ZikaAssociated Birth Defects Surveillance Texas 2016 2017 Noemi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you. 3/11/2021 18

Supplemental Slides 3/11/2021 19

Supplemental Slides 3/11/2021 19

Enhanced Surveillance for Zika-Associated Birth Defects Arboviral Case Investigation Forms Zoonosis Control Branch Laboratory

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

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

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

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

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

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

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

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

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