Director, Division of Congenital and Developmental Disorders
Centers for Disease Control and Prevention
Collected and analyzed critical data to help protect women and babies from the mosquito-borne Zika virus that was spreading rapidly in the U.S. and its territories
Infections from the mosquito-borne Zika virus exploded in the Americas and began to spread in the U.S. and its territories in 2015 and 2016, triggering devastating birth defects in babies whose mothers had been exposed during pregnancy, and causing widespread alarm.
Margaret (Peggy) Honein from the Centers for Disease Control and Prevention quickly assembled an emergency response team of nearly 200 people to gather the fast-breaking data, determine how the virus worked and figure out how best to protect mothers and babies.
“Peggy led the response to protect women and babies from a terrible new health threat,” said Dr. Tom Frieden, who was the CDC director when the outbreak occurred. “She worked with countries around the world to understand what they had already gone through. She established a means of monitoring and supporting women in this country who were or may have been exposed to Zika, and she worked quickly to prevent Zika to the greatest extent possible.”
A key part of her approach was setting up a system to collect information from women all across the country and in U.S territories who were potentially exposed to the Zika virus during pregnancy. As an expert on birth defects, and knowledgeable about epidemiology from early training in the field, Honein charted what was happening with the infected babies.
The surveillance system she created—the Zika Pregnancy and Infant Registry—had to be built from the ground up and as quickly as possible. States were brought on board to collect information and provide data about women in their jurisdictions who had been infected during pregnancy.
Meanwhile, the science about the Zika virus had become quite complex. Although researchers knew the virus was spread through mosquito bites, “the thing we did not know was the impact on development of the fetus and that transmission of the virus was also occurring sexually,’’ said Dr. Coleen Boyle, director of the CDC’s Center for Birth Defects and Developmental Disabilities.
Honein’s Zika-response team included a diverse group of specialists—maternal and child health care providers; pregnancy, birth defect and infectious disease experts; and emergency preparedness groups, among others. As they analyzed the incoming data, they prepared clinical guidelines for physicians and travel recommendations for women who were pregnant or thinking of becoming pregnant, and for their partners.
Honein and her team produced 13 evidence-based guidance documents and nine scientific publications during the Zika response to inform prevention efforts and the care of pregnant women and their babies. One landmark publication provided conclusive documentation of the health crisis—that among pregnant women with a confirmed Zika infection, 5 to 10 percent of live and stillborn babies had a related birth defect, with the largest number resulting from exposure during the first trimester.
Honein and her team created and oversaw the Zika pregnancy hotline to provide clinical consultations and disseminate vital information, and they established Zika Care Connect, a compendium of state and regional clinical care resources to help women find and access specialty services.
The data collection depended on state and local agencies and on research from countries already impacted by the outbreak. Honein was key to this effort.
“She led a collaboration with our state health departments, local health departments, international partners and the intensive effort with our territories to understand this new syndrome and take action to reduce the risk for babies and mothers,” said Dr. Anne Schuchat, CDC’s principal deputy director. “She brought extraordinary scientific expertise, leadership and management to an unprecedented emergency response to the Zika virus.”
Dr. Denise Jamieson of the Emory University School of Medicine described Honein as “an incredibly careful and gifted scientist” who has “an amazing ability to bring out the very best in people and get people motivated.”
“It’s hard to quantify how many pregnant women were protected against the devastating effects of the Zika infection directly due to her efforts, but based on what we know, I am confident her efforts had a significant impact,” Jamieson said. “And a lot of what she set up in terms of public health systems and public health response will translate when we have the next big outbreak of some devastating infectious disease.”