Dengue, Zika and chikungunya during pregnancy: pre- and post-travel advice and clinical management

Abstract

Rationale for review Young adults of childbearing age and pregnant women are travelling more frequently to tropical areas, exposing them to specific arboviral infections such as dengue, zika and chikungunya viruses, which may impact ongoing and future pregnancies. In this narrative review, we analyse their potential consequences on pregnancy outcomes and discuss current travel recommendations. Main findings Dengue virus may be associated with severe maternal complications, particularly post-partum haemorrhage. Its association with adverse fetal outcomes remains unclear, but prematurity, growth retardation and stillbirths may occur, particularly in cases of severe maternal infection. Zika virus is a teratogenic infectious agent associated with severe brain lesions, with similar risks to other well-known TORCH pathogens. Implications of chikungunya virus in pregnancy are mostly related to intrapartum transmission that may be associated with severe neonatal infections and long-term morbidity. Travel recommendations Few agencies provide specific travel recommendations for travelling pregnant patients or couples trying to conceive and discrepancies exist, particularly regarding Zika virus prevention. The risks significantly depend on epidemiological factors that may be difficult to predict. Prevention relies principally on mosquito control measures. Couples trying to conceive and pregnant women should receive adequate information about the potential risks. It seems reasonable to advise pregnant women to avoid unnecessary travel to Aedes spp. endemic regions. The current rationale to avoid travel and delay conception is debatable in the absence of any epidemic. Post-travel laboratory testing should be reserved for symptomatic patients.

Imported Arbovirus Infections in Spain, 2009–2018

“…As expected, having received pretravel information was a protective factor; however, a high proportion of patients did not seek pretravel advice, an area in need of improvement and identified in other studies (15). Although no vaccines are readily available for use in travelers, simple measures may limit the burden of some of these arbovirus infections, such as avoidance of mosquito bites and the correct diagnosis and education of patients who may transmit the infection to others (e.g., sexual transmission of ZIKV).…”

Zika virus seroprevalence in women who gave birth during Zika virus outbreak in Brazil - a prospective observational study

“…Such conditions provide ideal mosquito habitats, which exacerbated the recent ZIKV outbreak, as well as outbreaks of other arboviruses in Brazil. This puts both inhabitants and travelers at risk [ 10 ] because ZIKV infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies [ 11 ]. It seems a very difficult task to control the mosquito ( Aedes aegipty ) in a region without basic sanitation such as Recife.…”

A Zika Vaccine Generated Using the Chimeric Insect-Specific Binjari Virus Platform Protects against Fetal Brain Infection in Pregnant Mice

“…Either way, regulators would likely seek assurances that a new ZIKV vaccine does not cause ADE of DENV because of some unforeseen suboptimal feature of vaccine design or production. DENV infection during pregnancy can cause severe maternal complications, and severe maternal infections may also be associated with adverse fetal outcomes [ 29 ]. Herein, we show that BinJ/ZIKA-prME vaccination protects against viremia and fetal brain infection in IFNAR −/− dams, and that such vaccination does not cause DENV ADE in IFNAR −/− mice.…”