Transcript for CDC Telebriefing: New Vital Signs Report – Possible Zika virus infections in 44 U.S. states: What can healthcare providers do to help protect pregnant women and their babies?

OPERATOR: Welcome and thank you for standing by. At this time all participants are in a listen only mode. During the question and answer session, please press star 1 on your touch-tone phone. Today’s conference is being recorded. If you have any objections, you may disconnect at this point. Now I would like to turn the meeting over to Ms. Kathy Harben.

KATHY HARBEN: Thank you, Mary. Thank you all for joining us today for the release of a new CDC Vital Signs. This one is on protecting pregnant women and babies from Zika virus infection. We’re joined by the acting director of CDC, Dr. Anne Schuchat, as well as, Dr. Peggy Honein, H-O-N-E-I-N. She is co-lead of the pregnancy and birth defects task force of the CDC Zika virus response and is also chief of CDC’s birth defects branch. I’ll now turn the call over to Dr. Schuchat for opening remarks.

DR. ANNE SCHUCHAT: Thanks so much. Good afternoon, everyone. CDC works 24/7 to protect the health, safety, and security of all Americans. Each month in Vital Signs we focus on a disease on the front lines of CDC science and tell you what can be done to protect and save more lives. Today’s report updates what we know about Zika in the U.S. and provides a more comprehensive picture of how infection during pregnancy is affecting American families right now. We’re still seeing about 30 to 40 new Zika cases in pregnant women each week in the United States. With the current tally of more than 1,600 pregnant women with evidence of Zika reported nationwide. The majority of these cases involve travel to Zika-affected areas. While there is much left to learn about Zika, we do know this devastating outbreak is far from over, and the consequences of this outbreak are heartbreaking. This report features the latest data from the U.S. Zika pregnancy registry, which does not include Puerto Rico. According to our findings, in the 50 states plus D.C., there were nearly 1,000 pregnant women with lab evidence of Zika who completed their pregnancies in 2016. This is the largest series of infant outcomes among pregnant women with laboratory evidence of possible Zika that has been reported and is a critical part of CDC’s effort to better understand the impact of Zika during pregnancy. Fifty-one, or about 5 percent, had Zika-related birth defects, including microcephaly, brain abnormalities, and other serious problems. And these were from pregnancies with Zika virus exposure in 16 different countries or territories. Some of those pregnant women with lab evidence had confirmed Zika virus. Of this group, about 10 percent had a fetus or baby with birth defects. And that proportion increased to 15 percent for women with confirmed Zika during their first trimester. These estimates may not reflect the full impact of Zika virus in pregnancy, since some seemingly healthy babies born following pregnancies complicated by Zika may have developmental problems that become evident months after birth. That is why we are recommending babies receive close developmental monitoring and follow-up to identify any other disabilities.

The bottom line is this: Zika continues to be a threat to pregnant women in the United States. We found pregnant women with Zika reported in at least 44 states. With warm weather, a new mosquito season, and summer travel rapidly approaching, prevention is crucial to protect the health of mothers and babies. And clinicians caring for pregnant women and newborns throughout the nation need to know about Zika. Although we’re still learning about the full range of birth defects that can occur when a woman is infected with Zika during pregnancy, we have seen that it can cause brain abnormalities, vision problems, hearing problems, and other consequences of brain damage that might require lifelong specialized care. Some babies have seizures while others have little to no control over their arms and legs and cannot freely reach out to touch the things around them due to constricted joints. Some babies are not reaching their developmental milestones like sitting up. Some babies have significant feeding difficulties and have trouble swallowing or even breathing while feeding. Some babies cry constantly and are often inconsolable no matter what their caregiver does to soothe them. We’ve seen that these circumstances are just heartbreaking for families and clinicians. We’ve also learned that the effects of Zika infection during pregnancy are not always obvious at birth. Some babies whose mothers were infected with Zika during pregnancy may be born with head size in the normal range, but might have underlying brain abnormalities, experience slowed head growth, and develop microcephaly after birth. We understand Zika can be concerning, especially for pregnant women and families who live in or travel to areas with risk of Zika. And we realize how devastating the consequences of infection can be to the affected families. In addition, the cost for treating an infant with microcephaly is estimated at nearly 4 million. For those who survive into adulthood, the cost could be up to $10 million. CDC scientists have been working 24/7 to protect pregnant women and infants from Zika virus. Although progress has been made in understanding and combating Zika, our work is far from finished. Before we take questions, Dr. Peggy Honein will share more details from today’s report.

DR. PEGGY HONEIN: Thank you, Dr. Schuchat. Early in the response, we recognized the need to collect information about the effects of Zika infection during pregnancy. As a result, CDC rapidly established the U.S. Zika pregnancy registry, an enhanced surveillance system in collaboration with state, tribal, territorial and local health departments. The registry captures information about pregnant women infected with Zika and their babies up to one year of age from all states and territories, except Puerto Rico, which has a similar Zika pregnancy registry in collaboration with CDC. Today’s Vital Signs analyzed nearly 1,000 completed pregnancies reported to the U.S. registry between January 15th and December 27th, 2016. Testing for Zika is very complex, because of the narrow time window when testing can be done and the fact that many of those infected do not have symptoms. This report is the first to provide an analysis of a subgroup of 250 pregnant women in the United States with test results indicating laboratory confirmed Zika virus infection, who had completed their pregnancies in 2016. There are several findings we’re highlighting today. Of the nearly 1,000 pregnancies with evidence of possible Zika virus infection that were completed by the end of 2016, 51 or about 5 percent were reported with one or more of the birth defects that have been associated with Zika during pregnancy. Among a subset of 250 women with laboratory confirmed Zika infection, 24, or about 10 percent, resulted in a fetus or baby with Zika-associated birth defects. While much more data are needed, to our knowledge, this report includes pregnancy outcomes for the largest number of pregnancies with confirmed Zika that has been reported to date. Women with confirmed Zika infections in the first trimester had the highest risk of Zika-associated birth defects, with 15 percent of pregnancies resulting in a fetus or baby with birth defects. CDC recommends brain imaging after birth for all babies that are born to mothers with evidence of Zika during pregnancy. However, based on the data reported to the registry, only one in four babies with possible congenital Zika have received this brain imaging after birth. Brain imaging, for example, a head ultrasound or a CT, is important to look for abnormalities, because we know that some babies have underlying brain defects that are otherwise not evident at birth. Because we do not have brain imaging reports for most of the infants whose mothers had Zika during pregnancy, our current data might significantly underestimate the impact of Zika. The baseline prevalence of birth defects that are consistent with those that occur with Zika during pregnancy, but before Zika was introduced into the entire region of the Americas, was about three per 1,000 live births. The 10 percent of pregnancies with confirmed Zika that resulted in a fetus or infant with one of these Zika-associated birth defects in today’s report is more than 30 times higher than this baseline prevalence.

How can this information be used to protect the health of mothers and babies in the U.S.? First of all, prevention is key. There are basic steps people, and especially pregnant women and their male partners, can take to help protect themselves from Zika. Pregnant women should not travel to any areas with risk of Zika. And men with pregnant partners should use condoms or avoid having sex for the duration of the pregnancy if they have traveled to or live in an area with risk of Zika. People who must travel should talk to their health care provider about the risks before they go and take extra precautions like using an EPA-registered insect repellent to avoid getting bitten by mosquitoes. Pregnant women and their partners living in areas with risk of Zika should strictly follow steps to prevent mosquito bites and prevent sexual transmission by using condoms or not having sex during the pregnancy. Similar to other lifestyle changes routinely recommended to ensure a healthy pregnancy, Zika prevention efforts are very important for families living in areas where mosquitoes that carry Zika are present, including many parts of the continental U.S. Second, health care providers play a key role in these prevention efforts. This includes encouraging pregnant women to follow CDC’s prevention recommendations and asking their patients about possible Zika exposure when caring for pregnant women or babies and providing testing and follow-up care to affected babies to ensure the appropriate intervention services are available to them. They can also work with parents to create a coordinated care plan and monitor the baby’s development.

Last year, we released updated recommendations for health care providers caring for babies born to mothers who had Zika during pregnancy, and this included guidance for a comprehensive physical exam, brain imaging, newborn hearing screening and Zika lab tests. Data gathered for Vital Signs suggests only a quarter of babies born to mothers with possible Zika during their pregnancy received this brain imaging after birth. While the reasons for the lack of imaging are likely complex, there are opportunities here for improved monitoring among babies exposed to Zika during their pregnancy. We cannot identify all of the babies with serious brain abnormalities without the full evaluation, including brain imaging. We will continue to update our guidance as we learn more about Zika, and we encourage health care providers to stay up to date and follow CDC’s guidance as it is updated. Identifying these babies affected by Zika as soon as possible after birth is important to ensure they receive the best care possible. I would now like to turn back to Dr. Schuchat to wrap up before we take questions.

DR. ANNE SCHUCHAT: Thanks so much. It’s been more than a year since CDC released the first travel alert notice related to Zika virus in the Americas. Although Zika may seem like last year’s problem or an issue confined to Brazil and parts of the Caribbean, our findings reinforce that this is not the time to be complacent. As of last count, more than 5,100 Zika virus cases have been reported in the continental U.S. and Hawaii—the majority involving travelers returning from the areas with active Zika transmission. In addition, more than 1,600 pregnant women with evidence of Zika nationwide have been reported to the pregnancy registry. These could be your relatives, friends, or neighbors. We understand Zika can create a stressful situation for many families. We remain committed to protecting pregnant women and reducing the number of infants affected. This includes helping local areas and states control mosquito populations and researching innovative surveillance and control methods aimed at reducing the threat of Zika. We estimate that every year, about 40 million people in the United States travel to South America, Central America, or the Caribbean, where Zika has spread. And, unfortunately, every mosquito bite carries a risk. We know that about 10 percent of women with confirmed Zika in pregnancy had babies with birth defects last year. And this report found the risk of Zika-associated birth defects was highest for those infected in the first trimester. With a new mosquito season approaching in much of the nation, prevention efforts are crucial to protect Americans and particularly pregnant women and their babies from this devastating disease. Zika is still with us. We don’t know how much transmission there will be this year. But we can’t become complacent about the threat, when a single bite from a Zika-affected mosquito can lead to such a devastating condition. Don’t let this outbreak become your family’s heartbreak. I’ll stop there and turn it back to the moderator for questions.

KATHY HARBEN: Thank you, Dr. Schuchat. We are now ready for the Q&A period.

OPERATOR: We will now begin the question and answer session. If you would like to ask a question, please press star 1. One moment. We’ll wait for the first question. Dan Childs with ABC News, go ahead with your question.

DAN CHILDS: Thank you so much for taking my question. I actually had one and then a follow-up. The first one that I had is, you know, we had seen reports throughout this outbreak suggesting that there might be, in addition to Zika infection, some other factor that could be contributing to microcephaly risk in pregnant women. And, you know, we saw those “New England Journal of Medicine” numbers back in May out of Brazil suggesting up to a 13 percent microcephaly rate in women infected in their first trimester. My question is: to what extent might these new findings either support or refute the idea that some other factor might be involved along with Zika when it comes with microcephaly risk?

DR. ANNE SCHUCHAT: There aren’t data yet showing that a particular co-factor is important in risk of Zika complications in pregnancy. Our results, while based on a larger report than previous reports, are fairly consistent with information from other studies. Our study is different in that everyone in the study had laboratory evidence of Zika infection, and that we followed both symptomatic and asymptomatic women in pregnancy. I’m going to let Dr. Honein provide a little more information about how our report compares with previous studies.

DR. PEGGY HONEIN: Thank you very much. It is somewhat challenging to compare estimates with those from other reports, because of differences in methods and definitions. However, CDC published a surveillance case definition that we are using to monitor all data from the pregnancy registries and from rapid birth defects surveillance for these same birth defects. We reviewed the information that was presented in a cohort of 125 completed pregnancies in Rio de Janeiro with confirmed Zika infections that was published last December in “The New England Journal of Medicine,” and based on the information included in the report, determined that at least 13 had findings that met the CDC surveillance case definition for Zika-associated birth defects. So 13 out of 125 is about 10 percent. These 13 included reports of Zika infections in all three trimesters of pregnancy. There is also a recent report from French Guyana published in “Ultrasound in Obstetrics and Gynecology” on 301 pregnancies with confirmed Zika infections. Many of these pregnancies are ongoing and there’s not sufficient information reported yet to determine which met the CDC surveillance case definition. But ultrasound findings suggest brain abnormalities are present in about 13 percent of those with infections in the first or second trimester of pregnancy. While we have much more to learn about the impact of Zika during pregnancy, we are seeing some consistency in reports of these Zika-associated birth defects in pregnant women with Zika being monitored in different countries.

DAN CHILDS: Thank you so much and just one quick follow-up regarding the numbers that we’re seeing. I noticed that there was about 250 women who had confirmed evidence of Zika virus infection and then about — the remainder of which had possible Zika infection. It looks like the differentiator here was perhaps running the dengue test to rule out that flavivirus. Is there any reason why these women who had possible Zika infection didn’t receive the full battery of tests in order to absolutely confirm Zika infection?

DR. ANNE SCHUCHAT: The issue with the possible cases that didn’t get confirmation is generally that the time window when specimens were collected was likely after a nucleic acid test would be positive. There is a narrow time window around which the best test for active Zika infection is positive and so many of the women that didn’t have a confirmed diagnosis probably did have Zika infections. Some may have had other flaviviruses like dengue. So I would say there’s just a couple of weeks after an active infection where the PCR test or other similar nucleic acid tests will be positive.

DAN CHILDS: Wonderful, thank you.

KATHY HARBEN: Next question, please.

OPERATOR: Leghann Winnick from CBS News, you may go ahead with your question.

LEGHANN WINNICK: Hi, thank you. Could you confirm my understanding of the 51 fetuses or infants with birth defects? Did they have their Zika virus exposure from countries, 16 countries and not from the continental U.S. or Hawaii? What does that say to you, that for instance, no one from Florida is included there?

DR. ANNE SCHUCHAT: It does not matter where you get Zika infection in terms of the complications of pregnancy. The largest numbers of births, of completed pregnancies in the U.S. Zika pregnancy registry are for travelers and for the 51 birth defects that we report here, those women had exposure to Zika in the 16 countries or territories that we summarized. With larger numbers and larger numbers of pregnant women at risk, I would anticipate birth complications in any sample of women who develop Zika during pregnancy. We really think that this virus is very serious during pregnancy.

LEGHANN WINNICK: So if I could follow up, does that mean that perhaps people who were exposed in the U.S. haven’t reported or that their pregnancies are still ongoing?

DR. ANNE SCHUCHAT: What I can say is that we have more than a thousand pregnant women that are in the U.S. pregnancy registry so far. The country has more than 5,000 Zika-associated cases. We only have a couple of hundred Zika cases that were locally acquired in the continental U.S. right now, and most of those are not in pregnant women. The other thing to say is that CDC will not be reporting out individual state results from the U.S. Zika pregnancy registry. We have a certificate of confidentiality in order to do this work, and we really are protecting the privacy of the women and families involved here.

KATHY HARBEN: Next question, please.

OPERATOR: Lisa Schnirring, you may go ahead with your question with CIDRAP News.

LISA SCHNIRRING: Hi. Thanks for the good information today. You said that a quarter of the babies aren’t getting their brain scans and I know you said the reasons were complex. I was just wondering if you could kind of review what some of that is about, that would be great.

DR. ANNE SCHUCHAT: Yes, let me clarify. One out of four babies whose mothers had Zika during pregnancy did get brain imaging. Three out of four did not. That’s concerning. It’s important to say that the recommendation to do brain scanning or imaging in these babies is relatively new. Many clinicians may not yet be aware of it. As we pointed out, the cases of Zika in pregnancy that are part of this registry occurred in 44 different states and D.C. That means that clinicians anywhere in the country need to be aware of how to screen for exposure to Zika, how to diagnose it, and how to monitor for follow-up. This is a fairly rare condition, and a fairly new one for clinicians in America. And we want them to know how important it is to do the brain imaging following birth so that the developmental monitoring for the child and family can be done. So as of our report, it’s only one in four that got the recommended imaging. We hope this report will increase awareness and raise that number.

LISA SCHNIRRING: Thank you.

KATHY HARBEN: Next question, please.

OPERATOR: Nathan DiCamillo with Newsweek magazine, you may go ahead with your question.

NATHAN DICAMILLO: Hi, doctor, thanks. I see there’s 1,300 pregnant women with evidence of possible Zika infection who reported, but only a thousand completed since the end of the year. Do we know, are women terminating pregnancies over exposure to Zika?

DR. ANNE SCHUCHAT: The numbers, the discrepancy between the 972 and the 1,300 is just that the pregnancies haven’t been completed. As of now, actually, these are data in the report that just go through the end of December. But as of now, there are actually over 1,600 pregnancies in the U.S. pregnancy registry, you know, posted through March 23rd. As I mentioned, 30 to 40 additional are getting reported through our registry every week and the clinicians are updating information on completed pregnancies. So there’s quite a bit that’s in progress. We are reporting out live births and pregnancy losses, and that information is updated every two weeks. So you’ll be able to monitor our website for that. Because we had a large number amassed during 2016, and because women have been wondering what the risk is, what does this mean for my pregnancy, we wanted to share the information, even though we do continue to get reports.

NATHAN DICAMILLO: Thanks, doctor.

KATHY HARBEN: Next question, please.

OPERATOR: Maggie Fox with NBC News, you may go ahead with your question.

MAGGIE FOX: Thanks very much. The three out of four women who didn’t get imaging, do you have any idea whether it’s perhaps because they didn’t have access to the health care? How much does health insurance coverage control what happens here, influence what happens here? And who pays for it when a woman needs follow-up imaging? Thanks.

DR. ANNE SCHUCHAT: We don’t have information about the access issues that you raise. One thing we would like to stress is how important it is for clinicians to be aware of the recommendation. So I think you raise an important question for which we don’t have the answer, but we also feel that clinicians are not yet aware of the value of brain scanning.

MAGGIE FOX: Thank you.

KATHY HARBEN: Next question, please.

OPERATOR: Kenny Goldberg with KPBS News, you may go ahead with your question.

KENNY GOLDBERG: Hi. What’s going on with the development of a rapid point-of-care test for Zika?

DR. ANNE SCHUCHAT: There is research going on in a variety of diagnostic tests. One of the key gaps right now is to have an antibody test that is able to clearly differentiate Zika infection with other flaviviruses and that can give information about long-term previous Zika infection. You know, with another virus that can cause birth defects, rubella or German measles, we have a good diagnostic test that women get in pregnancy, which can tell the women and their doctors that the women are already protected or immune from that virus. That would be very helpful to have against Zika so women wouldn’t really need to be concerned about this in a pregnancy. Unfortunately, right now the tests that we have tell us about very recent infection in the last couple of weeks with nucleic acid testing and relatively recent infection with the IGM antibody test but not perfectly specific in terms of ruling out some of the other flaviviruses. Point-of-care tests are helpful but not the only thing that we need.

KATHY HARBEN: Next question, please.

OPERATOR: We’ll hold one moment for the next question. And we do have Mary Boyle with NHK Japan Broadcasting Corp. You may go ahead with your question.

MARY BOYLE: Hi, thank you. I have two questions. One is, so just to confirm that this report is only counting Zika contracted — I’m sorry, let me try that one more time. This report is only counting Zika that’s been contracted outside of the U.S., so women that have gone abroad or whose husbands have gone abroad and contracted Zika and have been infected that way and not in the U.S., right? And the second —

DR. ANNE SCHUCHAT: No, let me clarify that. The U.S. pregnancy registry that we’re reporting today covers deliveries that are in the continental U.S. and Hawaii. It doesn’t include deliveries in Puerto Rico, because there’s a separate registry. The women who have Zika-associated infections in the registry that’s reported today could have acquired that through travel, which is the vast majority of the completed pregnancies that we’re reporting, or they could have acquired their Zika locally.

MARY BOYLE: Okay. Okay.

DR. ANNE SCHUCHAT: The 51 birth defects that we report all did acquire this through travel.

MARY BOYLE: I see.

DR. ANNE SCHUCHAT: But as I mentioned, Zika infection acquired anywhere is a risk for a serious outcome in the child.

MARY BOYLE: Okay. I understand. My second question is, so this report is counting defects before birth or also before birth and that are recognized after birth?

DR. PEGGY HONEIN: The way that the report — essentially the report is looking at completed pregnancies. We’re not doing interim reports when, you know, a woman has an abnormal ultrasound in the second trimester. We’re waiting until the pregnancy is completed to update whether there’s a Zika-associated birth defect or not. And so there will be, you know, ongoing updates to this registry as more and more of the records in the registry go through completion of the pregnancy.

MARY BOYLE: Okay. So they’re all assessed after birth?

DR. PEGGY HONEIN: We have information both from prenatal reports and post-natal reports. But we only report out after the pregnancy is completed, whether it’s a live born infant or a pregnancy loss. So these 51 birth defects are among 45 live born infants and six pregnancy losses.

MARY BOYLE: Understood. Thank you very much.

KATHY HARBEN: Okay. We have time for one more question.

OPERATOR: Alan Gomez with USA Today, you may go ahead with your question.

ALAN GOMEZ: I apologize for ending on such a dumb question, but I just want to be absolutely sure on one point, following up on the previous question. Like in the release that you guys just sent out, it says of the 250 pregnant women with confirmed Zika in 2016, 24 had a fetus or baby with Zika-related birth defects. So just to be absolutely sure, does that deal with births? Because it also includes the word “fetus” obviously in the sentence. I just want to make sure what the pool is that we’re looking at when we’re using this 10 percent figure.

DR. ANNE SCHUCHAT: It includes both: both live births and fetal loss.

ALAN GOMEZ: Okay. Then in that case, could you just repeat the data on the births?

DR. PEGGY HONEIN: For the 51 totals, there were 45 live births and six pregnancy losses, of the 51 that had one of the Zika associated birth defects.

ALAN GOMEZ: Okay.

KATHY HARBEN: Thank you, Dr. Schuchat and thank you, Dr. Honein. We’ll be posting a transcript of this telebriefing later this afternoon. If you have follow-up questions now, you can either call us at 404-639-3286 or you can e-mail us at media@CDC.gov. Thank you.

OPERATOR: This concludes the call for today. Please disconnect your lines.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES