Reports of Suspected Congenital Zika Virus Infection Cases and Their Clinical Findings, Brazil and French Polynesia, 2013–2016

Report Type, Location, and No. of CasesLaboratory TestingMaternal Signs/Symptoms of Zika Virus Infection During pregnancyInfant Neuroimaging ResultsInfant Examination Findings (Percent Affected)
Birth DefectsNeurologicOphthalmologic
Case seriesNo Zika testingRash during first trimester (57%) or second trimester (14%)• Widespread brain calcifications (74%), mainly in the periventricular, parenchymal, and thalamic areas, as well as in the basal ganglia• Microcephaly, >2 SDs below the mean for gender and gestational age at birth (100%)• Hypertonia or spasticity (37%)• Abnormal funduscopic examination (18%)
8 states, Brazil35Infants’ TORCH serology testing negative• Ventriculomegaly (44%)• Excessive and redundant scalp skin (31%)• Hyperreflexia (20%)
35 infants• Neuronal migration disorders (33%)• Clubfoot (14%)• Irritability (20%)
• Arthrogryposis (11%)• Tremors (11%)
• Seizures (9%)
Case seriesNo Zika testingRash and arthralgia during first trimester (33%)• Brain calcifications (100%)• Microcephaly, OFC ≤28.5 cm at birth (100%)• Loss of foveal reflex (100%)
Brazil37Mothers’ and infants’ TORCH serology and HIV testing negative• Gross macular pigment mottling (100%)
3 infants• Macular neuroretinal atrophy (33%)
Case seriesNo Zika testingMalaise, rash, and/or arthralgia during first trimester (60%) or later in pregnancy (10%)• Brain calcifications (100%)• Microcephaly, >2 SDs below the mean for gender and age (100%)• Loss of foveal reflex (100%)
Brazil38Infants’ TORCH serology and HIV testing negative• Mild to gross macular pigment mottling (90%)
10 infants• Chorioretinal macular atrophy (20%)
• Optic nerve hypoplasia (40%)
• Optic nerve pallor (20%)
• Increased cup-to-disc ratio (30%)
Surveillance ReportNo Zika testingNone• Cerebral malformations or polymalformative syndromes (12 fetuses)• Brainstem dysfunction and absence of swallowing (5 infants)
French-Polynesia33Pregnancy coincided with a Zika virus outbreak
12 fetuses and 5 infants
Case seriesNo Zika testingRash, fever, arthralgia, headache, and/or pruritus during first (62%), second (14%), or third (3%) trimester• Microcephaly, OFC ≤32 cm (100%)• Focal pigment mottling (70%)
Brazil39Mothers’ and infants’ TORCH serology and HIV testing negative• Chorioretinal atrophy (70%)
29 infants• Optic nerve abnormalities (40%)
• Iris coloboma (10%)
• Lens subluxation (10%)
  • OFC, occipitofrontal circumference; TORCH, Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex, and syphilis.