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Both mothers lived in Cambodia, a region with known ZIKV, during their pregnancies and reported fever and rash in the second trimester. The infants were born with severe microcephaly. Testing for congenital infection at birth and genetic testing were unremarkable. In 2017, serologic testing for both mothers were consistent with prior ZIKV infection. Review of infant neuroimaging demonstrated ventriculomegaly, severe cerebral atrophy, and subcortical calcifications consistent with CZS. Given the maternal symptoms suggesting ZIKV infection during pregnancy and the combination of clinical and radiological features unique to CZS, CZS is strongly suspected in these children, suggesting that CZS occurred before the 2013\u20132014 French Polynesia outbreak. As such, CZS should be considered in older children with congenital microcephaly of unknown etiology and a history consistent with possible ZIKV exposure.<\/jats:p>","DOI":"10.1002\/ajmg.a.40378","type":"journal-article","created":{"date-parts":[[2018,8,7]],"date-time":"2018-08-07T03:31:17Z","timestamp":1533612677000},"page":"1882-1889","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Possible Congenital Zika Syndrome in Older Children Due to Earlier Circulation of Zika Virus"],"prefix":"10.1002","volume":"176","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7480-965X","authenticated-orcid":false,"given":"Victoria","family":"Chu","sequence":"first","affiliation":[{"name":"Kaiser Permanente  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyle R.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention  Fort Collins Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia A.","family":"Moore","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Meaney\u2010Delman","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg","family":"Nelson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente  Roseville California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Christian Sonne","sequence":"additional","affiliation":[{"name":"Kaiser Permanente  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy N.","family":"Dodge","sequence":"additional","affiliation":[{"name":"Helen DeVos Children's Hospital  Grand Rapids Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Glaser","sequence":"additional","affiliation":[{"name":"Kaiser Permanente  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja A.","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6641a1"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/humu.22263"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.03.014"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2011.04.003"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aws019"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31450-2"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2016.21.13.30181"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spen.2012.02.002"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00651-6"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1971.02110050067006"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30253-7"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30318-8"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i1901"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2016.0267"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.38170"},{"key":"e_1_2_7_17_1","doi-asserted-by":"crossref","unstructured":"Dick G. 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