Transcript : CDC Telebriefing – Update on Zika pregnancy outcomes in U.S. Territories

KATHY HARBEN: Thank you everyone for joining us today to discuss the release of a new MMWR report on pregnancy outcomes after Zika virus infection in the U.S. territories. One note the embargo lifts at 3:00 p.m. eastern time today. This is to give media a chance to review the materials we shared late this morning. We’re joined today by Dr. Anne Schuchat, the Acting Director of CDC and Dr. Peggy Honein, Co-Lead of the Birth Defects Task Force for the CDC’s Zika virus response and Chief of CDC’s birth defects branch. I’ll turn the call over to Dr. Schuchat.

ANNE SCHUCHAT: Thanks, everybody, for joining us this afternoon. Today’s report marks the first analysis of data reported to the Zika pregnancy and infant registries from the U.S. territories including the commonwealth of Puerto Rico, the U.S. Virgin Islands, the Federated States of Micronesia, the republic of the Marshall Islands and American Samoa. CDC scientists analyzed 3,900 pregnancies reported between January 1, 2016, and April 25th of this year. Of these, 2,549 pregnant women in the U.S. territories with evidence of Zika virus infection completed their pregnancies within this time frame. And 122, or 5%, had Zika associated birth defects. This percentage is consistent with what was reported earlier for Zika associated birth defects for pregnancies in women from the 50 states and District of Columbia during 2016. Today’s report is larger than previous ones. So we could also compare infant outcomes associated with Zika virus infection, diagnosed in the first, second or third trimester of pregnancy. Today’s report highlights the proportion of infants with possible Zika associated birth defects following infection identified in each trimester. We found that about 8% of pregnant women with confirmed Zika virus infection documented in their first trimester, had a fetus or a baby with a Zika associated defect, Compared to 5% in the second trimester and 4% in the third trimester. These data indicate that Zika virus associated with risks to pregnant — sorry, that Zika virus is associated with risks to pregnant women and their babies even when the infection is identified later during pregnancy. 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 know that it causes brain abnormalities, vision problems and other devastating consequences of brain damage that might require life long specialized care. Some babies have seizures, while others have little to no control over their limbs and cannot freely reach out to touch the things around them. Due to constricted joints. Some babies are not reaching their typical milestones. Like sitting up. Some babies have significant feeding difficulties and they 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 have also learned that the effects of Zika infection during pregnancy are not always obvious at birth. Some babies whose mother were infected during pregnancy may be born with the head size in the normal range but might have underlying brain abnormalities, experience slowed head growth and develop microcephaly after birth. That’s why identification of and follow-up care with babies with possible Zika virus infection is so crucial. It ensures that the babies receive appropriate care. As part of this report, CDC analyzed the proportion of infants born to women with evidence of possible Zika that were reported to the registries as receiving testing and screening. Dr. Peggy Honein will go into more details about whether they were being evaluated as recommended before I wrap up and we take questions. Dr. Honein?

PEGGY HONEIN: Thank you Dr. Schuchat. There are several findings in today’s report worth highlighting. in the U.S. territories women with confirmed Zika infections documented in the first trimester of their pregnancy have the highest proportion of Zika associated birth defects with 8% of pregnancies resulting in a fetus or baby with Zika associated birth defects, compared to 5% in the second trimester and 4% in the third trimester. In the U.S. states and D.C., which we reported on a few months ago, about 15% of pregnant women with confirmed Zika infection in the first trimester had a fetus or baby with Zika associated birth defects. It is important to note that these estimates for the impact of confirmed Zika during the first trimester are based on relatively small numbers and today’s numbers – 8% for first trimester infection in the U.S. territories, and the 15% we observed the U.S. states and D.C. may seem different, But the confidence intervals for these overlap, meaning there’s not a statistically significant difference. It is important that we continue monitoring pregnant women with Zika and the outcomes of their infants to assess the impact of first trimester infection on Zika associated birth defects as well as to assess the full impact that Zika virus infection during pregnancy can have. The continued follow-up of infants is critical to elucidate the impact that Zika has in pregnancy beyond just the abnormalities that are detected at the time of birth. Today’s report also highlights potential gaps in the evaluation of infants at birth with possible congenital Zika virus infection in the U.S. territories. Last year CDC released updated recommendations for health care providers caring for babies born to mothers who had evidence of Zika during their pregnancy, and this included guidance for a comprehensive physical exam, brain imaging, newborn hearing screening and Zika laboratory testing. What we found in this report from the territories is that nearly 60% of the infants with possible congenital Zika had test results for Zika at birth that were reported to the registries. And based on data reported to the Zika pregnancy and infant registries about half of the babies have received brain imaging after birth. This is higher than one out of four based on the data reported to the registries from the 50 U.S. states by March of this year. But more data has been reported to the registries every week from both the territories and the U.S. states. Brain imaging such as a head ultrasound is very important to look for abnormalities at birth because some babies have brain defects that are not evident if you don’t do imaging. We are continuing our outreach to health care providers and families to emphasize the importance of this brain imaging for babies that have possible congenital Zika infections. Nearly 80% of the infants with possible Zika were reported to have received the recommended hearing screening based on data reported to the registry. While we expect that all infants would have had hearing screening at birth, this screening might not have been documented in the medical record at the time when the birth hospitalization was abstracted for the registry. This information is encouraging, but there are still opportunities to ensure every health care provider is aware of how to screen for exposure to Zika, the need for comprehensive evaluation of infants and how to monitor and provide follow-up care. Identification and follow-up of infants with laboratory evidence of Zika virus infection during pregnancy can facilitate timely and appropriate clinical intervention services and assess the future needs. As you might recall, last fall, CDC discontinued reporting pregnancy outcomes from the U.S. territories because some jurisdictions were not using the standard CDC surveillance case definition. With this report, we are very pleased to announce that in late June CDC will resume regular reporting of the number of completed pregnancies and the outcomes of the pregnancies from the U.S. territories similar to how we report twice per month for the U.S. states and D.C. each jurisdiction may define a different case definition for reporting on their own website. However, in this report and for CDC’s regular reporting purposes, starting on June 22nd, all U.S. territories have expressed their agreement with using the same standard CDC surveillance case definition as the U.S. states and D.C. I would like to turn back to Dr. Schuchat to wrap up before we take questions.

ANNE SCHUCHAT: Thanks so much, Dr. Honein. This report, the first from the U.S. territories represents the largest number of completed pregnancies with laboratory confirmation of Zika virus infection to date. As these findings illustrate, Zika virus poses a serious threat to pregnant women and their babies regardless of when the infection is diagnosed during the pregnancy. We encourage people living in the areas with risk of Zika virus to talk to their health care providers about the risks and ways to prevent exposure through mosquito bites and sexual transmission. Similar to other changes routinely recommended to assure a healthy pregnancy, Zika virus prevention efforts are very important for families living in areas with mosquitos that carry the Zika virus. For example, people who have traveled to or live in an area with risk of Zika to take extra precautions, like using EPA registered insect repellent, wearing long sleeved shirts and pants, and staying or sleeping in places that have screened windows and doors to avoid getting bitten by mosquitos. In addition, pregnant women and their partners should use condoms during sex throughout the pregnancy, to avoid picking up the virus sexually. CDC continues to update our guidance as we learn more about Zika virus infection. Identifying babies affected by Zika virus as soon as possible after birth is important to ensure they receive the best care possible. There is much left to learn about Zika virus, but today’s report combined with recent findings from the 50 states, provides a more comprehensive picture of how Zika infection during pregnancy can impact families. It also provides information that can be used in planning for special needs care of children affected by Zika virus. Zika hasn’t gone away and while the number of new infections has decreased the virus remains a concern for families living in the U.S. territories. Pregnant women may have continued exposure to mosquitos carrying Zika virus in areas with known circulating Zika virus and therefore are at ongoing risk of infection. It’s important that the health care and public health community remain vigilant to ensure infants receive the care they need. With a new mosquito season and summer travel beginning, we can’t afford to be complacent. The bottom line of today’s report is that Zika infection identified during any trimester of pregnancy can lead to serious brain or other birth defects. While we continue to learn from last year’s epidemic, and assure care for those families impacted, we must continue preparing for another mosquito season while researchers seek more definitive prevention through vaccine development. I’d like to turn things back over to the moderator.

OPERATOR: Thank you. We will now begin the question and answer session. If you would like to ask a question over the phone, please press star followed by the number 1. Please record your name clearly when prompted. To withdraw your request, press star followed by the number 2. One moment while we wait for questions to queue. Helen Branswell, with STAT, your line is open.

HELEN BRANSWELL: Thank you for taking my question. I have two if I could please. The first relates to where these 122 babies were born. You mentioned I think Dr. Schuchat five territories. The publicly available data from those places don’t add up to anywhere near 122. And there have been problems getting accurate data from Puerto Rico. Does the CDC now feel that Puerto Rico is accurately describing the scope of the problem there and I have an unrelated question as a follow-up, please stand by.

HELEN BRANSWELL: Okay. I’m sorry. Essentially I have two questions. The first regards to reporting from Puerto Rico, there had been problems with Puerto Rico’s numbers. They are reporting 38 pregnancy outcomes, and I’m just wondering if you could tell me if you now feel that CDC is getting an accurate assessment from Puerto Rico of the scope of the problem there?

ANNE SCHUCHAT: Thanks so much and we apologize for missing the question. This is Dr. Schuchat responding. Yes, we do believe that Puerto Rico authorities are doing a very good job right now in evaluating babies whose mothers had Zika infection and characterizing them and reporting in. And we were very pleased that they participated in this report which is all of the U.S. territories. We — as Dr. Honein described, will be updating the website twice a month with the combined territories’ information and the Puerto Rico information will be using the CDC case definition as it’s updated. We do feel good. I was in Puerto Rico and I got to meet with the authorities and I congratulated them on the intense work involved in this epidemic.

HELEN BRANSWELL: If I could ask an unrelated follow-up, please. It’s regarding funding, does the CDC have funding to continue to operate the pregnancy registries going forward?

ANNE SCHUCHAT: The CDC is working off of emergency funds that were provided for fiscal year 2017 and we are very appreciative of those resources and that’s the focus of the work going on right now. I can’t really speculate about future funding but those are the resources that are providing support for the registries right now. Thank you. Next question.

MIKE STOBBE: Our next question comes from Mike Stobbe from the associated press. Your line is open. Mike Stobbe, with the Associated Press, your line is open.

MIKE STOBBE: Hi, can you hear me?

ANNE SCHUCHAT: Yes.

MIKE STOBBE: Sorry about that. I wanted to ask, I think the doctor had mentioned as you might recall last fall that there was a discontinuation of the pregnancy outcomes because she said some jurisdictions were not using the standard case definition — and Helen mentioned that we know Puerto Rico wasn’t. Were there others? What other territories weren’t using the standard case definition? Thank you.

ANNE SCHUCHAT: You know, one thing I would like to say is that Zika is a new condition and over the time since the first reports from brazil and then since CDC started to work with the states on reporting of Zika infection there have been updates to the way that we have requested reporting. You know, some things weren’t all considered at the beginning so this has been a moving target. I do want to stress that the outcomes we’re reporting in the birth outcomes of the territories are using the same definition of Zika associated birth defect as is being used in the 50 states and D.C. and that that definition is partially related to some of the great work that’s been done over the past year to characterize Zika associated birth defects. So i think it’s been a dynamic period. I don’t have any information about particular states or particular territories. I know that there’s been an evolution in how acute Zika infection, laboratory confirmed Zika infection and then birth outcomes associated with Zika have been reported based on our request as well as some local perspectives. So it’s probably one of those things that was in the first year of a new syndrome we learned from each other and we tried to get to a good place. Did you have a follow-up?

MIKE STOBBE: Well, I just — maybe Dr. Honein could answer since she made the statement. What were the other territories?

PEGGY HONEIN: So all the U.S. states and territories are following the same standard CDC case definition at this point.

MIKE STOBBE: Right, but which were the others that weren’t using the case definition previously?

PEGGY HONEIN: you know, we have been finalizing to a lot of last year was developing and finalizing the case definition so I think it would be difficult to characterize it at each point in time, but we are pleased that all the states and territories are following the standard case definition.

ANNE SCHUCHAT: So next question.

OPERATOR: Next question comes from Sandee Lamotte with CNN. Your line is open.

SANDEE LAMOTTE: Hi there. I have several questions. The first is to —

ANNE SCHUCHAT: You’re breaking up. Can you start again, please?

SANDEE LAMOTTE: Can you hear me now?

ANNE SCHUCHAT: Yes, we can.

SANDEE LAMOTTE: Hi, to follow up on Helen’s question, of the 122 babies can you give us the delineation as to how many were born in each of the various territories?

PEGGY HONEIN: No, I’m sorry, we aren’t reporting the data that way. The arrangements are to provide aggregated data that the individual territories may or can report their information on their own websites. But the collection of the U.S. pregnancy registry and the Puerto Rico registry territories other than — that collection has a assurance of privacy and it’s very important that we protect the individual families so we’re not providing disaggregated data so I don’t have that data. I think the key we’re seeing in the large report is very consistent with what we saw in the smaller report from the 50 states in D.C. and that is that Zika is a very serious virus when acquired during pregnancy.

KATHY HARBEN: Next question.

SANDEE LAMOTTE: Sorry, I had a follow-up —

ANNE SCHUCHAT: Absolutely, please.

SANDEE LAMOTTE: Thank you. In the height of the Zika epidemic last year, especially within Brazil there was a lot of conversation and numbers being crunched to say that perhaps about 1% of babies would be infected with Zika, of all the Zika possibilities, all of the Zika infections. So we’re now looking at maybe 5% between the data coming out of the territories and out of the U.S. mainland. Do you feel that’s a more accurate — how —

ANNE SCHUCHAT: Thank you for the question. It is — in fact we have been speaking here internally about whether our findings are consistent or whether our findings are extreme. Each of the reports on Zika infection in pregnancy and birth outcomes is somewhat different. Different populations. Different definitions, different periods, different subsets that are being used. Our findings are very consistent with previous reports. The initial modeling that was done suggested that just for microcephaly there may be 1 to 13% of Zika infections that would lead to that. Zika infections in the first trimester that would lead to that. That’s a pretty wide range. Our report is helping to narrow down what we think the estimates are because it’s a large report. Both the first trimester and then of infections diagnosed in the second or the third trimester. The 5% overall or the 8% confirmed in the first trimester each have uncertainties around them. But I think we’re narrowing the uncertainty and really do feel like the information is getting more helpful for women and their families to understand what infection may mean. We are still learning and the full spectrum of effects that Zika can have in pregnancy and the issue baby born looking fine exactly out they’ll develop and grow. Those are still questions that we will be following so the story isn’t all out. But I would say the predictions, the models, the early reports based on smaller numbers – our findings are very consistent. Next question.

OPERATOR: Our next question comes from Jonathan Austin, with the Virgin Islands Daily News. Your line is open.

JONATHAN AUSTIN: Good day. Two-part question. Number one, we have nearly 2 million visitors arrive on cruise ships every year. I’m trying to understand how the CDC can differentiate between infections in Ohio that came from Ohio and infections in Ohio that came because someone took a trip to the virgin islands on their honeymoon.

ANNE SCHUCHAT: Thank you so much for that question. The way that we do the reporting or we urge the reporting from states and territories is based on the residents. So if a person is a resident of Ohio, but travels overseas or travelled to the territories or another state, that report would come in from the state of residence. You know, a person can live in one place, travel to another place and in fact get diagnosed in a third place. And in general, in our reporting, we have the place of residence be the one to submit the report. We do ask in the reports about travel history. That’s why when we reported earlier in April about the Zika associated birth defects in the — from the 50 states and D.C., we included the result that the Zika infections had been acquired in 16 different countries or territories among those travelers. So there’s both where you live and there’s where you likely exposed and sometimes it’s the same place.

JONATHAN AUSTIN: Quickly, the second question, the United Nations development program in April said that the territory — the U.S. Virgin Islands could lose up to 2% of its GDP because of Zika. And said that the territory has the highest estimated cost associated with microcephaly. That comes in conjunction with the fact that the United States Virgin Islands has not one skilled nursing facility bed recognized by Medicare/Medicaid. Is CDC and the federal government looking forward to the 20, 30, 40 year plan for dealing with the microcephaly?

ANNE SCHUCHAT: Well, thank you for highlighting the huge economic toll that the virus has both in terms of the care of children affected and of course the economic loss from tourism or travel. One of the reasons CDC is so committed to transparency is to try to make sure that people have good information and that we don’t have out of size economic impacts. I would say in terms of care of these children that we know is very difficult situation for a family, a clinical site, or a community that CDC has been collaborating closely with the center for Medicaid and Medicare services and HRSA, throughout the Zika response, part of the department of the health and human services in the U.S. do help with funding the territories for clinical services and provider education and outreach. We know that this is a big, big challenge and it’s a very — it’s very appropriate that you raised that question. So thank you. Next question?

OPERATOR: Our next question comes from Lena Sun from The Washington post. Your line is open.

LENA SUN: Hi, thank you. Sorry, Dr. Schuchat, I just wanted to clarify something you had said earlier in answer to Helen’s question or — so the information that has been reported now that is in this report is all of those birth outcomes and, you know, pregnancy confirmations are following the CDC surveillance case definitions. Right?

ANNE SCHUCHAT: Yes, that’s right.

LENA SUN: Okay. So then did Puerto Rico give you guys different information or better information or more comprehensive information than what they are defining and posting on their own website because there is a disconnect. I mean, it’s a much smaller as Helen said a much smaller number. They may be defining it one way for their own posting purposes but for this report they gave you the same — you know, they gave you information according to CDC case definition.

ANNE SCHUCHAT: Yes, that’s right.

LENA SUN: Okay. And given that Puerto Rico has said it’s now — that the Zika epidemic has ended, is CDC changing its recommendation at all for pregnant women traveling to the territory?

ANNE SCHUCHAT: We are pleased that the incidents of new cases in Puerto Rico and in other areas is low at this point. But we continue to urge pregnant women to avoid travel to areas where Zika is spreading and that includes Puerto Rico. We think it’s very hard to know exactly what will happen in the new mosquito season and we want to make sure that women are aware of that if they’re pregnant. We can’t predict exactly how much Zika will be spreading these next several months or in fact the next couple years but we know that the vector is there and there are occasional cases occurring. And we want to make sure that women are aware of that. That said, there’s a huge effort ongoing in Puerto Rico to improve vector control, to make sure there’s very good outreach in the clinical community, both for pregnant women and for children and then my recent travel there i was very encouraged with the hard work of the Puerto Rico health department and the partners, the vector control unit, and so forth. So you know I think that our travel guidance gets reassessed periodically. We don’t know that much about Zika yet, because it’s really just one year’s worth of Zika circulating in the Caribbean and that — that we’re familiar with right now. Based on dengue and chikungunya, we don’t feel that the risk period is over with yet. That’s one of the reasons that investigators across the government and the private sector are looking at vaccine studies because we think this may be an ongoing risk and something we’d like to have definitive protection against. Next question.

OPERATOR: Next is it Nitza Perez, CGTM America. Your line is open.

NITZA PEREZ: Hi, good afternoon. Just for clarification purposes does the CDC agree with Puerto Rico’s assessment of that the Zika epidemic is over here in the island?

ANNE SCHUCHAT: We remain committed to working closely with Puerto Rico to support their efforts to control vectors fighting Zika, dengue, chikungunya. We were pleased to see the new cases decrease, that the epidemic wave, that peaked last summer and fall is over. And what we’re focused on now is remaining vigilant for a potential new case or a new rise. Working closely on surveillance as well as vector control. But we’re very pleased with the decrease following that large peak that they had last summer and fall and so we have good connections and communication with Puerto Rico and they have shared their data. They’re doing good surveillance. They continue to test and as they have described to us, testing women in pregnancies for Zika is going to be a routine going forward, regardless of the new cases occurring in terms of the febrile illness, because it’s important to work with women in caring for their pregnancies and the newborns. So we do agree that the disease went up and it’s come down. But that the risk is ongoing. That’s why they’re continuing the intensive surveillance and outreach and vector control.

NITZA PEREZ: But would you say that the epidemic is over in Puerto Rico?

ANNE SCHUCHAT: I think the way that I would put it is while there’s been a substantial decrease in the number of cases that very low levels of mosquito borne transmission are still occurring in Puerto Rico and similar areas and for that reason we continue to recommend vigilance and that pregnant women avoid travel. I think it may be a fun — function of word bug that’s the way we see that.

ANNE SCHUCHAT: Next question.

OPERATOR: Our next question is from Katherine St. Louis from New York Times. Your line is now open.

KATHERINE ST. LOUIS: Hi, the question that I had was whether or not the report resolves the question of whether symptomatic infection in pregnancy is more of a hazard or more dangerous to the fetus than the asymptomatic infection.

ANNE SCHUCHAT: Thanks for that question because we didn’t really highlight it. We did have larger numbers in this report than in some previous ones. And we found quite similar percent, similar results for women who had symptoms of Zika during pregnancy and women who did not have symptoms of Zika during pregnancy. In earlier reports, we highlighted that there were findings of women who had no symptoms developing babies with microcephaly or other serious brain abnormalities and our report confirms that. That whether there are symptoms or no symptoms there were birth defects identified. In fact, in our sample that had the nucleic acid test confirmed in Zika infection we had a slightly higher, but not a different percent with birth defects compared to those with symptoms. They’re similar numbers. 5% and 7% overlapping confidence intervals as we say in statistics but we didn’t have reassuring news for women who don’t have symptoms that’s why in Puerto Rico and similar areas we recommend and the clinicians are testing women regardless of symptoms.

KATHERINE ST. LOUIS: Thank you.

ANNE SCHUCHAT: Next question.

OPERATOR: Our next question comes from Phil Keating with Fox Channel News. Your line is open.

PHIL KEATING: That’s what I’m talking about. Okay, really quick, 5% versus 7%, symptomatic, asymptomatic, which was the 5% and which is the 75%?

ANNE SCHUCHAT: The 5% was symptomatic and it ranges from 4 to 6. That’s what we call a confidence interval. And the no symptoms was 7% and that ranged from 4 to 11. So you can see that they are essentially the same, but the point is that we can’t say if you don’t have symptoms you don’t have to worry. We think if you’re pregnant and you have travelled or are living in an area where Zika risk occurs that you need to be tested during pregnancy. In fact, multiple times. So that’s what we’re recommending in Puerto Rico and the clinicians there have been very good about that.

PHIL KEATING: I’m based out of Miami, which of course the Zika central last year.

ANNE SCHUCHAT: Right. We do recommend even without symptoms that the pregnant women get tested.

PHIL KEATING: Absolutely. Two quick questions. One, so you had the U.S. and — so the 50 states and D.C. study show — a smaller study showing up to 15%. The much larger study that we’re talking about today with the telebriefing, 5%. And all the territories. So would you say that the proper way to estimate the number of pregnant women who get Zika, who will have babies with birth defects and microcephaly is in between 5 and 15%?

ANNE SCHUCHAT: Let me clarify because I think your comparison was slightly different, apples and oranges.

PHIL KEATING: Okay.

ANNE SCHUCHAT: If we look the 15% from our earlier report was for confirmed pregnancies in the first trimester. that was essentially nine out of 60 pregnancies. That compares to 8% of confirmed first trimester infections in the current report and that 8% is 22 out of 276. So i think your general question was which number is right and i would just say that they are similar to each other because of the confidence intervals. Because the report from the territories is larger, the certainty is better. They’re probably closing in on about the right percentage but we’re still gathering more data about first trimester exposures. A key sort of — a key detail about our report from the territories is that we had many more pregnancies that were diagnosed in second and third trimester than we had diagnosed in the first trimester. So even though our first trimester numbers are bigger than the earlier report, our total numbers where the 5% comes from are weighted towards infections that were diagnosed in second or third trimester. So we epidemiologists feel like we have to see the rest of the first trimester infections to see what a population level number will be. I think the bottom line though for women is that there is no doubt that Zika virus infection during pregnancy, diagnosed during any trimester can lead to severe birth defects. It is important to avoid exposure to Zika during pregnancy, whether that’s mosquito or sexual exposure and very important to get tested if you’re exposed or living in one of those areas and have to the babies followed up carefully. This is dangerous virus in the context of the pregnancy setting. You know, you all may want to think about a range of infection, you know, early on we talked about that 1 to 13%. I think for first trimester it’s a fairly broad range. The point estimates were 8% versus 15%. The full confidence intervals are much wider.

PHIL KEATING: Thank you. Lastly, a critical question for men and women, partners, husbands and wives who discover they’re pregnant and then come to visit Miami-Dade county for vacation and then go home, realize, oh, my gosh, I’m having symptoms of Zika. A big question I had been debating recently and no one seemed to know the answer but I would assume you two will. If you’re a pregnant woman and you’re in first trimester or second or third trimester and you get a blood test and you discover whether you had symptoms or not, you showed signs of Zika infection. Which trimester — how soon would the regularly scheduled ultrasounds reveal that this fetus may or does have microcephaly and/or a high percentage of birth defect problems upon being born? So that that couple could then weigh the decision to terminate.

ANNE SCHUCHAT: That unfortunately — that question points to the major challenges with this virus. Based on what we know now, ultrasounds are not going to pick up immediately that there’s any harm from the virus. We’re still really learning about what happens during pregnancy in terms of the imaging and the other results. Based on what we know now, this virus is — it can cause severe harm. But that we don’t believe ultrasounds are going to give us the full story immediately or even after many weeks. So I would say that the OB/GYN community, the radiology community, the laboratory community, people are working very hard to understand what’s going on during the pregnancies but we don’t have simple tests and predictions right now. What we have are these population studies like we were reporting today. That give us that sense of, you know, it’s not 100% chance that your baby is going to have a birth defect, but it’s not 0%. It’s substantially higher than zero. Thanks so much for that question. We have time for one last question, operator.

OPERATOR: Robert Hein with American College OBGYN.

PHILIP HEIN: Yes I go by Philip Hein here. I wanted to ask about the CNS malformations. You said you had 4 and 5% in the trimester. Can you make a comment about the malformation, because not all are the same?

ANNE SCHUCHAT: Yes. Let me let Dr. Honein answer that question.

PEGGY HONEIN: So I think that one thing that is very important to emphasize is that the timing here as we have stratified by trimester that the infection was identified so this is based on when the laboratory test was conducted or when symptoms were reported. But may not represent the precise timing of infection. So we are seeing infants that have either brain abnormalities or microcephaly among those who had their infection identified in each trimester of pregnancy. But in some cases it’s a small head circumference without full information about the extent of the presence or absence of brain abnormalities. So I think your question is critical and we’re continuing to follow up on that. But at this stage what we have is fairly preliminary information about the impact that it’s having later in pregnancy. But we definitely have that high on our list of priorities to do more comprehensive follow-up.

PHILIP HEIN: And I certainly would emphasize that in the second/third trimester, as you release this data you need to release your definition in each of those cases of what the CNS malformation is. Just as an example, I may do MRI’s on kids in — at newborn life that I may find a couple percent will have abnormalities that are equivalent to what you’re calling a Zika abnormalities. Just because you see 4 to 5% doesn’t mean it was inherently due to Zika. And I think what — when you list these and you’re going to give the 4 to 5% I think it’s important that you put on the website and have a list of all these abnormalities so a physician or a group looking at such as ACOG can have an idea of what they’re dealing with. I think your point about not knowing the timing in pregnancy is very important. Because we need to make sure that you put that caveat in there because if it’s just timing of blood sample, and we don’t know when it occurred, those all could be first trimester exposures. Actually, what it tells me is you need to focus on the symptomatic because you know the timing and my question would be is the symptomatic ones in the third trimester what was their risk of a severe CNS abnormality?

ANNE SCHUCHAT: Thanks for the comments I think they’re important. As you can imagine, analysis continues and there’s more data to come. I would like to mention though in terms of what was considered a Zika associated abnormality and whether these would be the base line ones, there was a nice report of the base line expected rate of the family of birth defects that are considered in the congenital Zika syndrome. what was going on in several U.S. states prior to Zika’s arrival so that the incidences of these Zika defects in the Zika era could be compared. Of course, there’s a very low background rate. But the fold increases is quite large. I think the issues of further analysis is symptomatic and some these details are very important. The MMWR and other reports have the specific definitions of what is being considered in these abnormalities. I think for the clinical community and for counseling women is very important. Thank you for all the questions. I’m going to let us wrap up now.

KATHY HARBEN: Thank you, Dr. Schuchat and Dr. Ho for joining us today and thank you to the reporters who have joined. A transcript will be posted on the CDC newsroom website as soon as possible. If you have follow-up questions, you can call us at 404-639-3286 or send an e-mail to media @CDC .gov. Thank you for joining us and this concludes our call.

OPERATOR: That concludes today’s conference call. Thank you for participating. You may disconnect at this time.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES