Possible Zika Virus Infection Among Pregnant Women — United States and Territories, May 2016

Simeone, Regina M.; Shapiro-Mendoza, Carrie K.; Meaney‐Delman, Dana; Petersen, Emily E.; Galang, Romeo R.; Oduyebo, Titilope; Rivera-García, Brenda; Valencia‐Prado, Miguel; Newsome, Kimberly; Pérez-Padilla, Janice; Williams, Tonya; Biggerstaff, Matthew; Jamieson, Denise J.; Honein, Margaret A.

doi:10.15585/mmwr.mm6520e1

Cited by 45 publications

(27 citation statements)

References 8 publications

(5 reference statements)

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“…It is also one of the first reports to provide longitudinal follow-up of pregnant women with acute ZIKV. The symptoms commonly noted among women with confirmed ZIKV in this cohort are similar to those described in other cohorts; with rash, arthralgia, fever and conjunctivitis being the most common 3. This cohort reported fetal abnormalities regardless of the maternal gestation at the time of infection, whereas a recent larger study of pregnant women in Columbia with ZIKV showed no fetal abnormalities in women infected in their third trimester.…”

Section: Commentarysupporting

confidence: 81%

Prospective cohort study of pregnant Brazilian women elucidates link between Zika virus infection and fetal abnormalities

Bhadelia

2016

Evid Based Med

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Section: Commentarysupporting

confidence: 81%

Prospective cohort study of pregnant Brazilian women elucidates link between Zika virus infection and fetal abnormalities

Bhadelia

2016

Evid Based Med

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“…1,[15][16][17] Since the epidemic was first recognized in 2015, 39 countries and territories in the Americas have confirmed local mosquito-borne transmission of Zika virus infection. 17 Zika virus disease occurring in pregnant women has been reported from 21 countries as of June 9, 2016, 17 and 11 countries have reported the occurrence of microcephaly or other congenital abnormalities in fetuses or infants.…”

Section: Discussionmentioning

confidence: 99%

Autopsy and Postmortem Studies Are Concordant: Pathology of Zika Virus Infection Is Neurotropic in Fetuses and Infants With Microcephaly Following Transplacental Transmission

Schwartz

2016

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Pathology studies have been important in concluding that Zika virus infection occurring in pregnant women can result in vertical transmission of the agent from mother to fetus. Fetal and infant autopsies have provided crucial direct evidence that Zika virus can infect an unborn child, resulting in microcephaly, other malformations, and, in some cases, death.Objective.-To better understand the etiologic role and mechanism(s) of Zika virus in causing birth defects such as microcephaly, this communication analyzes the spectrum of clinical and autopsy studies reported from fetuses and infants who developed intrauterine Zika virus infection, and compares these findings with experimental data related to Zika virus infection.Design.-Retrospective analysis of reported clinical, autopsy, pathology, and related postmortem studies from 9 fetuses and infants with intrauterine Zika virus infection and microcephaly.Results.-All fetuses and infants examined demonstrated an overlapping spectrum of gross and microscopic neuropathologic abnormalities. Direct cytopathic effects of infection by the Zika virus were confined to the brain; in cases where other organs were evaluated, no direct viral effects were identified.Conclusions.-There is concordance of the spectrum of brain damage, reinforcing previous data indicating that the Zika virus has a strong predilection for cells of the fetal central nervous system following vertical transmission. The occurrence of additional congenital abnormalities suggests that intrauterine brain damage from Zika virus interferes with normal fetal development, resulting in fetal akinesia. Experimental in vitro and in vivo studies of Zika virus infection corroborate the human autopsy findings of neural specificity.

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“…All pregnant women with confirmed or presumptive Zika virus infection, or unspecified flavivirus infection, and their prenatally exposed offspring are being actively monitored for adverse maternal, fetal, neonatal, infant, and child health outcomes through the Zika Active Pregnancy Surveillance System, § a collaboration between PRDH and CDC. PRDH has followed CDC recommendations that pregnant women in areas with evidence of active Zika virus transmission receive screening tests during the first and second trimesters of pregnancy, regardless of symptoms (9). Among 7,308 asymptomatic pregnant women tested during January-July 2016, 43 (<1%) confirmed and 188 (3%) presumptive Zika virus infections were identified.…”

Section: Update: Ongoing Zika Virus Transmission -Puerto Rico Novembmentioning

confidence: 99%

Update: Ongoing Zika Virus Transmission — Puerto Rico, November 1, 2015–July 7, 2016

Adams¹,

Bello-Pagán²,

Lozier³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

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Zika virus is a flavivirus transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes, and infection can be asymptomatic or result in an acute febrile illness with rash (1). Zika virus infection during pregnancy is a cause of microcephaly and other severe birth defects (2). Infection has also been associated with Guillain-Barré syndrome (GBS) (3) and severe thrombocytopenia (4,5). In December 2015, the Puerto Rico Department of Health (PRDH) reported the first locally acquired case of Zika virus infection. This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico (6,7). A confirmed case of Zika virus infection is defined as a positive result for Zika virus testing by reverse transcription-polymerase chain reaction (RT-PCR) for Zika virus in a blood or urine specimen. A presumptive case is defined as a positive result by Zika virus immunoglobulin M (IgM) enzyme-linked immunosorbent assay (MAC-ELISA)* and a negative result by dengue virus IgM ELISA, or a positive test result by Zika IgM MAC-ELISA in a pregnant woman. An unspecified flavivirus case is defined as positive or equivocal results for both Zika and dengue virus by IgM ELISA. During November 1, 2015-July 7, 2016, a total of 23,487 persons were evaluated by PRDH and CDC Dengue Branch for Zika virus infection, including asymptomatic pregnant women and persons with signs or symptoms consistent with Zika virus disease or suspected GBS; 5,582 (24%) confirmed and presumptive Zika virus cases were identified. Persons with Zika virus infection were residents of 77 (99%) of Puerto Rico's 78 municipalities. During 2016, the percentage of positive Zika virus infection cases among symptomatic males and nonpregnant females who were tested increased from 14% in February to 64% in June. Among 9,343 pregnant women tested, 672 had confirmed or presumptive Zika virus infection, including 441 (66%) symptomatic women and 231 (34%) asymptomatic women. One patient died after developing severe thrombocytopenia (4). Evidence of Zika virus infection or recent unspecified flavivirus infection was detected in 21 patients with confirmed GBS. The widespread outbreak and accelerating increase in the number of cases in Puerto Rico warrants intensified vector control and personal protective behaviors to prevent new infections, particularly among pregnant women.

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Possible Zika Virus Infection Among Pregnant Women — United States and Territories, May 2016

Cited by 45 publications

References 8 publications

Prospective cohort study of pregnant Brazilian women elucidates link between Zika virus infection and fetal abnormalities

Prospective cohort study of pregnant Brazilian women elucidates link between Zika virus infection and fetal abnormalities

Autopsy and Postmortem Studies Are Concordant: Pathology of Zika Virus Infection Is Neurotropic in Fetuses and Infants With Microcephaly Following Transplacental Transmission

Update: Ongoing Zika Virus Transmission — Puerto Rico, November 1, 2015–July 7, 2016

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