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Readiness for an Increase in Congenital Zika Virus Infections in the United States: Geographic Distance to Pediatric Subspecialist Care

  • Jeanne Bertolli (a1), Joseph Holbrook (a1), Nina D. Dutton (a2), Bryant Jones (a2), Nicole F. Dowling (a1) and Georgina Peacock (a1)...



The study’s purpose was to investigate readiness for an increase in the congenital Zika infection (CZI) by describing the distribution of pediatric subspecialists needed for the care of children with CZI.


We applied county-level subspecialist counts to US maps, overlaying the geocoded locations of children’s hospitals to assess the correlation of hospital and subspecialist locations. We calculated travel distance from census tract centroids to the nearest in-state children’s hospital by state (with/without > 100 reported adult Zika virus cases) and by regions corresponding to the likely local Zika virus transmission area and to the full range of the mosquito vector. Travel distance percentiles reflect the population of children < 5 years old.


Overall, 95% of pediatric subspecialists across the United States are located in the same county or neighboring county as a children’s hospital. In the states where Zika virus transmission is likely, 25% of children must travel more than 50 miles for subspecialty care; in one state, 50% of children must travel > 100 miles.


The travel distance to pediatric subspecialty care varies widely by state and is likely to be an access barrier in some areas, particularly states bordering the Gulf of Mexico, which may have increasing numbers of CZI cases. (Disaster Med Public Health Preparedness. 2018 page 1 of 11)


Corresponding author

Correspondence and reprint requests to Dr Jeanne Bertolli, 1600 Clifton Road, MS E-88, Atlanta, GA 30329 (e-mail:


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Disaster Medicine and Public Health Preparedness
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