ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

AttributionNoncommercial 4.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, 

distribution, and reproduction in any medium, provided the original work is properly cited. 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e321, 2019 

ISDS 2019 Conference Abstracts 

Zika Pregnancy Surveillance: Transforming Data into 
Educational and Clinical Tools 

Kara Polen, Titilope Oduyebo, Jazmyn Moore, Sascha Ellinton, Regina Simeone, Samantha 
Olson, Margaret A. Honein, Dana Meaney-Delman 

Centers for Disease Control and Prevention, United States 

Objective 

To describe how Zika virus (Zika) surveillance data informs and improves testing guidance, clinical evaluation and management 

of pregnant women and infants with possible Zika infection 

Introduction 

Little was known about the maternal and fetal/infant effects of Zika infection before the 2015 outbreak in the Americas, which 

made it challenging for public health practitioners and clinicians to care for pregnant women and infants exposed to Zika. In 2016, 

CDC implemented a rapid surveillance system, the US Zika Pregnancy and Infant Registry, to collect information about the impact 

of Zika infection during pregnancy and inform the CDC response and clinical guidance. In partnership with state, tribal, local, and 

territorial health departments, CDC disseminated information from this surveillance system, which served as the foundation for 

educational materials and clinical tools for healthcare providers. 

Methods 

Throughout the Zika response, CDC worked closely with health officers, epidemiologists, and clinical partners to seek expert input 

on the interpretation of emerging data and the evaluation and management of these vulnerable populations. In response to requests 

from clinical and public health partners, CDC created targeted educational materials and tools to facilitate the implementation of 

clinical guidance. These materials equipped healthcare providers with the information needed to care for pregnant women and 

infants with Zika infection. Examples of products developed included: 1) screening tools to identify pregnant women for whom 

testing is indicated; 2) an interactive web tool to assist with implementation and interpretation of Zika testing guidance (Pregnancy 

and Zika Testing Widget); 3) patient counseling scripts; and 4) videos to explain critical clinical concepts (e.g., measurement of 

infant head circumference). These tools were informally pre-tested with the target audiences prior to dissemination, specifically to 

assess usefulness in clinical settings. CDC disseminated these tools through the CDC website and through comprehensive outreach 

(e.g., webinars, calls, email alerts) to various audiences. Additionally, several professional organizations incorporated these tools 

into regular communication with their membership. 

Results 

The US Zika Pregnancy and Infant Registry is currently monitoring infants from approximately 7,300 pregnancies in the US states 

and territories with laboratory evidence of Zika. Surveillance data provided valuable information, including clues toward the pattern 

of defects and other neurologic disabilities associated with congenital Zika infection, estimates of the risks associated with 

congenital infection, and timeframes of greatest risk during pregnancy, to help clinicians counsel pregnant patients with potential 

Zika exposure. CDC used these data to inform their clinical tools, particularly in pretest counseling materials and educational 

factsheets for healthcare providers to use with pregnant women with potential Zika exposure. 

After informal testing among healthcare providers, the tools received positive feedback regarding usefulness and applicability in 

clinical settings. Collectively, CDC’s Zika clinical tools were downloaded more than 300,000 times from CDC’s website. The 

Pregnancy and Zika Testing Widget was accessed and followed to an endpoint (e.g., Zika testing recommended) more than 17,000 

times, with more than 75% of users self-identifying as clinicians. 

Conclusions 

Rapid implementation of Zika surveillance captured evolving data about the impact of Zika on pregnant women and their infants. 

These data informed the development of clinical tools for healthcare providers caring for and counseling patients with Zika 

exposure. These tools ensured pregnant women and infants were adequately monitored during the Zika outbreak. Health education 

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ISDS Annual Conference Proceedings 2019. This is an Open Access article distributed under the terms of the Creative Commons 

AttributionNoncommercial 4.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, 

distribution, and reproduction in any medium, provided the original work is properly cited. 

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 11(1): e321, 2019 

ISDS 2019 Conference Abstracts 

materials and clinical tools based on surveillance data should be considered in future emergency responses, particularly when 

knowledge is rapidly evolving. 

References 

Zika Pregnancy Website CDC. https://www.cdc.gov/pregnancy/zika/materials/index.html 

 

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