AAP Project ECHO Zika

​AAP P​roject ​ECHO Zika​​​

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The American Academy of Pediatrics (AAP) implemented a national Project ECHO® (Extension for Community Healthcare Outcomes) Zika through a cooperative agreement with the US Department of Health and Human Services Maternal and Child Health Bureau (MCHB). The project launched in February 2017 and was funded through December 2018.

The AAP leveraged the ECHO (Extension for Community Healthcare Outcomes) modelTM to rapidly respond to the emerging Zika crisis in high risk areas, including Puerto Rico, the US Virgin Islands, and American Samoa by establishing and utilizing an international multidisciplinary expert group to guide comprehensive evaluation, diagnosis, management and support for children and their families affected by congenital Zika virus infection. The AAP Project ECHO® Zika aimed to increase pediatric clinician knowledge, comfort, and competence in providing care to children and their families affected by the Zika virus by increasing the clinical expertise of pediatric clinicians to more appropriately provide family-centered, comprehensive, coordinated, and culturally effective care in the context of a medical home for infants and families affected by the Zika virus. When Project ECHO Zika began, no network existed which linked primary care clinicians caring for infants with confirmed or possible CZS to specialists with experience in managing infants and children with similar conditions.

Through this project, the AAP, in collaboration with federal agencies, key partner organizations, and family representatives, worked hand-in-hand to ensure the healthcare system is prepared for future public health emergencies, leveraging the ECHO model approach and technology to respond quickly and offer clinician education and outreach.


The Advisory Committee and Faculty developed a standardized curriculum with the flexibility to evolve as new information becomes available. The following content/modules were available nationally over the course of the project.

  • Congenital Zika Virus Syndrome and Seizures | Slides (English​​)
  • Zika Virus History and Incidence | Slides (English,​ Spanish) | Watch Now​!
  • Congenital Abnormalities | Slides (English) ​
  • Psychosocial Support​​​​ | Slides (English)
  • Early Interventions and Community Resources | Slides (English​) | Watch Now!​
  • CDC Updates: Testing, Guidance and Surveillance | Slides (English​)
  • Congenital Contractures and Hypertonicity | Slides (En​glish​)
  • Zika Virus Incidence: March 2018 Update | Slides (English​​)
  • Routes of Transmission and Possible Outcomes | Slides (English​​​)
  • Clues to Diagnose Clinically Dengue, Chikungunya and Zika | Slides (English​​​​)
  • Imaging the Brain of Infants and Children: Congenital Zika Syndrome| Slides (English​​​)​
  • ​Ocular Manifestations of Congenital Zika Syndrome | Slides (English​)
  • Testing and Diagnostics | Slides ​(English​​)​​​
  • Zika Virus and Pregnancy | Slides (English​)​​
  • Psychosocial Resources | Slides (English​)
  • Follow-up Care for Infants and Children Affected by Zika Virus | Slides (English​​)​
  • Updated Interim Guidance for the Diagnosis, Evaluation and Management of Infants with Possible Congenital Zika Virus Infection | Slides (English​)
  • Zika Virus and Breastfeeding | Slides (English)

The flexible curriculum also included presentations by guest speakers and time-sensitive topics: 

  • Zika Outcomes and Development in Infants and Children (ZODIAC) Project | Slides (English)

  • Zika in Infants and Pregnancy (ZIP) Study and Community Engagement in Puerto Rico | Slides (English)

  • APNI in Puerto Rico: Empowering Families Affected by Congenital Zika Virus Infection | Slides (English​)

  • Hearing Loss in Infants and the Puerto Rican Experience | Slides (English)

  • U.S. Virgin Islands Zika Health Brigade | Slides (English)

  • Zika Virus Vaccine Efforts, June 2018 | Slides (English)


Case-based learning is a key component of the ECHO model.  Participants were highly encouraged to present a case. The presentation was typically 5-10 minutes long and could describe any current or previous patients that may have presented with symptoms related to (or potentially related to) Zika virus. View our case form online.  

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    Advisory Committee Members
    ​​Jennifer Bolden-Pitre, MA, JD/ Family Perspective/Family to Family Networks
    Manda Hall, MD/ Title V/Maternal and Child Health
    Philip Heine, MD/ Maternal-Fetal Medicine/Obstetrics/Gynecology
    Amy Houtrow, MD, PhD, MPH, FAAP/ Physical Medicine and Rehabilitation
    Susan L Hyman, MD, FAAP/ Developmental and Behavioral Medicine
    Yvonne (Bonnie) Maldonado, MD, FAAP/ Infectious Diseases
    Scott Needle, MD, FAAP/ Primary Care/Disaster Preparedness
    Bruce Baird Struminger, MD, MA/ECHO Institute
    Edwin Trevathan, MD, MPH, FAAP/ Neurology
    Ronald Yee, MD, MBA, FAAFP/ Federally Qualified Health Centers
    Fernando Ysern, MD, FAAP/ Pediatrics in Puerto Rico​
    Faculty Members
    ​James Bale, MD, FAAP/ Neurology
    Steve Caddle, MD, FAAP/ Primary Care
    Margaret Fisher, MD, FAAP/ Infectious Disease/Disaster Preparedness
    Deliana Garcia, MA/ Migrant Clinicians Network
    Dixie Griffin, MD, FAAP/ Primary Care
    Abigail Kroening, MD, FAAP/ Developmental/Behavioral Pediatrics
    Ana Medina, MD, FAAP/ Pediatrics in Puerto Rico
    Jennifer Bolden-Pitre, MA, JD/ Family Perspective
    Perry Sheffield, MD, FAAP/ Public and Environmental Health​
    Marcia Tartarella, MD/Ophthalmology



The Zika ECHO program regularly shared news and resources related to Zika virus.  Some of the resources previously shared include those listed below. See the AAP Zika Virus webpage for additional resources for pediatricians.

AAP Resources

CDC Resources

Scholarly Resources

  • Hoen B, Schaub B, Funk A, et al. Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas. N Engl J Med 2018; 378:985-994. DOI: http://dx.doi.org/10.1056/NEJMoa1709481.  

  • ​Fitzgerald B,  Boyle C, PhD, Honein M. Birth Defects Potentially Related to Zika Virus Infection During Pregnancy in the United States. JAMA. 2018;319(12):1195-1196. doi:10.1001/jama.2018.0126.

  • Satterfield-Nash A, Kotzky K, Allen J, et al. Health and Development at Age 19–24 Months of 19 Children Who Were Born with Microcephaly and Laboratory Evidence of Congenital Zika Virus Infection During the 2015 Zika Virus Outbreak — Brazil, 2017. MMWR Morb Mortal Wkly Rep 2017;66:1347–1351. DOI: http://dx.doi.org/10.15585/mmwr.mm6649a2.

  • Delaney A, Mai C, Smoots A, et al. Population-Based Surveillance of Birth Defects Potentially Related to Zika Virus Infection — 15 States and U.S. Territories, 2016. MMWR Morb Mortal Wkly Rep 2018;67:91–96. DOI: http://dx.doi.org/10.15585/mmwr.mm6703a2.

Other Resources

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