Adebanjo et al., 20174848 Adebanjo T, Godfred-Cato S, Viens L, Fischer M, Staples JE, Kuhnert-Tallman W, et al. Update: interim guidance for the diagnosis, evaluation, and management of infants with possible congenital Zika virus infection - United States, October 2017. MMWR Morb Mortal Wkly Rep. 2017;66:1089-99.; MMWR - Morbidity and Mortality Weekly Report |
Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with possible Congenital Zika Virus Infection - United States, October, 2017. Guideline article |
Infants with clinical findings consistent with CZS or Infants without CZS who were born to mothers with laboratory evidence of possible maternal Zika virus infection during pregnancy aABR by age 1 month if the newborn hearing screen was passed using only OAE. |
Amendment to the previous recommendations of 2016: A diagnostic ABR at 4-6 months or behavioral audiology at age 9 months is no longer recommended if the initial hearing screen is passed by automated ABR because of absence of data suggesting delayed-onset hearing loss in congenital ZIKV infection. |
Russell et al., 20164949 Russell K, Oliver SE, Lewis L, Barfield WD, Cragan J, Meaney-Delman D, et al. Update: interim guidance for the evaluation and management of infants with possible congenital Zika virus Infection - United States, August 2016. MMWR Morb Mortal Wkly Rep. 2016;65:870-8.; MMWR - Morbidity and Mortality Weekly Report |
Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with possible Congenital Zika Virus Infection - United States, August 2016. Guideline article |
Mothers with laboratory evidence of ZIKV with infants with no evidence of clinical abnormalities: Routine care, including PE, HC, weight/length and neurologic exam; Before discharge: hearing screen, postnatal head US; Infants testing positive for ZIKV: ABR and ophthalmology exam at age 2 wks and consider ABR at 4-6 months or behavioral audiology at age 9 months. |
Mothers with laboratory evidence of ZIKV, with infants with abnormalities consistent with CZS: Routine care, including PE, HC, weight/length and neurologic exam; Before discharge: hearing screen, ABR, postnatal head US, CBC, metabolic panel; LFTs; ophthalmologic exam, consider advanced neuroimaging; Consider transfer to hospital with subspecialty care; Infants testing negative: evaluate for other causes of congenital anomalies; further management as clinically indicated; Infants testing positive: thyroid screen by 2 wks and 3 mo; neurologic exam by 1 mo and 2 mo; ophthalmology exam by 3 mo and ABR by 4-6 mo; routine preventive health care including monitoring of feeding and growth; routine and congenital infection-specific anticipatory guidance; referral to specialists, including evaluation of other causes of congenital anomalies as needed. |
Mothers not tested for ZIKV or tested outside of appropriate Window, with infants with no evidence of clinical abnormalities: Maternal ZIKV testing; consider ZIKV placental testing; Routine care, including PE, HC, weight/length and neurologic exam; Before discharge: hearing screen, postnatal head US; Infant ZIKV testing if evidence of ZIKV infection on maternal testing; Outpatient management for appropriate infant clinical exam and test results. |
Mothers not tested for ZIKV or tested outside of appropriate Window, with infants with abnormalities consistent with CZS: Maternal ZIKV testing; consider ZIKV placental testing; Routine care, including PE, HC, weight/length and neurologic exam; Before discharge: hearing screen, ABR, postnatal head US, CBC, metabolic panel; LFTs; ophthalmologic exam, consider advanced neuroimaging; Consider transfer to hospital with subspecialty care; Infants testing negative: evaluate for other causes of congenital anomalies; further management as clinically indicated; Infants testing positive: refer to outpatient management for infant with abnormalities consistent with congenital Zika syndrome. |
Brasil. Ministério da Saúde. Scretaria de Atenção à Saúde, 2015.5555 Brasil. Ministério da Saúde, Secretaria de Atenc¸ão à Saúde BMda S. Protocolo de atenc¸ão à saúde e resposta à ocorrênciade microcefalia relacionada à infecc¸ão pelo vírus Zika. Versão 1.1; 2015, 49 p. Available at: http://pesquisa.bvsalud.org/portal/resource/pt/lil-768748 [accessed 17.04.18]. http://pesquisa.bvsalud.org/portal/resou...
Available from: www.saude.gov.br/svs
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Protocol for Health Care and Response to the Occurrence of Microcephaly related to Zika virus Infection. Manual of Health Care |
Newborn with microcephaly: Hearing screening test (OAE) with 24-48 h of life and ABR ideally in the maternity. If there is no equipment for ABR, send the patient to the nearest referral service (Specialized Center for Rehabilitation with hearing modality or High Complexity Auditory Rehabilitation Center), until the first month of life. In case of failure, retest must be performed within 30 days, preferably at the same place as the previous test. In case of retest failure, the child should be immediately referred for otorhinolaryngological and audiological diagnostic evaluation. Neonatal hearing screening test should not be performed in children with ear malformations (even if unilateral). These patients should be sent directly to a referral service for otorhinolaryngological and audiological diagnosis, according to the Neonatal Hearing Screening Guidelines. If hearing loss is diagnosed, the child should be sent for rehabilitation in reference service in auditory rehabilitation: Specialized Center in Rehabilitation with hearing modality or High Complexity. Auditory Rehabilitation Center. Microcephaly is a risk indicator for hearing loss. |
Leal et al., 201699 Leal M de C, Muniz LF, Ferreira TSA, Santos CM, Almeida LC, Van Der Linden V, et al. Hearing loss in infants with microcephaly and evidence of congenital Zika virus infection - Brazil, November 2015-May 2016. MMWR Morb Mortal Wkly Rep. 2016;65:917-9.; MMWR - Morbidity and Mortality Weekly Report |
Hearing Loss in Infants with Microcephaly and Evidence of Congenital Zika Virus Infection - Brazil, November 2015-May 2016. Case series |
To elucidate the full spectrum of hearing loss in infants with congenital Zika virus infection, testing and follow-up of all children born to women who had Zika virus infection during pregnancy, including infants with no apparent anomalies at birth, is needed. |
Sensorineural hearing loss should be considered part of the spectrum of clinical findings associated with congenital Zika virus infection, and congenital Zika virus infection should be considered a risk factor for hearing loss in auditory screening programs. |
Children with evidence of congenital Zika virus infection who have normal initial screening tests should receive regular follow-up, because onset of hearing loss could be delayed and the loss could be progressive. |
Leal et al., 201688 Leal M de C, Muniz LF, Caldas Neto S da S, van der Linden V, Ramos RCF. Sensorineural hearing loss in a case of congenital Zika virus. Braz J Otorhinolaryngol. 2016;30:1-3.; Brazilian Journal of Otorhinolaryngology |
Sensorineural hearing loss in a case of congenital Zika virus. Case report |
In hearing assessments protocols for neonates, mother's infection by Zika virus should be included among the risk factors for hearing loss. |
Borja et al., 20174242 Borja A, Araújo RPC de. Hearing screening in children exposed to zika virus during pregnancy. Rev Ciênc Médicas Biol. 2017;16:271.; Revista de Ciências médicas e Biológicas |
Hearing screening in children exposed to Zika virus during pregnancy. Case series |
The health services that provide care to this population (children exposed to Zika virus during pregnancy) should make parents or caregivers aware of the need to continue monitoring of hearing development up to 24 months of age, even if the child has passed the screening tests, understanding that late hearing loss may occur, as well as auditory development may present important delays that may compromise the development of language. |
Satterfield-Nash et al., 20171010 Satterfield-Nash A, Kotzky K, Allen J, Bertolli J, Moore CA, Pereira IO, et al. Health and development at age 19-24 months of 19 children who were born with microcephaly and laboratory evidence of congenital Zika virus infection during the 2015 Zika virus outbreak - Brazil, 2017. Morb Mortal Wkly Rep. 2017;66:1347-51.; MMWR - Morbidity and Mortality Weekly Report |
Health and Development at Age 19-24 Months of 19 Children Who Were Born with Microcephaly and Laboratory Evidence of Congenital Zika Virus Infection During the 2015 Zika Virus Outbreak - Brazil, 2017. Case series
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These findings allow for anticipation of medical and social service needs of affected children and their families, including early intervention services, and planning for resources to support these families in health care and community settings in Brazil, the United States, and other countries. |
Children with disabilities related to congenital Zika virus infection will need multidisciplinary care from various pediatric subspecialists (10). |
Long-term follow-up and measurement of developmental progression of children affected by Zika virus can inform intervention services and sub-specialties needed to provide optimal care for these children. |
Silva et al., 2017.1111 Silva MFA de A, Mendonça de Araújo FC. Hearing screeningin children exposed to Zika virus. In: II Congresso Brasileirode Ciências da Saúde. 2017. Available at: www.conbracis.com.br/2017/trabalhos-aprovados.php [accessed 17.04.18]. www.conbracis.com.br/2017/trabalhos-apro...
Available from: www.conbracis.com.br
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Hearing screening in children exposed to zika virus. Case series
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It is recommended that infants with microcephaly, exposed to the Zika virus, be screened with a-BAEP, since exposure to the Zika virus has been described as a risk indicator for hearing loss (RIHL) (Ministry of Health, 2016). The justification for performing this test in children with RIHL is the higher prevalence of non-identifiable retrocochlear hearing loss through otoacoustic emissions (MINISTRY OF HEALTH, 2012). |
Mittal et al., 20174646 Mittal R, Fifer RC, Liu XZ. A possible association between hearing loss and Zika virus infections. JAMA Otolaryngol Neck Surg. 2017;144:3-4.; JAMA Otolaryngology - Head & Neck Surgery |
A Possible Association Between Hearing Loss and Zika Virus Infection. Opinion article |
Otolaryngologists should monitor ZIKV exposed infants without hearing impairment at birth because they may develop HL at later stages of life. |
The early diagnosis and detection of HL in ZIKV-exposed infants will improve auditory rehabilitation, leading to improved long-term developmental outcomes. |
Fandiño-Cárdenas et al., 20184444 Fandiño-Cárdenas M, Molina-Franky J, Velandia R, Idrovo AJ, Alvarado-Socarras JL, Velandia R, et al. Zika virus infection during pregnancy and sensorineural hearing loss among children at 3 and 24 months post-partum. J Trop Pediatr. 2018;:1-8.; Journal of tropical Pediatrics |
Zika Virus Infection during Pregnancy and Sensorineural Hearing Loss among Children at 3 and 24 Months Post-Partum. Case series |
Hearing loss because of congenital ZIKV can be sensorineural, neural, conductive, alone or mixed. Therefore, a complete hearing assessment, including aABR and DPOAE, should be performed on all ZIKA-infected patients, thus ruling out auditory neuropathy syndrome and sensorineural hearing loss. |
Regardless if microcephaly is present, every neonate born with suspicious of gestational or congenital Zika infection needs to be tested at birth and in a follow-up with a complete audiology assessment, given the potential impairment of hearing over time, as occurs in CMV. |
The nature of the hearing loss in ZIKV infection may be progressive, and a follow-up hearing test must be conducted at least during the first 5 years o life. |
Martins et al., 201766 Martins OR, Rodrigues P de AL, Santos ACM dos, Ribeiro EZ, Nery AF, Lima JB. Otological findings in patients following infection with Zika virus: case report. Audiol - Commun Res. 2017;22:1-9.; Audiology Communication Research |
Otological findings in patients following infection with Zika virus: case report. Case series |
In view of the rapid spread of ZIKV in Brazil, it is suggested that patients should monitor their auditory health following ZIKV infection, since even though those patients may not report any alterations in their hearing accuracy; it is possible that the central auditory system could be affected. |
Vinhaes et al., 201777 Vinhaes ES, Santos LA, Dias L, Andrade NA, Bezerra VH, de Carvalho AT, et al. Transient hearing loss in adults associated with Zika virus infection. Clin Infect Dis. 2017;64:675-7.; Clinical Infectious Disease |
Transient Hearing Loss in Adults Associated With Zika Virus Infection. Case series |
Further investigation might also highlight other possible rare events such as permanent hearing loss, facilitating the possible recommendation of audiometry examinations in adults during ZIKV outbreaks. |
Peloggia et al., 20185353 Peloggia A, Ali M, Nanda K, Bahamondes L. Zika virus exposure in pregnancy and its association with newborn visual anomalies and hearing loss. Int J Gynecol Obstet. 2018;143:277-81.; International Journal of Gynecology and Obstetrics |
Zika virus exposure in pregnancy and its association with newborn visual anomalies and hearing loss. Narrative review |
Hearing examination of infants with suspected CZS infection, even in the absence of microcephaly, is essential, because the associated impairments might be underestimated if microcephaly continues to be the only inclusion criterion during the screening of this group of infants. |
Leite et al., 20181313 Leite RFP, Santos MSA, Pessoa ALS, Ribeiro EM, Cavalcanti LP de G, Giacheti CM, et al. Hearing screening in children with congenital zika virus syndrome in Fortaleza, Ceara, Brazil, 2016. Epidemiol Serv Saúde. 2018;27:1-10.; Epidemiologia e Serviços de Saúde |
Hearing Screening in children with Congenital Zika Virus Syndrome in Fortaleza, Ceará, Brazil, 2016. Case series |
The inclusion of the tympanometry in the hearing screening before the referral to the ABR is suggested. |
The hearing screening should be performed in children with CZS right after birth and the referral to the clinical and audiological diagnosis occur only in those who fail the screening, in early age. |
The a-ABR should be included in the hearing screening recommendation for children with CZS. |
Lage et al., 20191414 Lage M-LC, Nascimento-Carvalho C, Fernandes A, Carvalho A, Ventura P, Taguchi T, et al. Clinical, neuroimaging, and neurophysiological findings in children with microcephaly related to congenital zika virus infection. Int J Environ Res Public Health. 2019;16:309.; International Journal of Environmental Research and Public Health |
Clinical, Neuroimaging, and Neurophysiological Findings in Children with Microcephaly Related to Congenital Zika Virus Infection. Case series |
Children with microcephaly related to CZS need regular follow-ups, even the ones with normal initial screening tests, because hearing loss, like in other congenital viral infections, can be delayed and progressive. |
Leal et al., 20195252 Leal M de C, Ramos DS, Caldas Neto SS. Hearing loss from congenital Zika virus infection. Top Magn Reson Imaging. 2019;28:19-22.; Topics in Magnetic Resonance Imaging |
Hearing Loss From Congenital Zika Virus Infection. Narrative Review |
As congenital ZIKV infection should be considered a risk factor for hearing loss, neonatal hearing screening with auditory-evoked potential is recommended, maintaining clinical follow-up, even for those who pass the screening, with at least 1 audiological evaluation in the period between 24 and 30 months of age, as recommended for children who present risk factors for hearing loss. |
Calle-Giraldo et al., 20191616 Calle-Giraldo JP, Rojas CA, Hurtado IC, Barco C, Libreros D, Sánchez PJ, et al. Outcomes of congenital zika virus infection during an outbreak in Valle del Cauca, Colombia. Pediatr Infect Dis J. 2019;38:735-40.; The Pediatric Infectious Disease Journal |
Outcomes of Congenital Zika Virus Infection During an Outbreak in Valle del Cauca, Colombia. Case series |
Infants exposed during pregnancy should receive close neurologic, ophthalmologic and audiologic monitoring, even in the absence of microcephaly. |