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Morris RK, Johnstone E, Lees C, Morton V, Smith G. Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31). BJOG 2024; 131:e31-e80. [PMID: 38740546 DOI: 10.1111/1471-0528.17814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Key recommendations
All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP]
Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP]
Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A]
Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B]
Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C]
Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B]
Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C]
Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C]
Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B]
In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B]
Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B]
In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]
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Koenig MR, Vazquez J, Leyva Jaimes FB, Mitzey AM, Stanic AK, Golos TG. Decidual leukocytes respond to African lineage Zika virus infection with mild anti-inflammatory changes during acute infection in rhesus macaques. Front Immunol 2024; 15:1363169. [PMID: 38515747 PMCID: PMC10954895 DOI: 10.3389/fimmu.2024.1363169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Zika virus (ZIKV) can be vertically transmitted during pregnancy resulting in a range of adverse pregnancy outcomes. The decidua is commonly found to be infected by ZIKV, yet the acute immune response to infection remains understudied in vivo. We hypothesized that in vivo African-lineage ZIKV infection induces a pro-inflammatory response in the decidua. To test this hypothesis, we evaluated the decidua in pregnant rhesus macaques within the first two weeks following infection with an African-lineage ZIKV and compared our findings to gestationally aged-matched controls. Decidual leukocytes were phenotypically evaluated using spectral flow cytometry, and cytokines and chemokines were measured in tissue homogenates from the decidua, placenta, and fetal membranes. The results of this study did not support our hypothesis. Although ZIKV RNA was detected in the decidual tissue samples from all ZIKV infected dams, phenotypic changes in decidual leukocytes and differences in cytokine profiles suggest that the decidua undergoes mild anti-inflammatory changes in response to that infection. Our findings emphasize the immunological state of the gravid uterus as a relatively immune privileged site that prioritizes tolerance of the fetus over mounting a pro-inflammatory response to clear infection.
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Affiliation(s)
- Michelle R. Koenig
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Jessica Vazquez
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
| | - Fernanda B. Leyva Jaimes
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
| | - Ann M. Mitzey
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Aleksandar K. Stanic
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
| | - Thaddeus G. Golos
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
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Growth Velocity and Nutritional Status in Children Exposed to Zika Virus during Pregnancy from Amazonas Cohort, Brazil. Viruses 2023; 15:v15030662. [PMID: 36992371 PMCID: PMC10056230 DOI: 10.3390/v15030662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
The high incidence of Zika virus (ZIKV) infection in the period of 2015–2016 in Brazil may have affected linear height growth velocity (GV) in children exposed in utero to ZIKV. This study describes the growth velocity and nutritional status based on the World Organization (WHO) standards of children exposed to ZIKV during pregnancy and followed up in a tertiary unit, a reference for tropical and infectious diseases in the Amazon. Seventy-one children born between March 2016 and June 2018 were monitored for anthropometric indices: z-score for body mass index (BMI/A); weight (W/A); height (H/A) and head circumference (HC/A); and growth velocity. The mean age at the last assessment was 21.1 months (SD ± 8.93). Four children had congenital microcephaly and severe neurological impairment. The other 67 were non-microcephalic children (60 normocephalic and 7 macrocephalic); of these; 24.2% (16 children) had neurological alterations, and 28.8% (19 children) had altered neuropsychomotor development. Seventeen (24.2%) children had inadequate GV (low growth velocity). The frequencies of low growth among microcephalic and non-microcephalic patients are 25% (1 of 4 children) and 23.9% (16 of 67 children); respectively. Most children had normal BMI/A values during follow-up. Microcephalic patients showed low H/A and HC/A throughout the follow-up, with a significant reduction in the HC/A z-score. Non-microcephalic individuals are within the regular ranges for H/A; HC/A; and W/A, except for the H/A score for boys. This study showed low growth velocity in children with and without microcephaly, highlighting the need for continuous evaluation of all children born to mothers exposed to ZIKV during pregnancy.
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Herrera TT, Cubilla-Batista I, Goodridge A, Pereira TV. Diagnostic accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome: Systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:962765. [PMID: 36250095 PMCID: PMC9556817 DOI: 10.3389/fmed.2022.962765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe aim of this study was to assess the accuracy of prenatal imaging for the diagnosis of congenital Zika syndrome.Data sourcesMedline (via Pubmed), PubMed, Scopus, Web of Science, and Google Scholar from inception to March 2022. Two researchers independently screened study titles and abstracts for eligibility.Study eligibility criteriaObservational studies with Zika virus-infected pregnant women were included. The index tests included ultrasound and/or magnetic resonance imaging. The reference standard included (1) Zika infection-related perinatal death, stillbirth, and neonatal death within the first 48 h of birth, (2) neonatal intensive care unit admission, and (3) clinically defined adverse perinatal outcomes.Synthesis methodsWe extracted 2 × 2 contingency tables. Pooled sensitivity and specificity were estimated using the random-effects bivariate model and assessed the summary receiver operating characteristic (ROC) curve. Risk of bias was assessed using QUADAS 2 tool. The certainty of the evidence was evaluated with grading of recommendations.ResultsWe screened 1,459 references and included 18 studies (2359 pregnant women, 347 fetuses with confirmed Zika virus infection). Twelve studies (67%) were prospective cohorts/case series, and six (37%) were retrospective cohort/case series investigations. Fourteen studies (78%) were performed in endemic regions. Ten studies (56%) used prenatal ultrasound only, six (33%) employed ultrasound and fetal MRI, and two studies (11%) used prenatal ultrasound and postnatal fetal MRI. A total of six studies (ultrasound only) encompassing 780 pregnant women (122 fetuses with confirmed Zika virus infection) reported relevant data for meta-analysis (gestation age at which ultrasound imagining was captured ranged from 16 to 34 weeks). There was large heterogeneity across studies regarding sensitivity (range: 12 to 100%) and specificity (range: 50 to 100%). Under a random-effects model, the summary sensitivity of ultrasound was 82% (95% CI, 19 to 99%), and the summary specificity was 97% (71 to 100%). The area under the ROC curve was 97% (95% CI, 72 to 100%), and the summary diagnostic odds ratio was 140 (95% CI, 3 to 7564, P < 0.001). The overall certainty of the evidence was “very low”.ConclusionUltrasound may be useful in improving the diagnostic accuracy of Zika virus infection in pregnancy. However, the evidence is still substantially uncertain due to the methodological limitations of the available studies. Larger, properly conducted diagnostic accuracy studies of prenatal imaging for the diagnosis of congenital Zika syndrome are warranted.Systematic review registrationIdentifier [CRD42020162914].
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Affiliation(s)
- Tania T. Herrera
- Centro de Investigación Médica Pacifica Salud-INDICASAT AIP, Pacifica Salud, Hospital Punta Pacicifica, Panama City, Panama
- Centro de Biología Celular y Molecular de Enfermedades-Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
- *Correspondence: Tania T. Herrera,
| | - Idalina Cubilla-Batista
- Centro de Biología Celular y Molecular de Enfermedades-Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
- Hospital Rafael Estévez, Caja de Seguro Social, Aguadulce, Panama
| | - Amador Goodridge
- Centro de Biología Celular y Molecular de Enfermedades-Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
| | - Tiago V. Pereira
- Department of Health Sciences, College of Medicine, University of Leicester, Leicester, United Kingdom
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de Aguiar EB, Pone SM, Gomes Junior SCDS, Soares FVM, Zin AA, Vasconcelos ZFM, Ribeiro CTM, Pereira Junior JP, Moreira MEL, Nielsen-Saines K, Pone MVDS. Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life. Viruses 2022; 14:v14050876. [PMID: 35632618 PMCID: PMC9147871 DOI: 10.3390/v14050876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/12/2022] [Accepted: 04/15/2022] [Indexed: 12/20/2022] Open
Abstract
Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from −0.45 ± 0.1 to 0.27 ± 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus −1.84 ± 0.2 to −2.15 ± 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from −0.3 ± 0.1 at 1 month to 0.17 ± 0.2 SD between 31 and 36 months in the NCZS group, versus −2.3 ± 0.3 to −2.0 ± 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 ± 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 ± 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.
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Affiliation(s)
- Elisa Barroso de Aguiar
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
- Correspondence: ; Tel.: +55-21-99584-9013
| | - Sheila Moura Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Saint Clair dos Santos Gomes Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Fernanda Valente Mendes Soares
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Andrea Araujo Zin
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Zilton Farias Meira Vasconcelos
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Carla Trevisan Martins Ribeiro
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - José Paulo Pereira Junior
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Maria Elisabeth Lopes Moreira
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
| | - Karin Nielsen-Saines
- David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Marcos Vinicius da Silva Pone
- National Institute of Women, Children and Adolescents’ Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil; (S.M.P.); (S.C.d.S.G.J.); (F.V.M.S.); (A.A.Z.); (Z.F.M.V.); (C.T.M.R.); (J.P.P.J.); (M.E.L.M.); (M.V.d.S.P.)
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6
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Ausderau K, Kabakov S, Razo E, Mitzey AM, Bach KM, Crooks CM, Dulaney N, Keding L, Salas-Quinchucua C, Medina-Magües LG, Weiler AM, Bliss M, Eickhoff J, Simmons HA, Mejia A, Antony KM, Morgan T, Capuano S, Schneider ML, Aliota MT, Friedrich TC, O’Connor DH, Golos TG, Mohr EL. Neonatal Development in Prenatally Zika Virus-Exposed Infant Macaques with Dengue Immunity. Viruses 2021; 13:1878. [PMID: 34578459 PMCID: PMC8473338 DOI: 10.3390/v13091878] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023] Open
Abstract
Infants exposed to Zika virus (ZIKV) prenatally may develop birth defects, developmental deficits, or remain asymptomatic. It is unclear why some infants are more affected than others, although enhancement of maternal ZIKV infection via immunity to an antigenically similar virus, dengue virus (DENV), may play a role. We hypothesized that DENV immunity may worsen prenatal ZIKV infection and developmental deficits in offspring. We utilized a translational macaque model to examine how maternal DENV immunity influences ZIKV-exposed infant macaque neurodevelopment in the first month of life. We inoculated eight macaques with prior DENV infection with ZIKV, five macaques with ZIKV, and four macaques with saline. DENV/ZIKV-exposed infants had significantly worse visual orientation skills than ZIKV-exposed infants whose mothers were DENV-naive, with no differences in motor, sensory or state control development. ZIKV infection characteristics and pregnancy outcomes did not individually differ between dams with and without DENV immunity, but when multiple factors were combined in a multivariate model, maternal DENV immunity combined with ZIKV infection characteristics and pregnancy parameters predicted select developmental outcomes. We demonstrate that maternal DENV immunity exacerbates visual orientation and tracking deficits in ZIKV-exposed infant macaques, suggesting that human studies should evaluate how maternal DENV immunity impacts long-term neurodevelopment.
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Affiliation(s)
- Karla Ausderau
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin–Madison, Madison, WI 53706, USA; (K.A.); (S.K.); (K.M.B.); (N.D.); (M.L.S.)
- Waisman Center, University of Wisconsin–Madison, Madison, WI 53706, USA
| | - Sabrina Kabakov
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin–Madison, Madison, WI 53706, USA; (K.A.); (S.K.); (K.M.B.); (N.D.); (M.L.S.)
| | - Elaina Razo
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI 53792, USA;
| | - Ann M. Mitzey
- Department of Comparative Biosciences, University of Wisconsin–Madison, Madison, WI 53706, USA; (A.M.M.); (L.K.); (T.G.G.)
| | - Kathryn M. Bach
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin–Madison, Madison, WI 53706, USA; (K.A.); (S.K.); (K.M.B.); (N.D.); (M.L.S.)
| | - Chelsea M. Crooks
- Department of Pathobiological Sciences, University of Wisconsin–Madison, Madison, WI 53706, USA; (C.M.C.); (C.S.-Q.); (L.G.M.-M.); (T.C.F.)
| | - Natalie Dulaney
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin–Madison, Madison, WI 53706, USA; (K.A.); (S.K.); (K.M.B.); (N.D.); (M.L.S.)
| | - Logan Keding
- Department of Comparative Biosciences, University of Wisconsin–Madison, Madison, WI 53706, USA; (A.M.M.); (L.K.); (T.G.G.)
| | - Cristhian Salas-Quinchucua
- Department of Pathobiological Sciences, University of Wisconsin–Madison, Madison, WI 53706, USA; (C.M.C.); (C.S.-Q.); (L.G.M.-M.); (T.C.F.)
| | - Lex G. Medina-Magües
- Department of Pathobiological Sciences, University of Wisconsin–Madison, Madison, WI 53706, USA; (C.M.C.); (C.S.-Q.); (L.G.M.-M.); (T.C.F.)
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
| | - Mason Bliss
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison, WI 53792, USA;
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
| | - Kathleen M. Antony
- Department of Obstetrics and Gynecology, University of Wisconsin–Madison, Madison, WI 53705, USA;
| | - Terry Morgan
- Center for Developmental Health, Department of Obstetrics and Gynecology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Saverio Capuano
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
| | - Mary L. Schneider
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin–Madison, Madison, WI 53706, USA; (K.A.); (S.K.); (K.M.B.); (N.D.); (M.L.S.)
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Minneapolis, MN 55108, USA;
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin–Madison, Madison, WI 53706, USA; (C.M.C.); (C.S.-Q.); (L.G.M.-M.); (T.C.F.)
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
| | - David H. O’Connor
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
- Department of Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison, WI 53705, USA
| | - Thaddeus G. Golos
- Department of Comparative Biosciences, University of Wisconsin–Madison, Madison, WI 53706, USA; (A.M.M.); (L.K.); (T.G.G.)
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI 53715, USA; (A.M.W.); (M.B.); (H.A.S.); (A.M.); (S.C.III); (D.H.O.)
- Department of Obstetrics and Gynecology, University of Wisconsin–Madison, Madison, WI 53705, USA;
| | - Emma L. Mohr
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI 53792, USA;
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Li M, Brokaw A, Furuta AM, Coler B, Obregon-Perko V, Chahroudi A, Wang HY, Permar SR, Hotchkiss CE, Golos TG, Rajagopal L, Adams Waldorf KM. Non-human Primate Models to Investigate Mechanisms of Infection-Associated Fetal and Pediatric Injury, Teratogenesis and Stillbirth. Front Genet 2021; 12:680342. [PMID: 34290739 PMCID: PMC8287178 DOI: 10.3389/fgene.2021.680342] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/25/2021] [Indexed: 12/25/2022] Open
Abstract
A wide array of pathogens has the potential to injure the fetus and induce teratogenesis, the process by which mutations in fetal somatic cells lead to congenital malformations. Rubella virus was the first infectious disease to be linked to congenital malformations due to an infection in pregnancy, which can include congenital cataracts, microcephaly, hearing impairment and congenital heart disease. Currently, human cytomegalovirus (HCMV) is the leading infectious cause of congenital malformations globally, affecting 1 in every 200 infants. However, our knowledge of teratogenic viruses and pathogens is far from complete. New emerging infectious diseases may induce teratogenesis, similar to Zika virus (ZIKV) that caused a global pandemic in 2016-2017; thousands of neonates were born with congenital microcephaly due to ZIKV exposure in utero, which also included a spectrum of injuries to the brain, eyes and spinal cord. In addition to congenital anomalies, permanent injury to fetal and neonatal organs, preterm birth, stillbirth and spontaneous abortion are known consequences of a broader group of infectious diseases including group B streptococcus (GBS), Listeria monocytogenes, Influenza A virus (IAV), and Human Immunodeficiency Virus (HIV). Animal models are crucial for determining the mechanism of how these various infectious diseases induce teratogenesis or organ injury, as well as testing novel therapeutics for fetal or neonatal protection. Other mammalian models differ in many respects from human pregnancy including placentation, labor physiology, reproductive tract anatomy, timeline of fetal development and reproductive toxicology. In contrast, non-human primates (NHP) most closely resemble human pregnancy and exhibit key similarities that make them ideal for research to discover the mechanisms of injury and for testing vaccines and therapeutics to prevent teratogenesis, fetal and neonatal injury and adverse pregnancy outcomes (e.g., stillbirth or spontaneous abortion). In this review, we emphasize key contributions of the NHP model pre-clinical research for ZIKV, HCMV, HIV, IAV, L. monocytogenes, Ureaplasma species, and GBS. This work represents the foundation for development and testing of preventative and therapeutic strategies to inhibit infectious injury of human fetuses and neonates.
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Affiliation(s)
- Miranda Li
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
- Department of Biological Sciences, Columbia University, New York, NY, United States
| | - Alyssa Brokaw
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anna M. Furuta
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Veronica Obregon-Perko
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Hsuan-Yuan Wang
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Sallie R. Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Charlotte E. Hotchkiss
- Washington National Primate Research Center, University of Washington, Seattle, WA, United States
| | - Thaddeus G. Golos
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Lakshmi Rajagopal
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Kristina M. Adams Waldorf
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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8
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Candelo E, Sanz AM, Ramirez-Montaño D, Diaz-Ordoñez L, Granados AM, Rosso F, Nevado J, Lapunzina P, Pachajoa H. A Possible Association Between Zika Virus Infection and CDK5RAP2 Mutation. Front Genet 2021; 12:530028. [PMID: 33815457 PMCID: PMC8018576 DOI: 10.3389/fgene.2021.530028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Flaviviridae family belongs to the Spondweni serocomplex, which is mainly transmitted by vectors from the Aedes genus. Zika virus (ZIKV) is part of this genus. It was initially reported in Brazil in December 2014 as an unknown acute generalized exanthematous disease and was subsequently identified as ZIKV infection. ZIKV became widespread all over Brazil and was linked with potential cases of microcephaly. Case report We report a case of a 28-year-old Colombian woman, who came to the Obstetric Department with an assumed conglomerate of fetal abnormalities detected via ultrasonography, which was performed at 29.5 weeks of gestation. The patient presented with multiple abnormalities, which range from a suggested Arnold–Chiari malformation, compromising the lateral and third ventricles, liver calcifications, bilateral pyelocalic dilatations, other brain anomalies, and microcephaly. At 12 weeks of gestation, the vertical transmission of ZIKV was suspected. At 38.6 weeks of gestation, the newborn was delivered, with the weight in the 10th percentile (3,180 g), height in the 10th percentile (48 cm), and cephalic circumference under the 2nd percentile (31 cm). Due to the physical findings, brain magnetic resonance imaging (MRI) was performed, revealing a small and deviated brain stem, narrowing of the posterior fossa, a giant posterior fossa cyst with ventricular dilatation, a severe cortical and white matter thinning, cerebellar vermis with hypoplasia, and superior and lateral displacement of the cerebellum. In addition, hydrocephalus was displayed by the axial sequence, and the cerebral cortex was also compromised with lissencephaly. Schizencephaly was found with left frontal open-lip, and no intracranial calcifications were found. Two novel heterozygous nonsense mutations were identified using whole-exome sequencing, and both are located in exon 8 under the affection of ZIKV congenital syndrome (CZS) that produced a premature stop codon resulting in the truncation of the cyclin-dependent kinase 5 regulatory subunit-associated protein 2 (CDK5RAP2) protein. Conclusion We used molecular and microbiological assessments to report the initial case of vertically transmitted ZIKV infection with congenital syndrome associated with a neurological syndrome, where a mutation in the CDK5RAP2 gene was also identified. The CDK5RAP2 gene encodes a pericentriolar protein that intervenes in microtubule nucleation and centriole attachment. Diallelic mutation has previously been associated with primary microcephaly.
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Affiliation(s)
- Estephania Candelo
- Universidad Icesi, Ear Institute University College London and Fundación Valle del Lili, Cali, Colombia.,Center for Research on Congenital Anomalies and Rare Diseases (CIACER), Department of Basic Medical Sciences, Universidad Icesi, Cali, Colombia
| | | | - Diana Ramirez-Montaño
- Center for Research on Congenital Anomalies and Rare Diseases (CIACER), Department of Basic Medical Sciences, Universidad Icesi, Cali, Colombia
| | - Lorena Diaz-Ordoñez
- Center for Research on Congenital Anomalies and Rare Diseases (CIACER), Department of Basic Medical Sciences, Universidad Icesi, Cali, Colombia
| | | | | | - Julian Nevado
- Instituto de Genética Médica y Molecular (INGEMM), IdiPAZ, HospitalUniversitario La Paz, Madrid, CIBER de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Pablo Lapunzina
- Instituto de Genética Médica y Molecular (INGEMM), IdiPAZ, HospitalUniversitario La Paz, Madrid, CIBER de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Harry Pachajoa
- Center for Research on Congenital Anomalies and Rare Diseases (CIACER), Department of Basic Medical Sciences, Universidad Icesi, Cali, Colombia.,Genetics Department, Fundación Valledel Lili, Cali, Colombia
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9
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Drouin A, Wallbillich N, Theberge M, Liu S, Katz J, Bellovoda K, Se Yun Cheon S, Gootkind F, Bierman E, Zavras J, Berberich MJ, Kalocsay M, Guastaldi F, Salvadori N, Troulis M, Fusco DN. Impact of Zika virus on the human type I interferon osteoimmune response. Cytokine 2021; 137:155342. [PMID: 33130337 DOI: 10.1016/j.cyto.2020.155342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The developing field of osteoimmunology supports importance of an interferon (IFN) response pathway in osteoblasts. Clarifying osteoblast-IFN interactions is important because IFN is used as salvage anti-tumor therapy but systemic toxicity is high with variable clinical results. In addition, osteoblast response to systemic bursts and disruptions of IFN pathways induced by viral infection may influence bone remodeling. ZIKA virus (ZIKV) infection impacts bone development in humans and IFN response in vitro. Consistently, initial evidence of permissivity to ZIKV has been reported in human osteoblasts. HYPOTHESIS Osteoblast-like Saos-2 cells are permissive to ZIKV and responsive to IFN. METHODS Multiple approaches were used to assess whether Saos-2 cells are permissive to ZIKV infection and exhibit IFN-mediated ZIKV suppression. Proteomic methods were used to evaluate impact of ZIKV and IFN on Saos-2 cells. RESULTS Evidence is presented confirming Saos-2 cells are permissive to ZIKV and support IFN-mediated suppression of ZIKV. ZIKV and IFN differentially impact the Saos-2 proteome, exemplified by HELZ2 protein which is upregulated by IFN but non responsive to ZIKV. Both ZIKV and IFN suppress proteins associated with microcephaly/pseudo-TORCH syndrome (BI1, KI20A and UBP18), and ZIKV induces potential entry factor PLVAP. CONCLUSIONS Transient ZIKV infection influences osteoimmune state, and IFN and ZIKV activate distinct proteomes in Saos-2 cells, which could inform therapeutic, engineered, disruptions.
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Affiliation(s)
- Arnaud Drouin
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70114, United States; Department of Pathology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70114, United States
| | - Nicholas Wallbillich
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70114, United States
| | - Marc Theberge
- Tulane University, 6823 St Charles Ave, New Orleans, LA 70118, United States
| | - Sharon Liu
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70114, United States
| | - Joshua Katz
- Tulane University, 6823 St Charles Ave, New Orleans, LA 70118, United States
| | - Kamela Bellovoda
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Scarlett Se Yun Cheon
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Frederick Gootkind
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States
| | - Emily Bierman
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States
| | - Jason Zavras
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States
| | - Matthew J Berberich
- Laboratory of Systems Pharmacology, Harvard Medical School, Armenise Building, 200 Longwood, Ave, Boston, MA 02115, United States
| | - Marian Kalocsay
- Laboratory of Systems Pharmacology, Harvard Medical School, Armenise Building, 200 Longwood, Ave, Boston, MA 02115, United States
| | - Fernando Guastaldi
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States
| | - Nicolas Salvadori
- Institut de recherche pour le développement (IRD)-PHPT, Marseille, France; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Maria Troulis
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States
| | - Dahlene N Fusco
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70114, United States.
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10
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Souza JP, Méio MDBB, de Andrade LM, Figueiredo MR, Gomes Junior SC, Pereira Junior JP, Brickley E, Lopes Moreira ME. Adverse fetal and neonatal outcomes in pregnancies with confirmed Zika Virus infection in Rio de Janeiro, Brazil: A cohort study. PLoS Negl Trop Dis 2021; 15:e0008893. [PMID: 33395421 PMCID: PMC7781387 DOI: 10.1371/journal.pntd.0008893] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To analyze adverse fetal and neonatal outcomes of Zika virus infection by the timing of infection during pregnancy. Method: Cohort study of 190 pregnancies with 193 offspring with a positive RT-PCR test for Zika virus (March/2016 to April/2017). RESULTS Death or defects related to congenital Zika virus infection were identified in 37.3% of fetuses and newborns, and microcephaly in 21.4% of the newborns. The proportion of small for gestational age newborns was 21.9%. Maternal symptoms in the first trimester were significantly associated with the birth of newborns with microcephaly/cerebral atrophy, small for gestational age and with the deaths (one abortion, one stillbirth and the two neonatal deaths). Maternal infection during the second trimester was further associated with asymptomatic newborns at birth. The study showed that 58.5% of the offspring with microcephaly and / or cortical atrophy were small for gestational age, with an evident decrease in symptomatic offspring without microcephaly, 24.1%, and with only 9.1% in the asymptomatic group. CONCLUSION This study showed that the earlier the symptoms appear during gestation, the more severe the endpoints. We found a higher percentage of small for gestational age newborns exposed to Zika virus early in gestation. We also found a group of apparently asymptomatic newborns with proven Zika infection, which highlights the importance of follow up studies in this population.
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Affiliation(s)
- Juliana P. Souza
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Dalva B. B. Méio
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura Medeiros de Andrade
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mirza R. Figueiredo
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Saint Clair Gomes Junior
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose Paulo Pereira Junior
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elizabeth Brickley
- Assistant Professor of Infectious Disease Epidemiology, Faculty of Epidemiology and Population, London School Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira–IFF/Fundação Oswaldo Cruz–Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Clinico-epidemiological and genomic profile of first Zika Virus outbreak in India at Jaipur city of Rajasthan state. J Infect Public Health 2020; 13:1920-1926. [PMID: 33172818 DOI: 10.1016/j.jiph.2020.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND First Zika virus (ZIKV) positive case from North India was detected on routine surveillance of Dengue-Like Illness in an 85-year old female. Objective of the study was to conduct an investigation for epidemiological, clinical and genomic analysis of first ZIKV outbreak in Rajasthan, North India and enhance routine ZIKV surveillance. METHOD Outbreak investigation was performed in 3 Km radius of the index case among patient contacts, febrile cases, and pregnant women. Routine surveillance was enhanced to include samples from various districts of Rajasthan. Presence of ZIKV in serum and urine samples was detected by real time PCR test and CDC trioplex kit. Few ZIKV positive samples were sequenced using the next-generation sequencing method for genomic analysis. RESULT On outbreak investigation 153/2043 (7.48%) cases were found positive: 1/153 (0.65%) among contacts, 90/153 (58.8%) in fever cases, 62/153(40.5%) in pregnant females. In routine surveillance, 6/4722 (0.12%) serum samples were ZIKV positive.Majority of patients had mild signs and symptoms, no case of microcephaly and Guillain- Barre Syndrome was seen, 25 (40.3%) pregnant females delivered healthy babies, four (6.4%) reported abortion and three (4.8%) had intrauterine death, one (1.6%) child had colorectal malformation and died after few days of birth. ZIKV was found to belong to Asian lineage, mutation related to enhanced neuro-virulence and transmission in animal models was not found. CONCLUSION ZIKV was endogenous to India belonging to Asian Lineage. Disease profile of the ZIKV was asymptomatic to mild. No major anomaly was observed in infants born to ZIKV positive mothers; however, long term follow up of these children is required. There is need to scale up surveillance in the virology lab network of India for early detection and control. SUMMARY LINE Zika virus infection was endogenous due to Asian Lineage with mild disease, no case of microcephaly or Guillain- Barre Syndrome was seen but children need to be followed for anomalies and surveillance of ZIKV needs to be enhanced in the country.
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12
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Rose CE, Bertolli J, Attell JE, Moore CA, Melo F, Kotzky K, Krishna N, Satterfield-Nash A, Pereira IO, Pessoa A, Smith DC, Santelli ACFES, Peacock G. Early Growth Parameters as Predictors of Developmental Delay Among Children Conceived During the 2015-2016 Zika Virus Outbreak in Northeastern Brazil. Trop Med Infect Dis 2020; 5:tropicalmed5040155. [PMID: 33019699 PMCID: PMC7709658 DOI: 10.3390/tropicalmed5040155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 01/13/2023] Open
Abstract
Background: Identifying infants with congenital infection for early intervention will likely be challenging in future Zika virus outbreaks. We investigated indicators of risk for developmental delay among children born with and without obvious manifestations of congenital Zika virus infection. Methods: We evaluated 120 children conceived during the 2015−2016 Zika virus outbreak in Paraíba, Brazil. We analyzed data from children at birth; ages 1−7 months and approximately 24 months, using medical records (i.e., anthropometric measurements diagnoses), medical evaluation (i.e., Zika/other laboratory tests, dysmorphic features), and parent report (seizures, developmental delay). We used a Bayesian modeling approach to identify predictors of developmental delay. Results: Head circumference (HC) and length at birth and rates of growth for HC and length at follow-up were consistent across domains of developmental delay; (e.g., for every 1 cm per month decrease in HC growth rate; there was a corresponding decrease in the gross motor z-score). Modeling results indicated that HC and length at birth, and follow-up HC and length rates of growth, were predictive of developmental delay. Conclusion: These findings suggest that accurate measurement and frequent monitoring of HC and length, especially in the first few months of life, may be useful for identifying children possibly congenitally exposed to Zika virus who could benefit from early intervention services.
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Affiliation(s)
- Charles E. Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329-4027, USA; (C.E.R.); (C.A.M.)
| | - Jeanne Bertolli
- Division of Human Development and Disability, CDC, Atlanta, GA 30329-4027, USA;
- Correspondence:
| | | | - Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329-4027, USA; (C.E.R.); (C.A.M.)
| | - Flavio Melo
- Hospital Regional de Guarabira/Governo do Estado da Paraíba, João Pessoa, Paraíba 58225-000, Brazil;
| | - Kim Kotzky
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830-8007, USA; (K.K.); (A.S.-N.)
| | - Nevin Krishna
- Center for Preparedness and Response, CDC, Atlanta, GA 30329-4027, USA;
| | - Ashley Satterfield-Nash
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830-8007, USA; (K.K.); (A.S.-N.)
| | - Isabela Ornelas Pereira
- Department of Chronic Conditions and Sexually Transmitted Infections (DCCI), Ministry of Health of Brazil, Brasilia 70719-040, Brazil;
| | - Andre Pessoa
- Pediatrics Department of Ceara State Universitiy—UECE, Fortaleza, Ceará 60714-903, Brazil;
| | - Donna Camille Smith
- Division of Congenital and Developmental Disorders, CDC, Atlanta, GA 30329-4027, USA;
| | | | - Georgina Peacock
- Division of Human Development and Disability, CDC, Atlanta, GA 30329-4027, USA;
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13
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Abstract
Zika virus epidemics have potential large-scale population effects. Controlled studies of mice and nonhuman primates indicate that Zika affects fecundity, raising concerns about miscarriage in human populations. In regions of Brazil, Zika risk peaked months before residents learned about the epidemic and its relation to congenital anomalies. This spatiotemporal variation supports analysis of both biological effects of Zika infection on fertility and the effects of learning about Zika risk on reproductive behavior. Causal inference techniques used with vital statistics indicate that the epidemic caused reductions in birth cohort size of approximately one-quarter 18 months after Zika infection risk peaked but 10 months after public health messages advocated childbearing delay. The evidence is consistent with small but not statistically detectable biological reductions in fecundity, as well as large strategic changes in reproductive behavior to temporally align childbearing with reduced risk to infant health. The behavioral effects are larger for more-educated and older women, which may reflect facilitated access to information and to family planning services within high-risk, mosquito-infested urban locations as well as perceptions about the opportunity costs of risks to pregnancy and infant survival.
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Affiliation(s)
- Marcos A Rangel
- Sanford School of Public Policy, Duke University, 302 Towerview Road, Rubenstein Hall, Office 262, Durham, NC, 27708, USA.
- Bureau for Research and Economic Analysis of Development (BREAD), London, UK.
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
| | - Amar Hamoudi
- Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, USA
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14
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Bertolli J, Attell JE, Rose C, Moore CA, Melo F, Staples JE, Kotzky K, Krishna N, Satterfield-Nash A, Pereira IO, Pessoa A, Smith DC, Santelli ACFES, Boyle CA, Peacock G. Functional Outcomes among a Cohort of Children in Northeastern Brazil Meeting Criteria for Follow-Up of Congenital Zika Virus Infection. Am J Trop Med Hyg 2020; 102:955-963. [PMID: 32228785 PMCID: PMC7204564 DOI: 10.4269/ajtmh.19-0961] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Following the large outbreak of Zika virus in the Western Hemisphere, many infants have been born with congenital Zika virus infection. It is important to describe the functional outcomes seen with congenital infections to allow for their recognition and appropriate interventions. We evaluated 120 children conceived during the 2015-2016 Zika virus outbreak in Paraíba, Brazil, who were approximately 24 months old, to assess functional outcomes. All children met either anthropometric criteria or laboratory criteria suggestive of possible congenital Zika virus infection. We collected results of previous medical evaluations, interviewed parents, and performed physical examinations and functional assessments, for example, the Hammersmith Infant Neurological Examination (HINE). We compared patterns of neurologic outcomes and developmental delay at age 24 months by whether children met anthropometric or laboratory criteria, or both. Among children meeting both criteria, 60% (26/43) were multiply affected (had severe motor impairment, severe developmental delay, and suboptimal HINE scores), compared with 5% (3/57) meeting only laboratory criteria and none (0/20) meeting only anthropometric criteria. Of the remaining 91 children, 49% (45) had developmental delay, with more severe delay seen in children meeting both criteria. Although children meeting physical and laboratory criteria for potential congenital Zika virus infection were more severely affected, we did identify several children with notable adverse neurologic outcomes and developmental delay with no physical findings but potential laboratory evidence of Zika virus infection. Given this, all children who were potentially exposed in utero to Zika virus should be monitored in early childhood for deficits to allow for early intervention.
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Affiliation(s)
- Jeanne Bertolli
- Division of Human Development and Disability, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | - Charles Rose
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Flávio Melo
- Hospital Regional de Guarabira/Governo do Estado da Paraíba, João Pessoa, Brazil
| | | | - Kim Kotzky
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Nevin Krishna
- Office of Public Health Preparedness and Response, CDC, Atlanta, Georgia
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil
| | | | | | - Coleen A Boyle
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Georgina Peacock
- Division of Human Development and Disability, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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15
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Walker CL, Ehinger N, Mason B, Oler E, Little MTE, Ohuma EO, Papageorghiou AT, Nayeri U, Curry C, Adams Waldorf KM. Ultrasound prediction of Zika virus-associated congenital injury using the profile of fetal growth. PLoS One 2020; 15:e0233023. [PMID: 32401826 PMCID: PMC7219748 DOI: 10.1371/journal.pone.0233023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022] Open
Abstract
Zika virus (ZIKV) is a mosquito-transmitted flavivirus, recently linked to microcephaly and central nervous system anomalies following infection in pregnancy. Striking findings of disproportionate growth with a smaller than expected head relative to body length have been observed more commonly among fetuses with exposure to ZIKV in utero compared to pregnancies without ZIKV infection regardless of other signs of congenital infection including microcephaly. This study's objective was to determine the diagnostic accuracy of femur-sparing profile of intrauterine growth restriction for the identification of ZIKV-associated congenital injuries on postnatal testing. A retrospective cohort study of pregnant women with possible or confirmed ZIKV infection between January 1, 2016 and December 31, 2017 were included. Subjects were excluded if no prenatal ultrasound was available. A femur-sparing profile of growth restriction determined using INTERGROWTH-21st sonographic standard for head circumference to femur length (HC: FL). Congenital injuries were determined postnatally by imaging, comprehensive eye exam and standard newborn hearing screen. A total of 111 pregnant women diagnosed with ZIKV infection underwent fetal ultrasound and 95 neonates had complete postnatal evaluation. Prenatal microcephaly was detected in 5% of fetuses (6/111). Postnatal testing detected ZIKV-associated congenital injuries in 25% of neonates (24/95). A HC: FL Z-score ≤ -1.3 had a 52% specificity (95% CI 41-63%), 82% negative predictive value (NPV, 95% CI 73-88%) for the detection of ZIKV-associated congenital injuries in the neonatal period. A more stringent threshold with a Z-score ≤ -2 was associated with a 90% specificity (95% CI 81-95%), 81% NPV (95% CI 77-85%). Excluding cases of fetal microcephaly, HC: FL (Z-score ≤ -2) demonstrated a similar specificity (89%, 95% CI 81-95%) with superior NPV (87%, 95% CI 84-90%). The sonographic recognition of a normally proportioned fetus may be useful prenatally to exclude a wider spectrum of ZIKV-associated congenital injuries detected postnatally.
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Affiliation(s)
- Christie L. Walker
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Noah Ehinger
- Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Brittney Mason
- Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Elizabeth Oler
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
| | | | - Eric O. Ohuma
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Aris T. Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Unzila Nayeri
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Christine Curry
- Department of Obstetrics & Gynecology, University of Miami Health System, Miami, Florida, United States of America
| | - Kristina M. Adams Waldorf
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Sahlgrenska Academy, University of Gothenburg, Gothenburg University, Gothenburg, Sweden
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Harville EW, Buekens PM, Cafferata ML, Gilboa S, Tomasso G, Tong V. Measurement error, microcephaly prevalence and implications for Zika: an analysis of Uruguay perinatal data. Arch Dis Child 2020; 105:428-432. [PMID: 31836636 PMCID: PMC7450538 DOI: 10.1136/archdischild-2019-317678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/11/2019] [Accepted: 11/21/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE The Zika virus outbreak has drawn attention to microcephaly, whose definition is based on head circumference measuring below a percentile or number of SDs below the mean. The objective of this analysis was to assess how differences in measurement precision might affect prevalence and trends of microcephaly. METHODS Data from all births in Uruguay during 2010-2015 were obtained from the Perinatal Information System. The prevalence of births with microcephaly was calculated based on head circumference measurement at birth applying the INTERGROWTH-21st standards for sex and gestational age, and compared by method of ascertaining gestational age. RESULTS Rounding and digit preference was observed: 74% of head circumference measurements were reported as a whole centimetre value. The prevalence of births varied substantially by the criterion used to define microcephaly (<3 SD, <2 SD, <3rd percentile for gestational age) and could be halved or doubled based on adding or subtracting a half-centimetre from all reported head circumference measurements. If 4 days were added to gestational age calculations, rather than using completed gestational weeks (without days) for gestational age reporting, the prevalence was 1.7-2 times higher. DISCUSSION Rounding in measurement of head circumference and reporting preferences of gestational age may have contributed to a lower prevalence of microcephaly than expected in this population. Differences in head circumference measurement protocols and gestational age dating have the potential to affect the prevalence of babies reported with microcephaly, and this limitation should be acknowledged when interpreting head circumference data collected for surveillance.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Pierre M Buekens
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Suzanne Gilboa
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Giselle Tomasso
- Clinical and Epidemiological Research Unit, Montevideo, Uruguay
| | - Van Tong
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Schwarz ER, Oliveira LJ, Bonfante F, Pu R, Pozor MA, Maclachlan NJ, Beachboard S, Barr KL, Long MT. Experimental Infection of Mid-Gestation Pregnant Female and Intact Male Sheep with Zika Virus. Viruses 2020; 12:v12030291. [PMID: 32156037 PMCID: PMC7150993 DOI: 10.3390/v12030291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 12/11/2022] Open
Abstract
Zika virus (ZIKV) is an arbovirus that causes birth defects, persistent male infection, and sexual transmission in humans. The purpose of this study was to continue the development of an ovine ZIKV infection model; thus, two experiments were undertaken. In the first experiment, we built on previous pregnant sheep experiments by developing a mid-gestation model of ZIKV infection. Four pregnant sheep were challenged with ZIKV at 57–64 days gestation; two animals served as controls. After 13–15 days (corresponding with 70–79 days of gestation), one control and two infected animals were euthanized; the remaining animals were euthanized at 20–22 days post-infection (corresponding with 77–86 days of gestation). In the second experiment, six sexually mature, intact, male sheep were challenged with ZIKV and two animals served as controls. Infected animals were serially euthanized on days 2–6 and day 9 post-infection with the goal of isolating ZIKV from the male reproductive tract. In the mid-gestation study, virus was detected in maternal placenta and spleen, and in fetal organs, including the brains, spleens/liver, and umbilicus of infected fetuses. Fetuses from infected animals had visibly misshapen heads and morphometrics revealed significantly smaller head sizes in infected fetuses when compared to controls. Placental pathology was evident in infected dams. In the male experiment, ZIKV was detected in the spleen, liver, testes/epididymides, and accessory sex glands of infected animals. Results from both experiments indicate that mid-gestation ewes can be infected with ZIKV with subsequent disruption of fetal development and that intact male sheep are susceptible to ZIKV infection and viral dissemination and replication occurs in highly vascular tissues (including those of the male reproductive tract).
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Affiliation(s)
- Erika R. Schwarz
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
| | - Lilian J. Oliveira
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA;
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Instituto Zooprofilattico Sperimentale delle Venezie, 35020 Legnaro, Italy;
| | - Ruiyu Pu
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
| | - Malgorzata A. Pozor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - N. James Maclachlan
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA;
| | - Sarah Beachboard
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
| | - Kelli L. Barr
- Department of Biology, College of Arts and Sciences, Baylor University, Waco, TX 76798, USA;
| | - Maureen T. Long
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
- Correspondence:
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18
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Cooper HJ, Iwamoto M, Lash M, Conners EE, Paladini M, Slavinski S, Fine AD, Kennedy J, Heinke D, Ciaranello A, Seage GR, Lee EH. Maternal Zika Virus Infection: Association With Small-for-Gestational-Age Neonates and Preterm Birth. Obstet Gynecol 2019; 134:1197-1204. [PMID: 31764729 PMCID: PMC7147828 DOI: 10.1097/aog.0000000000003577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/19/2019] [Accepted: 08/29/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate whether antenatal Zika virus infection is associated with risk of having a small-for-gestational-age (SGA) neonate, risk of preterm birth, and lower mean birth weight of term neonates. METHODS For this retrospective observational study, we linked birth record data for women who delivered liveborn singleton neonates in New York City in 2016 to data for pregnant women with Zika virus infection reported to the New York City Health Department. We restricted the analysis to nonsmoking, nonwhite women and adjusted for maternal characteristics. Among women with antenatal Zika virus infection, we used modified Poisson regression to assess risks of having an SGA neonate and of delivering preterm, and linear regression to assess the association of infection with mean birth weight of term neonates. RESULTS Of 116,034 deliveries of singleton neonates in New York City in 2016, 251 (0.2%) were to women with antenatal Zika virus infection. A higher percentage of women with Zika virus infection delivered an SGA neonate compared with those without (11.2% vs 5.8%; adjusted relative risk [RR] 1.8; 95% CI 1.3-2.6). There was no difference in preterm birth prevalence for women with and without Zika virus infection (adjusted RR 1.0; 95% CI 0.69-1.6). Mean birth weight of term neonates born to women with Zika virus infection was 47 g less (95% CI -105 to 11 g); this difference was not statistically significant in crude or adjusted analyses. CONCLUSION For a cohort of New York City women, antenatal Zika virus infection was associated with an increased risk of having an SGA neonate, but not preterm birth or lower mean birth weight of term neonates. This supports a putative association between Zika virus infection during pregnancy and SGA.
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Affiliation(s)
- Hannah J Cooper
- Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, Queens, and the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York; and the Harvard T. H. Chan School of Public Health and the Medical Practice Evaluation Center, Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts
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Schwarz ER, Pozor MA, Pu R, Barr KL, Beachboard SE, MacLachlan NJ, Prakoso D, Long MT. Experimental Infection of Pregnant Female Sheep with Zika Virus During Early Gestation. Viruses 2019; 11:E795. [PMID: 31470560 PMCID: PMC6784126 DOI: 10.3390/v11090795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022] Open
Abstract
Zika virus (ZIKV) is a vertically and sexually transmissible virus resulting in severe congenital malformation. The goal of this study was to develop an ovine model of ZIKV infection. Between 28-35 days gestation (DG), four pregnant animals were infected with two doses of 6 × 106 PFU of ZIKV; four control animals received PBS. Animals were evaluated for 45 days (D) post-infection (PI) and necropsies were performed. Viral RNA was detected in infected ewe peripheral blood mononuclear cells (PBMC) during the first week PI; however, all fluids and tissues were negative upon culture. Anti-ZIKV IgM (1:400) and neutralizing antibodies were detected in all infected animals. Clinical disease, virus, or ZIKV antibodies were not detected in control ewes. After two weeks PI, fetal loss occurred in two infected animals, and at necropsy, three infected animals had placental petechiation and ecchymosis and one had hydramnion. Fetal morphometrics revealed smaller cranial circumference to crown-rump length ratios (p < 0.001) and relative brain weights (p = 0.038) in fetuses of infected animals compared with control fetuses. Immunophenotyping indicated an increase in B cells (p = 0.012) in infected sheep. Additionally, in vitro experiments using both adult and fetal cell lines demonstrated that ovine cells are highly permissive to ZIKV infection. In conclusion, ZIKV infection of pregnant sheep results in a change in fetal growth and gestational outcomes.
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Affiliation(s)
- Erika R Schwarz
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Malgorzata A Pozor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Ruiyu Pu
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Kelli L Barr
- Department of Biology, Colleges of Arts and Sciences, Baylor University, Waco, TX 76798, USA
| | - Sarah E Beachboard
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - N James MacLachlan
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Dhani Prakoso
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Maureen T Long
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA.
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20
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Counotte MJ, Meili KW, Taghavi K, Calvet G, Sejvar J, Low N. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review. F1000Res 2019; 8:1433. [PMID: 31754425 PMCID: PMC6852328 DOI: 10.12688/f1000research.19918.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The Zika virus (ZIKV) caused a large outbreak in the Americas leading to the declaration of a Public Health Emergency of International Concern in February 2016. A causal relation between infection and adverse congenital outcomes such as microcephaly was declared by the World Health Organization (WHO) informed by a systematic review structured according to a framework of ten dimensions of causality, based on the work of Bradford Hill. Subsequently, the evidence has continued to accumulate, which we incorporate in regular updates of the original work, rendering it a living systematic review. Methods: We present an update of our living systematic review on the causal relation between ZIKV infection and adverse congenital outcomes and between ZIKV and GBS for four dimensions of causality: strength of association, dose-response, specificity, and consistency. We assess the evidence published between January 18, 2017 and July 1, 2019. Results: We found that the strength of association between ZIKV infection and adverse outcomes from case-control studies differs according to whether exposure to ZIKV is assessed in the mother (OR 3.8, 95% CI: 1.7-8.7, I
2=19.8%) or the foetus/infant (OR 37.4, 95% CI: 11.0-127.1, I
2=0%). In cohort studies, the risk of congenital abnormalities was 3.5 times higher after ZIKV infection (95% CI: 0.9-13.5, I
2=0%). The strength of association between ZIKV infection and GBS was higher in studies that enrolled controls from hospital (OR: 55.8, 95% CI: 17.2-181.7, I
2=0%) than in studies that enrolled controls at random from the same community or household (OR: 2.0, 95% CI: 0.8-5.4, I
2=74.6%). In case-control studies, selection of controls from hospitals could have biased results. Conclusions: The conclusions that ZIKV infection causes adverse congenital outcomes and GBS are reinforced with the evidence published between January 18, 2017 and July 1, 2019.
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Affiliation(s)
| | - Kaspar Walter Meili
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
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Abstract
Understanding Zika virus (ZIKV) transmission and the risk of birth defects associated with infection during the childbearing years is imperative. Current knowledge helps guide communication, prevention, and planning efforts between health care providers and female patients of childbearing age. Providers must follow updated data and implement ongoing rapid, sensitive, and specific screening and diagnostic testing for ZIKV. Surveillance of infants with known, in utero ZIKV exposure or infection must be maintained to gain a broader understanding of potential defects or injuries that are not immediately obvious at birth and in early infancy.
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22
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Prata‐Barbosa A, Martins MM, Guastavino AB, Cunha AJLAD. Effects of Zika infection on growth. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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23
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Giles ML, Cole S. Zika Virus Infection and Implications for Reproduction. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Zika virus infection during pregnancy can have devastating effects on the foetus leading to congenital Zika syndrome. It is relevant therefore for couples living in countries with endemic Zika virus to understand the strategies they can utilise to reduce the chance of infection. In addition, couples planning pregnancy, or who are already pregnant, travelling to countries with Zika virus need to be informed of the potential risk and implications for future reproductive planning.
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Affiliation(s)
- Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Stephen Cole
- Department of Maternal-Fetal Medicine, The Royal Women’s Hospital, Melbourne, Australia
- Institute of Obstetrics and Gynaecology, Epworth Healthcare, Melbourne, Australia
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Prata-Barbosa A, Martins MM, Guastavino AB, Cunha AJLAD. Effects of Zika infection on growth. J Pediatr (Rio J) 2019; 95 Suppl 1:30-41. [PMID: 30593788 DOI: 10.1016/j.jped.2018.10.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To present the currently available evidence of the effects of congenital Zika virus infection on infant growth, to discuss possible intervening factors, and to describe preliminary data on this growth in a cohort of exposed children. SOURCE OF DATA Non-systematic review in PubMed, BVS, CAPES, Scopus, Web of Science, Cochrane and Google Scholar databases in the last 5 years, using the terms infection/disease by Zika virus and growth/nutrition/nutritional status/infant nutrition and nutritional needs. Additionally, the anthropometric data of the first 2.5 years of a cohort of children exposed to the Zika virus during pregnancy were reviewed. SYNTHESIS OF DATA Both intrauterine growth restriction and low birth weight were reported in series of cases of children with congenital Zika syndrome. The postnatal growth deficit of these children appears to be directly proportional to the degree of neurological impairment. The etiology is multifactorial, and nutritional and non-nutritional factors are probably involved. The data from the present cohort show that the head circumference evolution depends on this measurement at birth and that weight-height growth has a trend toward lower weight and length in children with congenital microcephaly and normocephalic at birth who develop some neurological abnormality. CONCLUSIONS The few existing data suggest that, in children with congenital Zika, the greater the degree of neurological impairment, the greater the impact on growth, whether or not associated with microcephaly at birth.
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Affiliation(s)
| | - Marlos Melo Martins
- Universidade Federal do Rio de Janeiro (UFRJ), Maternidade-Escola, Rio de Janeiro, RJ, Brazil
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25
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Walker CL, Little MTE, Roby JA, Armistead B, Gale M, Rajagopal L, Nelson BR, Ehinger N, Mason B, Nayeri U, Curry CL, Adams Waldorf KM. Zika virus and the nonmicrocephalic fetus: why we should still worry. Am J Obstet Gynecol 2019; 220:45-56. [PMID: 30171843 PMCID: PMC6501788 DOI: 10.1016/j.ajog.2018.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/12/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023]
Abstract
Zika virus is a mosquito-transmitted flavivirus and was first linked to congenital microcephaly caused by a large outbreak in northeastern Brazil. Although the Zika virus epidemic is now in decline, pregnancies in large parts of the Americas remain at risk because of ongoing transmission and the potential for new outbreaks. This review presents why Zika virus is still a complex and worrisome public health problem with an expanding spectrum of birth defects and how Zika virus and related viruses evade the immune response to injure the fetus. Recent reports indicate that the spectrum of fetal brain and other anomalies associated with Zika virus exposure is broader and more complex than microcephaly alone and includes subtle fetal brain and ocular injuries; thus, the ability to prenatally diagnose fetal injury associated with Zika virus infection remains limited. New studies indicate that Zika virus imparts disproportionate effects on fetal growth with an unusual femur-sparing profile, potentially providing a new approach to identify viral injury to the fetus. Studies to determine the limitations of prenatal and postnatal testing for detection of Zika virus-associated birth defects and long-term neurocognitive deficits are needed to better guide women with a possible infectious exposure. It is also imperative that we investigate why the Zika virus is so adept at infecting the placenta and the fetal brain to better predict other viruses with similar capabilities that may give rise to new epidemics. The efficiency with which the Zika virus evades the early immune response to enable infection of the mother, placenta, and fetus is likely critical for understanding why the infection may either be fulminant or limited. Furthermore, studies suggest that several emerging and related viruses may also cause birth defects, including West Nile virus, which is endemic in many parts of the United States. With mosquito-borne diseases increasing worldwide, there remains an urgent need to better understand the pathogenesis of the Zika virus and related viruses to protect pregnancies and child health.
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Affiliation(s)
- Christie L Walker
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, WA
| | - Marie-Térèse E Little
- Fourth Dimension Biomedical and Research Consulting, Victoria, British Columbia, Canada
| | - Justin A Roby
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, WA
| | - Blair Armistead
- Department of Global Health, University of Washington, Seattle, WA; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA
| | - Michael Gale
- Center for Innate Immunity and Immune Disease, Departments of Immunology, Microbiology, and Global Health, University of Washington, Seattle, WA
| | - Lakshmi Rajagopal
- Center for Innate Immunity and Immune Disease, Department of Pediatrics, University of Washington, Seattle, WA; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA
| | - Branden R Nelson
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Noah Ehinger
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL
| | - Brittney Mason
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL
| | - Unzila Nayeri
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL
| | - Christine L Curry
- Department of Obstetrics and Gynecology, University of Miami, Miami, FL
| | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA; Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA; Sahlgrenska Academy, Gothenburg University, Gothenburg Sweden.
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Yasri S, Wiwanitkit V. Femur-sparing pattern of fetal growth after maternal Zika virus infection. Am J Obstet Gynecol 2018; 219:514. [PMID: 30017677 DOI: 10.1016/j.ajog.2018.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sora Yasri
- KMT Primary Care Center, Bangkok, Thailand.
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Walker CL, Merriam AA, Gyamfi-Bannerman C, Adams Waldorf KM. Reply. Am J Obstet Gynecol 2018; 219:514-515. [PMID: 30025831 DOI: 10.1016/j.ajog.2018.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
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Valentine GC, Seferovic MD, Fowler SW, Major AM, Gorchakov R, Berry R, Swennes AG, Murray KO, Suter MA, Aagaard KM. Timing of gestational exposure to Zika virus is associated with postnatal growth restriction in a murine model. Am J Obstet Gynecol 2018; 219:403.e1-403.e9. [PMID: 29902449 DOI: 10.1016/j.ajog.2018.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Vertical transmission of Zika virus leads to infection of neuroprogenitor cells and destruction of brain parenchyma. Recent evidence suggests that the timing of infection as well as host factors may affect vertical transmission. As a result, congenital Zika virus infection may only become clinically apparent in the postnatal period. OBJECTIVE We sought to develop an outbred mouse model of Zika virus vertical transmission to determine if the timing of gestational Zika virus exposure yields phenotypic differences at birth and through adolescence. We hypothesized that later gestational inoculations would only become apparent in adolescence. STUDY DESIGN To better recapitulate human exposures, timed pregnant Swiss-Webster dams (n = 15) were subcutaneously inoculated with 1 × 104 plaque-forming units of first passage contemporary Zika virus HN16 strain or a mock injection on embryonic day 4, 8, or 12 with bioactive antiinterferon alpha receptor antibody administered in days preceding and proceeding inoculation. The antibody was given to prevent the robust type I interferon signaling cascade that make mice inherently resistant to Zika virus infection. At birth and adolescence (6 weeks of age) offspring were assessed for growth, brain weight, and biparietal head diameters, and Zika virus viral levels by reverse transcription-polymerase chain reaction or in situ hybridization. RESULTS Pups of Zika virus-infected dams infected at embryonic days 4 and 8 but not 12 were growth restricted (P < .003). Brain weights were significantly smaller at birth (P = .01) for embryonic day 8 Zika virus-exposed offspring. At 6 weeks of age, biparietal diameters were smaller for all Zika virus-exposed males and females (P < .05), with embryonic day 8-exposed males smallest by biparietal diameter and growth-restriction measurements (weight >2 SD, P = .0007). All pups and adolescent mice were assessed for Zika virus infection by reverse transcription-polymerase chain reaction. Analysis of all underweight pups reveled 1 to be positive for neuronal Zika virus infection by in situ hybridization, while a second moribund animal was diffusely positive at 8 days of age by Zika virus infectivity throughout the brain, kidneys, and intestine. CONCLUSION These findings demonstrate that postnatal effects of infection occurring at single time points continue to be detrimental to offspring in the postnatal period in a subset of littermates and subject to a window of gestational susceptibility coinciding with placentation. This model recapitulates frequently encountered clinical scenarios in nonendemic regions, including the majority of the United States, where travel-related exposure occurs in short and well-defined windows of gestation. Our low rate of infection and relatively rare evidence of congenital Zika syndrome parallels human population-based data.
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