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Brickley EB, Miranda-Filho DDB, Ximenes RADA. Preparing for the rapid research response to the possible vertical transmission of Oropouche virus: lessons from a decade of congenital Zika research. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00618-2. [PMID: 39348835 DOI: 10.1016/s1473-3099(24)00618-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 09/13/2024] [Accepted: 09/13/2024] [Indexed: 10/02/2024]
Affiliation(s)
- Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology & International Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife 50100-130, Brazil; Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Brazil.
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Castanha PMS, McEnaney PJ, Park Y, Bouwer A, Chaves EJF, Lins RD, Paciaroni NG, Dickson P, Carlson G, Cordeiro MT, Magalhaes T, Craigo J, Marques ETA, Kodadek T, Burke DS. Identification and characterization of a nonbiological small-molecular mimic of a Zika virus conformational neutralizing epitope. Proc Natl Acad Sci U S A 2024; 121:e2312755121. [PMID: 38743628 PMCID: PMC11127016 DOI: 10.1073/pnas.2312755121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/26/2024] [Indexed: 05/16/2024] Open
Abstract
Antigenic similarities between Zika virus (ZIKV) and other flaviviruses pose challenges to the development of virus-specific diagnostic tools and effective vaccines. Starting with a DNA-encoded one-bead-one-compound combinatorial library of 508,032 synthetic, non-natural oligomers, we selected and characterized small molecules that mimic ZIKV epitopes. High-throughput fluorescence-activated cell sorter-based bead screening was used to select molecules that bound IgG from ZIKV-immune but not from dengue-immune sera. Deep sequencing of the DNA from the "Zika-only" beads identified 40 candidate molecular structures. A lead candidate small molecule "CZV1-1" was selected that correctly identifies serum specimens from Zika-experienced patients with good sensitivity and specificity (85.3% and 98.4%, respectively). Binding competition studies of purified anti-CZV1-1 IgG against known ZIKV-specific monoclonal antibodies (mAbs) showed that CZV1-1 mimics a nonlinear, neutralizing conformational epitope in the domain III of the ZIKV envelope. Purified anti-CZV1-1 IgG neutralized infection of ZIKV in cell cultures with potencies comparable to highly specific ZIKV-neutralizing mAbs. This study demonstrates an innovative approach for identification of synthetic non-natural molecular mimics of conformational virus epitopes. Such molecular mimics may have value in the development of accurate diagnostic assays for Zika, as well as for other viruses.
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Affiliation(s)
- Priscila M. S. Castanha
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA15261
| | - Patrick J. McEnaney
- Department of Chemistry, The Herbert Wertheim University of Florida Scripps Institute for Biomedical Innovation and Technology, Jupiter, FL33458
| | - Yongseok Park
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA15261
| | - Anthea Bouwer
- Department of Microbiology and Molecular Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA15219
| | - Elton J. F. Chaves
- Department of Virology, Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Cidade Universitearia, Recife, Pernambuco50740-465, Brazil
| | - Roberto D. Lins
- Department of Virology, Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Cidade Universitearia, Recife, Pernambuco50740-465, Brazil
| | | | - Paige Dickson
- Department of Chemistry, The Herbert Wertheim University of Florida Scripps Institute for Biomedical Innovation and Technology, Jupiter, FL33458
| | | | - Marli T. Cordeiro
- Department of Virology, Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Cidade Universitearia, Recife, Pernambuco50740-465, Brazil
| | - Tereza Magalhaes
- Department of Entomology, Texas A&M University, College Station, TX77843
- Department of Preventive and Social Medicine, School of Medicine, Universidade Federal da Bahia, Bahia40026-010, Brazil
| | - Jodi Craigo
- Department of Microbiology and Molecular Genetics, School of Medicine, University of Pittsburgh, Pittsburgh, PA15219
| | - Ernesto T. A. Marques
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA15261
- Department of Virology, Aggeu Magalhaes Institute, Oswaldo Cruz Foundation, Cidade Universitearia, Recife, Pernambuco50740-465, Brazil
| | - Thomas Kodadek
- Department of Chemistry, The Herbert Wertheim University of Florida Scripps Institute for Biomedical Innovation and Technology, Jupiter, FL33458
| | - Donald S. Burke
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA15261
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Oliveira DMDS, de Barros Miranda-Filho D, de Alencar Ximenes RA, Montarroyos UR, Brickley EB, Pinto MHT, Martelli CMT, Ramos RC, de Araújo TVB, Eickmann SH, da Silva PFS, Carvalho MDCG, de Sousa Martins OS, Dos Santos ACO. Feeding characteristics and growth among children with prenatal exposure to Zika virus with and without microcephaly in the microcephaly epidemic research group pediatric cohort. BMC Pediatr 2024; 24:286. [PMID: 38685089 PMCID: PMC11057065 DOI: 10.1186/s12887-024-04728-9] [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: 01/23/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To describe the feeding characteristics and growth of children with prenatal exposure to Zika virus (ZIKV) from birth to 48 months. DESIGN Using data from the prospective Microcephaly Epidemic Research Group Pediatric Cohort (MERG-PC), children without microcephaly born to mothers with evidence of ZIKV infection during pregnancy (ZIKV-exposed children without microcephaly) and children with Zika-related microcephaly were compared using repeated cross-sectional analyses within the following age strata: birth; 1 to 12; 13 to 24; 25 to 36; and 37 to 48 months. The groups were compared in relation to prematurity, birth weight, breastfeeding, alternative feeding routes, dysphagia and anthropometric profiles based on the World Health Organization Anthro z-scores (weight-length/height, weight-age, length/height-age and BMI-age). RESULTS The first assessment included 248 children, 77 (31.05%) with microcephaly and 171 (68.95%) without microcephaly. The final assessment was performed on 86 children. Prematurity was 2.35 times higher and low birth weight was 3.49 times higher in children with microcephaly. The frequency of breastfeeding was high (> 80%) in both groups. On discharge from the maternity hospital, the frequency of children requiring alternative feeding route in both groups was less than 5%. After 12 months of age, children with microcephaly required alternative feeding route more often than children without microcephaly. In children with microcephaly, the z-score of all growth indicators was lower than in children without microcephaly. CONCLUSIONS Children with Zika-related microcephaly were more frequently premature and low birth weight and remained with nutritional parameters, i.e., weight-for-age, weight-for-length/height and length/height-for-age below those of the children without microcephaly.
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Affiliation(s)
- Danielle Maria da Silva Oliveira
- Speech Terapist and Epidemiologist Universidade de Pernambuco Santo Amaro- Recife- Pernambuco, Street Arnóbio Marques, Recife, 31050100-130, Brazil.
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Silva AJD, de Jesus ALS, Leal LRS, de Macêdo LS, da Silva Barros BR, de Sousa GF, da Paz Leôncio Alves S, Pena LJ, de Melo CML, de Freitas AC. Whole Yeast Vaccine Displaying ZIKV B and T Cell Epitopes Induces Cellular Immune Responses in the Murine Model. Pharmaceutics 2023; 15:1898. [PMID: 37514084 PMCID: PMC10385271 DOI: 10.3390/pharmaceutics15071898] [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: 05/15/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Improving antigen presentation is crucial for the success of immunization strategies. Yeasts are classically used as biofactories to produce recombinant proteins and are efficient vehicles for antigen delivery, in addition to their adjuvant properties. Despite the absence of epidemic outbreaks, several vaccine approaches continue to be developed for Zika virus infection. The development of these prophylactic strategies is fundamental given the severity of clinical manifestations, mainly due to viral neurotropism. The present study aimed to evaluate in vivo the immune response induced by P. pastoris recombinant strains displaying epitopes of the envelope (ENV) and NS1 ZIKV proteins. Intramuscular immunization with heat-attenuated yeast enhanced the secretion of IL-6, TNF-α, and IFN-γ, in addition to the activation of CD4+ and CD8+ T cells, in BALB/c mice. P. pastoris displaying ENV epitopes induced a more robust immune response, increasing immunoglobulin production, especially IgG isotypes. Both proposed vaccines showed the potential to induce immune responses without adverse effects, confirming the safety of administering P. pastoris as a vaccine vehicle. Here, we demonstrated, for the first time, the evaluation of a vaccine against ZIKV based on a multiepitope construct using yeast as a delivery system and reinforcing the applicability of P. pastoris as a whole-cell vaccine.
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Affiliation(s)
- Anna Jéssica Duarte Silva
- Laboratory of Molecular Studies and Experimental Therapy-LEMTE, Department of Genetics, Federal University of Pernambuco, Recife 50670-901, Brazil
| | | | - Lígia Rosa Sales Leal
- Laboratory of Molecular Studies and Experimental Therapy-LEMTE, Department of Genetics, Federal University of Pernambuco, Recife 50670-901, Brazil
| | - Larissa Silva de Macêdo
- Laboratory of Molecular Studies and Experimental Therapy-LEMTE, Department of Genetics, Federal University of Pernambuco, Recife 50670-901, Brazil
| | | | | | | | - Lindomar José Pena
- Department of Virology and Experimental Therapy, Instituto Aggeu Magalhães, Oswaldo Cruz Foundation, Recife 50670-901, Brazil
| | | | - Antonio Carlos de Freitas
- Laboratory of Molecular Studies and Experimental Therapy-LEMTE, Department of Genetics, Federal University of Pernambuco, Recife 50670-901, Brazil
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Ximenes RADA, Miranda-Filho DDB, Martinez-Espinoza FE, Brasil P. Still on the Brazilian Response to the Microcephaly Epidemic: A Meta-analysis of 1,548 Pregnant Women from 13 Cohorts to Evaluate the Risk of Adverse Outcomes. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:169-170. [PMID: 37224837 PMCID: PMC10208725 DOI: 10.1055/s-0043-1769107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Carabali M, Maxwell L, Levis B, Shreedhar P. Heterogeneity of Zika virus exposure and outcome ascertainment across cohorts of pregnant women, their infants and their children: a metadata survey. BMJ Open 2022; 12:e064362. [PMID: 36414312 PMCID: PMC9685007 DOI: 10.1136/bmjopen-2022-064362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To support the Zika virus (ZIKV) Individual Participant Data (IPD) Consortium's efforts to harmonise and analyse IPD from ZIKV-related prospective cohort studies and surveillance-based studies of pregnant women and their infants and children; we developed and disseminated a metadata survey among ZIKV-IPD Meta-Analysis (MA) study participants to identify and provide a comprehensive overview of study-level heterogeneity in exposure, outcome and covariate ascertainment and definitions. SETTING Cohort and surveillance studies that measured ZIKV infection during pregnancy or at birth and measured fetal, infant, or child outcomes were identified through a systematic search and consultations with ZIKV researchers and Ministries of Health from 20 countries or territories. PARTICIPANTS Fifty-four cohort or active surveillance studies shared deidentified data for the IPD-MA and completed the metadata survey, representing 33 061 women (11 020 with ZIKV) and 18 281 children. PRIMARY AND SECONDARY OUTCOME MEASURES Study-level heterogeneity in exposure, outcome and covariate ascertainment and definitions. RESULTS Median study sample size was 268 (IQR=100, 698). Inclusion criteria, follow-up procedures and exposure and outcome ascertainment were highly heterogenous, differing meaningfully across regions and multisite studies. Enrolment duration and follow-up for children after birth varied before and after the declaration of the Public Health Emergency of International Concern (PHEIC) and according to the type of funding received. CONCLUSION This work highlights the logistic and statistical challenges that must be addressed to account for the multiple sources of within-study and between-study heterogeneity when conducting IPD-MAs of data collected in the research response to emergent pathogens like ZIKV.
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Affiliation(s)
- Mabel Carabali
- Departement de Médecine Sociale et Préventive, Université de Montréal, Montreal, Quebec, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Maxwell
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
- Heidelberger Institut für Global Health, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, Staffordshire, UK
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Lobkowicz L, Miranda-Filho DDB, Montarroyos UR, Martelli CMT, de Araújo TVB, De Souza WV, Bezerra LCA, Dhalia R, Marques ETA, Sanchez Clemente N, Webster J, Vaughan A, Webb EL, Brickley EB, Ximenes RADA. Co-circulation of Chikungunya Virus during the 2015-2017 Zika Virus Outbreak in Pernambuco, Brazil: An Analysis of the Microcephaly Epidemic Research Group Pregnancy Cohort. Am J Trop Med Hyg 2022; 106:tpmd210449. [PMID: 35405646 PMCID: PMC9209936 DOI: 10.4269/ajtmh.21-0449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/20/2022] [Indexed: 12/05/2022] Open
Abstract
Co-circulation of arthropod-borne viruses, particularly those with shared mosquito vectors like Zika (ZIKV) and Chikungunya (CHIKV), is increasingly reported. An accurate differential diagnosis between ZIKV and CHIKV is of high clinical importance, especially in the context of pregnancy, but remains challenging due to limitations in the availability of specialized laboratory testing facilities. Using data collected from the prospective pregnancy cohort study of the Microcephaly Epidemic Research Group, which followed up pregnant persons with rash during the peak and decline of the 2015-2017 ZIKV epidemic in Recife, Pernambuco, Brazil, this study aims to describe the geographic and temporal distribution of ZIKV and CHIKV infections and to investigate the extent to which ZIKV and CHIKV infections may be clinically differentiable. Between December 2015 and June 2017, we observed evidence of co-circulation with laboratory confirmation of 213 ZIKV mono-infections, 55 CHIKV mono-infections, and 58 sequential ZIKV/CHIKV infections (i.e., cases with evidence of acute ZIKV infection with concomitant serological evidence of recent CHIKV infection). In logistic regressions with adjustment for maternal age, ZIKV mono-infected cases had lower odds than CHIKV mono-infected cases of presenting with arthralgia (aOR, 99% CI: 0.33, 0.15-0.74), arthritis (0.35, 0.14-0.85), fatigue (0.40, 0.17-0.96), and headache (0.44, 0.19-1.90). However, sequential ZIKV/CHIKV infections complicated discrimination, as they did not significantly differ in clinical presentation from CHIKV mono-infections. These findings suggest clinical symptoms alone may be insufficient for differentiating between ZIKV and CHIKV infections during pregnancy and therefore laboratory diagnostics continue to be a valuable tool for tailoring care in the event of arboviral co-circulation.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
| | - Ernesto T. A. Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aisling Vaughan
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth B. Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, Brasil
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Brasil
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8
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Lobkowicz L, Power GM, De Souza WV, Montarroyos UR, Martelli CMT, de Araùjo TVB, Bezerra LCA, Dhalia R, Marques ETA, Miranda-Filho DDB, Brickley EB, Ximenes RADA. Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017. BMJ Glob Health 2021; 6:bmjgh-2021-006811. [PMID: 34857522 PMCID: PMC8640636 DOI: 10.1136/bmjgh-2021-006811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil—the epicentre of the Brazilian microcephaly epidemic—has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.,Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, PE, Brasil.,Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
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Wilder-Smith A, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Solomon T, Jacobs BC, Pardo CA, Osorio L, Parra B, Lant S, Willison HJ, Leonhard S, Turtle L, Ferreira MLB, de Oliveira Franca RF, Lambrechts L, Neyts J, Kaptein S, Peeling R, Boeras D, Logan J, Dolk H, Orioli IM, Neumayr A, Lang T, Baker B, Massad E, Preet R. The legacy of ZikaPLAN: a transnational research consortium addressing Zika. Glob Health Action 2021; 14:2008139. [PMID: 35377284 PMCID: PMC8986226 DOI: 10.1080/16549716.2021.2008139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission's flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases.
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Affiliation(s)
- Annelies Wilder-Smith
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Tom Solomon
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Suzannah Lant
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Sonja Leonhard
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | | | | | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Suzanne Kaptein
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - James Logan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Ulster, United Kingdom
| | - Ieda M Orioli
- RELAMC and ECLAMC at Genetics Department, Federal University of Rio de Janeiro, Brazil
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Trudie Lang
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Bonny Baker
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Eduardo Massad
- School of Medicine, University of Sao Paulo and Fundacao Getulio Vargas, Sao Paulo, Brazil
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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10
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Neurodevelopment in Children Exposed to Zika Virus: What Are the Consequences for Children Who Do Not Present with Microcephaly at Birth? Viruses 2021; 13:v13081427. [PMID: 34452293 PMCID: PMC8402706 DOI: 10.3390/v13081427] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
The relation of Zika virus (ZIKV) with microcephaly is well established. However, knowledge is lacking on later developmental outcomes in children with evidence of maternal ZIKV infection during pregnancy born without microcephaly. The objective of this analysis is to investigate the impact of prenatal exposure to ZIKV on neuropsychomotor development in children without microcephaly. We evaluated 274 children including 235 ZIKV exposed and 39 controls using the Bayley-III Scales of Infant and Toddler Development (BSIDIII) and neurological examination. We observed a difference in cognition with a borderline p-value (p = 0.052): 9.4% of exposed children and none of the unexposed control group had mild to moderate delays. The prevalence of delays in the language and motor domains did not differ significantly between ZIKV-exposed and unexposed children (language: 12.3% versus 12.8%; motor: 4.7% versus 2.6%). Notably, neurological examination results were predictive of neurodevelopmental delays in the BSIDIII assessments for exposed children: 46.7% of children with abnormalities on clinical neurological examination presented with delay in contrast to 17.8% among exposed children without apparent neurological abnormalities (p = 0.001). Overall, our findings suggest that relative to their unexposed peers, ZIKV-exposed children without microcephaly are not at considerably increased risk of neurodevelopmental impairment in the first 42 months of life, although a small group of children demonstrated higher frequencies of cognitive delay. It is important to highlight that in the group of exposed children, an abnormal neuroclinical examination may be a predictor of developmental delay. The article contributes to practical guidance and advances our knowledge about congenital Zika.
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Qiao L, Martelli CMT, Raja AI, Sanchez Clemente N, de Araùjo TVB, Ximenes RADA, Miranda-Filho DDB, Ramond A, Brickley EB. Epidemic preparedness: Prenatal Zika virus screening during the next epidemic. BMJ Glob Health 2021; 6:bmjgh-2021-005332. [PMID: 34117012 PMCID: PMC8202108 DOI: 10.1136/bmjgh-2021-005332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 12/29/2022] Open
Abstract
Zika virus (ZIKV) is a vectorborne infectious agent of global public health significance due to its potential to cause severe teratogenic outcomes. The question of whether health systems should consider adopting screening programmes for ZIKV infections during pregnancy warrants consideration. In this analysis, we apply the Wilson-Jungner framework to appraise the potential utility of a prenatal ZIKV screening programme, outline potential screening strategies within the case-finding pathway, and consider other epidemiological factors that may influence the planning of such a screening programme. Our evaluation of a potential prenatal ZIKV screening programme highlights factors affirming its usefulness, including the importance of Congenital Zika Syndrome as a public health problem and the existence of analogous congenital prenatal screening programmes for STORCH agents (syphilis, toxoplasmosis, others (eg, human immunodeficiency virus, varicella-zoster virus, parvovirus B19), rubella, cytomegalovirus, and herpes simplex virus). However, our assessment also reveals key barriers to implementation, such as the need for more accurate diagnostic tests, effective antiviral treatments, increased social service capacity, and surveillance. Given that the reemergence of ZIKV is likely, we provide a guiding framework for policymakers and public health leaders that can be further elaborated and adapted to different contexts in order to reduce the burden of adverse ZIKV-related birth outcomes during future outbreaks.
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Affiliation(s)
- Luxi Qiao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, Pernambuco, Brasil.,Departamento de Medicina Interna, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | | | - Anna Ramond
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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12
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Duarte G, Miranda AE, Bermudez XPD, Saraceni V, Martinez-Espinosa FE. Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection. Rev Soc Bras Med Trop 2021; 54:e2020609. [PMID: 34008724 PMCID: PMC8210481 DOI: 10.1590/0037-8682-609-2020] [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: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
This article addresses the vector, sexual and vertical transmissions of the Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted more predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands specific prophylactic interventions, including the use of male or female condoms, especially among couples in a risk situation and planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system, and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with the basic principles of care and guidelines associated with the spread of the infection transcends the severity of the disease's symptoms. Although in Brazil Zika virus is predominantly transmitted by the Aedes aegypti mosquito, vertical and sexual transmission routes are important for reproductive health. Vertical transmission causes severe central nervous system structural abnormalities.
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Affiliation(s)
- Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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13
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Jacques IJAA, Katz L, Sena MA, Guimarães ABG, Silva YL, Albuquerque GDM, Pereira RO, de Albuquerque CAMC, Silva MAL, Oliveira PAS, Albuquerque MDFPM, Cordeiro MT, Marques ETA, França RFO, Martelli CMT, Castanha PMS, Braga C. High Incidence of Zika or Chikungunya Infection among Pregnant Women Hospitalized Due to Obstetrical Complications in Northeastern Brazil-Implications for Laboratory Screening in Arbovirus Endemic Area. Viruses 2021; 13:v13050744. [PMID: 33922819 PMCID: PMC8145990 DOI: 10.3390/v13050744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
The diagnostic of arbovirus-related obstetric complications in high-risk pregnancy and childbirth care is challenging, especially in endemic areas. We conducted a prospective study to track active or recent Zika (ZIKV), dengue (DENV), or chikungunya (CHIKV) virus infection among hospitalized pregnant women (PW) with obstetric complications in a hospital at the epicenter of Zika outbreak and ZIKV-related microcephaly in Brazil. Clinical data and blood samples were collected at enrollment and 10 days after the admission of study participants, between October 2018 and May 2019. Further clinical data were extracted from medical records. Samples were screened by molecular and serological tests. Out of 780 participants, 93.1% (95% CI: 91.1–94.7%) presented previous DENV exposure (IgG). ZIKV, CHIKV, and/or DENV laboratory markers of recent or active infection were detected in 130 PW, yielding a prevalence of 16.6% (95% CI: 14.2–19.5%); 9.4% (95% CI: 7.4–11.7%), 7.4% (95% CI: 5.7–9.7%), and 0.38% (95% CI: 0.1–1.2%) of CHIKV, ZIKV, and DENV infections, respectively. Most ZIKV infections were detected by molecular assays (89.6%), while CHIKV infections were detected by serology (95.9%). Our findings highlight the need for arbovirus infections screening in PW with obstetrical complications, potentially associated to these infections in endemic areas regardless of the signs or symptoms suggestive of arboviral disease.
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Affiliation(s)
- Iracema J. A. A. Jacques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Marília A. Sena
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Ana B. G. Guimarães
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Yasmim L. Silva
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Gabriela D. M. Albuquerque
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Raisa O. Pereira
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Camila A. M. C. de Albuquerque
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Maria Almerice L. Silva
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Paula A. S. Oliveira
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Maria de Fátima P. M. Albuquerque
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Marli T. Cordeiro
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Ernesto T. A. Marques
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.T.A.M.J.); (P.M.S.C.)
| | - Rafael F. O. França
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Celina M. T. Martelli
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Priscila M. S. Castanha
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.T.A.M.J.); (P.M.S.C.)
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife CEP 50100-130, PE, Brazil
| | - Cynthia Braga
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
- Correspondence: ; Tel.: +55-81-2101-2577
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14
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Alecrim MDGC, de Amorim MMR, de Araújo TVB, Brasil P, Brickley EB, Castilho MDC, Coelho BP, da Cunha AJLA, Duarte G, Estofolete CF, Gurgel RQ, Herrero-Silva J, Hofer CB, Lopes ASA, Martelli CMT, Melo ASDO, Miranda-Filho DDB, Montarroyos UR, Moreira ME, Mussi-Pinhata MM, de Oliveira CS, Passos SD, Prata-Barbosa A, dos Santos DN, Schuler-Faccini L, da Silva AAM, de Siqueira IC, Sousa PDS, Turchi MD, Ximenes RADA, Zara ALDSA. Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy. Viruses 2021; 13:v13040687. [PMID: 33923434 PMCID: PMC8072625 DOI: 10.3390/v13040687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/31/2022] Open
Abstract
Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.
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Affiliation(s)
| | - Melania Maria Ramos de Amorim
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife 50070-902, Brazil
| | | | - Patrícia Brasil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro 21040-360, Brazil;
| | | | - Marcia da Costa Castilho
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus 69040-000, Brazil; (M.d.G.C.A.); (M.d.C.C.)
| | - Bernadete Perez Coelho
- Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | | | - Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | - Cristina Barroso Hofer
- Departamento de Pediatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-971, Brazil; (A.J.L.A.d.C.); (C.B.H.)
| | | | | | - Adriana Suely de Oliveira Melo
- Universidade Federal de Campina Grande, Campina Grande 58428-830, Brazil; (M.M.R.d.A.); (A.S.d.O.M.)
- Instituto Paraibano de Diagnóstico (EMBRION), Campina Grande 58400-506, Brazil
| | | | | | | | - Marisa Marcia Mussi-Pinhata
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil; (G.D.); (M.M.M.-P.)
| | | | | | | | | | | | | | | | - Patrícia da Silva Sousa
- Centro de Referência em Neurodesenvolvimento, Assistência e Reabilitação de Crianças, Secretaria de Saúde do Estado do Maranhão, São Luís 65076-820, Brazil;
| | - Marília Dalva Turchi
- Departamento de Saude Coletiva, Universidade Federal de Goiás, Goiânia 74605-050, Brazil; (M.D.T.); (A.L.d.S.A.Z.)
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife 50100-130, Brazil;
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Recife 50670-901, Brazil
- Correspondence:
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15
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de Barros Miranda-Filho D, Brickley EB, Ramond A, Martelli CMT, Sanchez Clemente N, Velho Barreto de Araújo T, Rodrigues LC, Montarroyos UR, de Souza WV, de Albuquerque MDFPM, Ventura LO, Marques ETA, Leal MC, Eickmann SH, Wanderley Rocha MA, Sobral da Silva PF, Gomes Carvalho MDC, Ramos RCF, da Silva Oliveira DM, Xavier MDN, Vasconcelos RAL, Veras Gonçalves A, Brainer AM, Tenório Cordeiro M, Arraes de Alencar Ximenes R. The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile. Viruses 2021; 13:v13040602. [PMID: 33916084 PMCID: PMC8067191 DOI: 10.3390/v13040602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 12/21/2022] Open
Abstract
This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG–PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG–PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic. MERG–PC includes children from four groups recruited at different stages of the ZIKV microcephaly epidemic in Pernambuco, i.e., the Outpatient Group (OG/n = 195), the Microcephaly Case–Control Study (MCCS/n = 80), the MERG Pregnant Women Cohort (MERG-PWC/n = 336), and the Control Group (CG/n = 100). We developed a comprehensive array of clinical, laboratory, and imaging assessments that were undertaken by a ‘task force’ of clinical specialists in a single day at 3, 6, 12, 18 months of age, and annually from 24 months. Children from MCCS and CG had their baseline assessment at birth and children from the other groups, at the first evaluation by the task force. The baseline cohort includes 711 children born between February 2015 and February 2019. Children’s characteristics at baseline, excluding CG, were as follows: 32.6% (184/565) had microcephaly, 47% (263/559) had at least one physical abnormality, 29.5% (160/543) had at least one neurological abnormality, and 46.2% (257/556) had at least one ophthalmological abnormality. This ongoing cohort has contributed to the understanding of the congenital Zika syndrome (CZS) spectrum. The cohort has provided descriptions of paediatric neurodevelopment and early epilepsy, including EEG patterns and treatment response, and information on the frequency and characteristics of oropharyngeal dysphagia; cryptorchidism and its surgical findings; endocrine dysfunction; and adenoid hypertrophy in children with Zika-related microcephaly. The study protocols and questionnaires were shared across Brazilian states to enable harmonization across the different studies investigating microcephaly and CZS, providing the opportunity for the Zika Brazilian Cohorts Consortium to be formed, uniting all the ZIKV clinical cohorts in Brazil.
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Affiliation(s)
- Demócrito de Barros Miranda-Filho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Correspondence:
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Celina Maria Turchi Martelli
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (E.B.B.); (A.R.); (N.S.C.); (L.C.R.)
| | - Ulisses Ramos Montarroyos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
| | - Wayner Vieira de Souza
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Maria de Fátima P. M. de Albuquerque
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Liana O. Ventura
- Departamento de Oftalmologia, Fundação Altino Ventura, Recife 52171-011, Brazil;
| | - Ernesto T. A. Marques
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Mariana C. Leal
- Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife 50670-420, Brazil;
| | - Sophie H. Eickmann
- Departamento Materno-Infantil, Universidade Federal de Pernambuco, Recife 50670-420, Brazil;
| | | | - Paula Fabiana Sobral da Silva
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Maria Durce Costa Gomes Carvalho
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Regina Coeli F. Ramos
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
| | - Danielle Maria da Silva Oliveira
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Morgana do Nascimento Xavier
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Rômulo A. L. Vasconcelos
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Andreia Veras Gonçalves
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
| | - Alessandra Mertens Brainer
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Hospital Universitário Oswaldo Cruz, Recife 50100-130, Brazil; (M.A.W.R.); (R.C.F.R.); (A.V.G.)
| | - Marli Tenório Cordeiro
- Instituto Aggeu Magalhães—Fundação Oswaldo Cruz (Fiocruz), Recife 50740-465, Brazil; (C.M.T.M.); (W.V.d.S.); (M.d.F.P.M.d.A.); (E.T.A.M.); (M.d.N.X.); (M.T.C.)
| | - Ricardo Arraes de Alencar Ximenes
- Pós-Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife 50100-010, Brazil; (U.R.M.); (P.F.S.d.S.); (M.D.C.G.C.); (D.M.d.S.O.); (R.A.L.V.); (A.M.B.); (R.A.d.A.X.)
- Pós-Graduação em Medicina Tropical, Universidade Federal de Pernambuco, Recife 50670-901, Brazil
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Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil. PLoS Negl Trop Dis 2021; 15:e0009216. [PMID: 33684110 PMCID: PMC7971861 DOI: 10.1371/journal.pntd.0009216] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/18/2021] [Accepted: 02/07/2021] [Indexed: 11/20/2022] Open
Abstract
Background While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood. Methods Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy. Findings 376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages. The ability to meaningfully quantify the absolute and relative risks of Congenital Zika Syndrome is contingent on the accurate identification of ZIKV infections in pregnant women and the long-term follow-up of children at risk. This study builds on the evidence base on ZIKV in pregnancy by not only examining pregnancy and birth outcomes, but also considering later onset manifestations of Congenital Zika Syndrome, conducting a deep and standardized investigation of infant outcomes. In addition, it used unprecedented repeated testing and the use of multiple diagnostic platforms, including qRT-PCR, IgM and IgG3 ELISAs, and PRNTs to identify ZIKV cases. The absolute risk of microcephaly was 2.9%, of calcifications and/or ventriculomegaly was 7.2%, of additional neurologic alterations was 5.3%, of ophthalmologic abnormalities was 7% and of dysphagia was 1.8%. The manifestations presented more frequently in isolation than in combination (i.e., less than 1% of the children experienced abnormalities across all of the domains simultaneously). Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination
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Oidtman RJ, España G, Perkins TA. Co-circulation and misdiagnosis led to underestimation of the 2015-2017 Zika epidemic in the Americas. PLoS Negl Trop Dis 2021; 15:e0009208. [PMID: 33647014 PMCID: PMC7951986 DOI: 10.1371/journal.pntd.0009208] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/11/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023] Open
Abstract
During the 2015-2017 Zika epidemic, dengue and chikungunya-two other viral diseases with the same vector as Zika-were also in circulation. Clinical presentation of these diseases can vary from person to person in terms of symptoms and severity, making it difficult to differentially diagnose them. Under these circumstances, it is possible that numerous cases of Zika could have been misdiagnosed as dengue or chikungunya, or vice versa. Given the importance of surveillance data for informing epidemiological analyses, our aim was to quantify the potential extent of misdiagnosis during this epidemic. Using basic principles of probability and empirical estimates of diagnostic sensitivity and specificity, we generated revised estimates of reported cases of Zika that accounted for the accuracy of diagnoses made on the basis of clinical presentation with or without laboratory confirmation. Applying this method to weekly reported case data from 43 countries throughout Latin America and the Caribbean, we estimated that 944,700 (95% CrI: 884,900-996,400) Zika cases occurred when assuming all confirmed cases were diagnosed using molecular methods versus 608,400 (95% CrI: 442,000-821,800) Zika cases that occurred when assuming all confirmed cases were diagnosed using serological methods. Our results imply that misdiagnosis was more common in countries with proportionally higher reported cases of dengue and chikungunya, such as Brazil. Given that Zika, dengue, and chikungunya appear likely to co-circulate in the Americas and elsewhere for years to come, our methodology has the potential to enhance the interpretation of passive surveillance data for these diseases going forward. Likewise, our methodology could also be used to help resolve transmission dynamics of other co-circulating diseases with similarities in symptomatology and potential for misdiagnosis.
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Affiliation(s)
- Rachel J. Oidtman
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Guido España
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - T. Alex Perkins
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America
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Cavalcante TB, Ribeiro MRC, Sousa PDS, Costa EDPF, Alves MTSSDBE, Simões VMF, Batista RFL, Takahasi EHM, Amaral GA, Khouri R, Branco MDRFC, Mendes AKT, Costa LC, Campos MAG, Silva AAMD. Congenital Zika syndrome: Growth, clinical, and motor development outcomes up to 36 months of age and differences according to microcephaly at birth. Int J Infect Dis 2021; 105:399-408. [PMID: 33610784 DOI: 10.1016/j.ijid.2021.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Little is known regarding the developmental consequences of congenital Zika syndrome (CZS) without microcephaly at birth. Most previously published clinical series were descriptive and they had small sample sizes. STUDY DESIGN We conducted a cohort study to compare the growth, clinical, and motor development outcomes for 110 children with CZS born with and without microcephaly up to their third birthday. Ninety-three had their head circumference (HC) at birth abstracted and they did not have hypertensive hydrocephalus at birth, where 61 were born with microcephaly and 32 without. RESULTS The HC z-scores decreased steeply from birth to six months of age, i.e., from -3.77 to -6.39 among those with microcephaly at birth and from -1.03 to -3.84 among those without. Thus, at 6 months of age, the mean HC z-scores for children born without microcephaly were nearly the same as those for children born with microcephaly. Children born without microcephaly were less likely to have brain damage, ophthalmic abnormalities, and drug-resistant epilepsy, but the differences in many conditions were not statistically significant. CONCLUSIONS Children born without microcephaly were only slightly less likely to present severe neurologic impairment and to develop postnatal-onset microcephaly, and some of the original differences between the groups tended to dissipate with age.
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Affiliation(s)
| | | | - Patrícia da Silva Sousa
- Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children/NINAR - Health Secretariat of the State of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | | | - Eliana Harumi Morioka Takahasi
- Department of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil; Sarah Network of Neurorehabilitation Hospitals, São Luís, Maranhão, Brazil
| | | | - Ricardo Khouri
- Laboratory of Vector-Borne Infectious Diseases, Gonçalo Moniz Institute, Fiocruz-Bahia, and Department of Pathology and Legal Medicine, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
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Takahasi EHM, Alves MTSSDB, Ribeiro MRC, Souza VFP, Simões VMF, Borges MCR, Amaral GA, Gomes LN, Khouri R, da Silva Sousa P, Silva AAMD. Gross Motor Function in Children with Congenital Zika Syndrome. Neuropediatrics 2021; 52:34-43. [PMID: 33111304 DOI: 10.1055/s-0040-1718919] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little information on gross motor function of congenital Zika syndrome (CZS) children is available. OBJECTIVES To evaluate gross motor function in CZS children aged up to 3 years, and its associated factors and changes in a minimum interval of 6 months. METHODS One hundred children with CZS and cerebral palsy (36 with confirmed and 64 with presumed CZS) were evaluated with the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88/GMFM-66). Forty-six were reevaluated. Wilcoxon tests, Wilcoxon tests for paired samples, percentile scores, and score changes were performed. RESULTS Clinical and socioeconomic characteristics (except maternal age), GMFM scores and GMFCS classification of confirmed and probable cases, which were analyzed together, were similar. The mean age was 25.6 months (±5.5); the median GMFM-88 score was 8.0 (5.4-10.8); and the median GMFM-66 score was 20.5 (14.8-23.1); 89% were classified as GMFCS level V. Low economic class, microcephaly at birth, epilepsy, and brain parenchymal volume loss were associated with low GMFM-66 scores. The median GMFM-66 percentile score was 40 (20-55). On the second assessment, the GMFM-66 scores in two GMFCS level I children and one GMFCS level IV child improved significantly. In one GMFCS level III child, one GMFCS level IV child, and the group of GMFCS level V children, no significant changes were observed. CONCLUSIONS Almost all CZS children had severe cerebral palsy; in the third year of life, most presented no improvement in gross motor function and were likely approaching their maximal gross motor function potential.
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Affiliation(s)
- Eliana Harumi Morioka Takahasi
- Sarah Network of Neurorehabilitation Hospitals, São Luís, Maranhão, Brazil.,Public Health Department, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | - Valéria Ferreira Pereira Souza
- Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children - NINAR, State Department of Health of the State of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | - Lillian Nunes Gomes
- Laboratory of Immunology Human, Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Ricardo Khouri
- Laboratory of Vector-Borne Infectious Diseases, Gonçalo Moniz Institute, Salvador, Bahia, Brazil.,Department of Pathology and Legal Medicine, Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Patricia da Silva Sousa
- Reference Center on Neurodevelopment, Assistance and Rehabilitation of Children - NINAR, State Department of Health of the State of Maranhão, São Luís, Maranhão, Brazil
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Freitas DA, Souza-Santos R, Carvalho LMA, Barros WB, Neves LM, Brasil P, Wakimoto MD. Congenital Zika syndrome: A systematic review. PLoS One 2020; 15:e0242367. [PMID: 33320867 PMCID: PMC7737899 DOI: 10.1371/journal.pone.0242367] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The signs and symptoms of Zika virus infection are usually mild and self-limited. However, the disease has been linked to neurological complications such as Guillain-Barré syndrome and peripheral nerve involvement, and also to abortion and fetal deaths due to vertical transmission, resulting in various congenital malformations in newborns, including microcephaly. This review aimed to describe the o signs and symptoms that characterize the congenital Zika syndrome. METHODS AND FINDINGS A systematic review was performed with a protocol and described according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search strategy yielded 2,048 studies. After the exclusion of duplicates and application of inclusion criteria, 46 studies were included. The main signs and symptoms associated with the congenital Zika syndrome were microcephaly, parenchymal or cerebellar calcifications, ventriculomegaly, central nervous system hypoplasia or atrophy, arthrogryposis, ocular findings in the posterior and anterior segments, abnormal visual function and low birthweight for gestational age. CONCLUSIONS Zika virus infection during pregnancy can cause a series of changes in the growth and development of children, while impacting the healthcare system due to the severity of cases. Our findings outline the disease profile in newborns and infants and may contribute to the development and updating of more specific clinical protocols.
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Affiliation(s)
- Danielle A. Freitas
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Reinaldo Souza-Santos
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Liege M. A. Carvalho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Wagner B. Barros
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Luiza M. Neves
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Patrícia Brasil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Mayumi D. Wakimoto
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Ades AE, Brickley EB, Alexander N, Brown D, Jaenisch T, Miranda-Filho DDB, Pohl M, Rosenberger KD, Soriano-Arandes A, Thorne C, Ximenes RADA, de Araújo TVB, Avelino-Silva VI, Bethencourt Castillo SE, Borja Aburto VH, Brasil P, Christie CDC, de Souza WV, Gotuzzo H JE, Hoen B, Koopmans M, Martelli CMT, Martins Teixeira M, Marques ETA, Miranda MC, Montarroyos UR, Moreira ME, Morris JG, Rockx B, Saba Villarroel PM, Soria Segarra C, Tami A, Turchi MD, Giaquinto C, de Lamballerie X, Wilder-Smith A. Zika virus infection in pregnancy: a protocol for the joint analysis of the prospective cohort studies of the ZIKAlliance, ZikaPLAN and ZIKAction consortia. BMJ Open 2020; 10:e035307. [PMID: 33323426 PMCID: PMC7745317 DOI: 10.1136/bmjopen-2019-035307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Zika virus (ZIKV) infection in pregnancy has been associated with microcephaly and severe neurological damage to the fetus. Our aim is to document the risks of adverse pregnancy and birth outcomes and the prevalence of laboratory markers of congenital infection in deliveries to women experiencing ZIKV infection during pregnancy, using data from European Commission-funded prospective cohort studies in 20 centres in 11 countries across Latin America and the Caribbean. METHODS AND ANALYSIS We will carry out a centre-by-centre analysis of the risks of adverse pregnancy and birth outcomes, comparing women with confirmed and suspected ZIKV infection in pregnancy to those with no evidence of infection in pregnancy. We will document the proportion of deliveries in which laboratory markers of congenital infection were present. Finally, we will investigate the associations of trimester of maternal infection in pregnancy, presence or absence of maternal symptoms of acute ZIKV infection and previous flavivirus infections with adverse outcomes and with markers of congenital infection. Centre-specific estimates will be pooled using a two-stage approach. ETHICS AND DISSEMINATION Ethical approval was obtained at each centre. Findings will be presented at international conferences and published in peer-reviewed open access journals and discussed with local public health officials and representatives of the national Ministries of Health, Pan American Health Organization and WHO involved with ZIKV prevention and control activities.
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Affiliation(s)
- A E Ades
- Department of Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neal Alexander
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - David Brown
- Flavivirus Reference Laboratory, Fundacão Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Thomas Jaenisch
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | | | - Moritz Pohl
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Kerstin D Rosenberger
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Claire Thorne
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | | | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Patrícia Brasil
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Celia D C Christie
- Department of Child and Adolescent Health, University of the West Indies at Mona, Kingston, Jamaica
| | | | - Jose Eduardo Gotuzzo H
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Bruno Hoen
- INSERM Centre d'Investigation Clinique 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Guadeloupe, France
- Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles et de la Guyane, Pointe-à-Pitre, Guadeloupe, France
| | - Marion Koopmans
- Department of Viroscience, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | | | | | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Maria Elisabeth Moreira
- Figueira National Institute for Women's, Children's and Adolescents Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - J Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Barry Rockx
- Department of Viroscience, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Carmen Soria Segarra
- Universidad Católica de Santiago de Guayaquil, Guayaquil, Guayas, Ecuador
- SOSECALI C., Ltda, Guayaquil, Ecuador
| | - Adriana Tami
- Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Venezuela
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil
| | - Carlo Giaquinto
- Department of Woman's and Child's Health, Università degli Studi di Padova, Padova, Italy
| | - Xavier de Lamballerie
- Aix-Marseille Université Institut Universitaire de Technologie d'Aix-en-Provence, Aix-en-Provence, Provence-Alpes-Côte d'Azur, France
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Examining the Association of Socioeconomic Position with Microcephaly and Delayed Childhood Neurodevelopment among Children with Prenatal Zika Virus Exposure. Viruses 2020; 12:v12111342. [PMID: 33238584 PMCID: PMC7700457 DOI: 10.3390/v12111342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/07/2023] Open
Abstract
Increased rates of Zika virus have been identified in economically deprived areas in Brazil at the population level; yet, the implications of the interaction between socioeconomic position and prenatal Zika virus exposure on adverse neurodevelopmental outcomes remains insufficiently evaluated at the individual level. Using data collected between September 2015 and September 2019 from 163 children with qRT-PCR and/or IgM-confirmed prenatal exposure to Zika virus participating in a prospective cohort study in Rio de Janeiro, Brazil (NCT03255369), this study evaluated the relationships of socioeconomic indicators with microcephaly at birth and Bayley-III neurodevelopmental scores during the early life course. Adjusted logistic regression models indicated increased odds of microcephaly in children born to families with lower household income (OR, 95% CI: 3.85, 1.43 to 10.37) and higher household crowding (OR, 95% CI: 1.83, 1.16 to 2.91), while maternal secondary and higher education appeared to have a protective effect for microcephaly compared to primary education (OR, 95% CI: 0.33, 0.11 to 0.98 and 0.10, 0.03 to 0.36, respectively). Consistent with these findings, adjusted linear regression models indicated lower composite language (−10.78, 95% CI: −19.87 to −1.69), motor (−10.45, 95% CI: −19.22 to −1.69), and cognitive (−17.20, 95% CI: −26.13 to −8.28) scores in children whose families participated in the Bolsa Família social protection programme. As such, the results from this investigation further emphasise the detrimental effects of childhood disadvantage on human health and development by providing novel evidence on the link between individual level socioeconomic indicators and microcephaly and delayed early life neurodevelopment following prenatal Zika virus exposure.
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Plaque Reduction Neutralization Test (PRNT) in the Congenital Zika Syndrome: Positivity and Associations with Laboratory, Clinical, and Imaging Characteristics. Viruses 2020; 12:v12111244. [PMID: 33142747 PMCID: PMC7692785 DOI: 10.3390/v12111244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023] Open
Abstract
The short duration of viremia, low blood viral load, inaccessibility to timely specific diagnostic tests, and cross-reactions with other flaviviruses have hindered laboratory confirmation of Congenital Zika Syndrome (CZS). This study analyzes the positivity of the plaque reduction neutralization test (PRNT) in children with clinical or imaging characteristics of CZS and its association with laboratory, clinical, and imaging characteristics. The 94 clinical cases of CZS submitted to the ZIKV PRNT90 test were followed from 2016 to 2018. The mean age of children at PRNT90 collection was 22 ± 6 months Standard Deviation. The ZIKV PRNT90 was positive (titer ≥ 10) in 40 (42.5%) children. ZIKV PRNT90 positivity was associated with severe microcephaly in newborns (p = 0.016), lower head circumference z-score at birth (p = 0.043) and 24 months of age (p = 0.031), and severe reduction of the cerebral parenchyma volume (p = 0.021), expressing greater disease severity. Negative PRNT90 in children with characteristic signs of CZS may be due to false-negative results, indicating that the diagnosis of CZS should be primarily syndromic.
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Sobral da Silva PF, Eickmann SH, Arraes de Alencar Ximenes R, Ramos Montarroyos U, de Carvalho Lima M, Turchi Martelli CM, Velho Barreto de Araújo T, Brickley EB, Cunha Rodrigues L, Lima da Silva Pastich Gonçalves FC, Costa Gomes Carvalho MD, Vieira de Souza W, de Barros Miranda-Filho D. Pediatric neurodevelopment by prenatal Zika virus exposure: a cross-sectional study of the Microcephaly Epidemic Research Group Cohort. BMC Pediatr 2020; 20:472. [PMID: 33038931 PMCID: PMC7547521 DOI: 10.1186/s12887-020-02331-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/07/2020] [Indexed: 01/29/2023] Open
Abstract
Background The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly. Methods We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10–45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC. Results Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were ‘at risk of development delay’ according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were ‘at risk of development delay’. For children without microcephaly, the percentages found to be ‘at risk of developmental delay’ were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N = 94), 13.8%; Group 4 (N = 46), 21.7%. Conclusions Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.
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Alves LV, Leal CA, Alves JGB. Zika virus seroprevalence in women who gave birth during Zika virus outbreak in Brazil - a prospective observational study. Heliyon 2020; 6:e04817. [PMID: 32964154 PMCID: PMC7490532 DOI: 10.1016/j.heliyon.2020.e04817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/04/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background The recent Zika virus (ZIKV) outbreak in Brazil started in August 2015 and ended in May 2017 without effective public health measures for its control have been taken. The immunological status of a community may not only predict future outbreaks as well to answer questions regarding ZIKV not known yet. Objective To verify the seroprevalence of ZIKV in a group of women who were pregnant during the Zika virus outbreak in Recife, three to nine months after the delivery, and to evaluate the neurodevelopment of their children. Methods A cross-sectional study enrolled participants of a cohort study held at Instituto de Medicina Integral Professor Fernando Figueira (IMIP) during the ZIKV outbreak in Recife. Mothers who gave birth between the last trimester of 2015 and the first semester of 2016, period of the peak of microcephaly outbreak in Recife, were invited. All participants had the serum tested by the anti-ZIKV IgG/IgM enzyme-liked immunosorbent assays, ELISA kit (Euroimmun, Lübeck, Germany). All children whose mothers presented positive serology for ZIKV performed the IgG/IgM ELISA test for ZIKV. These children were also evaluated by a neuropediatrician and the Denver II development screening test was applied. Results Among the 132 studied pregnant women who gave birth at the peak of ZIKV outbreak in Recife, all were ZIKV IgM negative and 81 (61,3%) had ZIKV IgG positive. Mothers ZIKV IgG positive had more fever and rash during the pregnancy as compared with mothers negative for ZIKV; respectively 27/81 (33,3%) vs 6/51 (11,7%), p = 0.005 and 22/81 (27,2%) vs 4 (7,8%), p = 0.016. Only one child had IgG positive serology for ZIKV. No children had neurodevelopment defect for the age group and the Denver II normal scores. Conclusions A high ZIKV IgG seroprevalence in pregnant women at the end of the ZIKV outbreak in Recife was found. This finding suggests that community protective immunity may have contributed to the end of ZIKV outbreak in Recife, Brazil.
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Affiliation(s)
- Lucas Victor Alves
- Department of Neuropediatrics, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), USA
| | - Carla Adriana Leal
- Department of Pediatrics, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Brazil
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Mendes AKT, Ribeiro MRC, Lamy-Filho F, Amaral GA, Borges MCR, Costa LC, Cavalcante TB, Batista RFL, Sousa PDS, Silva AAMD. Congenital Zika syndrome: association between the gestational trimester of maternal infection, severity of brain computed tomography findings and microcephaly at birth. Rev Inst Med Trop Sao Paulo 2020; 62:e56. [PMID: 32844907 PMCID: PMC7447234 DOI: 10.1590/s1678-9946202062056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 12/25/2022] Open
Abstract
This study analyzed possible associations between the trimester of maternal Zika virus infection (ZIKV) in pregnancy, severity of brain computed tomography (CT) findings and the presence of microcephaly at birth in children with Congenital Zika Syndrome (CZS). It was an analytical study in a cohort of children with CZS. Symptoms of maternal infection were dichotomized into the 1st trimester of pregnancy and other trimesters. Head circumference (HC) at birth was used to calculate the z-score. Mild microcephaly was defined as HC between 2 and ≥3 standard deviations (SD) below the mean for each gestational age and sex, and severe microcephaly when HC <3 SD below average. Brain CT images were evaluated by two radiologists and classified, according to the severity, into mild, moderate and severe. Fisher’s exact, Mann-Whitney and Kruskal-Wallis tests were used to verify the associations between variables. In 108 children, maternal infection in the 1st trimester of pregnancy was associated with more severe brain CT abnormalities (p=0.038), greater severity of microcephaly at birth (p=0.013) and lower HC z-scores at birth (p=0.021). The severity of brain CT lesions was also associated with lower HC z-scores at birth (p<0.001). Maternal ZIKV infection during the first trimester of pregnancy proved to be an important risk factor for a more severe spectrum of CZS, as it is associated with more severe brain CT abnormalities and, consequently, with lower HC z-scores at birth.
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Affiliation(s)
| | | | - Fernando Lamy-Filho
- Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | | | | | - Patrícia da Silva Sousa
- Centro de Referência em Neurodesenvolvimento, Assistência e Reabilitação de Crianças, Secretaria de Saúde do Estado do Maranhão, São Luís, Maranhão, Brazil
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Lobkowicz L, Ramond A, Sanchez Clemente N, Ximenes RADA, Miranda-Filho DDB, Montarroyos UR, Martelli CMT, de Araújo TVB, Brickley EB. The frequency and clinical presentation of Zika virus coinfections: a systematic review. BMJ Glob Health 2020; 5:e002350. [PMID: 32381652 PMCID: PMC7228501 DOI: 10.1136/bmjgh-2020-002350] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is limited knowledge on the influence of concurrent coinfections on the clinical presentation of Zika virus (ZIKV) disease. METHODS To better understand the types, frequencies and clinical manifestations of ZIKV coinfections, we did a systematic review of four databases (PubMed, Embase, Web of Science, LILACS) without restrictions for studies on ZIKV coinfections confirmed by nucleic acid (quantitative real-time-PCR) testing of ZIKV and coinfecting pathogens. The review aimed to identify cohort, cross-sectional, case series and case report studies that described frequencies and/or clinical signs and symptoms of ZIKV coinfections. Conference abstracts, reviews, commentaries and studies with imprecise pathogen diagnoses and/or no clinical evaluations were excluded. RESULTS The search identified 34 articles from 10 countries, comprising 2 cohort, 10 cross-sectional, 8 case series and 14 case report studies. Coinfections were most frequently reported to have occurred with other arthropod-borne viruses (arboviruses); out of the 213 coinfections described, ZIKV infections co-occurred with chikungunya in 115 cases, with dengue in 68 cases and with both viruses in 19 cases. Other coinfecting agents included human immunodeficiency, Epstein-Barr, human herpes and Mayaro viruses, Leptospira spp, Toxoplasma gondii and Schistosoma mansoni. ZIKV-coinfected cases primarily presented with mild clinical features, typical of ZIKV monoinfection; however, 9% of cases in cohort and cross-sectional studies were reported to experience complications. CONCLUSION Based on the evidence collated in this review, coinfections do not appear to strongly influence the clinical manifestations of uncomplicated ZIKV infections. Further research is needed to confirm whether risk of severe complications is altered when ZIKV infection co-occurs with other infections. PROSPERO REGISTRATION NUMBER CRD42018111023.
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Affiliation(s)
- Ludmila Lobkowicz
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Carvalho MDCG, Ximenes RAA, Montarroyos UR, da Silva PFS, Andrade-Valença LPA, Eickmann SH, Ramos RC, Rocha MÂW, de Araujo TVB, de Albuquerque MDFPM, Martelli CMT, de Souza WV, Brickley EB, Miranda-Filho DDB. Early epilepsy in children with Zika-related microcephaly in a cohort in Recife, Brazil: Characteristics, electroencephalographic findings, and treatment response. Epilepsia 2020; 61:509-518. [PMID: 32065676 PMCID: PMC7155083 DOI: 10.1111/epi.16444] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 01/08/2023]
Abstract
Objective To estimate the incidence of epilepsy in children with Zika‐related microcephaly in the first 24 months of life; to characterize the associated clinical and electrographic findings; and to summarize the treatment responses. Methods We followed a cohort of children, born during the 2015‐2016 Zika virus (ZIKV) epidemic in Brazil, with congenital microcephaly and evidence of congenital ZIKV infection on neuroimaging and/or laboratory testing. Neurological assessments were performed at ≤3, 6, 12, 15, 18, 21, and 24 months of life. Serial electroencephalograms were performed over the first 24 months. Results We evaluated 91 children, of whom 48 were female. In this study sample, the cumulative incidence of epilepsy was 71.4% in the first 24 months, and the main type of seizure was infantile spasms (83.1%). The highest incidence of seizures occurred between 3 and 9 months of age, and the risk remained high until 15 months of age. The incidence of infantile spasms peaked between 4 and 7 months and was followed by an increased incidence of focal epilepsy cases after 12 months of age. Neuroimaging results were available for all children, and 100% were abnormal. Cortical abnormalities were identified in 78.4% of the 74 children evaluated by computed tomography and 100% of the 53 children evaluated by magnetic resonance imaging. Overall, only 46.1% of the 65 children with epilepsy responded to treatment. The most commonly used medication was sodium valproate with or without benzodiazepines, levetiracetam, phenobarbital, and vigabatrin. Significance Zika‐related microcephaly was associated with high risk of early epilepsy. Seizures typically began after the third month of life, usually as infantile spasms, with atypical electroencephalographic abnormalities. The seizure control rate was low. The onset of seizures in the second year was less frequent and, when it occurred, presented as focal epilepsy.
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Affiliation(s)
| | - Ricardo A A Ximenes
- University of Pernambuco, Recife, Brazil.,Federal University of Pernambuco, Recife, Brazil
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Affiliation(s)
- Didier Musso
- Laboratoire Eurofins Labazur Guyane, Cayenne, French Guiana
| | | | - David Baud
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Affiliation(s)
- Carlo Ticconi
- Department of Surgical Sciences, University Tor Vergata, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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