ZikaAssociated Birth Defects Surveillance Texas 2016 2017 Noemi

Zika-Associated Birth Defects Surveillance – Texas, 2016 -2017. Noemi B. Hall, Ph. D.

Testing Outcomes and Birth Defect Status of Fetal Losses or Infants Delivered in Texas to Mothers with Evidence of Zika Infection during Pregnancy – as of December 22, 2017 Laboratory Testing Completed Laboratory Testing Not Completed TOTAL Laboratory Evidence of Zika Infection No Laboratory Evidence of Zika Infection Has Birth Defect Consistent w/ Zika 4 9 2 15 Has Other Birth Defects 0 2 9 11 Has No Apparent Birth Defects 8 76 109 192 TOTAL 12 87 120 219 3/11/2021 2

Testing Outcomes and Birth Defect Status of Fetal Losses or Infants Delivered in Texas to Mothers with Evidence of Zika Infection during Pregnancy – as of December 22, 2017 Laboratory Testing Completed Laboratory Testing Not Completed TOTAL Laboratory Evidence of Zika Infection No Laboratory Evidence of Zika Infection Has Birth Defect Consistent w/ Zika 4 9 2 15 Has Other Birth Defects 0 2 9 11 Has No Apparent Birth Defects 8 76 109 192 TOTAL 12 87 120 219 3/11/2021 3

Testing Outcomes and Birth Defect Status of Fetal Losses or Infants Delivered in Texas to Mothers with Evidence of Zika Infection during Pregnancy – as of December 22, 2017 Laboratory Testing Completed Laboratory Testing Not Completed TOTAL Laboratory Evidence of Zika Infection No Laboratory Evidence of Zika Infection Has Birth Defect Consistent w/ Zika 4 9 2 15 Has Other Birth Defects 0 2 9 11 Has No Apparent Birth Defects 8 76 109 192 TOTAL 12 87 120 219 3/11/2021 4

Testing Outcomes and Birth Defect Status of Fetal Losses or Infants Delivered in Texas to Mothers with Evidence of Zika Infection during Pregnancy – as of December 22, 2017 Laboratory Testing Completed Laboratory Testing Not Completed TOTAL Laboratory Evidence of Zika Infection No Laboratory Evidence of Zika Infection Has Birth Defect Consistent w/ Zika 4 9 2 15 Has Other Birth Defects 0 2 9 11 Has No Apparent Birth Defects 8 76 109 192 TOTAL 12 87 120 219 3/11/2021 5

Pregnancy Outcomes of Women with Evidence of Zika Virus Infection in Texas, 2016 -2017 254 3/11/2021 Pregnant women with evidence of Zika virus infection 6

Maternal Demographics 207 known outcomes as of 11/3/2017 Maternal Race/Ethnicity Non-Hispanic White Non-Hispanic Black Hispanic Asian Other Unknown Maternal Age at Birth < 20 20 - 29 30 - 39 40+ 3/11/2021 Cases, n = 207 5 5 149 1 2 45 Cases, n = 202 52 103 43 4 % 2. 4 72. 0 0. 5 1. 0 21. 7 % 25. 7 51. 0 21. 3 2. 0 7

Pregnancy Outcomes of Women with Evidence of Zika Virus Infection in Texas, 2016 -2017 254 219 Pregnant women with evidence of Zika virus infection Pregnancy outcomes reviewed by DSHS staff • Zika testing status known • Presence or absence of birth defects 3/11/2021 8

Completed Pregnancy Outcomes 219 known outcomes as of 12/22/2017 Pregnancy Outcomes Live born Stillborn Fetal loss 3/11/2021 Cases, n = 219 213 1 5 % 97. 3 0. 4 2. 3 9

Deliveries to Women with Evidence of Zika Virus Infection in Texas, 2016 -2017 3/11/2021 10

Infants/Fetuses Delivered by Mothers with Evidence of Zika Virus Infection During Pregnancy, by County and Infant’s Zika Testing Status, 12/22/2017 3/11/2021 11

Travel History of Women with Evidence of Zika and Known Pregnancy Outcomes, Texas, as of 11/3/2017 es ic l ub ep an ic R n pi p li P hi in om D 3/11/2021 12

Pregnancy Outcomes of Women with Evidence of Zika Virus Infection in Texas, 2016 -2017 254 219 Pregnant women with evidence of Zika virus infection Pregnancy outcomes reviewed by DSHS staff 99 Infants with completed testing for Zika virus 3/11/2021 • Infant serum tested • Urine, placenta, other tissues 13

Pregnancy Outcomes of Women with Evidence of Zika Virus Infection in Texas, 2016 -2017 254 219 99 Infants with completed testing for Zika virus 3/11/2021 Pregnant women with evidence of Zika virus infection Pregnancy outcomes reviewed by DSHS staff 120 Infants/fetal losses with incomplete testing for Zika virus 14

Zika-Associated Birth Defects in 15 of 219 Pregnancy Outcomes Microcephaly 1 2 3 4 Other Brain Abnormalities Other Zika-Associated Birth Defects Testing Status + + 5 6 7 8 9 10 11 12 13 14 15 3/11/2021 15

Zika-Associated Birth Defects in 15 of 219 Pregnancy Outcomes Microcephaly 1 2 3 4 5 6 Other Brain Abnormalities Other Zika-Associated Birth Defects Testing Status + + 7 8 9 10 11 12 13 14 15 3/11/2021 16

Zika-Associated Birth Defects in 15 of 219 Pregnancy Outcomes Other Brain Abnormalities Other Zika-Associated Birth Defects Microcephaly 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 3/11/2021 Testing Status + + - 17

Thank you. 3/11/2021 18

Supplemental Slides 3/11/2021 19

Enhanced Surveillance for Zika-Associated Birth Defects Arboviral Case Investigation Forms Zoonosis Control Branch Laboratory Testing Reports Local Health Departments Providers/ Facilities Birth Defects Epi and Surv Branch CDC US Zika Pregnancy Registry CDC Birth Defects Surveillance Regional Social Workers, DSHS Vital Records Data 3/11/2021 20

Enhanced Surveillance for Zika-Associated Birth Defects Arboviral Case Investigation Forms Zoonosis Control Branch Laboratory Testing Reports Local Health Departments Providers/ Facilities Birth Defects Epi and Surv Branch CDC US Zika Pregnancy Registry CDC Birth Defects Surveillance Regional Social Workers, DSHS Vital Records Data 3/11/2021 21

Reported Maternal Travel Exposure 207 known outcomes as of 11/3/2017 Travel by Country Multiple Countries 15 Cases, n = 207 El Salvador Guatemala Honduras Nicaragua 59 6 45 3 Brazil Colombia Guyana Venzuela 2 1 1 6 Antigua Cuba Domician Republic Haiti Jamaica Puerto Rico St. Lucia St. Thomas 1 2 2 1 1 1 Brownsville, Texas Mexico 1 56 Phillipines Thailand 1 1 % 7. 2 Central America 28. 5 2. 9 21. 7 1. 4 South America 1. 0 0. 5 2. 9 Carribbean 0. 5 1. 0 0. 5 0. 5 North America 0. 5 27. 0 Southeast Asia 3/11/2021 0. 5 22

Reported Maternal Travel Exposure (cont. ) 207 known outcomes as of 11/3/2017 Travel by Region Carribean Central America North America Southeast Asia Multiple Countries/Regions 3/11/2021 Cases, n = 207 10 113 57 10 2 15 % 4. 8 54. 6 27. 5 4. 8 1. 0 7. 2 23

Completed Pregnancies Over Time 207 known outcomes as of 11/3/2017 Delivery Month* Q 1 2016 Q 2 2016 Q 3 2016 Q 4 2016 Q 1 2017 Q 2 2017 Q 3 2017 Q 4 2017 Cases, n = 202 3 13 40 50 43 37 15 1 % 1. 5 6. 4 19. 8 24. 8 21. 3 18. 3 7. 4 0. 5 *Q 1 = January - March Q 2 = April - June Q 3 = July - September Q 4 = October – December 3/11/2021 24

Demographics of Infants/Fetal Losses 207 known outcomes as of 11/3/2017 Infant Sex Male Female Unknown 3/11/2021 Cases, n = 207 98 82 27 % 47. 0 40. 0 13. 0 25

Zika-related Birth Defects in 15 of 219 Pregnancy Other Brain Other Zika-related Microcephaly Outcomes Abnormalities Birth Defects 1 2 3 4 5 6 7 8 9 10 Tes

Zika-Associated Birth Defects in 15 of 219 Pregnancy Outcomes Microcephaly 1 2 3 4 3/11/2021 Other Brain Abnormalities Other Zika-Associated Birth Defects Testing Status + + 27

Zika-Associated Birth Defects in 15 of 219 Pregnancy Outcomes Microcephaly 1 2 3 4 5 6 3/11/2021 Other Brain Abnormalities Other Zika-Associated Birth Defects Testing Status + + 28