PMID- 29813148 OWN - NLM STAT- MEDLINE DCOM- 20190927 LR - 20190927 IS - 2168-6211 (Electronic) IS - 2168-6203 (Print) IS - 2168-6203 (Linking) VI - 172 IP - 7 DP - 2018 Jul 1 TI - Symptomatic Zika Virus Infection in Infants, Children, and Adolescents Living in Puerto Rico. PG - 686-693 LID - 10.1001/jamapediatrics.2018.0870 [doi] AB - IMPORTANCE: Little information is available regarding Zika virus (ZIKV) infection in children. OBJECTIVE: To describe patients younger than 18 years who were infected with ZIKV and were enrolled in the Sentinel Enhanced Dengue and Acute Febrile Illness Surveillance System (SEDSS). DESIGN, SETTING, AND PARTICIPANTS: Children infected with ZIKV with 7 or fewer days of fever or emancipated minors aged 14 to 17 years with a generalized maculopapular rash, arthritis or arthralgia, or nonpurulent conjunctivitis were eligible for enrollment on or before December 31, 2016, in Puerto Rico. Patients were evaluated using ZIKV polymerase chain reaction testing at 7 or fewer days after the onset of symptoms. Available ZIKV polymerase chain reaction-positive specimens were evaluated to determine viral loads. EXPOSURES: Confirmed polymerase chain reaction-positive ZIKV infection. MAIN OUTCOMES AND MEASURES: Clinical characteristics and viral loads of symptomatic children with confirmed ZIKV infection. RESULTS: Of 7191 children enrolled in SEDSS on or before December 31, 2016, only those with confirmed ZIKV infection (351 participants) were included in this study. Participants who had confirmed ZIKV infection included 25 infants (7.1%), 69 children (19.7%) aged 1 to 4 years, 95 (27.1%) aged 5 to 9 years, and 162 (46.1%) aged 10 to 17 years. Among these, 260 patients (74.1%) presented for evaluation of ZIKV infection at fewer than 3 days after the onset of symptoms, 340 (96.9%) were discharged to home after evaluation, and 349 (99.4%) had fever, 280 (79.8%) had a rash, 243 (69.2%) had facial or neck erythema, 234 (66.7%) had fatigue, 223 (63.5%) had headache, 212 (60.4%) had chills, 206 (58.7%) had pruritus, and 204 (58.1%) had conjunctival hyperemia. Of 480 specimens collected (317 serum and 163 urine specimens) from 349 children, the median number of days after the onset of symptoms was lower for children who had serum specimens (1 day [interquartile range (IQR), 1-2 days]) than for children who had urine specimens (2 [1-3] days) (P < .001). Of 131 children who had both serum and urine specimens collected on the same day, the median viral load was higher in serum than in urine (median [IQR], 23 098 [8784-88 242] copies/mL for serum vs 9966 [2815-52 774] copies/mL for urine; P = .02). When a single serum sample from each of 317 patients was analyzed, there were no statistically significant differences in median viral loads according to age, sex, or disposition. However, the median serum viral load varied significantly according to the number of days after the onset of symptoms (0 days, 106 778 [IQR, 9772-1 571 718] copies/mL; 1 day, 46 299 [10 663-255 030] copies/mL; 2 days, 20 678 [8763-42 458] copies/mL; and >/=3 days, 15 901 [5135-49 248] copies/mL; P = .001). CONCLUSIONS AND RELEVANCE: This study represents the largest study to date of ZIKV infection in the pediatric population. Most children infected with ZIKV had fever, rash, and conjunctival hyperemia. The children usually presented for evaluation at fewer than 3 days after the onset of symptoms. Viral loads for ZIKV were higher in serum vs urine specimens. Median viral loads in serum specimens differed significantly according to the number of days after the onset of symptoms. FAU - Read, Jennifer S AU - Read JS AD - Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. AD - Now with Department of Pediatrics, University of Vermont Medical Center, Burlington. FAU - Torres-Velasquez, Brenda AU - Torres-Velasquez B AD - Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. FAU - Lorenzi, Olga AU - Lorenzi O AD - Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. FAU - Rivera Sanchez, Aidsa AU - Rivera Sanchez A AD - Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. FAU - Torres-Torres, Sanet AU - Torres-Torres S AD - Department of Pediatrics, St Luke's Episcopal Hospital-Ponce Health Sciences University Consortium, Ponce, Puerto Rico. FAU - Rivera, Lillian V AU - Rivera LV AD - Department of Pediatrics, St Luke's Episcopal Hospital-Ponce Health Sciences University Consortium, Ponce, Puerto Rico. AD - Department of Pediatrics, School of Medicine, Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico. FAU - Capre-Franceschi, Sheila M AU - Capre-Franceschi SM AD - Department of Pediatrics, St Luke's Episcopal Hospital-Ponce Health Sciences University Consortium, Ponce, Puerto Rico. FAU - Garcia-Gubern, Carlos AU - Garcia-Gubern C AD - Department of Emergency Medicine, St. Luke's Episcopal Hospital-Ponce Health Sciences University Consortium, Ponce, Puerto Rico. FAU - Munoz-Jordan, Jorge AU - Munoz-Jordan J AD - Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. FAU - Santiago, Gilberto A AU - Santiago GA AD - Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico. FAU - Alvarado, Luisa I AU - Alvarado LI AD - Department of Pediatrics, St Luke's Episcopal Hospital-Ponce Health Sciences University Consortium, Ponce, Puerto Rico. LA - eng GR - U01 CK000437/CK/NCEZID CDC HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - JAMA Pediatr JT - JAMA pediatrics JID - 101589544 SB - IM CIN - JAMA Pediatr. 2018 Jul 1;172(7):624-625. PMID: 29813163 MH - Adolescent MH - Age Distribution MH - Child MH - Female MH - Hospitalization/statistics & numerical data MH - Humans MH - Infant MH - Male MH - Population Surveillance MH - Puerto Rico/epidemiology MH - Time Factors MH - Viral Load MH - Zika Virus/isolation & purification MH - Zika Virus Infection/diagnosis/*epidemiology/virology PMC - PMC6137503 COIS- Conflict of Interest Disclosures: None reported. EDAT- 2018/05/31 06:00 MHDA- 2019/09/29 06:00 PMCR- 2019/05/29 CRDT- 2018/05/30 06:00 PHST- 2018/05/31 06:00 [pubmed] PHST- 2019/09/29 06:00 [medline] PHST- 2018/05/30 06:00 [entrez] PHST- 2019/05/29 00:00 [pmc-release] AID - 2681638 [pii] AID - poi180022 [pii] AID - 10.1001/jamapediatrics.2018.0870 [doi] PST - ppublish SO - JAMA Pediatr. 2018 Jul 1;172(7):686-693. doi: 10.1001/jamapediatrics.2018.0870.