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

Bhadelia, Nahid

doi:10.1136/ebmed-2016-110476

Cited by 3 publications

(2 citation statements)

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“…It has been estimated that 5 to 42% of neonates from infected pregnant women develop congenital abnormalities [ 2 , 5 – 8 ]. Nevertheless, there is only a paucity of studies specifically designed to elucidate which maternal- and pregnancy-related factors may be associated with the development of congenital abnormalities among infected pregnant women [ 9 – 11 ]. The identification of such factors might allow the development of interventions aiming to prevent the Congenital Zika Syndrome (CZS).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the development of Congenital Zika Syndrome: a case-control study

et al. 2019

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BackgroundWe aim to investigate possible maternal- and pregnancy-related factors associated with the development of Congenital Zika Syndrome (CZS) in children of mothers with probable gestational infection.MethodsThis case-control study, we recruited mother-infant pairs between May 2015 and October 2017 in a pediatric infectious disease clinic in Rio de Janeiro. Inclusion criteria required either that the mother reported Zika infection symptoms during pregnancy or that the infant presented with clinical or imaging features of the CZS. Exclusion criteria included detection of an alternative cause for the patient’s presentation or negative polymerase chain reaction assays for Zika in all specimens tested within 12 days from the beginning of maternal symptoms. Infants with CZS (CDC definition) were selected as cases and infants without CZS, but with probable maternal Zika virus infection during pregnancy, were selected as controls. Maternal and pregnancy-related informations were collected and their relationship to the presence of congenital anomalies due to CZS was assessed by Fisher exact or Mann-Whitney test.ResultsOut of the 42 included neonates, 24 (57.1%) were diagnosed with CZS (cases). The mean maternal age at the birth was 21 years old. The early occurrence of maternal symptoms during pregnancy was the only variable associated with CZS (odds ratio = 0.87, 95% CI: 0.78–0.97).Case’s mothers presented symptoms until the 25th week of gestational age (GA), while control’s mothers presented until 36th weeks of GA. Income; illicit drug, alcohol, or tobacco use during pregnancy; other infections during pregnancy (including previous dengue infection) were not associated with CZS.ConclusionsOur study corroborates the hypothesis that Zika virus infection earlier in pregnancy is a risk factor to the occurrence of congenital anomalies in their fetuses.

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Section: Introductionmentioning

confidence: 99%

Factors associated with the development of Congenital Zika Syndrome: a case-control study

et al. 2019

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“…ZIKV spread rapidly throughout the Americas [ 4 ], and the World Health Organization (WHO) declared Zika a Public Health Emergency of International Concern in February of 2016 [ 4 ]. ZIKV infection in adults has been associated with Guillain-Barré Syndrome [ 4 – 6 ], and infection during pregnancy can have devastating effects, including severe congenital birth defects such as microcephaly and other neurological and developmental sequelae [ 7 – 10 ]. In Nicaragua, Zika was first confirmed in January of 2016, and the country experienced an explosive epidemic between June and September of 2016 [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Zika virus infection in Nicaraguan households

et al. 2018

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Zika virus (ZIKV) infection recently caused major epidemics in the Americas and is linked to congenital birth defects and Guillain-Barré Syndrome. A pilot study of ZIKV infection in Nicaraguan households was conducted from August 31 to October 21, 2016, in Managua, Nicaragua. We enrolled 33 laboratory-confirmed Zika index cases and their household members (109 contacts) and followed them on days 3–4, 6–7, 9–10, and 21, collecting serum/plasma, urine, and saliva specimens along with clinical, demographic, and socio-economic status information. Collected samples were processed by rRT-PCR to determine viral load (VL) and duration of detectable ZIKV RNA in human bodily fluids. At enrollment, 11 (10%) contacts were ZIKV rRT-PCR-positive and 23 (21%) were positive by IgM antibodies; 3 incident cases were detected during the study period. Twenty of 33 (61%) index households had contacts with ZIKV infection, with an average of 1.9 (range 1–6) positive contacts per household, and in 60% of these households, ≥50% of the members were positive for ZIKV infection. Analysis of clinical information allowed us to estimate the symptomatic to asymptomatic (S:A) ratio of 14:23 (1:1.6) among the contacts, finding 62% of the infections to be asymptomatic. The maximum number of days during which ZIKV RNA was detected was 7 days post-symptom onset in saliva and serum/plasma and 22 days in urine. Overall, VL levels in serum/plasma, saliva, and urine specimens were comparable, with means of 5.6, 5.3 and 4.5 log10 copies/ml respectively, with serum attaining the highest VL peak at 8.1 log10 copies/ml. Detecting ZIKV RNA in saliva over a similar time-period and level as in serum/plasma indicates that saliva could potentially serve as a more accessible diagnostic sample. Finding the majority of infections to be asymptomatic emphasizes the importance of silent ZIKV transmission and helps inform public health interventions in the region and globally.

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Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: From systematic review to living systematic review

et al. 2018

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The Zika virus (ZIKV) outbreak in the Americas has caused Background. international concern due to neurological sequelae linked to the infection, such as microcephaly and Guillain-Barré syndrome (GBS). The World Health Organization stated that there is "sufficient evidence to conclude that Zika virus is a cause of congenital abnormalities and is a trigger of GBS". This conclusion was based on a systematic review of the evidence published until 30.05.2016. Since then, the body of evidence has grown substantially, leading to this update of that systematic review with new evidence published from 30.05.2016 -18.01.2017, update 1.We review evidence on the causal link between ZIKV infection and Methods. adverse congenital outcomes and the causal link between ZIKV infection and GBS or immune-mediated thrombocytopaenia purpura. We also describe the transition of the review into a living systematic review, a review that is continually updated.Between 30.05.2016 and 18.01.2017, we identified 2413 Results. publications, of which 101 publications were included. The evidence added in this update confirms the conclusion of a causal association between ZIKV and adverse congenital outcomes. New findings expand the evidence base in the dimensions of biological plausibility, strength of association, animal experiments and specificity. For GBS, the body of evidence has grown during the search period for update 1, but only for dimensions that were already populated in the previous version. There is still a limited understanding of the biological pathways that potentially cause the occurrence of autoimmune disease following ZIKV infection.This systematic review confirms previous conclusions that ZIKV Conclusions. is a cause of congenital abnormalities, including microcephaly, and is a trigger of GBS. The transition to living systematic review techniques and methodology provides a proof of concept for the use of these methods to synthesise evidence about an emerging pathogen such as ZIKV. Keywords

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

Cited by 3 publications

References 6 publications

Factors associated with the development of Congenital Zika Syndrome: a case-control study

Factors associated with the development of Congenital Zika Syndrome: a case-control study

Zika virus infection in Nicaraguan households

Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: From systematic review to living systematic review

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