Most children born with microcephaly – small head size for age – and evidence of congenital Zika virus infection face severe health and developmental challenges at ages 19-24 months, according to results from a new investigation led by the Centers for Disease Control and Prevention (CDC) in collaboration with the State Health Secretariat of Paraíba and the Ministry of Health of Brazil.

The report, published in the Morbidity and Mortality Weekly Report (MMWR), is the first to describe the health and developmental effects of congenital Zika virus infection in children with microcephaly through 2 years of age. These problems include an inability to sit independently, difficulties with sleeping and feeding, seizures, and hearing and vision problems. Many of the children faced challenges in multiple areas.

Although previous publications described the health effects in infants born with microcephaly during the Zika outbreak, this is the first investigation to characterize the health and development of these children as they age. The findings give a more complete picture of the lifelong challenges that will affect children born with microcephaly during the Zika outbreaks in Brazil and elsewhere.

The investigation took place in northeastern Brazil, where Zika affected thousands of children born during 2015 to 2016. The results provide important information to help the United States, Brazil, and other countries prepare for the unprecedented challenges posed for children affected by Zika virus infection.

“Children severely affected by Zika virus are falling far behind age-appropriate developmental milestones, and their challenges are becoming more evident as they age,” said CDC Director Brenda Fitzgerald, MD. “Continued monitoring of all children with congenital Zika exposure is critical to understand the full impact of the infection during pregnancy and to support these families for the long-term.”

In collaboration with the Ministry of Health of Brazil, scientists working on CDC’s Zika Outcomes and Development in Infants and Children (ZODIAC) investigation compiled a comprehensive description of the health and development of 19 children with microcephaly and laboratory evidence of congenital Zika virus. The investigation relied on direct clinical assessments, caregiver interviews, and medical record review. Investigators found that, of the 19 children:

  • Eleven had indications of possible seizure disorder;
  • Ten had sleep difficulties;
  • Nine had feeding difficulties, such as trouble swallowing;
  • Thirteen children had hearing problems and 11 had vision problems, such as not responding to the sound of a rattle and not being able to follow a moving object with their eyes;
  • Fifteen children had severe motor impairments, including inability to sit independently;
  • Fourteen children had at least three of these challenges, complicating their care; and
  • Eight had been previously hospitalized, with bronchitis/pneumonia being the most commonly reported reason for hospitalization (6 of the 8).

“As children born affected by Zika virus grow up, they will need specialized care from many types of healthcare providers and caregivers,” said Georgina Peacock, M.D., M.P.H., director of CDC’s Division of Human Development and Disability. “It’s important that we use these findings to start planning now for their long-term care and stay vigilant in Zika prevention efforts in the United States and around the world.”