Should infants with postnatal Zika infection be monitored long-term?

A collaborative research team is recommending long-term clinical monitoring for infants infected with Zika soon after their birth. This guidance is based on new results demonstrating that Zika infection of infant rhesus macaques in the first few months results in persistent abnormalities in brain structure, behaviour and emotions.

The research surrounding Zika has primarily focused on the effects of infection in utero, such as microcephaly; however, this study investigated the impacts of Zika infection in first year of life, a time of major growth and maturation for the brain.

The research, published recently in Science Translational Medicine, hypothesized that postnatal Zika infection could have adverse neurological consequences lasting for months or even years, similar to other viral infections in infancy, including HIV and cytomegalovirus.

The team studied eight macaques using both structural and functional MRI scans at 3 and 6 months of age to evaluate the outcomes of the Zika infection. The study’s lead researcher, Ann Chahroudi (Emory University, GA, USA) explained: “The scans were critical for confirming which brain regions were affected by the virus and/or indirectly harmed by inflammation and, importantly, the persistent brain abnormalities predicted some of the behavioral changes we observed.”

The researchers discovered that postnatal Zika infection appeared to have adverse neurological consequences, although effects on the brain were noted to be more subtle than those resulting from congenital infection.

First author, Maud Mavigner (University of Emory) commented: “Some of the specific findings we report are Zika virus invasion of the nervous system, enlargement of lateral ventricles, and abnormal maturation of the hippocampus and other brain regions. These results are similar to congenital infection, but also provide new insights into changes that occur in the first year of life with early postnatal Zika virus exposure.”

These results suggest that infants should be closely monitored following Zika infection at any stage of development. In addition, this monkey model could allow for further detailed investigations into postnatal infection and allow the testing of novel interventions.

Chahroudi concluded: “The neurological, behavioral and emotional differences remained months after the virus cleared from the blood of the infants. This is why our team now recommends more than just routine monitoring for pediatric patients known to be infected with Zika.”

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