A grim first: New York City reports baby born with a Zika-related defect

NEW YORK — Health officials on Friday reported the first baby born in New York City with the Zika-related birth defect known as microcephaly, a condition marked by an abnormally small head and impaired brain development.

The virus has caused more than 1,500 children to be born with birth defects around the world, mostly in Brazil. As it continues to spread, doctors are struggling to understand the virus and to prepare for its effects.

The baby in New York is one of a growing number of children born in the United States with microcephaly, a condition that requires intensive care and can lead to a variety of problems, including seizures, vision and hearing loss and intellectual disability.

There have been reports of about a dozen children in the United States being born with Zika-related microcephaly since the spring, including cases in New Jersey and Florida.

As in those instances, the mother in New York is thought to have been infected while traveling to one of the roughly 50 countries where Zika is endemic.

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Health officials said that the baby with microcephaly tested positive for the virus after being born at a New York City hospital this month. They declined to provide additional details about the case, including whether the virus had been previously diagnosed in the mother, or if she was monitored as part of a national registry created to track pregnancy outcomes for those who become infected.

At a news conference on Friday, officials said the case should serve as warning to anyone who considered the virus to be just a theoretical threat and once again urged all pregnant women not to travel to countries where Zika is endemic.

"While not surprising, given the travel trends of our global city, this case is a strong reminder of the tragic consequences of the Zika virus," Dr. Mary T. Bassett, New York City's health commissioner, said in a statement. "We are monitoring the baby's health closely and connecting the family with the necessary services to take care of their child."

As of last week, 2,000 pregnant women in the city who had traveled to areas where there is active transmission of Zika had requested testing, officials said. Of those who have been tested, 41 have been confirmed to have the virus as of July 15.

"I remind all pregnant women in New York City, and those trying to get pregnant, that they should delay travel to places where there is active Zika transmission," Bassett said. "As we see today, the consequences for the child can be devastating."

As awareness of the Zika virus has grown, so have requests for tests. The city health department received 56 requests July 15, officials said.

The virus is most often spread by the Aedes aegypti mosquito, but there is increasing concern about other means of transmission.

The risk of sexual transmission has been a growing concern, and, last week, the health department reported the first case of a woman passing the virus to a man through intercourse.

More recently, a case in Utah raised new questions because it did not appear that the virus had been transmitted through sex or by mosquito.

The Utah patient, who has fully recovered, was a "family contact" who provided care for an older man who had become infected with the virus after traveling abroad.

As that case illustrated, much remains unknown about the virus, including how exactly it is able to travel from mother to fetus, a capacity uncommon among viruses.

While most people infected with Zika suffer only a mild illness, the virus poses a great danger to women who are pregnant. Studies have shown that a pregnant woman who becomes infected has a chance of from 1 to 29 percent of her child being born with microcephaly. The wide range reflects the lack of scientific knowledge on the subject.

There is no cure for Zika, and health officials estimate that it will cost more than $10 million to care for each child born with birth defects.

The Centers for Disease Control and Prevention convened a conference for doctors this week as part of an effort to develop best practices for caring for children born with microcephaly and other Zika-related birth defects.

As with the virus itself, there are many questions about how to best care for affected children and counsel their families.

For instance, all the cases so far have involved children born with microcephaly, known as congenital microcephaly.

But officials do not yet know if a newborn infected with Zika at birth could develop microcephaly later, which is called acquired microcephaly. There is also an incomplete understanding of other possible developmental problems that may be associated with the virus.

Even detecting microcephaly before birth is complicated.

During pregnancy, a baby's head grows because the brain grows. Microcephaly can occur because a baby's brain has not developed properly during pregnancy, or has stopped growing after birth.

However, the earliest that the condition has been detected in ultrasounds is the mid-to-late second trimester; it is more commonly detected in the third trimester.

"The city has been preparing for this scenario for many months now, and we stand ready to help families caring for an infant with microcephaly," Herminia Palacio, deputy mayor for health and human services, said. "This case is a sad reminder that Zika can have tragic consequences for pregnant women."