional and modern, based on her household mobilization of economic resources, permitting an understanding of the patterns underlying household economic behavior that is not possible in univariate analyses of socioeconomic variables. For the Bolivian women the strategy involving more education and higher occupational status was associated with higher measures of several nutritional status indicators, including body mass index, arm muscle area, and peripheral skinfolds. But among the Samoan women, where substantial obesity was the norm, there were no significant differences in anthropometric measurements based on economic strategies. These data argue for the importance of directly measuring the potential consequences of variation in household economic strategies rather than merely inferring such, and of assessing ethnographically relevant aspects of household economic production rather than limiting analyses to non-context-specific economic indicators such as income. This focus on household strategy is likely to be fruitful especially where economic and nutritional conditions are marginal. The findings from Bolivia also support efforts in developing countries to improve girls' education, and thereby occupational prospects, as a means to improve their health status as women.