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Zhang Y, Sheng Z, Chen Q, Zhou A, Cao J, Xue F, Ye Y, Wu N, Gao N, Fan D, Liu L, Li Y, Wang P, Liang L, Zhou D, Zhang F, Li F, An J. Neutrophil infiltration leads to fetal growth restriction by impairing the placental vasculature in DENV-infected pregnant mice. EBioMedicine 2023; 95:104739. [PMID: 37544202 PMCID: PMC10432184 DOI: 10.1016/j.ebiom.2023.104739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/22/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Dengue virus (DENV) infection during pregnancy increases the risk of adverse fetal outcomes, which has become a new clinical challenge. However, the underlying mechanism remains unknown. METHODS The effect of DENV-2 infection on fetuses was investigated using pregnant interferon α/β receptor-deficient (Ifnar1-/-) mice. The histopathological changes in the placentas were analyzed by morphological techniques. A mouse inflammation array was used to detect the cytokine and chemokine profiles in the serum and placenta. The infiltration characteristics of inflammatory cells in the placentas were evaluated by single-cell RNA sequencing. FINDINGS Fetal growth restriction observed in DENV-2 infection was mainly caused by the destruction of the placental vasculature rather than direct damage from the virus in our mouse model. After infection, neutrophil infiltration into the placenta disrupts the expression profile of matrix metalloproteinases, which leads to placental dysvascularization and insufficiency. Notably, similar histopathological changes were observed in the placentas from DENV-infected puerperae. INTERPRETATION Neutrophils play key roles in placental histopathological damage during DENV infection, which indicates that interfering with aberrant neutrophil infiltration into the placenta may be an important therapeutic target for adverse pregnancy outcomes in DENV infection. FUNDING The National Key Research and Development Plans of China (2021YFC2300200-02 to J.A., 2019YFC0121905 to Q.Z.C.), the National Natural Science Foundation of China (NSFC) (U1902210 and 81972979 to J. A., 81902048 to Z. Y. S., and 82172266 to P.G.W.), and the Support Project of High-level Teachers in Beijing Municipal Universities in the Period of 13th Five-year Plan, China (IDHT20190510 to J. A.).
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Affiliation(s)
- Yingying Zhang
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China; Department of Blood Transfusion, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ziyang Sheng
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
| | - Qiaozhu Chen
- Department of Ob&Gyn, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Anni Zhou
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiaying Cao
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Feiyang Xue
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yanzhen Ye
- Department of Obstetrics and Gynecology, People's Hospital of Nanhai District, Foshan City, 528200, Guangdong, China
| | - Na Wu
- Laboratory Animal Center, Capital Medical University, Beijing, 100069, China
| | - Na Gao
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Dongying Fan
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Libo Liu
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yuetong Li
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Peigang Wang
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Li Liang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Deshan Zhou
- Department of Histology and Embryology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Fuchun Zhang
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fang Li
- Department of Ob&Gyn, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China; Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
| | - Jing An
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
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Howard-Jones AR, Pham D, Sparks R, Maddocks S, Dwyer DE, Kok J, Basile K. Arthropod-Borne Flaviviruses in Pregnancy. Microorganisms 2023; 11:433. [PMID: 36838398 PMCID: PMC9959669 DOI: 10.3390/microorganisms11020433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Flaviviruses are a diverse group of enveloped RNA viruses that cause significant clinical manifestations in the pregnancy and postpartum periods. This review highlights the epidemiology, pathophysiology, clinical features, diagnosis, and prevention of the key arthropod-borne flaviviruses of concern in pregnancy and the neonatal period-Zika, Dengue, Japanese encephalitis, West Nile, and Yellow fever viruses. Increased disease severity during pregnancy, risk of congenital malformations, and manifestations of postnatal infection vary widely amongst this virus family and may be quite marked. Laboratory confirmation of infection is complex, especially due to the reliance on serology for which flavivirus cross-reactivity challenges diagnostic specificity. As such, a thorough clinical history including relevant geographic exposures and prior vaccinations is paramount for accurate diagnosis. Novel vaccines are eagerly anticipated to ameliorate the impact of these flaviviruses, particularly neuroinvasive disease manifestations and congenital infection, with consideration of vaccine safety in pregnant women and children pivotal. Moving forward, the geographical spread of flaviviruses, as for other zoonoses, will be heavily influenced by climate change due to the potential expansion of vector and reservoir host habitats. Ongoing 'One Health' engagement across the human-animal-environment interface is critical to detect and responding to emergent flavivirus epidemics.
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Affiliation(s)
- Annaleise R. Howard-Jones
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research—NSW Health Pathology, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - David Pham
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research—NSW Health Pathology, Westmead, NSW 2145, Australia
| | - Rebecca Sparks
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research—NSW Health Pathology, Westmead, NSW 2145, Australia
| | - Susan Maddocks
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research—NSW Health Pathology, Westmead, NSW 2145, Australia
| | - Dominic E. Dwyer
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research—NSW Health Pathology, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead, NSW 2145, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research—NSW Health Pathology, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead, NSW 2145, Australia
| | - Kerri Basile
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research—NSW Health Pathology, Westmead, NSW 2145, Australia
- Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW 2145, Australia
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3
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Watanabe S, Vasudevan SG. Clinical and experimental evidence for transplacental vertical transmission of flaviviruses. Antiviral Res 2023; 210:105512. [PMID: 36572192 DOI: 10.1016/j.antiviral.2022.105512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
The Zika virus (ZIKV) epidemic outbreak in Americas in 2016 attracted global attention because of the association of the virus infection with severe birth defects such as microcephaly, mediated through transplacental virus transmission during pregnancy. Less well-known, but also reported is the increasing evidence that prenatal vertical transmission can be caused by other flaviviruses such as dengue virus (DENV). Currently, the mechanism(s) that cause the vertical transmission of flaviviruses is understudied. Here we review the published reports of clinical evidence of intrauterine transmission of ZIKV and other flaviviruses. We also discuss the animal models for flavivirus infection during pregnancy that have been developed to study the mechanisms underlying the transplacental transmission of flaviviruses in order to develop potential countermeasures for its prevention.
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Affiliation(s)
- Satoru Watanabe
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road, 169857, Singapore.
| | - Subhash G Vasudevan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road, 169857, Singapore
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4
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Souza RT, Brasileiro M, Ong M, Delaney L, Vieira MC, Dias MAB, Pasupathy D, Cecatti JG. Investigation of stillbirths in Brazil: A systematic scoping review of the causes and related reporting processes in the past decade. Int J Gynaecol Obstet 2022; 161:711-725. [PMID: 36373189 DOI: 10.1002/ijgo.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recognizing the causes of stillbirths and their associated conditions is essential to reduce its occurrence. OBJECTIVE To describe information on stillbirths in Brazil during the past decade. SEARCH STRATEGY A literature search was performed from January 2010 to December 2020. SELECTION CRITERIA Original observational studies and clinical trials. DATA COLLECTION AND ANALYSIS Data were manually extracted to a spreadsheet and descriptive analysis was performed. RESULTS A total of 55 studies were included; 40 studies (72.2%) used the official data stored by national public health systems. Most articles aimed to estimate the rate and trends of stillbirth (60%) or their causes (55.4%). Among the 16 articles addressing the causes of death, 10 (62.5%) used the International Classification of Diseases; most of the articles only specified the main cause of death. Intrauterine hypoxia was the main cause reported (ranging from 14.3% to 54.9%). CONCLUSION Having a national system based on compulsory notification of stillbirths may not be sufficient to provide quality information on occurrence and, especially, causes of death. Further improvements of the attribution and registration of causes of deaths and the implementation of educational actions for improving reporting systems are advisable. Finally, expanding the investigation of contributing factors associated with stillbirths would create an opportunity for further development of prevention strategies in low- and middle-income countries such as Brazil.
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Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Mariana Brasileiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Melissa Ong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Louisa Delaney
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Marcos A B Dias
- Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK.,Westmead Reproduction and Perinatal Medicine Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
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5
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Watanabe S, Chan KWK, Tan NWW, Mahid MBA, Chowdhury A, Chang KTE, Vasudevan SG. Experimental evidence for a high rate of maternal-fetal transmission of dengue virus in the presence of antibodies in immunocompromised mice. EBioMedicine 2022; 77:103930. [PMID: 35290828 PMCID: PMC8921544 DOI: 10.1016/j.ebiom.2022.103930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Congenital disorders associated with prenatal vertical transmission of Zika virus (ZIKV) is well established since the 2016 outbreak in the Americas. However, despite clinical reports of similar mode of transmission for other flaviviruses such as dengue virus (DENV), the phenomenon has not been experimentally explored. Methods Pregnant AG129 mice were infected with DENV1 in the presence or absence of enhancing antibodies at different gestational time points. ZIKV was used for comparison. We quantified viral load in fetus and placentas and performed comprehensive gene expression profiling in the maternal (decidua) and fetal portion of placenta separately. Findings We demonstrate in a laboratory experimental setting that DENV can be transmitted vertically in a gestation stage-dependent manner similar to ZIKV, and this incidence drastically increases in the presence of enhancing antibodies. Interestingly, a high rate of DENV fetal infection occurs even though the placental viral load is significantly lower than that found in ZIKV-infected dams. Comprehensive gene expression profiling revealed DENV infection modulates a variety of inflammation-associated genes comparable to ZIKV in decidua and fetal placenta in early pregnancy. Interpretation Our findings suggest that the virus-induced modulation of host gene expression may facilitate DENV to cross the placental barrier in spite of lower viral burden compared to ZIKV. This mouse model may serve to identify the host determinants required for the vertical transmission of flaviviruses and develop appropriate countermeasures. Funding National Medical Research Council/Open Fund Individual Research Grant MOH-000524 (SW), MOH-000086 and OFIRG20nov-0017 (SGV).
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Affiliation(s)
- Satoru Watanabe
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore.
| | - Kitti Wing Ki Chan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore
| | - Nicole Wei Wen Tan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore
| | | | - Avisha Chowdhury
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore
| | - Kenneth Tou En Chang
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore; Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - Subhash G Vasudevan
- Program in Emerging Infectious Diseases, Duke-NUS Medical School, 8-College Road 169857, Singapore; Institute for Glycomics, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
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6
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Yang X, Quam MBM, Zhang T, Sang S. Global burden for dengue and the evolving pattern in the past 30 years. J Travel Med 2021; 28:6368502. [PMID: 34510205 DOI: 10.1093/jtm/taab146] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dengue is the most prevalent and rapidly spreading mosquito-borne viral disease. We present the global, regional and national burden of dengue from 1990 to 2019 based on the findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). METHODS Based upon GBD 2019 dengue data on age-standardized incidence rate (ASIR), age-standardized death rate (ASDR) and age-standardized disability-adjusted life years (DALYs) rate, this study estimates and presents annual percentage change (EAPC) to quantify trends over time to assess potential correlates of increased dengue activity, such as global travel and warming. RESULTS Globally from 1990 to 2019, dengue incident cases, deaths and DALYs gradually increased. Those under 5 years of age, once accounting for the largest portion of deaths and DALYs in 1990, were eclipsed by those who were 15-49 years old in 2019. Age standardized incidence [ASIR: EAPC: 3.16, 95% confidence interval (CI): 2.90-3.43], death (ASDR: EAPC: 5.42, 95% CI: 2.64-8.28) and DALY rates (EAPC: 2.31, 95% CI: 2.00-2.62) accelerated most among high-middle and high sociodemographic index (SDI) regions. South-East Asia and South Asia had most of the dengue incident cases, deaths and DALYs, but East Asia had the fastest rise in ASIR (EAPC: 4.57, 95% CI: 4.31, 4.82), while Tropical Latin America led in ASDR (EAPC: 11.32, 95% CI: 9.11, 13.58) and age-standardized DALYs rate (EAPC: 4.13, 95% CI: 2.98, 5.29). SDI showed consistent bell-shaped relationship with ASIR, ASDR and age-standardized DALYs rate. Global land-ocean temperature index and air passenger travel metrics were found to be remarkably positively correlated with dengue burden. CONCLUSIONS The burden of dengue has become heavier from 1990 to 2019, amidst the three decades of urbanization, warming climates and increased human mobility in much of the world. South-East Asia and South Asia remain as regions of concern, especially in conjunction with the Americas' swift rise in dengue burden.
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Affiliation(s)
- Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China.,Clinical Research Center, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Mikkel B M Quam
- Section on Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Sweden.,Division of Epidemiology, College of Public Health, The Ohio State University, 43210, USA
| | - Tongchao Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China.,Clinical Research Center, Shandong University, Jinan, Shandong 250012, People's Republic of China
| | - Shaowei Sang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong 250012, People's Republic of China.,Clinical Research Center, Shandong University, Jinan, Shandong 250012, People's Republic of China.,Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong 250012, People's Republic of China
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7
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Badran EF, Darwish RM, Khader Y, AlMasri R, Al Jaberi M, AlMasri M, AlSa'di F, Yosef LA, Al-Badaineh N. Adverse pregnancy outcomes during the COVID-19 lockdown. A descriptive study. BMC Pregnancy Childbirth 2021; 21:761. [PMID: 34758778 PMCID: PMC8579176 DOI: 10.1186/s12884-021-04221-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The ongoing spread coronavirus disease worldwide has caused major disruptions and led to lockdowns. Everyday lifestyle changes and antenatal care inaccessibility during the coronavirus disease 2019 (COVID-19) pandemic have variable results that affect pregnancy outcomes. This study aimed to assess the alterations in stillbirth, neonatal-perinatal mortality, preterm birth, and birth weight during the COVID-19 national lockdown. METHODS We used the data from the Jordan stillbirths and neonatal death surveillance system to compare pregnancy outcomes (gestational age, birth weight, small for gestational age, stillbirth, neonatal death, and perinatal death) between two studied periods (11 months before the pandemic (May 2019 to March 2020) vs. 9 months during the pandemic (April 2020 to March 1st 2020). Separate multinomial logistic and binary logistic regression models were used to compare the studied outcomes between the two studied periods after adjusting for the effects of mother's age, income, education, occupation, nationality, health sector, and multiplicity. RESULTS There were 31106 registered babies during the study period; among them, 15311 (49.2%) and 15795 (50.8%) births occurred before and during the COVID-19 lockdown, respectively. We found no significant differences in preterm birth and stillbirth rates, neonatal mortality, or perinatal mortality before and during the COVID-19 lockdown. Our findings report a significantly lower incidence of extreme low birth weight (ELBW) infants (<1kg) during the COVID-19 lockdown period than that before the lockdown (adjusted OR 0.39, 95% CI 0.3-0.5: P value <0.001) CONCLUSIONS: During the COVID-19 lockdown period, the number of infants born with extreme low birth weight (ELBW) decreased significantly. More research is needed to determine the impact of cumulative socio-environmental and maternal behavioral changes that occurred during the pandemic on the factors that contribute to ELBW infants.
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Affiliation(s)
- Eman F Badran
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan.
| | - Rula M Darwish
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Yousef Khader
- Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
| | - Rama AlMasri
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Mira Al Jaberi
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Mohammad AlMasri
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Farah AlSa'di
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Leen Abu Yosef
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
| | - Noor Al-Badaineh
- Department of Pediatrics, School of Medicine, The University of Jordan, PO Box 11492, Amman, Jordan
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8
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Brar R, Suri V, Suri V, Singh MP, Biswal M, Sikka P. Fever During Pregnancy: Etiology and Fetomaternal Outcomes. J Obstet Gynaecol India 2021; 72:102-108. [PMID: 34539122 PMCID: PMC8438559 DOI: 10.1007/s13224-021-01562-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Etiological spectrum of fever in pregnant women and its impact on fetomaternal outcomes were studied.
Methods This was a hospital-based prospective study, conducted over 12 months. All pregnant women with fever were screened and detailed etiological evaluation carried out. Maternal and foetal outcomes were noted.
Results One hundred and eighty-one pregnant women with fever were included. Common causes were dengue 44 (24.3%), hepatitis E 26 (14.4%) and urinary tract infection (UTI) 22 (12.2%). Mosquito-borne diseases accounted for the highest burden 61 (33.7%). Second most common were diseases transmitted by feco-oral route 46 (25.4%). Maternal deaths occurred in 29 (16%) patients. Common causes of death were hepatitis E infection in 9 of 26 (34.6%) cases, dengue in 7 of 44 (15.9%) and tuberculosis in 5 of 11 (45.5%) cases.
Conclusion Dengue, hepatitis E and UTI were the most common causes of fever during pregnancy. Most cases were caused by vector- and water-borne diseases and thus potentially preventable. Overall maternal mortality was 16%.
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Affiliation(s)
- Rinnie Brar
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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9
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Dengue in pregnancy: Review article. Eur J Obstet Gynecol Reprod Biol 2021; 261:205-210. [PMID: 33971383 DOI: 10.1016/j.ejogrb.2021.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
Dengue is the most common viral mosquito- borne disease. It is a major public health problem, especially in tropical and sub-tropical areas worldwide. According to the World Health Organization (WHO), approximately 40% of the world's population (over 2.5 billion people) live in areas with high risk of contracting dengue infection. Adults of childbearing age and pregnant women are travelling more frequently to tropical areas. Therefore exposing themselves to specific arboviral infections such as dengue, which may impact ongoing and future pregnancies. Clinical manifestations of dengue are wide ranging from asymptomatic to needing intensive care in cases of hemorrhagic dengue fever. The effects of dengue during and on pregnancy are unclear, moreover there is a lack of a cohesive reference to inform women of reproductive age who live in or travel to endemic areas and are at risk of contracting dengue. Here we present review of literature specifically looking at etiology, pathogenesis, clinical manifestations, management of dengue in pregnancy as well as its effect on maternal health and fetal outcomes. There is clear evidence to suggest adverse maternal outcomes in women with symptomatic dengue in low resource countries. A high index of clinical suspicion and early referral to tertiary center will prevent maternal -fetal serious adverse events in endemic areas. This review will help Clinicians in advising as well as managing women who travel during pregnancy to endemic areas as well as clinicians based in endemic areas who are managing women with dengue in pregnancy.
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10
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Ginige S, Flower R, Viennet E. Neonatal Outcomes From Arboviruses in the Perinatal Period: A State-of-the-Art Review. Pediatrics 2021; 147:peds.2020-009720. [PMID: 33737375 DOI: 10.1542/peds.2020-009720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/24/2022] Open
Abstract
Since the 2016 Zika outbreak and the understanding of the teratogenic effect of this infection, there has been a newfound interest in arbovirus infections and their effects on pregnancy, resulting in numerous publications in the last 5 years. However, limited literature focuses on arbovirus infection in different stages of pregnancy and their effect on the neonate. There is currently no consensus management of perinatal acquisition of arboviruses, and current evidence is largely anecdotal observational reports. Teratogens can have different effects on the developing fetus depending on the time of infection, so infections during pregnancy should be analyzed by trimester. A better understanding of arbovirus infection in the perinatal period is required to assist obstetric, neonatal, and pediatric clinicians in making decisions about the management of mother and neonate. Our objective was to assess the evidence of adverse neonatal outcomes for several arboviral infections when contracted during the perinatal period to guide clinicians in managing these patients. There are 8 arboviruses for which neonatal outcomes from maternal acquisition in the perinatal period have been reported, with the most data for dengue and Chikungunya virus infections. The evidence reviewed in this article supports the adoption of preventive strategies to avoid ticks and mosquitoes close to the date of delivery. For the other arbovirus infections, further community-based cohort studies during outbreaks are required to evaluate whether these infections have a similar teratogenic impact.
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Ades AE, Soriano-Arandes A, Alarcon A, Bonfante F, Thorne C, Peckham CS, Giaquinto C. Vertical transmission of Zika virus and its outcomes: a Bayesian synthesis of prospective studies. THE LANCET. INFECTIOUS DISEASES 2021; 21:537-545. [PMID: 33068528 PMCID: PMC7992034 DOI: 10.1016/s1473-3099(20)30432-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Prospective studies of Zika virus in pregnancy have reported rates of congenital Zika syndrome and other adverse outcomes by trimester. However, Zika virus can infect and damage the fetus early in utero, but clear before delivery. The true vertical transmission rate is therefore unknown. We aimed to provide the first estimates of underlying vertical transmission rates and adverse outcomes due to congenital infection with Zika virus by trimester of exposure. METHODS This was a Bayesian latent class analysis of data from seven prospective studies of Zika virus in pregnancy. We estimated vertical transmission rates, rates of Zika-virus-related and non-Zika-virus-related adverse outcomes, and the diagnostic sensitivity of markers of congenital infection. We allowed for variation between studies in these parameters and used information from women in comparison groups with no PCR-confirmed infection, where available. FINDINGS The estimated mean risk of vertical transmission was 47% (95% credible interval 26 to 76) following maternal infection in the first trimester, 28% (15 to 46) in the second, and 25% (13 to 47) in the third. 9% (4 to 17) of deliveries following infections in the first trimester had symptoms consistent with congenital Zika syndrome, 3% (1 to 7) in the second, and 1% (0 to 3) in the third. We estimated that in infections during the first, second, and third trimester, respectively, 13% (2 to 27), 3% (-5 to 14), and 0% (-7 to 11) of pregnancies had adverse outcomes attributable to Zika virus infection. Diagnostic sensitivity of markers of congenital infection was lowest in the first trimester (42% [18 to 72]), but increased to 85% (51 to 99) in trimester two, and 80% (42 to 99) in trimester three. There was substantial between-study variation in the risks of vertical transmission and congenital Zika syndrome. INTERPRETATION This preliminary analysis recovers the causal effects of Zika virus from disparate study designs. Higher transmission in the first trimester is unusual with congenital infections but accords with laboratory evidence of decreasing susceptibility of placental cells to infection during pregnancy. FUNDING European Union Horizon 2020 programme.
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Affiliation(s)
- A E Ades
- Department of Population Health Science, University of Bristol Medical School, Bristol, UK,Correspondence to: Prof A E Ades, Department of Population Health Science, University of Bristol Medical School, Bristol BS8 2PS, UK
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Ana Alarcon
- Department of Neonatology, Hospital Universitari Sant Joan de Déu, Sant Joan de Déu Research Institute, Barcelona, Spain
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Italy
| | - Claire Thorne
- Population Policy and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Catherine S Peckham
- Population Policy and Practice Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Carlo Giaquinto
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, Padua, Italy
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12
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Fleck-Derderian S, Nelson CA, Cooley KM, Russell Z, Godfred-Cato S, Oussayef NL, Oduyebo T, Rasmussen SA, Jamieson DJ, Meaney-Delman D. Plague During Pregnancy: A Systematic Review. Clin Infect Dis 2021; 70:S30-S36. [PMID: 32435806 DOI: 10.1093/cid/ciz1228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Yersinia pestis continues to cause sporadic cases and outbreaks of plague worldwide and is considered a tier 1 bioterrorism select agent due to its potential for intentional use. Knowledge about the clinical manifestations of plague during pregnancy, specifically the maternal, fetal, and neonatal risks, is very limited. METHODS We searched 12 literature databases, performed hand searches, and consulted plague experts to identify publications on plague during pregnancy. Articles were included if they reported a case of plague during pregnancy and at least 1 maternal or fetal outcome. RESULTS Our search identified 6425 articles, of which 59 were eligible for inclusion and described 160 cases of plague among pregnant women. Most published cases occurred during the preantibiotic era. Among those treated with antimicrobials, the most commonly used were sulfonamides (75%) and streptomycin (54%). Among cases treated with antimicrobials, maternal mortality and fetal fatality were 29% and 62%, respectively; for untreated cases, maternal mortality and fetal fatality were 67% and 74%, respectively. Five cases demonstrated evidence of Y. pestis in fetal or neonatal tissues. CONCLUSIONS Untreated Y. pestis infection during pregnancy is associated with a high risk of maternal mortality and pregnancy loss. Appropriate antimicrobial treatment can improve maternal survival, although even with antimicrobial treatment, there remains a high risk of pregnancy loss. Limited evidence suggests that maternal-fetal transmission of Y. pestis is possible, particularly in the absence of antimicrobial treatment. These results emphasize the need to treat or prophylax pregnant women with suspected plague with highly effective antimicrobials as quickly as possible.
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Affiliation(s)
- Shannon Fleck-Derderian
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.,Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Fellowship Program, Oak Ridge, Tennessee, USA
| | - Christina A Nelson
- Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Katharine M Cooley
- Synergy America, Contracting Agency for Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Zachary Russell
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Fellowship Program, Oak Ridge, Tennessee, USA.,Emergency Preparedness and Response Branch, Division of Preparedness and Emerging Infections, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nadia L Oussayef
- Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Titilope Oduyebo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Epidemiology, University of Florida College of Medicine and College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dana Meaney-Delman
- Infant Outcomes Monitoring, Research and Prevention Branch, Division of Birth Defects and Infant Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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13
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McClure EM, Silver RM, Kim J, Ahmed I, Kallapur M, Ghanchi N, Nagmoti MB, Dhaded S, Aceituno A, Tikmani SS, Saleem S, Guruprasad G, Goudar SS, Goldenberg RL. Maternal infection and stillbirth: a review. J Matern Fetal Neonatal Med 2020; 35:4442-4450. [PMID: 33233978 DOI: 10.1080/14767058.2020.1852206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Maternal infections likely are an important cause of stillbirths, especially in sub-Saharan Africa and south Asia, where the burden is highest. Due to the lack of routine testing for infection, which can be complex and often expensive, the prevalence of infection during pregnancy and the association of many infections with stillbirth are not well-documented, especially in low-resource countries.Methods: Following an extensive literature review of infection and stillbirth initially published in 2010, we conducted a review of literature in the last 10 years to identify infections associated with stillbirth, focused on those in low-resource settings.Results: During the last 10 years, over 40 bacterial, viral and other pathogens have been associated with stillbirth. Newly emerging viral infections such as Denge as well as several well-established, but not yet eliminated infections such as rubella have been associated with stillbirth. Two of the maternal infections most strongly associated with stillbirth, each with about a 2-fold risk, are malaria and syphilis but others have been associated with risk in a range of studies. With a lack of routine antenatal screening, many pathogens are identified as associated with stillbirth only through case reports. Infection remains an important, yet understudied, cause of stillbirth.Conclusion: Research studies to determine definitive associations between various infections and stillbirth are important to better understand the role of infections and strategies to reduce infection-related stillbirth.Summary This review explores the association between infections and stillbirths focusing on low-income country studies published in the last 10 years. Much information about these relationships comes from case reports. Research resulting in a better understanding of the causes and strategies to reduce infection-related stillbirth is necessary.
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Affiliation(s)
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jean Kim
- RTI International, Durham, NC, USA
| | - Imran Ahmed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Najia Ghanchi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mahantesh B Nagmoti
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Sangappa Dhaded
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | | | | | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, Jawaharlal Nehru Medical College, Belagavi, India
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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14
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Barbosa GCG, Ali MS, Araujo B, Reis S, Sena S, Ichihara MYT, Pescarini J, Fiaccone RL, Amorim LD, Pita R, Barreto ME, Smeeth L, Barreto ML. CIDACS-RL: a novel indexing search and scoring-based record linkage system for huge datasets with high accuracy and scalability. BMC Med Inform Decis Mak 2020; 20:289. [PMID: 33167998 PMCID: PMC7654019 DOI: 10.1186/s12911-020-01285-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Record linkage is the process of identifying and combining records about the same individual from two or more different datasets. While there are many open source and commercial data linkage tools, the volume and complexity of currently available datasets for linkage pose a huge challenge; hence, designing an efficient linkage tool with reasonable accuracy and scalability is required. Methods We developed CIDACS-RL (Centre for Data and Knowledge Integration for Health – Record Linkage), a novel iterative deterministic record linkage algorithm based on a combination of indexing search and scoring algorithms (provided by Apache Lucene). We described how the algorithm works and compared its performance with four open source linkage tools (AtyImo, Febrl, FRIL and RecLink) in terms of sensitivity and positive predictive value using gold standard dataset. We also evaluated its accuracy and scalability using a case-study and its scalability and execution time using a simulated cohort in serial (single core) and multi-core (eight core) computation settings. Results Overall, CIDACS-RL algorithm had a superior performance: positive predictive value (99.93% versus AtyImo 99.30%, RecLink 99.5%, Febrl 98.86%, and FRIL 96.17%) and sensitivity (99.87% versus AtyImo 98.91%, RecLink 73.75%, Febrl 90.58%, and FRIL 74.66%). In the case study, using a ROC curve to choose the most appropriate cut-off value (0.896), the obtained metrics were: sensitivity = 92.5% (95% CI 92.07–92.99), specificity = 93.5% (95% CI 93.08–93.8) and area under the curve (AUC) = 97% (95% CI 96.97–97.35). The multi-core computation was about four times faster (150 seconds) than the serial setting (550 seconds) when using a dataset of 20 million records. Conclusion CIDACS-RL algorithm is an innovative linkage tool for huge datasets, with higher accuracy, improved scalability, and substantially shorter execution time compared to other existing linkage tools. In addition, CIDACS-RL can be deployed on standard computers without the need for high-speed processors and distributed infrastructures.
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Affiliation(s)
- George C G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.
| | - M Sanni Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,NDORMS, Center for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Bruno Araujo
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Sandra Reis
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Samila Sena
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Maria Y T Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Julia Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Rosemeire L Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Leila D Amorim
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Robespierre Pita
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil
| | - Marcos E Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Computer Science Department, Federal University of Bahia (UFBA), Salvador, Brazil.,Department of Statistics, London School of Economics and Political Science (LSE), London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fiocruz Bahia, Parque Tecnológico da Bahia, Edf. Tecnocentro, sala 315, Rua Mundo, no 121, Salvador, 41301-110, Brazil.,Institute of Public Health, Federal University of Bahia (UFBA), Salvador, Brazil
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15
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Tougma SA, Zoungrana/Yaméogo WN, Dahourou DL, Salou/Kagoné IA, Compaoré TR, Kaboré A, Kagoné T, Drabo MK, Meda N. Dengue virus infection and pregnancy outcomes during the 2017 outbreak in Ouagadougou, Burkina Faso: A retrospective cohort study. PLoS One 2020; 15:e0238431. [PMID: 32886677 PMCID: PMC7473539 DOI: 10.1371/journal.pone.0238431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction Dengue fever is a re-emerging pathology in Burkina Faso. It affects everyone and pregnant women are not left out. The objective of this study was to estimate the burden of dengue fever and to assess its effects on pregnancy outcomes in hospitalized pregnant women during the 2017 outbreak in Ouagadougou, Burkina Faso. Method This was a retrospective cohort study including febrile pregnant women from five health facilities in Ouagadougou. The study was carried out from July 1st to December 31st, 2017. A logistic stepwise regression was performed to identify the pregnancy adverse outcomes risk factors. Results Our study included 424 pregnant women at a mean age of 27.1 years old (Standard deviation: 6.23 years). Overall 28.54% (121/424) were infected with dengue virus. During follow-up, 29.01% (123/424) presented an adverse pregnancy outcome. Adjusted for gestational age and clinical symptoms, the risk of adverse pregnancy outcome was twice as high among dengue infected women as compared to uninfected women with an adjusted Odds Ratio (aOR) = 2.09 (1.08–4.05). The risk of the adverse pregnancy outcome was higher in the third trimester of pregnancy with aOR = 1.66 (1.02–2.72) in dengue fever infected women. Conclusion Dengue fever is a risk factor for adverse pregnancy outcomes, especially in the third trimester in Burkina Faso. The implementation of effective anti-vectorial control interventions and better management of dengue fever during pregnancy are needed to improve pregnancy outcomes.
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Affiliation(s)
- Serge Alain Tougma
- Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Ministry of Health, Ouagadougou, Burkina Faso
- * E-mail:
| | | | - Désiré Lucien Dahourou
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Centre Muraz, Bobo Dioulasso, Burkina Faso
| | | | - T. Rébeca Compaoré
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Ahmed Kaboré
- Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | | | - Maxime K. Drabo
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Nicolas Meda
- Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre Muraz, Bobo Dioulasso, Burkina Faso
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16
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O'Kelly B, Lambert JS. Vector-borne diseases in pregnancy. Ther Adv Infect Dis 2020; 7:2049936120941725. [PMID: 32944240 PMCID: PMC7469740 DOI: 10.1177/2049936120941725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Vector-borne infections cause a significant proportion of world-wide morbidity and mortality and many are increasing in incidence. This is due to a combination of factors, primarily environmental change, encroachment of human habitats from urban to peri-urban areas and rural to previously uninhabited areas, persistence of poverty, malnutrition and resource limitation in geographical areas where these diseases are endemic. Pregnant women represent the single largest ‘at risk’ group, due to immune-modulation and a unique physiological state. Many of these diseases have not benefitted from the same level of drug development as other infectious and medical domains, a factor attributing to the ‘neglected tropical disease’ title many vector-borne diseases hold. Pregnancy compounds this issue as data for safety and efficacy for many drugs is practically non-existent, precluding exposure in pregnancy to many first-line therapeutic agents for ‘fear of the unknown’ or overstated adverse pregnancy-foetal outcomes. In this review, major vector-borne diseases, their impact on pregnancy outcomes, current treatment, vaccination and short-comings of current medical practice for pregnant women will be discussed.
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Affiliation(s)
- Brendan O'Kelly
- Infectious Diseases Specialist Registrar, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John S Lambert
- Consultant in Infectious Diseases, Medicine and Sexual Health (GUM), Mater, Rotunda and UCD, Mater Misericordiae University Hospital, Clinic 6, Eccles St, Inns Quay, Dublin, D07 R2WY University College Dublin Rotunda Maternity Hospital
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17
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Sanchez Clemente N, Brickley EB, Paixão ES, De Almeida MF, Gazeta RE, Vedovello D, Rodrigues LC, Witkin SS, Passos SD. Zika virus infection in pregnancy and adverse fetal outcomes in São Paulo State, Brazil: a prospective cohort study. Sci Rep 2020; 10:12673. [PMID: 32728054 PMCID: PMC7391725 DOI: 10.1038/s41598-020-69235-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/09/2020] [Indexed: 01/17/2023] Open
Abstract
Robust epidemiological and biological evidence supports a causal link between prenatal Zika Virus (ZIKV) infection and congenital brain abnormalities including microcephaly. However, it remains uncertain if ZIKV infection in pregnancy also increases the risk for other adverse fetal and birth outcomes. In a prospective cohort study we investigated the influence of ZIKV on the prevalence of prematurity, low birth weight, small-for-gestational-age, and fetal death as well as microcephaly (i.e., overall and disproportionate) in the offspring of women attending a high-risk pregnancy clinic during the recent ZIKV outbreak in Brazil. During the recruitment period (01 March 2016-23 August 2017), urine samples were tested for ZIKV by RT-PCR from all women attending the high-risk pregnancy clinic at Jundiaí University Hospital and from the neonates after delivery. Of the 574 women evaluated, 44 (7.7%) were ZIKV RT-PCR positive during pregnancy. Of the 409 neonates tested, 19 (4.6%) were ZIKV RT-PCR positive in the first 10 days of life. In this cohort, maternal ZIKV exposure was not associated with increased risks of prematurity, low birth weight, small-for-gestational-age, or fetal death. However, relative to ZIKV-negative neonates, ZIKV-positive infants had a five-fold increased risk of microcephaly overall (RR 5.1, 95% CI 1.2-22.5) and a ten-fold increased risk of disproportionate microcephaly (RR 10.3, 95% CI 2.0-52.6). Our findings provide new evidence that, in a high-risk pregnancy cohort, ZIKV RT-PCR positivity in the neonate at birth is strongly associated with microcephaly. However, ZIKV infection during pregnancy does not appear to influence the risks of prematurity, low birth weight, small-for-gestational-age or fetal death in women who already have gestational comorbidities. The results suggest disproportion between neonatal head circumference and weight may be a useful screening indicator for the detection of congenital microcephaly associated with ZIKV infection.
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Affiliation(s)
- Nuria Sanchez Clemente
- Department of Epidemiology, University of São Paulo, São Paulo, Brazil.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Enny S Paixão
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Rosa E Gazeta
- Jundiaí Medical School, Jundiaí University, São Paulo, Brazil
| | | | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
- Institute of Tropical Medicine, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Saulo D Passos
- Jundiaí Medical School, Jundiaí University, São Paulo, Brazil
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18
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Jaubert J, Atiana L, Larrieu S, De Vos P, Somon-Payet C, Porcherat S, Mboussou Y, Naze F, Picot S, Boukerrou M, Robillard PY, Gérardin P. Q fever seroprevalence in parturient women: the EQRUN cross-sectional study on Reunion Island. BMC Infect Dis 2020; 20:261. [PMID: 32245372 PMCID: PMC7118902 DOI: 10.1186/s12879-020-04969-w] [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: 03/18/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background Q fever (Coxiella burnetii infection) has been associated with adverse perinatal outcomes. After investigating the obstetrical importance of Q fever on Reunion island and demonstrating an association between incident Q fever and miscarriage, we conducted a cross-sectional serosurvey to assess the prevalence of Coxiella burnetii infection among parturient women. Methods Between January 9 and July 24, 2014, within the level-4 maternity of Saint Pierre hospital and the level-1 maternity of Le Tampon, we proposed to screen all parturient women for Coxiella burnetii serology. Seropositivity was defined using indirect immunofluorescence for a dilution of phase 2 IgG titre ≥1:64. Further dilutions were chosen to discriminate recent or active infections from past or prevalent infections (< 1:128) and classify these as either possible (1:128), or probable (≥1:256). Recurrent miscarriage, stillbirth, preterm birth, small-for-gestational as well as a composite outcome of these adverse pregnancy outcomes were compared according to seropositivity using bivariate analysis or propensity score matching of seropositive and seronegative women on confounding factors. Results Among 1112 parturient women screened for Q fever over this 7-month period, 203 (18.3%) were seropositive. Overall weighted seroprevalence was of 20.1% (95%CI, 17.7–22.5%). Weighted seroprevalence of probable infections was 4.7% (95%CI 3.4–5.9%), while > 90% of positive serologies corresponded to past infections or false positives. Seropositivity was associated with none of the abovementioned adverse perinatal outcomes, whether in unpaired or matched analyses on propensity score. Conclusion The magnitude and the pattern of seroprevalence suggest that Q fever is endemic on Reunion island. In this context, we found no significant contribution of prevalent Coxiella burnetii infection to adverse pregnancy outcomes. Although reassuring, these data put in our endemic context, with a previously demonstrated increased risk of incident Q fever associated miscarriage, encourage us to protect pregnant women against the risk of new infection, periconceptional or early in pregnancy.
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Affiliation(s)
- Julien Jaubert
- Laboratoire de Bactériologie, Virologie et Parasitologie, Centre Hospitalier Universitaire (CHU) de la Réunion, Saint Pierre, Reunion, France
| | - Laura Atiana
- Laboratoire de Bactériologie, Virologie et Parasitologie, Centre Hospitalier Universitaire (CHU) de la Réunion, Saint Pierre, Reunion, France
| | - Sophie Larrieu
- CIRE Océan Indien, Santé Publique France, French National Public Health Agency, Saint Denis, Reunion, France
| | | | - Claudine Somon-Payet
- Maternité, Pôle Femme Mère Enfant, CHU de la Réunion, St Pierre, Reunion, France
| | - Sylvaine Porcherat
- INSERM CIC 1410 Epidémiologie Clinique, Centre Hospitalier Universitaire, Groupe Hospitalier Sud Réunion, CHU Réunion, BP 350, 97448, Saint Pierre, Cedex-Reunion, France
| | - Yoan Mboussou
- Laboratoire de Bactériologie, Virologie et Parasitologie, Centre Hospitalier Universitaire (CHU) de la Réunion, Saint Pierre, Reunion, France
| | - Florence Naze
- Laboratoire de Bactériologie, Virologie et Parasitologie, Centre Hospitalier Universitaire (CHU) de la Réunion, Saint Pierre, Reunion, France
| | - Sandrine Picot
- Laboratoire de Bactériologie, Virologie et Parasitologie, Centre Hospitalier Universitaire (CHU) de la Réunion, Saint Pierre, Reunion, France
| | - Malik Boukerrou
- Maternité, Pôle Femme Mère Enfant, CHU de la Réunion, St Pierre, Reunion, France.,CEPOI-EA7388, Pôle Femme Mère Enfant, CHU de la Réunion, Saint Pierre, Reunion, France
| | - Pierre-Yves Robillard
- Maternité, Pôle Femme Mère Enfant, CHU de la Réunion, St Pierre, Reunion, France.,CEPOI-EA7388, Pôle Femme Mère Enfant, CHU de la Réunion, Saint Pierre, Reunion, France
| | - Patrick Gérardin
- INSERM CIC 1410 Epidémiologie Clinique, Centre Hospitalier Universitaire, Groupe Hospitalier Sud Réunion, CHU Réunion, BP 350, 97448, Saint Pierre, Cedex-Reunion, France. .,UM 134 PIMIT Processus Infectieux en Milieu Insulaire Tropical, Université de La Réunion, INSERM 1187, CNRS 9192, IRD 249, CYROI, Sainte Clotilde, Reunion, France.
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19
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Researching Zika in pregnancy: lessons for global preparedness. THE LANCET. INFECTIOUS DISEASES 2020; 20:e61-e68. [PMID: 32085848 DOI: 10.1016/s1473-3099(20)30021-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/09/2020] [Accepted: 01/12/2020] [Indexed: 11/20/2022]
Abstract
Our understanding of congenital infections is based on prospective studies of women infected during pregnancy. The EU has funded three consortia to study Zika virus, each including a prospective study of pregnant women. Another multi-centre study has been funded by the US National Institutes of Health. This Personal View describes the study designs required to research Zika virus, and questions whether funding academics in the EU and USA to work with collaborators in outbreak areas is an effective strategy. 3 years after the 2015-16 Zika virus outbreaks, these collaborations have taught us little about vertical transmission of the virus. In the time taken to approve funding, agree contracts, secure ethics approval, and equip laboratories, Zika virus had largely disappeared. By contrast, prospective studies based on local surveillance and standard-of-care protocols have already provided valuable data. Threats to fetal and child health pose new challenges for global preparedness requiring support for the design and implementation of locally appropriate protocols. These protocols can answer the key questions earlier than externally designed studies and at lower cost. Local protocols can also provide a framework for recruitment of unexposed controls that are required to study less specific outcomes. Other priorities include accelerated development of non-invasive tests, and longer-term storage of neonatal and antenatal samples to facilitate retrospective reconstruction of cohort studies.
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20
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Mubashir M, Ahmed KS, Mubashir H, Quddusi A, Farooq A, Ahmed SI, Jamil B, Qureshi R. Dengue and malaria infections in pregnancy : Maternal, fetal and neonatal outcomes at a tertiary care hospital. Wien Klin Wochenschr 2020; 132:188-196. [PMID: 31997066 PMCID: PMC7095108 DOI: 10.1007/s00508-019-01606-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
Background Malaria and dengue cause major morbidity in developing nations and are more severe in pregnancy. Maternal, fetal, and neonatal outcomes in pregnant patients infected with dengue or malaria were studied. Methods The medical records of pregnant women admitted with either dengue or malaria infections from 2011–2015 to this hospital were reviewed. Clinical outcomes and laboratory tests were examined. Results Of 85 women, 56%, 21%, and 22% had contracted dengue, malaria, and multiple infections, respectively. Pregnant women who had contracted dengue fever alone were more likely to present to the hospital at an earlier gestational age (24 weeks, p = 0.03). Women with multiple infections, were more likely to deliver earlier (30 weeks, p < 0.01). Women with malaria were more likely to have low birth weight deliveries (mean birth weight 2394 g, p = 0.03). The incidence of in-hospital deaths among the cohort was 7%. Conclusion It is imperative to develop guidelines to screen for and diagnose dengue and malaria in pregnancy. Electronic supplementary material The online version of this article (10.1007/s00508-019-01606-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - Ayesha Farooq
- Aga Khan University Medical College, Karachi, Pakistan.
| | - Sheikh Irfan Ahmed
- Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Rahat Qureshi
- Department of Obstetrics and Gynaecology, Aga Khan University, Karachi, Pakistan
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21
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Feifel J, Gebauer M, Schumacher M, Beyersmann J. Nested exposure case-control sampling: a sampling scheme to analyze rare time-dependent exposures. LIFETIME DATA ANALYSIS 2020; 26:21-44. [PMID: 30426275 DOI: 10.1007/s10985-018-9453-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
For large cohort studies with rare outcomes, the nested case-control design only requires data collection of small subsets of the individuals at risk. These are typically randomly sampled at the observed event times and a weighted, stratified analysis takes over the role of the full cohort analysis. Motivated by observational studies on the impact of hospital-acquired infection on hospital stay outcome, we are interested in situations, where not necessarily the outcome is rare, but time-dependent exposure such as the occurrence of an adverse event or disease progression is. Using the counting process formulation of general nested case-control designs, we propose three sampling schemes where not all commonly observed outcomes need to be included in the analysis. Rather, inclusion probabilities may be time-dependent and may even depend on the past sampling and exposure history. A bootstrap analysis of a full cohort data set from hospital epidemiology allows us to investigate the practical utility of the proposed sampling schemes in comparison to a full cohort analysis and a too simple application of the nested case-control design, if the outcome is not rare.
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Affiliation(s)
- Jan Feifel
- Ulm University, Helmholtzstrasse 20, 89081, Ulm, Germany.
| | - Madlen Gebauer
- Ulm University, Helmholtzstrasse 20, 89081, Ulm, Germany
| | - Martin Schumacher
- University Medical Center Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Jan Beyersmann
- Ulm University, Helmholtzstrasse 20, 89081, Ulm, Germany
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22
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Barreto ML, Ichihara MY, Almeida BA, Barreto ME, Cabral L, Fiaccone RL, Carreiro RP, Teles CAS, Pitta R, Penna GO, Barral-Netto M, Ali MS, Barbosa G, Denaxas S, Rodrigues LC, Smeeth L. The Centre for Data and Knowledge Integration for Health (CIDACS): Linking Health and Social Data in Brazil. Int J Popul Data Sci 2019; 4:1140. [PMID: 34095542 PMCID: PMC8142622 DOI: 10.23889/ijpds.v4i2.1140] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Centre for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador, Bahia-Brazil with the objective of integrating data and knowledge aiming to answer scientific questions related to the health of the Brazilian population. This article details our experiences in the establishment and operations of CIDACS, as well as efforts made to obtain high-quality linked data while adhering to security, ethical use and privacy issues. Every effort has been made to conduct operations while implementing appropriate structures, procedures, processes and controls over the original and integrated databases in order to provide adequate datasets to answer relevant research questions. Looking forward, CIDACS is expected to be an important resource for researchers and policymakers interested in enhancing the evidence base pertaining to different aspects of health, in particular when investigating, from a nation-wide perspective, the role of social determinants of health and the effects of social and environmental policies on different health outcomes.
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Affiliation(s)
- ML Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - MY Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - BA Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - ME Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Computer Science Department, Federal University of Bahia (UFBA), Salvador, Brazil.
| | - L Cabral
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - RL Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Statistics Department, Federal University of Bahia (UFBA), Brazil.
| | - RP Carreiro
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - CAS Teles
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - R Pitta
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - GO Penna
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Tropical Medicine Centre, University of Brasília (UnB), Brazil.
- Escola Fiocruz de Governo, FIOCRUZ Brasília, Brazil.
| | - M Barral-Netto
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - MS Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
| | - S Denaxas
- Institute of Health Informatics, University College London, United Kingdom.
| | - LC Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
| | - L Smeeth
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
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23
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Halstead S, Wilder-Smith A. Severe dengue in travellers: pathogenesis, risk and clinical management. J Travel Med 2019; 26:5551100. [PMID: 31423536 DOI: 10.1093/jtm/taz062] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/14/2022]
Abstract
RATIONALE FOR REVIEW Dengue is a frequent cause of febrile illness among travellers and has overtaken malaria as the leading cause of febrile illness for those traveling to Southeast Asia. The purpose is to review the risk of dengue and severe dengue in travellers with a particular focus on the pathogenesis and clinical management of severe dengue. RISK, PATHOGENESIS AND CLINICAL MANAGEMENT The risk of travel-acquired dengue depends on destination, season and duration of travel and activities during travel. Seroconversion rates reported in travellers, therefore, vary between <1% and >20%. The most common life-threatening clinical response to dengue infection is the dengue vascular permeability syndrome, epidemiologically linked to secondary infection, but can also occur in primary infection. Tertiary and quaternary infections are usually associated with mild or no disease. Antibody-dependent enhancement, viral factors, age, host factors and clinical experience of the managing physician modulate the risk of progressing to severe dengue. The relative risk of severe dengue in secondary versus primary infection ranges from 2 to 7. The absolute risk of severe dengue in children in highly endemic areas is ~0.1% per year for primary infections and 0.4% for secondary infections. About 2-4% of secondary infections lead to severe dengue. Severe dengue and death are both relatively rare in general travellers but more frequently in those visiting friends and relatives. Clinical management of severe dengue depends on judicious use of fluid rehydration. CONCLUSIONS Although dengue is a frequent cause of travel illness, severe dengue and deaths are rare. Nevertheless, dengue infections can interrupt travel and lead to evacuation and major out-of-pocket costs. Dengue is more frequent than many other travel-related vaccine preventable diseases, such as hepatitis A, hepatitis B, rabies, Japanese encephalitis and yellow fever, indicating a need for a dengue vaccine for travellers.
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Affiliation(s)
- Scott Halstead
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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24
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Paixão ES, Campbell OM, Teixeira MG, Costa MC, Harron K, Barreto ML, Leal MB, Almeida MF, Rodrigues LC. Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil. BMJ Open 2019; 9:e023529. [PMID: 31345962 PMCID: PMC6661644 DOI: 10.1136/bmjopen-2018-023529] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Dengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes. DESIGN AND SETTING We conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012. PARTICIPATING We linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks' gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome. RESULTS We included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period. CONCLUSION This study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers.
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Affiliation(s)
- Enny S Paixão
- IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Oona M Campbell
- IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | | | - Maria Cn Costa
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | - Katie Harron
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimento para Saúde, Fiocruz, Salvador, Bahia, Brazil
| | - Maira B Leal
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
| | - Marcia F Almeida
- School of Public Health, Universidade de São Paulo, São Paulo, Brazil
| | - Laura C Rodrigues
- IDE, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
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Abstract
BACKGROUND Despite increasing information in the literature regarding congenital Zika infection, gaps remain in our knowledge of its clinical manifestations. METHODS We did a prospective observational study of exposed fetuses and infants whose mothers developed symptomatic and confirmed Zika infection during pregnancy in Valle del Cauca, Colombia. We performed neurological, ophthalmologic and audiologic evaluations, and classified outcomes as possibly or uncertainly related to Zika. Frequencies of outcomes were compared according to the trimester of pregnancy when infection occurred. RESULTS We evaluated 171 products of gestation including 17 pregnancy losses and 154 patients evaluated postnatally. Ninety (52.6%) pregnancies presented an adverse outcome, 36% possibly related with Zika and the remaining 64% of uncertain relation. Infection in the first trimester had the highest frequencies of adverse outcomes possibly related with Zika compared with the second and third trimesters (39% vs. 12.5% vs. 12%) with risk ratios of adverse outcomes possibly related to Zika in pregnancies infected in the first versus second or third trimester of 3.1 (95% CI: 2.4-4.1) and 3.3 (95% CI: 2.5-4.2), respectively. The frequencies of pregnancy loss and microcephaly were 9.4% and 4.5%, respectively. Auditory and ophthalmic abnormalities possibly related with Zika were present in 3% and 6% of the patients evaluated, respectively. CONCLUSIONS We observed a high frequency of gestational and neonatal complications in pregnant women who acquired Zika infection, especially in early pregnancy, resulting in a broad spectrum of clinical manifestations. Preventive measures are urgently needed to reduce the clinical burden during future Zika outbreaks.
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26
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Paixão ES, Teixeira MG, Costa MDCN, Barreto ML, Rodrigues LC. Symptomatic Dengue during Pregnancy and Congenital Neurologic Malformations. Emerg Infect Dis 2019; 24:1748-1750. [PMID: 30124410 PMCID: PMC6106414 DOI: 10.3201/eid2409.170361] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Dengue virus infection during pregnancy increased the risk for any neurologic congenital anomaly in the infant by roughly 50% and for other congenital malformations of brain 4-fold. Our results show an association between dengue during pregnancy and congenital anomalies of the brain, suggesting that flaviviruses other than Zika virus are associated with such malformations.
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27
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Paixão ES, Campbell OMR, Rodrigues LC, Teixeira MG, Costa MDCN, Brickley EB, Harron K. Validating linkage of multiple population-based administrative databases in Brazil. PLoS One 2019; 14:e0214050. [PMID: 30921353 PMCID: PMC6438533 DOI: 10.1371/journal.pone.0214050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background Linking routinely-collected data provides an opportunity to measure the effects of exposures that occur before birth on maternal, fetal and infant outcomes. High quality linkage is a prerequisite for producing reliable results, and there are specific challenges in mother-baby linkage. Using population-based administrative databases from Brazil, this study aimed to estimate the accuracy of linkage between maternal deaths and birth outcomes and dengue notifications, and to identify potential sources of bias when assessing the risk of maternal death due to dengue in pregnancy. Methods We identified women with dengue during pregnancy in a previously linked dataset of dengue notifications in women who had experienced a live birth or stillbirth during 2007–2012. We then linked this dataset with maternal death records probabilistically using maternal name, age and municipality. We estimated the accuracy of the linkage, and examined the characteristics of false-matches and missed-matches to identify any sources of bias. Results Of the 10,259 maternal deaths recorded in 2007–2012, 6717 were linked: 5444 to a live birth record, 1306 to a stillbirth record, and 33 to both a live and stillbirth record. After identifying 2620 missed-matches and 124 false-matches, our estimated sensitivity was 72%, specificity was 88%, and positive predictive value was 98%. Linkage errors were associated with maternal education and self-identified race; women with more than 7 years of education or who self-declared as Caucasian were more likely to link. Dengue status was not associated with linkage error. Conclusion Despite not having unique identifiers to link mothers and birth outcomes, we demonstrated a high standard of linkage, with sensitivity and specificity values comparable to previous literature. Although there were no differences in the characteristics of dengue cases missed or included in our linked dataset, linkage error occurred disproportionally by some social-demographic characteristics, which should be taken into account in future analyses.
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Affiliation(s)
- Enny S. Paixão
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
- * E-mail:
| | - Oona M. R. Campbell
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
| | - Laura C. Rodrigues
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
| | - Maria Glória Teixeira
- Instituto de Saúde Coletiva, Rua Basílio da Gama, s/n.Canela, CEP, Salvador, Bahia, Brazil
| | | | | | - Katie Harron
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, United Kingdom
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28
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Kramer LD, Long MT. Editorial overview. Curr Opin Virol 2019; 27:iv-v. [PMID: 29223217 DOI: 10.1016/j.coviro.2017.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Laura D Kramer
- Arbovirus Laboratory, Wadsworth Center, New York State Department of Health and School of Public Health, State University of New York, Albany, NY, USA.
| | - Maureen T Long
- Fern Audette Chair and Associate Professor, Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Veterinary Academic Building V3-157, 2015 SW 16th Avenue, Gainesville, FL 32608, USA.
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Abstract
Mortality from severe dengue is low, but the economic and resource burden on health services remains substantial in endemic settings. Unfortunately, progress towards development of effective therapeutics has been slow, despite notable advances in the understanding of disease pathogenesis and considerable investment in antiviral drug discovery. For decades antibody-dependent enhancement has been the prevalent model to explain dengue pathogenesis, but it was only recently demonstrated in vivo and in clinical studies. At present, the current mainstay of management for most symptomatic dengue patients remains careful observation and prompt but judicious use of intravenous hydration therapy for those with substantial vascular leakage. Various new promising technologies for diagnosis of dengue are currently in the pipeline. New sample-in, answer-out nucleic acid amplification technologies for point-of-care use are being developed to improve performance over current technologies, with the potential to test for multiple pathogens using a single specimen. The search for biomarkers that reliably predict development of severe dengue among symptomatic individuals is also a major focus of current research efforts. The first dengue vaccine was licensed in 2015 but its performance depends on serostatus. There is an urgent need to identify correlates of both vaccine protection and disease enhancement. A crucial assessment of vector control tools should guide a research agenda for determining the most effective interventions, and how to best combine state-of-the-art vector control with vaccination.
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Affiliation(s)
- Annelies Wilder-Smith
- London School of Hygiene & Tropical Medicine, London, UK; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | - Eng-Eong Ooi
- Duke-National University of Singapore Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Olaf Horstick
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Bridget Wills
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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30
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Goldenberg RL, McClure EM. Dengue and stillbirth. THE LANCET. INFECTIOUS DISEASES 2018; 17:886-888. [PMID: 28845788 DOI: 10.1016/s1473-3099(17)30455-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/07/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA.
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Shrestha P, Roberts T, Homsana A, Myat TO, Crump JA, Lubell Y, Newton PN. Febrile illness in Asia: gaps in epidemiology, diagnosis and management for informing health policy. Clin Microbiol Infect 2018; 24:815-826. [PMID: 29581051 DOI: 10.1016/j.cmi.2018.03.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing evidence is becoming available on the aetiology and management of fevers in Asia; the importance of these fevers has increased with the decline in the incidence of malaria. AIMS To conduct a narrative review of the epidemiology and management of fevers in South and South-East Asia and to highlight gaps in our knowledge that impair evidence-based health policy decisions. SOURCES A narrative review of papers published since 2012 on developments in fever epidemiology, diagnosis and treatment in South and South-East Asia. The papers that the authors felt were pivotal, from their personal perspectives, are discussed. CONTENT We identified 100 studies. Among the 30 studies (30%)-including both children and adults-that investigated three or more pathogens, the most frequently reported fever aetiology was dengue (reported by 15, 50%), followed by leptospirosis (eight, 27%), scrub typhus (seven, 23%) and Salmonella serovar Typhi (six, 20%). Among four studies investigating three or more pathogens in children, dengue and Staphylococcus aureus were the most frequent, followed by non-typhoidal Salmonella spp, Streptococcus pneumoniae, Salmonella serovar Typhi, and Orientia tsutsugamushi. Increased awareness is needed that rickettsial pathogens are common but do not respond to cephalosporins, and that alternative therapies, such as tetracyclines, are required. IMPLICATIONS Many key gaps remain, and consensus guidelines for study design are needed to aid comparative understanding of the epidemiology of fevers. More investment in developing accurate and affordable diagnostic tests for rural Asia and independent evaluation of those already on the market are needed. Treatment algorithms, including simple biomarker assays, appropriate for empirical therapy of fevers in different areas of rural Asia should be a major aim of fever research. Enhanced antimicrobial resistance (AMR) surveillance and openly accessible databases of geography-specific AMR data would inform policy on empirical and specific therapy. More investment in innovative strategies facilitating infectious disease surveillance in remote rural communities would be an important component of poverty reduction and improving public health.
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Affiliation(s)
- P Shrestha
- Infectious Diseases Data Observatory, University of Oxford, UK
| | - T Roberts
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - A Homsana
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - T O Myat
- Department of Microbiology, University of Medicine 1, Yangon, Myanmar; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - J A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Y Lubell
- Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - P N Newton
- Infectious Diseases Data Observatory, University of Oxford, UK; Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, University of Oxford, UK.
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Chaiworapongsa T, Romero R, Erez O, Tarca AL, Conde-Agudelo A, Chaemsaithong P, Kim CJ, Kim YM, Kim JS, Yoon BH, Hassan SS, Yeo L, Korzeniewski SJ. The prediction of fetal death with a simple maternal blood test at 20-24 weeks: a role for angiogenic index-1 (PlGF/sVEGFR-1 ratio). Am J Obstet Gynecol 2017; 217:682.e1-682.e13. [PMID: 29037482 PMCID: PMC5951183 DOI: 10.1016/j.ajog.2017.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fetal death is an obstetrical syndrome that annually affects 2.4 to 3 million pregnancies worldwide, including more than 20,000 in the United States each year. Currently, there is no test available to identify patients at risk for this pregnancy complication. OBJECTIVE We sought to determine if maternal plasma concentrations of angiogenic and antiangiogenic factors measured at 24-28 weeks of gestation can predict subsequent fetal death. STUDY DESIGN A case-cohort study was designed to include 1000 randomly selected subjects and all remaining fetal deaths (cases) from a cohort of 4006 women with a singleton pregnancy, enrolled at 6-22 weeks of gestation, in a pregnancy biomarker cohort study. The placentas of all fetal deaths were histologically examined by pathologists who used a standardized protocol and were blinded to patient outcomes. Placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor-1 concentrations were measured by enzyme-linked immunosorbent assays. Quantiles of the analyte concentrations (or concentration ratios) were estimated as a function of gestational age among women who delivered a live neonate but did not develop preeclampsia or deliver a small-for-gestational-age newborn. A positive test was defined as analyte concentrations (or ratios) <2.5th and 10th centiles (placental growth factor, placental growth factor/soluble vascular endothelial growth factor receptor-1 [angiogenic index-1] and placental growth factor/soluble endoglin) or >90th and 97.5th centiles (soluble vascular endothelial growth factor receptor-1 and soluble endoglin). Inverse probability weighting was used to reflect the parent cohort when estimating the relative risk. RESULTS There were 11 fetal deaths and 829 controls with samples available for analysis between 24-28 weeks of gestation. Three fetal deaths occurred <28 weeks and 8 occurred ≥28 weeks of gestation. The rate of placental lesions consistent with maternal vascular underperfusion was 33.3% (1/3) among those who had a fetal death <28 weeks and 87.5% (7/8) of those who had this complication ≥28 weeks of gestation. The maternal plasma angiogenic index-1 value was <10th centile in 63.6% (7/11) of the fetal death group and in 11.1% (92/829) of the controls. The angiogenic index-1 value was <2.5th centile in 54.5% (6/11) of the fetal death group and in 3.7% (31/829) of the controls. An angiogenic index-1 value <2.5th centile had the largest positive likelihood ratio for predicting fetal death >24 weeks (14.6; 95% confidence interval, 7.7-27.7) and a relative risk of 29.1 (95% confidence interval, 8.8-97.1), followed by soluble endoglin >97.5th centile and placental growth factor/soluble endoglin <2.5th, both with a positive likelihood ratio of 13.7 (95% confidence interval, 7.3-25.8) and a relative risk of 27.4 (95% confidence interval, 8.2-91.2). Among women without a fetal death whose plasma angiogenic index-1 concentration ratio was <2.5th centile, 61% (19/31) developed preeclampsia or delivered a small-for-gestational-age neonate; when the 10th centile was used as the cut-off, 37% (34/92) of women had these adverse outcomes. CONCLUSION (1) A maternal plasma angiogenic index-1 value <2.5th centile (0.126) at 24-28 weeks of gestation carries a 29-fold increase in the risk of subsequent fetal death and identifies 55% of subsequent fetal deaths with a false-positive rate of 3.5%; and (2) 61% of women who have a false-positive test result will subsequently experience adverse pregnancy outcomes.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Adi L Tarca
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Piya Chaemsaithong
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Chong Jai Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon Mee Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Hyun Yoon
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sonia S Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Steven J Korzeniewski
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
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Paixão ES, Harron K, Andrade K, Teixeira MG, Fiaccone RL, Costa MDCN, Rodrigues LC. Evaluation of record linkage of two large administrative databases in a middle income country: stillbirths and notifications of dengue during pregnancy in Brazil. BMC Med Inform Decis Mak 2017; 17:108. [PMID: 28716074 PMCID: PMC5513351 DOI: 10.1186/s12911-017-0506-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/10/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Due to the increasing availability of individual-level information across different electronic datasets, record linkage has become an efficient and important research tool. High quality linkage is essential for producing robust results. The objective of this study was to describe the process of preparing and linking national Brazilian datasets, and to compare the accuracy of different linkage methods for assessing the risk of stillbirth due to dengue in pregnancy. METHODS We linked mothers and stillbirths in two routinely collected datasets from Brazil for 2009-2010: for dengue in pregnancy, notifications of infectious diseases (SINAN); for stillbirths, mortality (SIM). Since there was no unique identifier, we used probabilistic linkage based on maternal name, age and municipality. We compared two probabilistic approaches, each with two thresholds: 1) a bespoke linkage algorithm; 2) a standard linkage software widely used in Brazil (ReclinkIII), and used manual review to identify further links. Sensitivity and positive predictive value (PPV) were estimated using a subset of gold-standard data created through manual review. We examined the characteristics of false-matches and missed-matches to identify any sources of bias. RESULTS From records of 678,999 dengue cases and 62,373 stillbirths, the gold-standard linkage identified 191 cases. The bespoke linkage algorithm with a conservative threshold produced 131 links, with sensitivity = 64.4% (68 missed-matches) and PPV = 92.5% (8 false-matches). Manual review of uncertain links identified an additional 37 links, increasing sensitivity to 83.7%. The bespoke algorithm with a relaxed threshold identified 132 true matches (sensitivity = 69.1%), but introduced 61 false-matches (PPV = 68.4%). ReclinkIII produced lower sensitivity and PPV than the bespoke linkage algorithm. Linkage error was not associated with any recorded study variables. CONCLUSION Despite a lack of unique identifiers for linking mothers and stillbirths, we demonstrate a high standard of linkage of large routine databases from a middle income country. Probabilistic linkage and manual review were essential for accurately identifying cases for a case-control study, but this approach may not be feasible for larger databases or for linkage of more common outcomes.
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Affiliation(s)
- Enny S Paixão
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Katie Harron
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Kleydson Andrade
- Instituto de Saúde Coletiva, Rua Basílio da Gama, s/n.Canela, Salvador, Bahia CEP 40110040 Brazil
| | - Maria Glória Teixeira
- Instituto de Saúde Coletiva, Rua Basílio da Gama, s/n.Canela, Salvador, Bahia CEP 40110040 Brazil
| | - Rosemeire L. Fiaccone
- Departamento de Estatística, Av Ademar de Barros, s/n Ondina, Salvador, Bahia CEP 40170110 Brazil
| | | | - Laura C. Rodrigues
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
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