Infectious Disease

Extended maternal Zika viraemia is a big danger issue for start defects

January 14, 2021

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Prolonged viraemia in Zika-infected mothers is associated with a seven-fold higher risk of neonatal or fetal side effects compared to pregnancies without prolonged viraemia, researchers reported.

The study results published in Emerging Infectious Diseases also showed that prolonged viraemia in mothers is associated with a two-fold higher risk of congenital infections than in mothers with Zika virus who do not experience prolonged viraemia.

Leo Pomar

“In the event of Zika infection during pregnancy, the maternal viraemia duration should be respected as it can be an important risk factor for maternal and fetal transmission and subsequent adverse outcomes if it lasts longer than 30 days.” Leo Pomar, PhD, from the University Hospital Lausanne in Switzerland, said Healio.

Pomar and colleagues enrolled pregnant women with Zika virus and uninfected pregnant women in a prospective cohort study at a hospital in French Guiana during the first months of the Zika epidemic between January and July 2016.

Among these were 33 infected and 326 uninfected women who were tested during each trimester and at delivery. The researchers defined prolonged viraemia as ongoing virus detection 30 days or more after infection and adverse outcomes as fetal loss or neurological abnormalities.

They found that adverse outcomes in the newborns and fetuses of the 14 mothers with prolonged viraemia (40%) were more common than in the 19 infected mothers who did not have prolonged viraemia (5.3%; adjusted RR = 7.2; 95 % CI, 0.9) -57.6) or newborns and fetuses from uninfected mothers (6.6%; aRR = 6.7; 95% CI, 3-15.1). They also found that congenital infections were more common in newborns and fetuses born to mothers with prolonged viraemia compared to the other two cohorts (60% versus 26.3% versus 0%; aRR = 2.3; 95 % CI, 0.9-5.5)).

“Our results are not surprising. They confirm the hypothesis that was made at the start of the pandemic, ”Pomar said. “The limits of our study lie mainly in the low proportion of patients with longer viraemia, which prevents the association with more subtle signs and symptoms and a possible selection bias in Zika cohorts, since mothers of fetuses and newborns with undesirable results have undergone systematic reverse transcription – PCR tests that could overestimate the rate of undesirable results. This would not affect the comparison with the control groups. “

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Sarah B. Mulkey, MD, PhD)

Sarah B. Mulkey

The key message of this study is that a pregnant woman with Zika virus infection and persistent viraemia – Zika PCR test positive for 30 days or more after symptoms are detected or the virus is first detected – is at a significantly increased risk of having a congenital baby Zika syndrome and its associated abnormal neurological outcomes. Sequential tests for persistent viraemia may provide more information about the risk to the fetus for women infected with Zika virus. The study by Driggers and colleagues, referred to in the article, was the first report to raise concern that prolonged viraemia may be more likely to be associated with abnormal fetal outcomes, since in this case the fetus had significant cerebral abnormalities and the mother had prolonged viraemia. This 2016 case report in the New England Journal of Medicine is from my colleagues at Children’s National Hospital. However, the presence of prolonged viraemia does not necessarily indicate that the fetus or child has Zika-related birth defects, but is a laboratory test that can be used as a marker of increased risk.

This study could support an addition to the current clinical guidelines for evaluating pregnant women with Zika virus infection that Zika PCR tests should be performed serially to negative every 2 to 4 weeks, along with serial imaging to assess fetal Detect anomalies. The presence of prolonged viraemia may increase clinical concern about a possible risk of infection to the fetus.

Other Zika pregnancy cohorts with available Zika PCR data should produce similar results when data are available. In a future Zika virus outbreak, pregnant women should be given serial Zika PCR tests to better correlate the duration of the viraemia with the pregnancy and the child’s results.

Reference:

Driggers RW et al. N Engl J Med. 2016; doi: 10.1056 / NEJMoa1601824.

Sarah B. Mulkey

Fetal-neonatal neurologist

Co-Director of the Congenital Infection Program

National Children’s Hospital

Washington, DC

Disclosure: Mulkey reports that he has received grants from the NIH and the Thrasher Research Fund for Zika studies.

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