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Paixao ES, Cerqueira-Silva T, Florentino PT, Carroll O, Sanchez Clemente N, Lawlor DA, Ribeiro Silva RDC, Rodrigues LC, Smeeth L, Barreto ML. A nationwide longitudinal investigation on the role of prenatal exposure to infectious diseases on the onset of chronic conditions in children and adolescents in Brazil. Wellcome Open Res 2024; 9:320. [PMID: 39429627 PMCID: PMC11489840 DOI: 10.12688/wellcomeopenres.22430.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2024] [Indexed: 10/22/2024] Open
Abstract
Background In utero exposure to infections might set the stage for a chain of events leading to a wide spectrum of long-term health outcomes observed in children and adolescents. This proposal aims to investigate whether syphilis, zika, dengue and chikungunya during pregnancy can increase the risk of the offspring developing a non-infectious chronic condition during childhood and adolescence. Objectives 1) Estimate the risk of non-infectious chronic conditions associated to syphilis, zika, dengue and chikungunya during pregnancy and when appropriate, explore if the risk varies by timing during pregnancy when the infection is acquired (first, second or third trimester) and severity (such as severe or mild dengue); 2) Investigate whether in uterus exposure to maternal infection affects the growth pattern of children and adolescents; 3) Examine the extent to which the relationship between maternal infection and non-infectious chronic outcomes are mediated by intrauterine growth restriction and preterm birth. Methods We will compare health outcomes and growth trajectories of children and adolescents born to mothers with and without specific infections during pregnancy using conventional multivariable regression in the whole study population, in a within sibship design, using the subgroup of offspring with at least one sibling who is not exposed to the infection, and negative control outcome. Then we will decompose the direct and mediated effects (by preterm birth and small for gestational age) of maternal infection on chronic disorders. Results and Conclusions The results from this study will advance our understanding of the relationship between infections during pregnancy and chronic disorders, with widespread implications enabling targeting of critical points along the path from in utero exposure to outcomes to avoid or mitigate illness and disability over the life course.
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Affiliation(s)
- Enny S. Paixao
- Faculty of Epidemiology and Population Health, London School of hygiene and Tropical Medicine, London, UK
- Centre for Data and Knowledge Integration for Health, Salvador, Brazil
| | - Thiago Cerqueira-Silva
- Faculty of Epidemiology and Population Health, London School of hygiene and Tropical Medicine, London, UK
| | | | - Orlagh Carroll
- Faculty of Epidemiology and Population Health, London School of hygiene and Tropical Medicine, London, UK
| | - Nuria Sanchez Clemente
- Centre for Neonatal and Paediatric Infection, St George's University, Saint George's, Saint George, UK
| | - Deborah A. Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, United Kingdom; Population Health Science, Bristol Medical School, University of Bristol, Bristol, England, UK
| | | | - Laura Cunha Rodrigues
- Faculty of Epidemiology and Population Health, London School of hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of hygiene and Tropical Medicine, London, UK
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Martelli CMT, Cortes F, Brandão-Filho SP, Turchi MD, de Souza WV, de Araújo TVB, Ximenes RADA, Miranda-Filho DDB. Clinical spectrum of congenital Zika virus infection in Brazil: Update and issues for research development. Rev Soc Bras Med Trop 2024; 57:e00301. [PMID: 39082517 PMCID: PMC11290870 DOI: 10.1590/0037-8682-0153-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/26/2024] [Indexed: 08/02/2024] Open
Abstract
This review aimed to provide an update on the morphological and/or functional abnormalities related to congenital Zika virus (ZIKV) infection, based on primary data from studies conducted in Brazil since 2015. During the epidemic years (2015-2016), case series and pediatric cohort studies described several birth defects, including severe and/or disproportionate microcephaly, cranial bone overlap, skull collapse, congenital contractures (arthrogryposis and/or clubfoot), and visual and hearing abnormalities, as part of the spectrum of Congenital Zika Syndrome (CZS). Brain imaging abnormalities, mainly cortical atrophy, ventriculomegaly, and calcifications, serve as structural markers of CZS severity. Most case series and cohorts of microcephaly have reported the co-occurrence of epilepsy, dysphagia, orthopedic deformities, motor function impairment, cerebral palsy, and urological impairment. A previous large meta-analysis conducted in Brazil revealed that a confirmed ZIKV infection during pregnancy was associated with a 4% risk of microcephaly. Additionally, one-third of children showed at least one abnormality, predominantly identified in isolation. Studies examining antenatally ZIKV-exposed children without detectable abnormalities at birth reported conflicting neurodevelopmental results. Therefore, long-term follow-up studies involving pediatric cohorts with appropriate control groups are needed to address this knowledge gap. We recognize the crucial role of a national network of scientists collaborating with international research institutions in understanding the lifelong consequences of congenital ZIKV infection. Additionally, we highlight the need to provide sustainable resources for research and development to reduce the risk of future Zika outbreaks.
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Affiliation(s)
| | - Fanny Cortes
- Universidade de Pernambuco, Pós-Graduação em Ciências da Saúde, Recife, PE, Brasil
| | | | - Marilia Dalva Turchi
- Universidade Federal de Goiás, Programa de Pós-Graduação em Medicina Tropical e Saúde Pública, Goiânia, GO, Brasil
| | - Wayner Vieira de Souza
- Instituto Aggeu Magalhães, Programa de Pós-Graduação em Saúde Pública, Recife, PE, Brasil
| | | | - Ricardo Arraes de Alencar Ximenes
- Universidade de Pernambuco, Pós-Graduação em Ciências da Saúde, Recife, PE, Brasil
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Medicina Tropical, Recife, PE, Brasil
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Max R, Toval-Ruiz C, Becker-Dreps S, Gajewski AM, Martinez E, Cross K, Blette B, Ortega O, Collado D, Zepeda O, Familiar I, Boivin MJ, Chavarria M, Meléndez MJ, Mercado JC, de Silva A, Collins MH, Westreich D, Bos S, Harris E, Balmaseda A, Gower EW, Bowman NM, Stringer E, Bucardo F. Neurodevelopment in preschool children exposed and unexposed to Zika virus in utero in Nicaragua: a prospective cohort study. Lancet Glob Health 2024; 12:e1129-e1138. [PMID: 38876760 PMCID: PMC11289744 DOI: 10.1016/s2214-109x(24)00176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/23/2024] [Accepted: 04/11/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Data on long-term neurodevelopmental outcomes of normocephalic children (born with normal head circumference) exposed to Zika virus in utero are scarce. We aimed to compare neurodevelopmental outcomes in normocephalic children up to age 48 months with and without Zika virus exposure in utero. METHODS In this prospective cohort study, we included infants from two cohorts of normocephalic children born in León and Managua, Nicaragua during the 2016 Zika epidemic. In León, all women pregnant during the two enrolment periods were eligible. In Managua, mother-child pairs were included from three districts in the municipality of Managua: all women who became pregnant before June 15, 2016, and had a due date of Sept 15, 2016 or later were eligible. Infants were serologically classified as Zika virus-exposed or Zika virus-unexposed in utero and were followed up prospectively until age 48 months. At 36 months and 48 months of age, the Mullen Scales of Early Learning (MSEL) assessment was administered. Primary outcomes were MSEL early learning composite (ELC) scores at 30-48 months in León and 36-48 months in Managua. We used an inverse probability weighting generalised estimating equations model to assess the effect of Zika virus exposure on individual MSEL cognitive domain scores and ELC scores, adjusted for maternal education and age, poverty status, and infant sex. FINDINGS The initial enrolment period for the León cohort was between Jan 31 and April 5, 2017 and the second was between Aug 30, 2017, and Feb 22, 2018. The enrolment period for the Managua cohort was between Oct 24, 2019, and May 5, 2020. 478 mothers (482 infants) from the León cohort and 615 mothers (609 infants) from the Managua cohort were enrolled, of whom 622 children (303 from the León cohort; 319 from the Managua cohort) were included in the final analysis; four children had microcephaly at birth and thus were excluded from analyses, two from each cohort. 33 (11%) of 303 children enrolled in León and 219 (69%) of 319 children enrolled in Managua were exposed to Zika virus in utero. In both cohorts, no significant differences were identified in adjusted mean ELC scores between Zika virus-exposed and unexposed infants at 36 months (between-group difference 1·2 points [95% CI -4·2 to 6·5] in the León cohort; 2·8 [-2·4 to 8·1] in the Managua cohort) or at 48 months (-0·9 [-10·8 to 8·8] in the León cohort; 0·1 [-5·1 to 5·2] in the Managua cohort). No differences in ELC scores between Zika virus-exposed and unexposed infants exceeded 6 points at any time between 30 months and 48 months in León or between 36 months and 48 months in Managua, which was considered clinically significant in other settings. INTERPRETATION We found no significant differences in neurodevelopmental scores between normocephalic children with in-utero Zika virus exposure and Zika virus-unexposed children at age 36 months or 48 months. These findings are promising, supporting typical neurodevelopment in Zika virus-exposed normocephalic children, although additional follow-up and research is warranted. FUNDING National Institute of Child Health and Development, National Institute of Allergy and Infectious Diseases, and Fogarty International Center. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Ryan Max
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Christian Toval-Ruiz
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Facultad de Ingeniería, Universidad Tecnológica La Salle, León, Nicaragua
| | - Sylvia Becker-Dreps
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Evelin Martinez
- División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Ciudad de México, México
| | - Kaitlyn Cross
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bryan Blette
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Oscar Ortega
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Omar Zepeda
- Centro de Investigación en Enfermedades Tropicales, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Michael J Boivin
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Meylin Chavarria
- Department of Microbiology, National Autonomous University of Nicaragua at León, León, Nicaragua
| | - María José Meléndez
- Department of Microbiology, National Autonomous University of Nicaragua at León, León, Nicaragua
| | - Juan Carlos Mercado
- Sustainable Sciences Institute, Managua, Nicaragua; National Virology Laboratory at the Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Aravinda de Silva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew H Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra Bos
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley, Berkeley, CA, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley, Berkeley, CA, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua; National Virology Laboratory at the Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalie M Bowman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Filemón Bucardo
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rodríguez-Rabassa M, Appleton AA, Rosario-Villafañe V, Repollet-Carrer I, Borges-Rodríguez M, Dedós-Peña L, González M, Velázquez-González P, Muniz-Rodriguez K, Mántaras-Ortiz C, Rivera-Amill V, Olivieri-Ramos O, Alvarado-Domenech LI. Associations between the social environment and early childhood developmental outcomes of Puerto Rican children with prenatal Zika virus exposure: a cross-sectional study. BMC Pediatr 2024; 24:342. [PMID: 38755525 PMCID: PMC11100158 DOI: 10.1186/s12887-024-04806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Prenatal exposure to the Zika virus can lead to microcephaly and adverse developmental outcomes, even in children without evident birth defects. The social environment plays a crucial role in infant health and developmental trajectories, especially during periods of heightened brain plasticity. The study aimed to assess socioenvironmental factors as predictors of developmental outcomes of 36-month-old children exposed to Zika virus prenatally. STUDY DESIGN This cross-sectional study included 53 mothers and 55 children enrolled in the Pediatric Outcomes of Prenatal Zika Exposure cohort study in Puerto Rico. The study performs follow-up developmental assessments of children born to mothers with confirmed and probable Zika virus infection during pregnancy. Mothers completed socioenvironmental questionnaires (e.g., Perceived Neighborhood Scale and US Household Food Insecurity Survey). Children's developmental outcomes were assessed with the Bayley Scales of Infant and Toddler Development: Third Edition, the Ages and Stages Questionnaires: Third Edition, the Ages and Stages Questionnaire-Socioemotional: Second Edition, and the Child Adjustment and Parent Efficacy Scale. RESULTS Linear regression models, adjusting for a child's sex and age and maternal education, revealed that early life exposure to food insecurity and maternal pregnancy stressors were significantly associated with poorer developmental outcomes in Zika virus-exposed children at 36 months of age. Maternal resilience representation of adaptive ability was associated with the preservation of adequate developmental outcomes in children. CONCLUSIONS Pregnancy and early childhood are critical life periods for ensuring optimal brain development in children. While the mechanisms in the interaction of children with their environment are complex, the risk and protective factors identified in the study are modifiable through public policy and preventive initiatives. Implementation of comprehensive strategies that improve access to social support programs, educational and nutritional interventions, and mental health services during pregnancy and early childhood can enhance the developmental potential of vulnerable children.
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Affiliation(s)
- Mary Rodríguez-Rabassa
- Department of Pediatrics, Ponce Health Sciences University, Ponce, PR, Puerto Rico.
- RCMI Center for Research Resources, Ponce Health Sciences University, Ponce, PR, Puerto Rico.
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico.
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY, USA
| | | | | | | | - Lydiet Dedós-Peña
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, Puerto Rico
| | - Marielly González
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico
| | - Paola Velázquez-González
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico
| | | | - Claudia Mántaras-Ortiz
- Clinical Psychology Program, Ponce Health Sciences University, Ponce, PR, 00732-7004, Puerto Rico
| | - Vanessa Rivera-Amill
- RCMI Center for Research Resources, Ponce Health Sciences University, Ponce, PR, Puerto Rico
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5
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Alger J, Cafferata ML, López R, Wiggins LD, Callejas A, Castillo M, Fúnes J, Rico F, Valencia D, Varela D, Alvarez Z, Berrueta M, Bock H, Bustillo C, Calderón A, Ciganda A, García-Aguilar J, García K, Gibbons L, Gilboa SM, Harville EW, Hernández G, López W, Lorenzana I, Luque MT, Maldonado C, Moore C, Ochoa C, Parham L, Pastrana K, Paternina-Caicedo A, Rodríguez H, Stella C, Tannis AF, Wesson DM, Zúniga C, Tong VT, Buekens P. Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people. Pediatr Res 2024; 95:566-572. [PMID: 38057577 PMCID: PMC11045253 DOI: 10.1038/s41390-023-02951-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.
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Affiliation(s)
- Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras.
| | | | - Raquel López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Callejas
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Mario Castillo
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Jenny Fúnes
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Fátima Rico
- Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas Varela
- Servicio de Neurología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Zulma Alvarez
- Unidad de Vigilancia de la Salud, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Harry Bock
- Dirección General, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Dra. Nerza Paz, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Carolina Bustillo
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Alejandra Calderón
- Centro de Salud Alonso Suazo, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Villanueva, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Alvaro Ciganda
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Jorge García-Aguilar
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Kimberly García
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gustavo Hernández
- Departamento de Pediatría, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Wendy López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Marco T Luque
- Servicio de Infectología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Carlos Maldonado
- Servicio de Oftalmología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Cynthia Moore
- Goldbelt Professional Services, LLC, Chesapeake, VA, USA
| | - Carlos Ochoa
- Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Leda Parham
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Karla Pastrana
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Angel Paternina-Caicedo
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Heriberto Rodríguez
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Candela Stella
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Dawn M Wesson
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Van T Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Godoi JTAM, Negrini SFBM, Aragon DC, Rocha PRH, Amaral FR, Negrini BVM, Teixeira SR, Yamamoto AY, Bettiol H, Mussi-Pinhata MM. Normocephalic Children Exposed to Maternal Zika Virus Infection Do Not Have a Higher Risk of Neurodevelopmental Abnormalities around 24 Months of Age than Unexposed Children: A Controlled Study. Pathogens 2023; 12:1219. [PMID: 37887735 PMCID: PMC10609945 DOI: 10.3390/pathogens12101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
Although very few controlled studies are available, in utero Zika virus (ZIKV)-exposed children are considered at risk for neurodevelopmental abnormalities. We aimed to identify whether there is an excess risk of abnormalities in non-microcephalic children born to mothers with confirmed ZIKV infection compared with ZIKV-unexposed children from the same population. In a cross-sectional study nested in two larger cohorts, we compared 324 ZIKV-exposed children with 984 unexposed controls. Outcomes were assessed using the Bayley Screening Test III applied around 24 months of age. Relative risks for classifying children as emergent or at-risk for neurodevelopmental delay in at least one of five domains were calculated, adjusting for covariates. In four of the five domains, few children were classified as emergent (4-12%) or at-risk (0.3-2.16%) but for the expressive communication domain it was higher for emergent (19.1-42.9%). ZIKV-exposed children were half as frequently classified as emergent, including after adjusting for covariates [RR = 0.52 (CI 95% 0.40; 0.66)]. However, no difference was detected in the at-risk category [RR = 0.83 (CI 95% 0.48; 1.44)]. Normocephalic children exposed to the Zika virus during pregnancy do not have a higher risk of being classified as at risk for neurodevelopmental abnormalities at two years of age.
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Affiliation(s)
- Juannicelle T. A. M. Godoi
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Silvia F. B. M. Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Davi C. Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Paulo R. H. Rocha
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Fabiana R. Amaral
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Bento V. M. Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Sara R. Teixeira
- Department of Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto CEP 14049-900, São Paulo, Brazil;
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Aparecida Y. Yamamoto
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Heloisa Bettiol
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Marisa M. Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
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7
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Ribeiro MFM, Queiróz KBPD, Prudente COM. Motor development of children exposed to the zika virus: systematic reviews. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract Objectives: to describe the motor development, in the first two years of life, of children with evidence of congenital Zika virus syndrome (CZS) at birth and of children exposed to the Zika virus (ZIKV) during pregnancy, but without evidence of CZS. Methods: systematic review, according to the recommendations of the Preferred Reporting Items for Systematic Reviews (PRISMA). The search took place in the VHL/LILACS interface and BIREME/ PubMed interface databases until March 2020. Two researchers analyzed the quality of the studies using the Johanna Briggs Institute methodology. Results: 21 articles were selected. Children with CZS have severe impairment of motor functions and a high prevalence of spastic cerebral palsy. At two years of life, most reached only early levels of motor development; with impaired vision, hearing, language, cognition, behavior, and social interaction. On the other hand, children exposed to ZIKV, but without evidence of CZS, are at lower risk, about 20% have late manifestations of delay and/or neurodevelopmental disorder. Variables associated with greater motor impairment are early maternal infection, preterm birth, lower head circumference, abnormal imaging, use of anticonvulsant, increasing age, arthrogryposis, epilepsy, deficits in vision, language, cognition, and lower income. Conclusion: Most children with CZS show severe motor impairment; a small part of those exposed to ZIKV, without evidence of the syndrome at birth, have alteration in neurodevelopment. Those children should be followed in the long-term, since some manifestations may occur belatedly.
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8
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Characteristics of children of the Microcephaly Epidemic Research Group Pediatric Cohort who developed postnatal microcephaly. Sci Rep 2022; 12:15778. [PMID: 36138062 PMCID: PMC9500100 DOI: 10.1038/s41598-022-19389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
The number of studies published on postnatal microcephaly in children with Congenital Zika Syndrome is small, clinical presentations vary and aspects of the evolution of these children remain unclarified. The present case series examined clinical characteristics and assessed the growth velocity of the head circumference, weight and height Z-scores in 23 children who developed postnatal microcephaly during follow-up in the Microcephaly Epidemic Research Group Pediatric Cohort. To estimate the change in the head circumference, weight and height Z-scores over time and compare the mean difference between sexes, we used multilevel mixed-effects linear regressions with child-specific random effects. Among these children, 60.9% (n = 14/23) presented with craniofacial disproportion, 60.9% (n = 14/23) with strabismus, 47.8% (n = 11/23) with early onset seizures, 47.8% (n = 11/23) with dysphagia and 43.5% (n = 10/23) with arthrogryposis. Of the 82.7% (n = 19/23) children who underwent neuroimaging, 78.9% (n = 15/19) presented with alterations in the central nervous system. Monthly growth velocity, expressed in Z-scores, of the head circumference was − 0.098 (95% CI % − 0.117 to − 0.080), of weight was: − 0.010 (95%-CI − 0.033 to 0.014) and of height was: − 0.023 (95%-CI − 0.046 to 0.0001). Postnatal microcephaly occurred mainly in children who had already presented with signs of severe brain damage at birth; there was variability in weight and height development, with no set pattern.
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9
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Cortical Auditory Evoked Potentials in Children with Prenatal Exposure to Zika Virus. Viruses 2022; 14:v14091923. [PMID: 36146729 PMCID: PMC9502411 DOI: 10.3390/v14091923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Prenatal exposure to ZIKV can cause neurologic and auditory damage. The electrophysiological responses obtained by Cortical Auditory Evoked Potentials (CAEP) may provide an objective method to investigate the function of cortical auditory pathways in children exposed to ZIKV. This case series analyzed the findings of CAEP in prenatal-period ZIKV-exposed children with and without microcephaly. The CAEP was performed in a total of 24 children. Five magnetic resonance imaging (MRI) images of the inner ear and brain of microcephalic children were analyzed and compared with CAEP measurements. Ventriculomegaly (80%), cortical/subcortical calcification (80%), and brain reduction (60%) were the most common alterations in the MRI. The P1-N1-P2 complex of the CAEP was observed in all children evaluated. The peak N2 was absent in two children. In the comparison of the CAEP measurements between the groups, children with microcephaly presented a higher amplitude of P2 (p = 0.017), which may reflect immaturity of the auditory pathways. Microcephalic and normocephalic children with prenatal exposure to ZIKV presented with the mandatory components of the CAEPs, regardless of changes in the CNS, suggesting that this population has, to some extent, the cortical ability to process sound stimuli preserved.
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10
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Marbán-Castro E, Vazquez Guillamet LJ, Pantoja PE, Casellas A, Maxwell L, Mulkey SB, Menéndez C, Bardají A. Neurodevelopment in Normocephalic Children Exposed to Zika Virus in Utero with No Observable Defects at Birth: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127319. [PMID: 35742566 PMCID: PMC9223424 DOI: 10.3390/ijerph19127319] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022]
Abstract
Zika virus (ZIKV) infection during pregnancy is a cause of pregnancy loss and multiple clinical and neurological anomalies in children. This systematic review aimed to assess the effect of ZIKV exposure in utero on the long-term neurodevelopment of normocephalic children born to women with ZIKV infection in pregnancy. This review was conducted according to the PRISMA guidelines for systematic reviews and meta-analyses. We performed a random effects meta-analysis to estimate the cross-study prevalence of neurodevelopmental delays in children using the Bayley Scales for Infant and Toddler Development (BSID-III). The risk of bias was assessed using Cochrane’s Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Full-text reviews were performed for 566 articles, and data were extracted from 22 articles corresponding to 20 studies. Nine articles including data from 476 children found 6.5% (95% CI: 4.1–9.3) of infants and children to have any type of non-language cognitive delay; 29.7% (95% CI: 21.7–38.2) to have language delay; and 11.5% (95% CI: 4.8–20.1) to have any type of motor delay. The pooled estimates had a high level of heterogeneity; thus, results should be interpreted with caution. Larger prospective studies that include a non-exposed control group are needed to confirm whether ZIKV exposure in utero is associated with adverse child neurodevelopmental outcomes.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Correspondence: ; Tel.: +34-932-271851
| | - Laia J. Vazquez Guillamet
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
| | - Percy Efrain Pantoja
- Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Aina Casellas
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
| | - Lauren Maxwell
- Heidelberg Institute for Global Health, Heidelberg University, 69120 Heidelberg, Germany;
| | - Sarah B. Mulkey
- Children’s National Hospital, Washington, DC 20010, USA;
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Clara Menéndez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigaçâo em Saúde de Manhiça (CISM), Rua 12, Cambeve CP 1929, Maputo 1929, Mozambique
| | - Azucena Bardají
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigaçâo em Saúde de Manhiça (CISM), Rua 12, Cambeve CP 1929, Maputo 1929, Mozambique
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11
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Schuler-Faccini L, Del Campo M, García-Alix A, Ventura LO, Boquett JA, van der Linden V, Pessoa A, van der Linden Júnior H, Ventura CV, Leal MC, Kowalski TW, Rodrigues Gerzson L, Skilhan de Almeida C, Santi L, Beys-da-Silva WO, Quincozes-Santos A, Guimarães JA, Garcez PP, Gomes JDA, Vianna FSL, Anjos da Silva A, Fraga LR, Vieira Sanseverino MT, Muotri AR, Lopes da Rosa R, Abeche AM, Marcolongo-Pereira C, Souza DO. Neurodevelopment in Children Exposed to Zika in utero: Clinical and Molecular Aspects. Front Genet 2022; 13:758715. [PMID: 35350244 PMCID: PMC8957982 DOI: 10.3389/fgene.2022.758715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Five years after the identification of Zika virus as a human teratogen, we reviewed the early clinical manifestations, collectively called congenital Zika syndrome (CZS). Children with CZS have a very poor prognosis with extremely low performance in motor, cognitive, and language development domains, and practically all feature severe forms of cerebral palsy. However, these manifestations are the tip of the iceberg, with some children presenting milder forms of deficits. Additionally, neurodevelopment can be in the normal range in the majority of the non-microcephalic children born without brain or eye abnormalities. Vertical transmission and the resulting disruption in development of the brain are much less frequent when maternal infection occurs in the second half of the pregnancy. Experimental studies have alerted to the possibility of other behavioral outcomes both in prenatally infected children and in postnatal and adult infections. Cofactors play a vital role in the development of CZS and involve genetic, environmental, nutritional, and social determinants leading to the asymmetric distribution of cases. Some of these social variables also limit access to multidisciplinary professional treatment.
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Affiliation(s)
- Lavínia Schuler-Faccini
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Miguel Del Campo
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Liana O Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | | | - André Pessoa
- Hospital Infantil Albert Sabin, Fortaleza, Brazil.,Universidade Estadual do Ceará, Fortaleza, Brazil
| | | | - Camila V Ventura
- Department of Ophthalmology, Fundação Altino Ventura, FAV, Recife, Brazil
| | | | - Thayne Woycinck Kowalski
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,CESUCA-Centro Universitário, Cachoeirinha, Brazil
| | | | | | - Lucélia Santi
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Walter O Beys-da-Silva
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Jorge A Guimarães
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | | | - Fernanda Sales Luiz Vianna
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - André Anjos da Silva
- School of Medicine, Graduate Program in Medical Sciences-Universidade do Vale do Taquari-UNIVATES, Lajeado, Brazil.,School of Medicine, Universidade do Vale do Rio dos Sinos-UNISINOS, São Leopoldo, Brazil
| | - Lucas Rosa Fraga
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | - Maria Teresa Vieira Sanseverino
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Alysson R Muotri
- Department of Pediatrics, School of Medicine, University of California San Diego, and Rady Children's Hospital San Diego, San Diego, CA, United States
| | | | - Alberto Mantovani Abeche
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clinicas de Porto Alegre, HCPA, Porto Alegre, Brazil
| | | | - Diogo O Souza
- Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil
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12
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Díaz-Martínez LA, Rojas MA, Pinilla-García LS, Becerra-Mojica CH, Pérez-Vera LA, Gutiérrez-Sánchez LÁ, Contreras-García GA, Rueda-Ordoñez CG, Villar L. Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women. PLoS Negl Trop Dis 2022; 16:e0009854. [PMID: 35255097 PMCID: PMC8929705 DOI: 10.1371/journal.pntd.0009854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/17/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration:www.clinicaltrials.gov, NCT02943304. Previous studies have identified a cause-effect relationship between fetal exposure to the Zika virus (ZIKV) and the development of central nervous system (CNS) anomalies and variable degrees of neurodevelopmental delay. This study aimed to compare the neurodevelopmental outcome of infants without CNS anomalies from two groups. One born to symptomatic ZIKV exposed women and another to asymptomatic ZIKV unexposed women. The ZIKV-exposed women were older, had a higher percentage of women in middle-class socioeconomic strata, had a higher level of education, were more likely to be single, and had higher rates of pregnancy comorbidity and premature births compared to ZIKV unexposed women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). Infants born to symptomatic ZIKV exposed women had higher motor and cognitive scores at 12 and 24 months CA, respectively, than infants born to ZIKV unexposed women. We conclude that infants without CNS anomalies born to ZIKV exposed women had normal neurodevelopment up to 24 months of CA than infants born to ZIKV unexposed women, supporting an all-or-nothing effect with maternal ZIKV exposure. School performance evaluation is required.
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Affiliation(s)
| | - Mario Augusto Rojas
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Colombian Association of Neonatology (ASCON), Colombian Neonatal Research Network (CNRN), Bogotá, Colombia
- * E-mail:
| | | | - Carlos Hernán Becerra-Mojica
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Maternal-fetal Medicine Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
| | - Luis Alfonso Pérez-Vera
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Colombian Association of Neonatology (ASCON), Colombian Neonatal Research Network (CNRN), Bogotá, Colombia
- Neonatal Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
| | - Luz Ángela Gutiérrez-Sánchez
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Maternal-fetal Medicine Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
- Clínica Materno Infantil San Luis, Bucaramanga, Colombia
| | | | | | - Luis Villar
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- ZIKAlliance Consortium, Bucaramanga, Colombia
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13
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Blackmon K, Evans R, Fernandes M, Landon B, Noel T, Macpherson C, Cudjoe N, Burgen KS, Punch B, Krystosik A, Grossi-Soyster EN, LaBeaud AD, Waechter R. Neurodevelopment in normocephalic children with and without prenatal Zika virus exposure. Arch Dis Child 2022; 107:244-250. [PMID: 34479857 PMCID: PMC8857021 DOI: 10.1136/archdischild-2020-321031] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Zika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls. DESIGN Cohort study. SETTING Public health centres in Grenada, West Indies. PATIENTS 384 mother-child pairs were enrolled during a period of active ZIKV transmission (April 2016-March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum. MAIN OUTCOME MEASURES The INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child's exposure status. RESULTS A total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays. CONCLUSIONS Overall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.
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Affiliation(s)
- Karen Blackmon
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA .,Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Michelle Fernandes
- Department of Paediatrics, University of Southampton, Southampton Children’s Hospital, Southhampton, UK,Nuffield Department of Women's Productive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Barbara Landon
- Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Trevor Noel
- Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Calum Macpherson
- Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Nikita Cudjoe
- Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Kemi S Burgen
- Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Bianca Punch
- Windward Islands Research and Education Foundation, St. Georges, Grenada
| | - Amy Krystosik
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, USA
| | - Elysse N Grossi-Soyster
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, USA
| | - Angelle Desiree LaBeaud
- Department of Pediatrics, Infectious Disease Division, Stanford University School of Medicine, Stanford, California, USA
| | - Randall Waechter
- Windward Islands Research and Education Foundation, St. Georges, Grenada,Department of Physiology, Neuroscience, and Behavioral Sciences, St George's University School of Medicine, St. George's, Grenada
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14
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Key AP, de Moura Negrini SF, Tanuri Caldas CA, Teixeira SR, Anastasio AR, Cavalcante J, Mussi-Pinhata MM, Hood LJ. A prospective study of neurodevelopmental trends between 3 and 24 months in normocephalic infants with prenatal Zika virus exposure: Evidence of emerging communication delays in the NATZIG cohort. Early Hum Dev 2021; 163:105470. [PMID: 34563832 PMCID: PMC8629952 DOI: 10.1016/j.earlhumdev.2021.105470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Developmental trends between 3 and 24 months were assessed in 194 normocephalic infants with prenatal Zika virus exposure. Bayley Scales of Infant and Toddler Development Screening Test-3rd Edition cognitive scores remained in the typical range. Communication skills developed at a slower rate suggesting that neurodevelopmental delays may emerge at older ages.
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Affiliation(s)
- Alexandra P. Key
- Vanderbilt University Medical Center, Nashville, TN, USA, Corresponding author. (A.P. Key)
| | | | | | - Sara Reis Teixeira
- Clinical University Hospital at Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Adriana R.T. Anastasio
- Clinical University Hospital at Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Juliana Cavalcante
- Clinical University Hospital at Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Marisa M. Mussi-Pinhata
- Clinical University Hospital at Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Linda J. Hood
- Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Mercado-Reyes M, Gilboa SM, Valencia D, Daza M, Tong VT, Galang RR, Winfield CM, Godfred-Cato S, Benavides M, Villanueva JM, Thomas JD, Daniels J, Zaki S, Reagan-Steiner S, Bhatnagar J, Schiffer J, Steward-Clark E, Ricaldi JN, Osorio J, Sancken CL, Pardo L, Tinker SC, Anderson KN, Rico A, Burkel VK, Hojnacki J, Delahoy MJ, González M, Osorio MB, Moore CA, Honein MA, Ospina Martinez ML. Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016-2018. Trop Med Infect Dis 2021; 6:183. [PMID: 34698287 PMCID: PMC8544689 DOI: 10.3390/tropicalmed6040183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/18/2021] [Accepted: 10/07/2021] [Indexed: 01/16/2023] Open
Abstract
Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May-November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia's existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.
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Affiliation(s)
- Marcela Mercado-Reyes
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Marcela Daza
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Van T. Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Romeo R. Galang
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Christina M. Winfield
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Mónica Benavides
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Julie M. Villanueva
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jennifer D. Thomas
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jonathan Daniels
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sherif Zaki
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sarah Reagan-Steiner
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Julu Bhatnagar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jarad Schiffer
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Evelene Steward-Clark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Jessica N. Ricaldi
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Johana Osorio
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Christina L. Sancken
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Lissethe Pardo
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Kayla N. Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Angelica Rico
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | | | - Jacob Hojnacki
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA;
| | | | - Maritza González
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - May B. Osorio
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Margaret A. Honein
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Martha Lucia Ospina Martinez
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
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Gouvea LA, Martins M, Vivacqua D, Rosseto J, Lima G, Frota AC, Abreu T, Araujo A, Hofer CB. Complications and Sequelae in Patients With Congenital Microcephaly Associated With Zika Virus Infection: Two-Year Follow-Up. J Child Neurol 2021; 36:537-544. [PMID: 33406966 DOI: 10.1177/0883073820983163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aim to describe the long term follow-up of a cohort of children exposed in utero to the Zika virus. METHODS Descriptive study of a cohort of microcephalic children due to Zika virus. Logistic regression was used to evaluate variables associated with worse prognosis epilepsy. RESULTS We followed 28 children (15 females), with a median follow-up of 24 months (IQR = 12-28). During the follow-up, 1 infant died. The median head circumference at birth was 29 cm (IQR = 27-31). All presented a global developmental delay. The most frequent central nervous system abnormalities were on cortical development in 22 participants; dysgenesis of corpus callosum in 13; ventriculomegaly in 25; and calcifications in 24. A total of 9 presented ocular abnormalities, 4 auditory impairment. During follow-up, 12 presented with sleep disorders, 10 with irritability, and 23 with epilepsy (2 with generalized tonic-clonic, 3 with generalized tonic-clonic and spasms, 12 with spasms, 3 tonic and spasms, and 3 motor focal and spasms). The median age at the begin of the epilepsy was 4 months (IQR = 2-10), the median number of drugs used to control the epilepsy was 2 (IQR = 2-3). Maternal illicit drug use during pregnancy was associated with worse prognosis epilepsy (Lennox-Gastaut syndrome, West syndrome, or status epilepticus). A total of 19 presented with dysphagia, 10 children required gastrostomy. CONCLUSION Children with microcephaly due to Zika virus presented with several complications during follow-up, as epilepsy, spastic diplegia, and global developmental delay.
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Affiliation(s)
- Luane A Gouvea
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
| | - Marlos Martins
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
| | - Daniela Vivacqua
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
| | - Julia Rosseto
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
| | - Giulia Lima
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
| | - Ana Cristina Frota
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
| | - Thalita Abreu
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
| | - Alexandra Araujo
- 28125Universidade Federal do Rio de Janeiro, v. Pedro Calmon, Rio de Janeiro, Brazil
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Cardona-Ospina JA, Zapata MF, Grajales M, Arias MA, Grajales J, Bedoya-Rendón HD, González-Moreno GM, Lagos-Grisales GJ, Suárez JA, Rodríguez-Morales AJ. Physical Growth and Neurodevelopment of a Cohort of Children after 3.5 Years of Follow-up from Mothers with Zika Infection during Pregnancy-Third Report of the ZIKERNCOL Study. J Trop Pediatr 2021; 67:6284403. [PMID: 34037794 DOI: 10.1093/tropej/fmab032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION In utero Zika virus (ZIKV) exposure has been related to a group of congenital structural abnormalities called the congenital Zika syndrome, which also has been related to neurodevelopment alterations even in normocephalic children. Physical growth has been less explored, and delayed growth and malnutrition have been reported. OBJECTIVE The objective of this study is to describe the growth and neurodevelopment features of normocephalic infants born from a cohort of mothers with RT-PCR confirmed ZIKV during pregnancy in Risaralda, Colombia. METHODS We conducted a retrospective cohort, including normocephalic children born from mothers with RT-PCR confirmed ZIKV infection during pregnancy in Risaralda, Colombia. Physical growth was measured using WHO standards, and neurodevelopment was measured with the abbreviated neurodevelopment scale 2 validated for Colombia. RESULTS After verifying inclusion and exclusion criteria, 16 children were followed during a median time of 28 months (IQR 23-31 months); for a total of 116 visits, 87.5% (n = 14) of the patients developed a growth alteration. Five presented post-natal microcephaly, and among them, four presented malnutrition or low height. Six patients developed macrocephaly. Patients with a normal head circumference had normal neurodevelopment. Only one patient with microcephaly persisted with impairment of the neurodevelopment at the end of follow-up. All the patients with macrocephaly had normal neurodevelopment. DISCUSSION Our study suggests that growth could be altered in infants with in utero Zika exposure. We found a high proportion of patients with overgrowth and macrocephaly. Future studies should consider endocrine follow-up of children born with in utero Zika exposure to explore these findings' possible aetiologies. CONCLUSION We found a high proportion of growth alterations, particularly with overgrowth features and macrocephaly. Our study suggests that in addition to neurodevelopment impairment, growth could be altered in infants and children with in utero Zika exposure, even in those patients born without CZS.
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Affiliation(s)
- Jaime A Cardona-Ospina
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda 660004, Colombia.,Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, 660003, Colombia.,Emerging Infectious Diseases and Tropical Medicine Research Group, Instituto para la Investigación en Ciencias Biomédicas-Sci-Help, Pereira, Risaralda, 660009, Colombia
| | - María Fernanda Zapata
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda 660004, Colombia
| | - Manuela Grajales
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda 660004, Colombia
| | - María Alejandra Arias
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda 660004, Colombia
| | - Jennifer Grajales
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda 660004, Colombia
| | | | | | - Guillermo J Lagos-Grisales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, 660003, Colombia
| | - José Antonio Suárez
- Investigador SNI Senacyt Panamá, Clinical Research Department, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
| | - Alfonso J Rodríguez-Morales
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda 660004, Colombia.,Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, 660003, Colombia.,Emerging Infectious Diseases and Tropical Medicine Research Group, Instituto para la Investigación en Ciencias Biomédicas-Sci-Help, Pereira, Risaralda, 660009, Colombia
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Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus. Viruses 2021; 13:v13030523. [PMID: 33810110 PMCID: PMC8005078 DOI: 10.3390/v13030523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/01/2023] Open
Abstract
Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.
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Marbán-Castro E, Goncé A, Fumadó V, Martínez MJ, López M, García-Otero L, Salazar L, Esteve C, Salvia D, Fortuny C, Eixarch E, Fuente-Moreno M, Pinazo MJ, Oliveira I, Rodríguez-Valero N, Requena-Méndez A, Camprubí D, Saco A, Castillo P, Vázquez A, de Ory F, Navero-Castillejos J, Casellas A, González R, Muñoz J, Gascón J, Ordi J, Menéndez C, Bardají A. Zika virus infection in pregnant travellers and impact on childhood neurodevelopment in the first two years of life: A prospective observational study. Travel Med Infect Dis 2021; 40:101985. [PMID: 33601028 DOI: 10.1016/j.tmaid.2021.101985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The emergence of Zika virus (ZIKV) represents a threat with consequences on maternal and children's health. We aimed to assess the clinical and epidemiological characteristics of pregnant women returning from ZIKV affected areas, and the effects of maternal ZIKV infection on birth outcomes and children's health. METHODS This was a hospital-based prospective observational study conducted at the Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain, from January 2016 to February 2020. RESULTS One hundred and ninety-five pregnant women who had travelled to ZIKV affected areas during pregnancy were recruited. Four women (2.1%) had a confirmed ZIKV infection, 40 women (20.5%) a probable infection, and 151 (77.4%) were negative for ZIKV. Among the ZIKV confirmed cases, a pregnant woman suffered a miscarriage, highly plausible to be associated with ZIKV infection. Brain cysts and microcalcifications were detected in 7% of fetuses or infants from women with confirmed or probable ZIKV infection. Neurodevelopmental delay in the language function was found in 33.3% out of the 21 children evaluated. CONCLUSIONS These findings contribute to the understanding of ZIKV prevalence estimates, and the impact of maternal ZIKV infection on pregnancy outcomes and children's health. Results highlight the importance of long-term surveillance in pregnant travellers and their children.
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Affiliation(s)
| | - Anna Goncé
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Fumadó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Tropical Pathology and Imported Diseases, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clínic, Barcelona, Spain
| | - Marta López
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura García-Otero
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Salazar
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Esteve
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Dolors Salvia
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Tropical Pathology and Imported Diseases, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Elisenda Eixarch
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | - María Jesús Pinazo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inés Oliveira
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Ana Requena-Méndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Global Public Health, Karolinska Institutet, Sweden
| | - Daniel Camprubí
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Ana Vázquez
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando de Ory
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joaquim Gascón
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Global Public Health, Karolinska Institutet, Sweden
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
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Abtibol-Bernardino MR, de Almeida Peixoto LDFA, de Oliveira GA, de Almeida TF, Rodrigues GRI, Otani RH, Soares Chaves BC, de Souza Rodrigues C, de Andrade ABCA, de Fatima Redivo E, Fernandes SS, da Costa Castilho M, Gomes Benzecry S, Bôtto-Menezes C, Martinez-Espinosa FE, Costa Alecrim MDG. Neurological Findings in Children without Congenital Microcephaly Exposed to Zika Virus in Utero: A Case Series Study. Viruses 2020; 12:v12111335. [PMID: 33233769 PMCID: PMC7699969 DOI: 10.3390/v12111335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
The Zika virus can induce a disruptive sequence in the fetal brain and is manifested mainly by microcephaly. Knowledge gaps still exist as to whether the virus can cause minor disorders that are perceived later on during the first years of life in children who are exposed but are asymptomatic at birth. In this case series, we describe the outcomes related to neurodevelopment through the neurological assessment of 26 non-microcephalic children who had intrauterine exposure to Zika virus. Children were submitted for neurological examinations and Bayley Scales-III (cognition, language, and motor performance). The majority (65.4%) obtained satisfactory performance in neurodevelopment. The most impaired domain was language, with 30.7% impairment. Severe neurological disorders occurred in five children (19.2%) and these were spastic hemiparesis, epilepsy associated with congenital macrocephaly (Zika and human immunodeficiency virus), two cases of autism (one exposed to Zika and Toxoplasma gondii) and progressive sensorineural hearing loss (GJB2 mutation). We concluded that non-microcephalic children with intrauterine exposure to Zika virus, in their majority, had achieved satisfactory performance in all neurodevelopmental domains. One third of the cases had some impairment, but the predominant group had mild alterations, with low occurrence of moderate to severe disorders, similar to other studies in Brazil.
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Affiliation(s)
- Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Correspondence:
| | - Lucíola de Fátima Albuquerque de Almeida Peixoto
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Geruza Alfaia de Oliveira
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil; (G.A.d.O.); (G.R.I.R.)
| | | | | | - Rodrigo Haruo Otani
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (R.H.O.); (S.G.B.)
| | - Beatriz Caroline Soares Chaves
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Anny Beatriz Costa Antony de Andrade
- Postgraduate Program in Living Conditions and Health Situations in the Amazon PPGVIDA, Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil;
| | - Elijane de Fatima Redivo
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Salete Sara Fernandes
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
| | - Marcia da Costa Castilho
- Department of Virology, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil;
| | - Silvana Gomes Benzecry
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (R.H.O.); (S.G.B.)
| | - Camila Bôtto-Menezes
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Medicine, School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (R.H.O.); (S.G.B.)
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
| | - Flor Ernestina Martinez-Espinosa
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Postgraduate Program in Living Conditions and Health Situations in the Amazon PPGVIDA, Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil;
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Laboratory of Territory, Environment, Health and Sustainability, Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine, University of Amazonas State, Manaus 69040-000, Brazil; (L.d.F.A.d.A.P.); (B.C.S.C.); (C.d.S.R.); (E.d.F.R.); (S.S.F.); (C.B.-M.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Malaria, Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus 69040-000, Brazil
- Medical Course Coordination, Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
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Quantitative definition of neurobehavior, vision, hearing and brain volumes in macaques congenitally exposed to Zika virus. PLoS One 2020; 15:e0235877. [PMID: 33091010 PMCID: PMC7580995 DOI: 10.1371/journal.pone.0235877] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022] Open
Abstract
Congenital Zika virus (ZIKV) exposure results in a spectrum of disease ranging from severe birth defects to delayed onset neurodevelopmental deficits. ZIKV-related neuropathogenesis, predictors of birth defects, and neurodevelopmental deficits are not well defined in people. Here we assess the methodological and statistical feasibility of a congenital ZIKV exposure macaque model for identifying infant neurobehavior and brain abnormalities that may underlie neurodevelopmental deficits. We inoculated five pregnant macaques with ZIKV and mock-inoculated one macaque in the first trimester. Following birth, growth, ocular structure/function, brain structure, hearing, histopathology, and neurobehavior were quantitatively assessed during the first week of life. We identified the typical pregnancy outcomes of congenital ZIKV infection, with fetal demise and placental abnormalities. We estimated sample sizes needed to define differences between groups and demonstrated that future studies quantifying brain region volumes, retinal structure, hearing, and visual pathway function require a sample size of 14 animals per group (14 ZIKV, 14 control) to detect statistically significant differences in at least half of the infant exam parameters. Establishing the parameters for future studies of neurodevelopmental outcomes following congenital ZIKV exposure in macaques is essential for robust and rigorous experimental design.
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The developmental spectrum of prenatal Zika virus exposure. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:345-346. [PMID: 32199079 DOI: 10.1016/s2352-4642(20)30071-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 11/20/2022]
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