Visual findings in children exposed to Zika in utero in Nicaragua

• Authors: Evelin Martinez, Natl Autonomous Univ Nicaragua; Ryan Max, University of North Carolina Chapel Hill; Filemón Bucardo, Natl Autonomous Univ Nicaragua; Elizabeth M Stringer, University of North Carolina Chapel Hill; Sylvia Becker-Dreps, University of North Carolina Chapel Hill; Christian Toval-Ruiz, National Autonomous University of Nicaragua, León (UNAN-León, Managua); Meylin Chavarria, National Autonomous University of Nicaragua, León (UNAN-León, Managua); María J Meléndez-Balmaceda, National Autonomous University of Nicaragua, León (UNAN-León, Managua); Carlos Nuñez, Victoria Mota Hospital, Jinotega, Nicaragua; Matthew Collins, Emory University; Michael Boivin, Michigan State University; Shiara Ortiz-Pujols, Med Express/Optum, Minneapolis, Minnesota; Omar Zepeda, National Autonomous University of Nicaragua, León (UNAN-León, Managua), Nicaragua; Kaitlyn Cross, University of North Carolina Chapel Hill; Emily W Gower, University of North Carolina Chapel Hill; Natalie M Bowman, University of North Carolina Chapel Hill; Sara F Grace, North Carolina Eye Ear Nose & Throat
• Journal Title: PLOS NEGLECTED TROPICAL DISEASES
• Volume: Volume 17, Number 5
• Publisher: PUBLIC LIBRARY SCIENCE | 2023-05-01, Pages e0011275-e0011275
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pntd.0011275
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Infectious Diseases; Parasitology; Tropical Medicine

Abstract

Knowledge regarding the frequency of ocular abnormalities and abnormal visual function in children exposed to Zika virus (ZIKV) in utero but born without congenital Zika syndrome (CZS) is limited. We hypothesized that children exposed to ZIKV in utero born without CZS may have visual impairments in early childhood. We performed ophthalmic examination between 16 and 21 months of age and neurodevelopment assessment at 24 months of age with the Mullen Scales of Early Learning test (MSEL) on children enrolled in a cohort born to women pregnant during and shortly after the ZIKV epidemic in Nicaragua (2016–2017). ZIKV exposure status was defined based on maternal and infant serological testing. Visual impairment was defined as abnormal if the child had an abnormal ophthalmic exam and/or low visual reception score in the MSEL assessment. Of 124 children included in the analysis, 24 (19.4%) were classified as ZIKV-exposed and 100 (80.6%) unexposed according to maternal or cord blood serology. Ophthalmic examination showed that visual acuity did not differ significantly between groups, thus, 17.4% of ZIKV-exposed and 5.2% of unexposed had abnormal visual function (p = 0.07) and 12.5% of the ZIKV-exposed and 2% of the unexposed had abnormal contrast testing (p = 0.05). Low MSEL visual reception score was 3.2-fold higher in ZIKV-exposed than unexposed children, but not statistically significant (OR 3.2, CI: 0.8–14.0; p = 0.10). Visual impairment (a composite measure of visual function or low MESL visual reception score) was present in more ZIKV-exposed than in unexposed children (OR 3.7, CI: 1.2, 11.0; p = 0.02). However, the limited sample size warrants future investigations to fully assess the impact of in utero ZIKV exposure on ocular structures and visual function in early childhood, even in apparently healthy children.