RESUMO
BACKGROUND: The United States Virgin Islands (USVI) Department of Health (DOH) conducted a second Zika health brigade (ZHB) in 2021 to provide recommended Zika-related pediatric health screenings, including vision, hearing, neurologic, and developmental screenings, for children in the USVI. This was replicated after the success of the first ZHB in 2018, which provided recommended Zika-related pediatric health screenings to 88 infants and children exposed to Zika virus (ZIKV) during pregnancy. METHODS: Ten specialty pediatric care providers were recruited and traveled to the USVI to conduct the screenings. USVI DOH scheduled appointments for children included in CDC's U.S. Zika Pregnancy and Infant Registry (USZPIR). During the ZHB, participants were examined by pediatric ophthalmologists, pediatric audiologists, and pediatric neurologists. We report the percentage of participants who were referred for additional follow-up care or given follow-up recommendations in the 2021 ZHB and compare these referrals and recommendations to those given in the 2018 ZHB. RESULTS: Thirty-three children born to mothers with laboratory evidence of ZIKV infection during pregnancy completed screenings at the 2021 ZHB, of which 15 (45%) children were referred for additional follow-up care. Ophthalmological screenings resulted in the highest number of new referrals for a specialty provider among ZHB participants, with 6 (18%) children receiving referrals for that specialty. Speech therapy was the most common therapy referral, with 10 (30%) children referred, of which 9 (90%) were among those who attended the 2018 ZHB. CONCLUSIONS: Thirty-three children in a jurisdiction with reduced access to healthcare specialists received recommended Zika-related pediatric health screenings at the ZHB. New and continuing medical and developmental concerns were identified and appropriate referrals for follow-up care and services were provided. The ZHB model was successful in creating connections to health services not previously received by the participants.
Assuntos
Complicações Infecciosas na Gravidez , Infecção por Zika virus , Zika virus , Gravidez , Lactente , Feminino , Humanos , Criança , Ilhas Virgens Americanas , PartoRESUMO
Among children born with laboratory-confirmed Zika virus (ZIKV) infection, visual impairment (VI) can occur despite normal ocular structure. The objective of this report is to describe ocular findings and visual function among children examined during the Department of Health Zika Health Brigade (ZHB) in the United States Virgin Islands in March 2018. This analysis is based on a retrospective chart review of children eligible to participate in the ZHB (i.e., part of the US Zika Pregnancy and Infant Registry) and who were examined by ophthalmologists. Eighty-eight children attended the ZHB. This report includes 81 children [48 (59.3%) males] whose charts were located [average gestational age = 37.6 weeks (range: 27.6-41.3) and average adjusted age at examination = 9.1 months (range: 0.9-21.9)]. Of those examined, 5/81 (6.2%) had microcephaly at birth, 2/81 (2.5%) had a structural eye abnormality, and 19/72 (26.4%) had VI. Among children with normal ocular structure and neurologic examination, 13/51 (25.5%) had VI. Despite a low incidence of abnormal ocular structure and microcephaly, about a quarter of children examined had VI. Our findings emphasize that ophthalmological examinations should be performed in all children with suspicion for antenatal ZIKV infection, even children with normal ocular structure and neurologic examination.
RESUMO
In 2017, Hurricanes Irma and Maria caused significant damage to the United States Virgin Islands (USVI), heightening the challenges many residents faced in accessing adequate healthcare and receiving recommended Zika virus screening services. To address this challenge, the USVI Department of Health (DOH) requested technical assistance from the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the American Academy of Pediatrics (AAP) to organize a health brigade to bring needed medical care to an underserved population. It also established the development of important partnerships between federal and private partners as well as between clinical providers and public health entities such as the Epidemiology & Disease Reporting, Maternal Child Health (MCH), and Infant and Toddlers Programs within the DOH, and local clinicians. This health brigade model could be replicated to ensure recommended evaluations are delivered to populations that may have unmet medical needs due to the complexity of the conditions and/or rural location.
RESUMO
INTRODUCTION: Zika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning. METHODS: Pregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection. RESULTS: Among 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both. CONCLUSION: One in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.
Assuntos
Anormalidades Congênitas/virologia , Transtornos do Neurodesenvolvimento/virologia , Vigilância da População , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/congênito , Samoa Americana/epidemiologia , Pré-Escolar , Anormalidades Congênitas/epidemiologia , District of Columbia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Microcefalia/epidemiologia , Microcefalia/virologia , Micronésia/epidemiologia , Transtornos do Neurodesenvolvimento/epidemiologia , Gravidez , Porto Rico/epidemiologia , Sistema de Registros , Estados Unidos/epidemiologia , Ilhas Virgens Americanas/epidemiologia , Zika virus/isolamento & purificaçãoRESUMO
Research suggests that Mexican immigrants arrive in the United States with equivalent or better health than native-born whites but lose their advantage over time. We seek to examine systematically how well the patterns of initial advantage and deteriorating health apply to immigrants originating from other regions of the world - regions that represent a growing proportion of U.S. immigrants. We begin by identifying which of the groups in our study have a health advantage compared to U.S.-born whites and to Mexican immigrants. We then we assess changes in health over time, controlling for variation in the health profiles of cohorts upon arrival. We use logistic regression of self-rated health and heart conditions with data from the 2004-2013 National Health Interview Survey. The results reveal diversity and similarity in health outcomes across world regions of origin, both on arrival and over time. By comparing and contrasting cases previously examined in isolation, we clarify and qualify theories of the immigrant health paradox and health deterioration.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Nível de Saúde , Adulto , Povo Asiático/etnologia , Povo Asiático/estatística & dados numéricos , População Negra/etnologia , População Negra/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Autorrelato , Estados Unidos/etnologia , População Branca/etnologia , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
This article draws on theories of gender inequality and immigrant health to hypothesize differences among the largest immigrant population, Mexicans, and a lesser known population of Middle Easterners. Using data from the 2000-2007 National Health Interview Surveys, we compare health outcomes among immigrants to those among U.S.-born whites and assess gender differences within each group. We find an immigrant story and a gender story. Mexican and Middle Eastern immigrants are healthier than U.S.-born whites, and men report better health than women regardless of nativity or ethnicity. We identify utilization of health care as a primary mechanism that contributes to both patterns. Immigrants are less likely than U.S.-born whites to interact with the health care system, and women are more likely to do so than men. Thus, immigrant and gender health disparities may partly reflect knowledge of health status rather than actual health.