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McMahon R, Fuchs U, Schneider M, Hadl S, Hochreiter R, Bitzer A, Kosulin K, Koren M, Mader R, Zoihsl O, Wressnigg N, Dubischar K, Buerger V, Eder-Lingelbach S, Jaramillo JC. A randomized, double-blinded Phase 3 study to demonstrate lot-to-lot consistency and to confirm immunogenicity and safety of the live-attenuated chikungunya virus vaccine candidate VLA1553 in healthy adults†. J Travel Med 2024; 31:taad156. [PMID: 38091981 PMCID: PMC10911060 DOI: 10.1093/jtm/taad156] [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: 10/12/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND The global spread of the chikungunya virus (CHIKV) increases the exposure risk for individuals travelling to or living in endemic areas. This Phase 3 study was designed to demonstrate manufacturing consistency between three lots of the single shot live-attenuated CHIKV vaccine VLA1553, and to confirm the promising immunogenicity and safety data obtained in previous trials. METHODS This randomized, double-blinded, lot-to-lot consistency, Phase 3 study, assessed immunogenicity and safety of VLA1553 in 408 healthy adults (18-45 years) in 12 sites across the USA. The primary endpoint was a comparison of the geometric mean titre (GMT) ratios of CHIKV-specific neutralizing antibodies between three VLA1553 lots at 28 days post-vaccination. Secondary endpoints included immunogenicity and safety over 6 months post-vaccination. RESULTS GMTs were comparable between the lots meeting the acceptance criteria for equivalence. The average GMT (measured by 50% CHIKV micro plaque neutralization test; μPRNT50) peaked with 2643 at 28 days post-vaccination and decreased to 709 at 6 months post-vaccination. An excellent seroresponse rate (defined as μPRNT50 titre ≥ 150 considered protective) was achieved in 97.8% of participants at 28 days post-vaccination and still persisted in 96% at 6 months after vaccination. Upon VLA1553 immunization, 72.5% of participants experienced adverse events (AEs), without significant differences between lots (related solicited systemic AE: 53.9% of participants; related solicited local AE: 19.4%). Overall, AEs were mostly mild or moderate and resolved without sequela, usually within 3 days. With 3.9% of participants experiencing severe AEs, 2.7% were classified as related, whereas none of the six reported serious adverse events was related to the administration of VLA1553. CONCLUSIONS All three lots of VLA1553 recapitulated the safety and immunogenicity profiles of a preceding Phase 3 study, fulfilling pre-defined consistency requirements. These results highlight the manufacturability of VLA1553, a promising vaccine for the prevention of CHIKV disease for those living in or travelling to endemic areas.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael Koren
- Walter Reed Army Institute of Research, Bethesda, MD, USA
| | - Robert Mader
- CRETA GmbH, Campus Vienna Biocenter 3, 1030 Vienna, Austria
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Jacob-Nascimento LC, Portilho MM, Anjos RO, Moreira PSS, Stauber C, Weaver SC, Kitron U, Reis MG, Ribeiro GS. Detection of Chikungunya Virus RNA in Oral Fluid and Urine: An Alternative Approach to Diagnosis? Viruses 2024; 16:235. [PMID: 38400011 PMCID: PMC10891727 DOI: 10.3390/v16020235] [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: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
To evaluate whether oral fluids (OF) and urine can serve as alternative, non-invasive samples to diagnose chikungunya virus (CHIKV) infection via RT-qPCR, we employed the same RNA extraction and RT-qPCR protocols on paired serum, OF and urine samples collected from 51 patients with chikungunya during the acute phase of the illness. Chikungunya patients were confirmed through RT-qPCR in acute-phase sera (N = 19), IgM seroconversion between acute- and convalescent-phase sera (N = 12), or IgM detection in acute-phase sera (N = 20). The controls included paired serum, OF and urine samples from patients with non-arbovirus acute febrile illness (N = 28) and RT-PCR-confirmed dengue (N = 16). Nine (47%) of the patients with positive RT-qPCR for CHIKV in sera and two (17%) of those with CHIKV infection confirmed solely via IgM seroconversion had OF positive for CHIKV in RT-qPCR. One (5%) patient with CHIKV infection confirmed via serum RT-qPCR was positive in the RT-qPCR performed on urine. None of the negative control group samples were positive. Although OF may serve as an alternative sample for diagnosing acute chikungunya in specific settings, a negative result cannot rule out an infection. Further research is needed to investigate whether OF and urine collected later in the disease course when serum becomes RT-qPCR-negative may be helpful in CHIKV diagnosis and surveillance, as well as to determine whether urine and OF pose any risk of CHIKV transmission.
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Affiliation(s)
- Leile Camila Jacob-Nascimento
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (L.C.J.-N.); (M.M.P.); (R.O.A.); (P.S.S.M.); (M.G.R.)
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40026-010, Brazil
| | - Moyra M. Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (L.C.J.-N.); (M.M.P.); (R.O.A.); (P.S.S.M.); (M.G.R.)
| | - Rosângela O. Anjos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (L.C.J.-N.); (M.M.P.); (R.O.A.); (P.S.S.M.); (M.G.R.)
| | - Patrícia S. S. Moreira
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (L.C.J.-N.); (M.M.P.); (R.O.A.); (P.S.S.M.); (M.G.R.)
| | - Christine Stauber
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA;
| | - Scott C. Weaver
- Department of Microbiology & Immunology and World Reference Center for Emerging Viruses and Arboviruses, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Uriel Kitron
- Department of Environmental Sciences, Emory University, Atlanta, GA 30322, USA;
| | - Mitermayer G. Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (L.C.J.-N.); (M.M.P.); (R.O.A.); (P.S.S.M.); (M.G.R.)
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40026-010, Brazil
- Yale School of Public Health, Yale University, New Haven, CT 06520-8034, USA
| | - Guilherme S. Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador 40296-710, Brazil; (L.C.J.-N.); (M.M.P.); (R.O.A.); (P.S.S.M.); (M.G.R.)
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador 40026-010, Brazil
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Torres dos Santos Lopes D, Cerutti Junior C, Areias Cabidelle A, Espinosa Miranda A, Drumond Louro I, Pamplona de Góes Cavalcanti L, Vicente CR. Factors associated with hospitalization in the acute phase of Chikungunya. PLoS One 2023; 18:e0296131. [PMID: 38134205 PMCID: PMC10745164 DOI: 10.1371/journal.pone.0296131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Determine characteristics associated with hospitalization in the acute phase of Chikungunya. METHODS Cross-sectional study including data on Chikungunya cases reported in Vitória, Espírito Santo state, Brazil, between March 2016 and December 2021. RESULTS Hospitalizations accounted for 1.42% (n = 41) of the 2,868 cases included. There were statistically significant differences between hospitalized and non-hospitalized regarding age (P 0.001), which was lower among hospitalized patients, and pregnancy, which was more frequent in the hospitalized group (P 0.010). Patients younger than two years old and older than 65 years corresponded to 31.7% of hospitalizations. Back pain (OR = 0.134; 95% CI = 0.044-0.409) and arthralgia (OR = 0.226; 95% CI = 0.083-0.613) were protective factors for hospitalization. CONCLUSION Groups at risk of severe Chikungunya, including those under two and over 65 years of age, may require more hospitalization, even with milder manifestations.
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Affiliation(s)
| | - Crispim Cerutti Junior
- Postgraduate Program in Infectious Disease, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Aline Areias Cabidelle
- Health Surveillance Sector, Health Department of Vitória, Vitória, Espírito Santo, Brazil
| | - Angelica Espinosa Miranda
- Postgraduate Program in Infectious Disease, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Iuri Drumond Louro
- Postgraduate Program in Biotechnology, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- Department of Biology, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Creuza Rachel Vicente
- Postgraduate Program in Infectious Disease, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
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Bastos Filho PP, Francisco MVLDO, Santos CS, de Almeida BL, Souza MSDJ, Ribeiro DVB, de Araújo IMB, Lima BGDC, Rajan J, de Siqueira IC. High seroprevalence of antibodies against arboviruses in postpartum women in Salvador, Brazil. IJID REGIONS 2023; 9:55-58. [PMID: 37868343 PMCID: PMC10585381 DOI: 10.1016/j.ijregi.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/24/2023]
Abstract
Objectives Arboviruses represent a major challenge to public health in Brazil. Dengue (DENV) virus has been endemic for decades, and the introduction of Zika (2015) and Chikungunya (2014) viruses (CHIKV) has imposed a significant burden on the country. The present study aimed to investigate the seroprevalence of Zika virus (ZIKV), DENV and CHIKV in women in Salvador, Bahia-Brazil. Methods Cross-sectional study involving postpartum women admitted to a maternity hospital in Salvador, Brazil. Anti-ZIKV, anti-DENV and anti-CHIKV immunoglobulin G was measured by enzyme-linked immunosorbent assay. Results A total of 302 women were enrolled with a median age: 26 years, interquartile range (21-33). Most self-declared as mixed-race or black skin color (92.4%). The seroprevalence was 57% for ZIKV); 91.4% for DENV, and 7.6% for CHIKV. Most participants denied awareness of previous arboviral infection, although 67 (22.3%) reported a previous history of ZIKV infection, 34 (11.1%) DENV infection and 9 (3%) CHIKV infection. Conclusion Our data indicate a high prevalence of past ZIKV and DENV infections in the population studied. Most of the participants remain susceptible to future CHIKV infection, highlighting the need for preventive and educational interventions. Our results suggest the need for continuous epidemiological surveillance of arboviral diseases, particularly among women residing in at-risk regions.
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Affiliation(s)
- Pedro Paulo Bastos Filho
- Instituto de Perinatologia da Bahia, IPERBA-SESAB, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | | | | | | | | | | | | | - Jayant Rajan
- Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, USA
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Devaraju M, Li A, Ha S, Li M, Shivakumar M, Li H, Nishiguchi EP, Gérardin P, Waldorf KA, Al-Haddad BJS. Beyond TORCH: A narrative review of the impact of antenatal and perinatal infections on the risk of disability. Neurosci Biobehav Rev 2023; 153:105390. [PMID: 37708918 PMCID: PMC10617835 DOI: 10.1016/j.neubiorev.2023.105390] [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: 06/13/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/16/2023]
Abstract
Infections and inflammation during pregnancy or early life can alter child neurodevelopment and increase the risk for structural brain abnormalities and mental health disorders. There is strong evidence that TORCH infections (i.e., Treponema pallidum, Toxoplasma gondii, rubella virus, cytomegalovirus, herpes virus) alter fetal neurodevelopment across multiple developmental domains and contribute to motor and cognitive disabilities. However, the impact of a broader range of viral and bacterial infections on fetal development and disability is less well understood. We performed a literature review of human studies to identify gaps in the link between maternal infections, inflammation, and several neurodevelopmental domains. We found strong and moderate evidence respectively for a higher risk of motor and cognitive delays and disabilities in offspring exposed to a range of non-TORCH pathogens during fetal life. In contrast, there is little evidence for an increased risk of language and sensory disabilities. While guidelines for TORCH infection prevention during pregnancy are common, further consideration for prevention of non-TORCH infections during pregnancy for fetal neuroprotection may be warranted.
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Affiliation(s)
- Monica Devaraju
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Amanda Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA; Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA
| | - Sandy Ha
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Miranda Li
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA; University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Megana Shivakumar
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Hanning Li
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Erika Phelps Nishiguchi
- University of Hawaii, Department of Pediatrics, Division of Community Pediatrics, 1319 Punahou St, Honolulu, HI, USA
| | - Patrick Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion, France; Platform for Clinical and Translational Research, Centre Hospitalier Universitaire, Saint Pierre, Réunion, France
| | - Kristina Adams Waldorf
- University of Washington, Department of Obstetrics, 1959 NE Pacific St, Seattle, WA 98195, USA.
| | - Benjamin J S Al-Haddad
- University of Minnesota, Department of Pediatrics, Division of Neonatology, Academic Office Building, 2450 Riverside Ave S AO-401, Minneapolis, MN 55454, USA; Masonic Institute for the Developing Brain, 2025 E River Pkwy, Minneapolis, MN 55414, USA.
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Hills SL, Wong JM, Staples JE. Arboviral vaccines for use in pregnant travelers. Travel Med Infect Dis 2023; 55:102624. [PMID: 37517630 DOI: 10.1016/j.tmaid.2023.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023]
Abstract
Pregnant women traveling abroad can be exposed to a variety of arboviruses, primarily spread by mosquitoes or ticks. Some arboviral infections can be of particular concern for pregnant women or their fetuses. Vaccination is one preventive measure that can reduce the risk for infection. Several arboviral vaccines have been licensed for many years and can be used to prevent infection in travelers, namely Japanese encephalitis, yellow fever, and tick-borne encephalitis vaccines. Recommendations on use of these vaccines in pregnancy vary. Other arboviral vaccines have been licensed but are not indicated for use in pregnant travelers (e.g., dengue vaccines) or are in development (e.g., chikungunya, Zika vaccines). This review describes arboviral vaccines for travelers, focusing on women who are pregnant and those planning travel during pregnancy.
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Affiliation(s)
- S L Hills
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.
| | - J M Wong
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA
| | - J E Staples
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Pozzetto B, Grard G, Durand G, Paty MC, Gallian P, Lucas-Samuel S, Diéterlé S, Fromage M, Durand M, Lepelletier D, Chidiac C, Hoen B, Nicolas de Lamballerie X. Arboviral Risk Associated with Solid Organ and Hematopoietic Stem Cell Grafts: The Prophylactic Answers Proposed by the French High Council of Public Health in a National Context. Viruses 2023; 15:1783. [PMID: 37766192 PMCID: PMC10536626 DOI: 10.3390/v15091783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Diseases caused by arboviruses are on the increase worldwide. In addition to arthropod bites, most arboviruses can be transmitted via accessory routes. Products of human origin (labile blood products, solid organs, hematopoietic stem cells, tissues) present a risk of contamination for the recipient if the donation is made when the donor is viremic. Mainland France and its overseas territories are exposed to a complex array of imported and endemic arboviruses, which differ according to their respective location. This narrative review describes the risks of acquiring certain arboviral diseases from human products, mainly solid organs and hematopoietic stem cells, in the French context. The main risks considered in this study are infections by West Nile virus, dengue virus, and tick-borne encephalitis virus. The ancillary risks represented by Usutu virus infection, chikungunya, and Zika are also addressed more briefly. For each disease, the guidelines issued by the French High Council of Public Health, which is responsible for mitigating the risks associated with products of human origin and for supporting public health policy decisions, are briefly outlined. This review highlights the need for a "One Health" approach and to standardize recommendations at the international level in areas with the same viral epidemiology.
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Affiliation(s)
- Bruno Pozzetto
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
- GIMAP Team, CIRI-Centre International de Recherche en Infectiologie, Université Jean Monnet de Saint-Etienne, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, 42023 Saint-Etienne, France
- Department of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Gilda Grard
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France; (G.G.); (G.D.); (X.N.d.L.)
- French Armed Forces Biomedical Research Institute (IRBA), Valérie-André, 91220 Brétigny-sur-Orge, France
| | - Guillaume Durand
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France; (G.G.); (G.D.); (X.N.d.L.)
- French Armed Forces Biomedical Research Institute (IRBA), Valérie-André, 91220 Brétigny-sur-Orge, France
| | - Marie-Claire Paty
- Santé Publique France, The French Public Health Agency, 94410 Saint-Maurice, France;
| | - Pierre Gallian
- Etablissement Français du Sang, 93218 Saint-Denis, France;
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), 13385 Marseille, France
| | | | | | - Muriel Fromage
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), 93200 Saint-Denis, France;
| | - Marc Durand
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
| | - Didier Lepelletier
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
| | - Christian Chidiac
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
- Department of Infectious and Tropical Diseases, University Hospital of Lyon, 69002 Lyon, France
| | - Bruno Hoen
- Haut Conseil de la Santé Publique, Ministère de la Santé et de la Prévention, 75007 Paris, France; (M.D.); (D.L.); (C.C.); (B.H.)
- Department of Infectious Diseases, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Xavier Nicolas de Lamballerie
- National Reference Center for Arboviruses, National Institute of Health and Medical Research (Inserm), 13005 Marseille, France; (G.G.); (G.D.); (X.N.d.L.)
- French Armed Forces Biomedical Research Institute (IRBA), Valérie-André, 91220 Brétigny-sur-Orge, France
- Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), 13385 Marseille, France
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Sagay AS, Hsieh SC, Dai YC, Chang CA, Ogwuche J, Ige OO, Kahansim ML, Chaplin B, Imade G, Elujoba M, Paul M, Hamel DJ, Furuya H, Khoury R, Boaventura VS, de Moraes L, Kanki PJ, Wang WK. Chikungunya virus antepartum transmission and abnormal infant outcomes in Nigeria. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.05.23293675. [PMID: 37609297 PMCID: PMC10441498 DOI: 10.1101/2023.08.05.23293675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Chikungunya virus (CHIKV) has become a global public health concern since the reemergence of the Indian Ocean lineage and expansion of the Asian genotype. CHIKV infection causes acute febrile illness, rash, and arthralgia and during pregnancy may affect both mothers and infants. The mother-to-child transmission (MTCT) of CHIKV in Africa remains understudied. We screened 1006 pregnant women at two clinics in Nigeria between 2019 and 2022 and investigated the prevalence and MTCT of CHIKV. Of the 1006, 119 tested positive for CHIKV IgM, of which 36 underwent detailed laboratory tests. While none of the IgM reactive samples were RT-PCR positive, 14 symptomatic pregnant women were confirmed by CHIKV neutralization test. Twelve babies were followed with 8 normal and 4 abnormal outcomes, including stillbirth, cleft lip/palate with microcephaly, preterm delivery, polydactyly with sepsis and jaundice. CHIKV IgM testing identified 3 antepartum transmissions, further studies will determine its impact in antepartum infection.
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Bartholomeeusen K, Daniel M, LaBeaud DA, Gasque P, Peeling RW, Stephenson KE, Ng LFP, Ariën KK. Chikungunya fever. Nat Rev Dis Primers 2023; 9:17. [PMID: 37024497 PMCID: PMC11126297 DOI: 10.1038/s41572-023-00429-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/08/2023]
Abstract
Chikungunya virus is widespread throughout the tropics, where it causes recurrent outbreaks of chikungunya fever. In recent years, outbreaks have afflicted populations in East and Central Africa, South America and Southeast Asia. The virus is transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Chikungunya fever is characterized by severe arthralgia and myalgia that can persist for years and have considerable detrimental effects on health, quality of life and economic productivity. The effects of climate change as well as increased globalization of commerce and travel have led to growth of the habitat of Aedes mosquitoes. As a result, increasing numbers of people will be at risk of chikungunya fever in the coming years. In the absence of specific antiviral treatments and with vaccines still in development, surveillance and vector control are essential to suppress re-emergence and epidemics.
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Affiliation(s)
- Koen Bartholomeeusen
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Matthieu Daniel
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis, France
- Service de Médecine d'Urgences-SAMU-SMUR, CHU de La Réunion, Saint-Denis, France
| | - Desiree A LaBeaud
- Department of Pediatrics, Division of Infectious Disease, Stanford University School of Medicine, Stanford, CA, USA
| | - Philippe Gasque
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis, France
- Laboratoire d'Immunologie Clinique et Expérimentale Océan Indien LICE-OI, Université de La Réunion, Saint-Denis, France
| | - Rosanna W Peeling
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Kathryn E Stephenson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Lisa F P Ng
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research, Singapore, Singapore
- National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.
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Simon F, Caumes E, Jelinek T, Lopez-Velez R, Steffen R, Chen LH. Chikungunya: risks for travellers. J Travel Med 2023; 30:6989692. [PMID: 36648431 PMCID: PMC10075059 DOI: 10.1093/jtm/taad008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
RATIONALE FOR REVIEW Chikungunya outbreaks continue to occur, with changing epidemiology. Awareness about chikungunya is low both among the at-risk travellers and healthcare professionals, which can result in underdiagnosis and underreporting. This review aims to improve awareness among healthcare professionals regarding the risks of chikungunya for travellers. KEY FINDINGS Chikungunya virus transmission to humans occurs mainly via daytime-active mosquitoes, Aedes aegypti and Aedes albopictus. The areas where these mosquitoes live is continuously expanding, partly due to climate changes. Chikungunya is characterized by an acute onset of fever with joint pain. These symptoms generally resolve within 1-3 weeks but at least one-third of the patients suffer from debilitating rheumatologic symptoms for months to years. Large outbreaks in changing regions of the world since the turn of the 21st century (e.g. Caribbean, La Réunion; currently Brazil, India) have resulted in growing numbers of travellers importing chikungunya, mainly to Europe and North America. Viremic travellers with chikungunya infection have seeded chikungunya clusters (France, United States of America) and outbreaks (Italy in 2007 and 2017) in non-endemic countries where Ae. albopictus mosquitoes are present. Community preventive measures are important to prevent disease transmission by mosquitoes. Individual preventive options are limited to personal protection measures against mosquito bites, particularly the daytime-active mosquitos that transmit the chikungunya virus. Candidate vaccines are on the horizon and regulatory authorities will need to assess environmental and host risk factors for persistent sequelae, such as obesity, age (over 40 years), and history of arthritis or inflammatory rheumatologic disease to determine which populations should be targeted for these chikungunya vaccines. CONCLUSIONS/RECOMMENDATIONS Travellers planning to visit destinations with active CHIKV circulation should be advised about the risk for chikungunya, prevention strategies, the disease manifestations, possible chronic rheumatologic sequelae, and if symptomatic, seek medical evaluation and report potential exposures.
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Affiliation(s)
- Fabrice Simon
- Service de Pathologie Infectieuse et Tropicale, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - Eric Caumes
- Centre de Diagnostic; Hôpital de l'Hôtel-Dieu, Paris, France
| | - Tomas Jelinek
- Berlin Centre for Travel & Tropical Medicine, Berlin, Germany
| | - Rogelio Lopez-Velez
- Ramón y Cajal Institute for Health Research (IRyCIS). Ramón y Cajal University Hospital, Madrid, Spain
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Center on Travelers' Health, University of Zurich, Zurich, Switzerland.,Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston TX, USA
| | - Lin H Chen
- Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
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11
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Fernandes MDCR, Monte WSD, Bezerra FSB. Avaliação do desenvolvimento tecnológico em saúde a partir da ocorrência das epidemias de zika e chikungunya no Brasil. CAD SAUDE PUBLICA 2023; 39:e00090022. [PMID: 37018775 DOI: 10.1590/0102-311xpt090022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 02/07/2023] [Indexed: 04/05/2023] Open
Abstract
Buscando compreender como as epidemias de zika e chikungunya incitaram o desenvolvimento tecnológico, este estudo realizou levantamento de dados epidemiológicos e prospecção tecnológica, utilizando dados do Instituto Nacional da Propriedade Industrial (INPI) e do Orbit Intelligence. Ainda, analisou produtos desenvolvidos e em desenvolvimento a nível mundial e aqueles registrados no Brasil por meio da Agência Nacional de Vigilância Sanitária (Anvisa). No ano de 2016, observou-se o maior número de casos totais para ambas as doenças. A prospecção tecnológica nacional revelou que há interesse global em desenvolver tecnologias para essas doenças e depositar suas patentes no Brasil, tendo as empresas como principais depositantes. Por sua vez, a prospecção tecnológica global mostrou que o ano de 2016 configura-se como importante marco na evolução do número de patentes para zika e chikungunya, sugerindo que as epidemias brasileiras estimularam o mundo no desenvolvimento de novos insumos para a saúde. Os Estados Unidos e a China são as principais jurisdições, tendo as universidades como maiores depositantes. A análise de produtos a nível global revelou que apenas dois chegaram ao mercado para zika e um para chikungunya, e as vacinas estão na categoria principal. A busca na Anvisa revelou que há mais produtos registrados para zika do que em comparação à chikungunya. Os principais fabricantes legais são empresas brasileiras, com pedidos de registro realizados principalmente pelas empresas DiaSorin S.p.A., ECO Diagnóstica Ltda. e Chembio Diagnostics Brazil Ltda. Apesar do visível estímulo à pesquisa, desenvolvimento e patenteamento gerado pelas epidemias de zika e chikungunya no Brasil, isso não garantiu a chegada de novos produtos ao mercado nem acesso da população a eles.
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Symptomatic Chikungunya Virus Infection and Pregnancy Outcomes: A Nested Case-Control Study in French Guiana. Viruses 2022; 14:v14122705. [PMID: 36560712 PMCID: PMC9787529 DOI: 10.3390/v14122705] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
During the Chikungunya epidemic in the Caribbean and Latin America, pregnant women were affected by the virus in French Guiana. The question of the impact of the virus on pregnancy was raised because of the lack of scientific consensus and published data in the region. Thus, during the Chikungunya outbreak in French Guiana, a comparative study was set up using a cohort of pregnant women. The objective was to compare pregnancy and neonatal outcomes between pregnant women with Chikungunya virus (CHIKV) infection and pregnant women without CHIKV. Of 653 mothers included in the cohort, 246 mothers were included in the case-control study: 73 had CHIKV fever during pregnancy and 173 had neither fever nor CHIKV during pregnancy. The study did not observe any severe clinical presentation of CHIKV in the participating women. There were no intensive care unit admissions. In addition, the study showed no significant difference between the two groups with regard to pregnancy complications. However, the results showed a potential excess risk of neonatal ICU admission of the newborn when the maternal infection occurred within 7 days before delivery. These results suggest that special attention should be paid to neonates whose mothers were infected with CHIKV shortly before delivery.
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13
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The Seroprevalence and Hidden Burden of Chikungunya Endemicity and Malaria Mono- and Coinfection in Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158896. [PMID: 35897268 PMCID: PMC9330559 DOI: 10.3390/ijerph19158896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
Background: Mosquito-borne infections are of global health concern because of their rapid spread and upsurge, which creates a risk for coinfections. Chikungunya, an arbovirus disease transmitted by Aedes aegypti or A. albopictus, and malaria, a parasitic disease transmitted by Anopheles gambiae, are prevalent in Nigeria and neighbouring countries, but their burden and possible coinfections are poorly understood. In this study, we investigated the seroprevalence, hidden burden and endemicity of chikungunya and malaria in three regions in Nigeria. Methods: A cross-sectional sero-survey was conducted on 871 participants in three regions of Nigeria. The samples were collected from outpatients employing simple random sampling. All serum sample analyses were performed using CHIKV virus-like particle recomLine Tropical Fever for the presence of arboviral antibody serological marker IgG immunoblot for chikungunya and malaria RDT (Rapid Diagnostic Test) for malaria parasites. Results: The seroprevalences of chikungunya and malaria mono-infection were 64.9% and 27.7%, respectively, while the coinfection seroprevalence was 71.9%. The central (69.5%) and northern (67.0%) regions showed more significant seroprevalences than the southern region (48.0%). The seroprevalence and the hidden burden of chikungunya and malaria infections varied across the three geographical regions. Conclusions: This study highlighted an unexpectedly high seroprevalence and hidden endemicity of chikungunya and a less surprising high malaria endemicity in three regions of Nigeria.
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Susceptibility to endemic Aedes-borne viruses among pregnant women in Risaralda, Colombia. Int J Infect Dis 2022; 122:832-840. [PMID: 35817285 DOI: 10.1016/j.ijid.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Aedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. METHODS A cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood was obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. RESULTS Most women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016, but only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. CONCLUSIONS Hence, a high proportion pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating risk for future epidemics in this region.
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15
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Benjamanukul S, Chansaenroj J, Chirathaworn C, Poovorawan Y. Atypical skin manifestation in severe acute chikungunya infection in a pregnant woman: a case report. J Med Case Rep 2022; 16:5. [PMID: 34986884 PMCID: PMC8731213 DOI: 10.1186/s13256-021-03197-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with chikungunya virus infection commonly present with fever, skin rash, and severe joint pain. The vesiculobullous rash is rare in adults but common in infants. In addition, septic shock and acute respiratory distress syndrome are rare complications of atypical and severe acute chikungunya infection. Case presentation We report the presence of an 18-year-old Thai female, at 31 weeks gestation, with fever, maculopapular rash, and polyarthritis. The rash later progressed to a vesiculobullous pattern, and she developed septic shock and acute respiratory distress syndrome. Skin biopsy and blood were positive for chikungunya virus RNA. The patient was intubated with a mechanical ventilator and subsequently fully recovered. Conclusion Atypical skin manifestation and severe acute disease is likely due to immune response attenuation in pregnancy. The possibility of progression to severe or atypical disease in pregnant women suffering chikungunya should always be considered.
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Affiliation(s)
| | - Jira Chansaenroj
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chintana Chirathaworn
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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16
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da Encarnação Sá-Guimarães T, Salles TS, Rocha Dos Santos C, Moreira MF, de Souza W, Caldas LA. Route of Zika virus infection in Aedes aegypti by transmission electron microscopy. BMC Microbiol 2021; 21:300. [PMID: 34717555 PMCID: PMC8557066 DOI: 10.1186/s12866-021-02366-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background Zika fever has been a global health security threat, especially in the tropical and subtropical regions where most of the cases occur. The disease is caused by Zika virus (ZIKV), which belongs to the family Flaviviridae, genus Flavivirus. The virus is transmitted by Aedes mosquitoes, mostly by Aedes aegypti, during its blood meal. In this study we present a descriptive analysis, by transmission electron microscopy (TEM), of ZIKV infection in A. aegypti elected tissues at the 3rd day of infection. ZIKV vertical transmission experiments by oral infection were conducted to explore an offspring of natural infection. Results Gut and ovary tissues harbored a higher number of viral particles. The ZIKV genome was also detected, by RT-qPCR technique, in the organism of orally infected female mosquitoes and in their eggs laid. Conclusions The data obtained suggest that the ovary is an organ susceptible to be infected with ZIKV and that virus can be transmitted from mother to a fraction of the progeny.
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Affiliation(s)
| | - Tiago Souza Salles
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, CEP 21941-909, Rio de Janeiro, RJ, Brazil.,Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, CEP 21941-902, Rio de Janeiro, RJ, Brazil
| | - Carlucio Rocha Dos Santos
- Laboratório de Fisiologia e Controle de Artrópodes Vetores, Instituto Oswaldo Cruz, CEP 21040-900, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Monica Ferreira Moreira
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, CEP 21941-909, Rio de Janeiro, RJ, Brazil.,Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, CEP 21941-902, Rio de Janeiro, RJ, Brazil
| | - Wanderley de Souza
- Universidade Federal do Rio de Janeiro, Centro Nacional de Biologia Estrutural e Bioimagem (CENABIO), CEP 21941-902, Rio de Janeiro, RJ, Brazil.,Instituto de Biofísica Carlos Chagas Filho, Laboratório de Ultraestrutura Celular Hertha Meyer, Universidade Federal do Rio de Janeiro, CEP 21941-902, Rio de Janeiro, RJ, Brazil
| | - Lucio Ayres Caldas
- Instituto de Biofísica Carlos Chagas Filho, Laboratório de Ultraestrutura Celular Hertha Meyer, Universidade Federal do Rio de Janeiro, CEP 21941-902, Rio de Janeiro, RJ, Brazil. .,Duque de Caxias, Universidade Federal do Rio de Janeiro, Núcleo Multidisciplinar de Pesquisa UFRJ-Xerém em Biologia - NUMPEX-BIO, RJ, CEP: 25265-970, Rio de Janeiro, Brazil.
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17
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Abstract
Chikungunya fever (CHIKF) is an arbovirus disease caused by chikungunya virus (CHIKV), an alphavirus of Togaviridae family. Transmission follows a human-mosquito-human cycle starting with a mosquito bite. Subsequently, symptoms develop after 2-6 days of incubation, including high fever and severe arthralgia. The disease is self-limiting and usually resolve within 2 weeks. However, chronic disease can last up to several years with persistent polyarthralgia. Overlapping symptoms and common vector with dengue and malaria present many challenges for diagnosis and treatment of this disease. CHIKF was reported in India in 1963 for the first time. After a period of quiescence lasting up to 32 years, CHIKV re-emerged in India in 2005. Currently, every part of the country has become endemic for the disease with outbreaks resulting in huge economic and productivity losses. Several mutations have been identified in circulating strains of the virus resulting in better adaptations or increased fitness in the vector(s), effective transmission, and disease severity. CHIKV evolution has been a significant driver of epidemics in India, hence, the need to focus on proper surveillance, and implementation of prevention and control measure in the country. Presently, there are no licensed vaccines or antivirals available; however, India has initiated several efforts in this direction including traditional medicines. In this review, we present the current status of CHIKF in India.
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18
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de St Maurice A, Ervin E, Chu A. Ebola, Dengue, Chikungunya, and Zika Infections in Neonates and Infants. Clin Perinatol 2021; 48:311-329. [PMID: 34030816 DOI: 10.1016/j.clp.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging infectious diseases, including Ebola, chikungunya, Zika, and dengue, may have significant impacts on maternal-fetal dyads and neonatal outcomes. Pregnant women infected with Ebola demonstrate high mortality and very low evidence of neonatal survival. Maternal chikungunya infection can result in high rates of perinatal transmission, and infected neonates demonstrate variable disease severity. Dengue can be transmitted to neonates via vertical transmission or perinatal transmission. Zika is characterized by mild disease in pregnant women, but congenital infection can be severe. Treatment largely is supportive for these diseases, and vaccine development remains under way, with promising recent advances, notably for Ebola.
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Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Los Angeles, 924 Westwood Boulevard, Suite 900, CA 90095, USA.
| | - Elizabeth Ervin
- Post-baccalaureate Premedical Program, University of Michigan, Office of Graduate and Postdoctoral Studies, 2960 Taubman Health Science Library, 1135 Catherine Street, Ann Arbor, MI 48109, USA
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, 10833 Le Conte Avenue, MDCC B2-411, Los Angeles, CA 90095, USA
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19
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Fajardo TCG, Gazeta RE, Catalan DT, Mello AS, da Silva ACB, Bertozzi APAP, Santos GRD, Pinto CAL, Monteiro CO, Machado RRG, Oliveira DBL, Durigon EL, Passos SD. Neonatal consequences of maternal exposure to the chikungunya virus: Case reports. Medicine (Baltimore) 2021; 100:e25695. [PMID: 33907147 PMCID: PMC8084008 DOI: 10.1097/md.0000000000025695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/08/2021] [Indexed: 12/03/2022] Open
Abstract
RATIONALE The chikungunya virus (CHIKV) was first isolated in a Tanzanian epidemic area between 1952 and 1953. The best description of the CHIKV transmission during pregnancy can be found in a well-documented epidemic in 2005, in the "La Reunion" island, a French territory located in the Indian Ocean, in which about one-third of the population was infected. Reports of arbovirus infections in pregnancy are increasing over time, but the spectrum of clinical findings remains an incognita among researchers, including CHIKV. PATIENT CONCERNS In this report, it was possible to verify 2 cases exposed to CHIKV during foetal period and the possible implications of the infection on gestational structures and exposed children after the birth. DIAGNOSIS In both cases, the mothers were positive by laboratory tests in serologic analysis for CHIKV, as ezyme-linked immunossorbent assay (ELISA), plaque reduction neutralisation testing (PRNT) and immunofluorescence (IF); but there were no positive tests in quantitative polymerase chain reaction (qPCR) for mothers or children. INTERVENTIONS The exposed children were followed up in a paediatrics clinic in order not only to provide the medical assistance, but also to verify child development and the possible implications and neurocognitive changes caused by gestational infection. OUTCOMES There were neurological and developmental changes in one of the children followed up on an outpatient basis. There was an improvement in the neurological situation and symptoms only 3 years and 1 month after birth. LESSONS Based on the cases presented, we can conclude that clinical symptoms of CHIKV maternal infection may occur late in new-borns and can affect their development.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Cairo Oliveira Monteiro
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Edison Luiz Durigon
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Saulo Duarte Passos
- Laboratory of Paediatric Infectology, Jundiaí School of Medicine
- Department of Paediatric, Jundiaí School of Medicine
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20
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Vertical transmission of chikungunya virus: A systematic review. PLoS One 2021; 16:e0249166. [PMID: 33891622 PMCID: PMC8064608 DOI: 10.1371/journal.pone.0249166] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/13/2021] [Indexed: 01/23/2023] Open
Abstract
Objectives To describe and estimate the frequency of pregnancy outcomes, clinical and laboratory characteristics of vertical transmission of CHIKV in the neonate. Study design We performed a systematic review evaluating the clinical presentation of perinatally-acquired CHIKV infection in neonates. The search was performed using Medline (via PubMed), LILACS, Web of Science, Scielo, Google Scholar and Open grey to identify studies assessing vertical transmission of CHIKV up to November 3, 2020. There were no search restrictions regarding the study type, the publication date or language. Studies with no documented evidence of CHIKV infection in neonates (negative RT-PCR or absence of IgM) were excluded. Results From the 227 studies initially identified, 42 were selected as follows: 28 case reports, 7 case series, 2 cross-sectional studies and 5 cohort studies, for a total of 266 CHIKV infected neonates confirmed by serological and/or molecular tests. The vertical transmission rate was 50% in the Reunion Island outbreak, which was the subject of the majority of the studies; the premature delivery were reported in 19 (45.2%) studies; the rate of fetal distress was 19.6% of infected babies and fetal loss occurred in 2% of the cases. Approximately 68.7% of newborns were diagnosed with encephalopathy or encephalitis after perinatally acquired CHIKV. Most of the infected neonates were born healthy, developing CHIKV sepsis clinical syndrome within the first week of life. Conclusions We alert neonatologists to the late manifestations of neonatal CHIKV infection, relevant to the management and reduction of morbidity. A limitation of our review was that it was not possible to carry out meta-analysis due to differences in study design and the small number of participants.
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21
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Ribeiro IM, Souto PCS, Borbely AU, Tanabe ELL, Cadavid A, Alvarez AM, Bueno J, Agudelo O, Robles RG, Ayala-Ramírez P, Sacerdoti F, Szasz T, Damiano AE, Ibarra C, Escudero C, Lima VV, Giachini FR. The limited knowledge of placental damage due to neglected infections: ongoing problems in Latin America. Syst Biol Reprod Med 2021; 66:151-169. [PMID: 32482148 DOI: 10.1080/19396368.2020.1753850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The placenta works as a selective barrier, protecting the fetus from potential infections that may affect the maternal organism during pregnancy. In this review, we will discuss several challenging infections that are common within Latin American countries and that may affect the maternal-fetal interface and pose risks to fetal development. Specifically, we will focus on emerging infectious diseases including the arboviruses, malaria, leishmaniasis, and the bacterial foodborne disease caused by Shiga toxin-producing Escherichia coli. We will also highlight some topics of interest currently being studied by research groups that comprise an international effort aimed at filling the knowledge gaps in this field. These topics address the relationship between exposure to microorganisms and placental abnormalities, congenital anomalies, and complications of pregnancy. ABBREVIATIONS ADE: antibody-dependent enhancement; CCL2: monocyte chemoattractant protein-1; CCL3: macrophage inflammatory protein-1 α; CCL5: chemokine (C-C motif) ligand 5; CHIKV: chikungunya virus; DCL: diffuse cutaneous leishmaniasis; DENV: dengue virus; Gb3: glycolipid globotriaosylceramyde; HIF: hypoxia-inducible factor; HUS: hemolytic uremic syndrome; IFN: interferon; Ig: immunoglobulins; IL: interleukin; IUGR: intrauterine growth restriction; LCL: localized cutaneous leishmaniasis; LPS: lipopolysaccharid; MCL: mucocutaneous leishmaniasis; NO: nitric oxide; PCR: polymerase chain reaction; PGF: placental growth factor; PM: placental malaria; RIVATREM: Red Iberoamericana de Alteraciones Vasculares em transtornos del Embarazo; sVEGFR: soluble vascular endothelial growth factor receptor; STEC: shiga toxin-producing Escherichia coli; stx: shiga toxin protein; TNF: tumor necrosis factor; TOAS: T cell original antigenic sin; Var2CSA: variant surface antigen 2-CSA; VEGF: vascular endothelial growth factor; VL: visceral leishmaniasis; WHO: world health organization; YFV: yellow fever virus; ZIKV: Zika virus.
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Affiliation(s)
- Isabela Moreti Ribeiro
- Laboratory of Vascular Biology and Histopathology, Institute of Health Sciences and Health, Federal University of Mato Grosso , Barra Do Garcas, Brazil
| | - Paula Cristina Souza Souto
- Laboratory of Vascular Biology and Histopathology, Institute of Health Sciences and Health, Federal University of Mato Grosso , Barra Do Garcas, Brazil
| | - Alexandre U Borbely
- Cell Biology Laboratory, Institute of Health and Biological Sciences, Federal University of Alagoas , Alagoas, Brazil
| | - Eloiza Lopes Lira Tanabe
- Cell Biology Laboratory, Institute of Health and Biological Sciences, Federal University of Alagoas , Alagoas, Brazil
| | - Angela Cadavid
- Grupo Reproducción, Facultad De Medicina Universidad De Antioquia , Medellin, Colombia
| | - Angela M Alvarez
- Grupo Reproducción, Facultad De Medicina Universidad De Antioquia , Medellin, Colombia
| | - Julio Bueno
- Grupo Reproducción, Facultad De Medicina Universidad De Antioquia , Medellin, Colombia
| | - Olga Agudelo
- Grupo Salud Y Comunidad, Facultad De Medicina Universidad De Antioquia , Medellin, Colombia
| | - Reggie García Robles
- Physiological Sciences Department, Faculty of Medicine, Pontificia Universidad Javeriana , Bogotá, Colombia
| | - Paola Ayala-Ramírez
- Human Genetics Institute, Facultad De Medicina, Pontificia Universidad Javeriana , Bogotá, Colombia
| | - Flavia Sacerdoti
- Laboratorio De Fisiopatogenia, Instituto De Fisiología Y Biofísica Bernardo Houssay (IFIBIO)- CONICET- Departamento De Fisiología, Facultad De Medicina, Universidad De Buenos Aires . Buenos Aires, Argentina
| | - Theodora Szasz
- Departamento of Physiology, Augusta University , Augusta, USA
| | - Alicia E Damiano
- Cátedra De Biología Celular Y Molecular, Departamento De Ciencias Biológicas, Facultad De Farmacia Y Bioquímica, Universidad De Buenos Aires . Buenos Aires, Argentina.,Laboratorio De Biología De La Reproducción, Instituto De Fisiología Y Biofísica Bernardo Houssay (IFIBIO)- CONICET- Facultad De Medicina, Universidad De Buenos Aires . Buenos Aires, Argentina
| | - Cristina Ibarra
- Cátedra De Biología Celular Y Molecular, Departamento De Ciencias Biológicas, Facultad De Farmacia Y Bioquímica, Universidad De Buenos Aires . Buenos Aires, Argentina
| | - Carlos Escudero
- Vascular Physiology Laboratory, Group of Research and Innovation in Vascular Health (GRIVAS Health), Basic Sciences Department Faculty of Sciences, Universidad Del Bio-Bio , Chillan, Chile
| | - Victor V Lima
- Laboratory of Vascular Biology and Histopathology, Institute of Health Sciences and Health, Federal University of Mato Grosso , Barra Do Garcas, Brazil
| | - Fernanda R Giachini
- Laboratory of Vascular Biology and Histopathology, Institute of Health Sciences and Health, Federal University of Mato Grosso , Barra Do Garcas, Brazil
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Correia F, Kerr L, Frota C, Barreto I, Almeida R, Pamplona L, Araújo L, Myiajima F, Lima S, Araújo F, Simões L, Júnior F, Martins A, Dias L, Alcântara I, Silva A, Sanhueza C, Ribeiro M, Teixeira M, Meyer A, Júnior J, Vasconcelos L, Sousa P, Saraiva S, Wesson D, Kendall C. Factors associated with Chikungunya infection in a cohort of women aged 15-39 y in Fortaleza, Brazil. Trans R Soc Trop Med Hyg 2021; 115:1070-1079. [PMID: 33460441 DOI: 10.1093/trstmh/traa182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/10/2020] [Accepted: 12/23/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Outbreaks of Chikungunya virus (CHIKV) occurred in Brazil during 2015-2017. Fortaleza was the city that reported the most cases. METHODS The first round of a cohort study was conducted among women aged 15-39 y in Fortaleza, Brazil, in 2018 (Zika in Fortaleza). We collected sera to detect CHIKV IgG and IgM antibodies. Factors for CHIKV infection were identified using a Poisson regression model. RESULTS We evaluated 1466 serum samples and 13.8% and 37.2% of women were found positive for CHIKV IgM and IgG antibodies, respectively. Living with more than four others in the same house and having an abandoned house nearby were associated with CHIKV infection. Being currently pregnant was associated with a decreased probability of CHIKV infection, which was also associated with pregnant women reporting using more repellent, both inside and outside the house, than non-pregnant women. CONCLUSIONS Crowding in households and abandoned houses nearby can increase potential transmission. Policies providing better living conditions and regulation of abandoned sites and buildings are necessary to control the mosquito population. Programmes providing repellant at low or no cost to pregnant women should be implemented in the neighbourhoods where arbovirus infections are endemic.
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Affiliation(s)
- Francisco Correia
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Ligia Kerr
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Cristiane Frota
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Ivana Barreto
- Laboratório de Saúde Pública do Estado do Ceará (LACEN), 2405 Barão de Studart Avenue, Dionísio Torres, Fortaleza 60120-002, Brazil
| | - Rosa Almeida
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Luciano Pamplona
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Larissa Araújo
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Fábio Myiajima
- Laboratório de Saúde Pública do Estado do Ceará (LACEN), 2405 Barão de Studart Avenue, Dionísio Torres, Fortaleza 60120-002, Brazil
| | - Shirlene Lima
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil.,Oswaldo Cruz Foundation (Fiocruz), Branch Ceara, Eusebio 61760-000, Brazil
| | - Fernanda Araújo
- Oswaldo Cruz Foundation (Fiocruz), Branch Ceara, Eusebio 61760-000, Brazil
| | - Leda Simões
- Oswaldo Cruz Foundation (Fiocruz), Branch Ceara, Eusebio 61760-000, Brazil
| | - Francisco Júnior
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Adriano Martins
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Livia Dias
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Ilka Alcântara
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Ana Silva
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Carlos Sanhueza
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Marco Ribeiro
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Maria Teixeira
- Laboratório de Saúde Pública do Estado do Ceará (LACEN), 2405 Barão de Studart Avenue, Dionísio Torres, Fortaleza 60120-002, Brazil
| | - Anya Meyer
- Laboratório de Saúde Pública do Estado do Ceará (LACEN), 2405 Barão de Studart Avenue, Dionísio Torres, Fortaleza 60120-002, Brazil
| | - José Júnior
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Lucas Vasconcelos
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Paulo Sousa
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Susy Saraiva
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil
| | - Dawn Wesson
- Tulane School of Public Health and Tropical Medicine, 6823 St Charles Ave, New Orleans, LA 70118, USA
| | - Carl Kendall
- Federal University of Ceará, 1608 Prof. Costa Mendes Street, Didactics Building, 5th floor, Rodolfo Teófilo, Fortaleza 60430-160, Brazil.,Tulane School of Public Health and Tropical Medicine, 6823 St Charles Ave, New Orleans, LA 70118, USA
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23
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Foeller ME, Nosrat C, Krystosik A, Noel T, Gérardin P, Cudjoe N, Mapp-Alexander V, Mitchell G, Macpherson C, Waechter R, LaBeaud AD. Chikungunya infection in pregnancy - reassuring maternal and perinatal outcomes: a retrospective observational study. BJOG 2020; 128:1077-1086. [PMID: 33040457 DOI: 10.1111/1471-0528.16562] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV). DESIGN Retrospective observational study. SETTING Grenada. POPULATION Women who gave birth during a Chikungunya outbreak between January 2014 and September 2015 were eligible. METHODS This descriptive study investigated 731 mother-infant pairs who gave birth during a CHIKV outbreak. Women and infants underwent serological testing for CHIKV by ELISA. MAIN OUTCOME MEASURES Primary outcomes: composite pregnancy complication (abruption, vaginal bleeding, preterm labour/cervical incompetence, cesarean delivery for fetal distress/abruption/placental abnormality or delivery for fetal distress) and composite neonatal morbidity. RESULTS Of 416 mother-infant pairs, 150 (36%) had CHIKV during pregnancy, 135 (33%) had never had CHIKV, and 131 (31%) had CHIKV outside of pregnancy. Mean duration of joint pain was shorter among women infected during pregnancy (μ = 898 days, σ = 277 days) compared with infections outside of pregnancy (μ = 1064 days, σ = 244 days) (P < 0.0001). Rates of pregnancy complications (RR = 0.76, P = 0.599), intrapartum complications (RR = 1.50, P = 0.633), and neonatal outcomes were otherwise similar. Possible mother-to-child transmission occurred in two (1.3%) mother-infant pairs and two of eight intrapartum infections (25%). CONCLUSION CHIKV infection during pregnancy may be protective against long-term joint pain sequelae that are often associated with acute CHIKV infection. Infection during pregnancy did not appear to pose a risk for pregnancy complications or neonatal health, but maternal infection just prior to delivery might have increased risk of mother-to-child transmission of CHIKV. TWEETABLE ABSTRACT Chikungunya infection did not increase risk of pregnancy complications or adverse neonatal outcomes, unless infection was just prior to delivery.
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Affiliation(s)
- M E Foeller
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - C Nosrat
- Program in Human Biology, Stanford University, Stanford, CA, USA
| | - A Krystosik
- Division of Infectious Disease, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
| | - T Noel
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - P Gérardin
- INSERM CIC1410, Centre Hospitalier Universitaire de la Réunion, Saint Pierre, Réunion.,Unité Mixte 134 PIMIT (INSERM 1187, CNRS 9192, IRD 249, Université de La Réunion), Sainte Clotilde, Réunion
| | - N Cudjoe
- Windward Islands Research and Education Foundation, True Blue, Grenada
| | - V Mapp-Alexander
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - G Mitchell
- Ministry of Health, St. Georges, Grenada
| | - C Macpherson
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - R Waechter
- Windward Islands Research and Education Foundation, True Blue, Grenada.,St. George's University, St. Georges, Grenada
| | - A D LaBeaud
- Division of Infectious Disease, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
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Corrêa DG, Di Maio Ferreira FCPDA, Hygino da Cruz LC, Brasil P, Rueda Lopes FC. Longitudinal brain magnetic resonance imaging of children with perinatal Chikungunya encephalitis. Neuroradiol J 2020; 33:532-537. [PMID: 32955404 DOI: 10.1177/1971400920959070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chikungunya virus can be transmitted perinatally leading to serious neurological sequelae. We report the longitudinal evolution of the brain magnetic resonance imaging aspects of three cases of mother-to-child Chikungunya virus transmission. The first magnetic resonance imaging scan presented brain cavitations, with or without corpus callosum diffusion restriction. Follow-up scans showed reduction in the volume of cavitations, with resolution of the restricted diffusion. However, one patient presented with a normal brain magnetic resonance image, despite the delay in neurocognitive development.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Brazil.,Department of Radiology, Hospital Universitário Antônio Pedro, Brazil
| | | | | | - Patrícia Brasil
- Department of Infectious Diseases, Fundação Oswaldo Cruz, Brazil
| | - Fernanda Cristina Rueda Lopes
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Brazil.,Department of Radiology, Hospital Universitário Antônio Pedro, Brazil
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25
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O'Kelly B, Lambert JS. Vector-borne diseases in pregnancy. Ther Adv Infect Dis 2020; 7:2049936120941725. [PMID: 32944240 PMCID: PMC7469740 DOI: 10.1177/2049936120941725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Vector-borne infections cause a significant proportion of world-wide morbidity and mortality and many are increasing in incidence. This is due to a combination of factors, primarily environmental change, encroachment of human habitats from urban to peri-urban areas and rural to previously uninhabited areas, persistence of poverty, malnutrition and resource limitation in geographical areas where these diseases are endemic. Pregnant women represent the single largest ‘at risk’ group, due to immune-modulation and a unique physiological state. Many of these diseases have not benefitted from the same level of drug development as other infectious and medical domains, a factor attributing to the ‘neglected tropical disease’ title many vector-borne diseases hold. Pregnancy compounds this issue as data for safety and efficacy for many drugs is practically non-existent, precluding exposure in pregnancy to many first-line therapeutic agents for ‘fear of the unknown’ or overstated adverse pregnancy-foetal outcomes. In this review, major vector-borne diseases, their impact on pregnancy outcomes, current treatment, vaccination and short-comings of current medical practice for pregnant women will be discussed.
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Affiliation(s)
- Brendan O'Kelly
- Infectious Diseases Specialist Registrar, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John S Lambert
- Consultant in Infectious Diseases, Medicine and Sexual Health (GUM), Mater, Rotunda and UCD, Mater Misericordiae University Hospital, Clinic 6, Eccles St, Inns Quay, Dublin, D07 R2WY University College Dublin Rotunda Maternity Hospital
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26
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Dengue, chikungunya and zika virus coinfection: results of the national surveillance during the zika epidemic in Colombia. Epidemiol Infect 2020; 147:e77. [PMID: 30869010 PMCID: PMC6518562 DOI: 10.1017/s095026881800359x] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Our objective was to determine the frequency of zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) virus coinfection and describe the mortality cases that occurred during the epidemiologic surveillance of the ZIKV epidemic in Colombia. We analysed all cases of suspected ZIKV infection that were reported to the National Institute of Health (October 2015–December 2016). DENV, CHIKV and ZIKV RNA were detected in serum or tissue samples using polymerase chain reaction assay. Medical records of the fatal cases were reviewed. We identified that 23 871 samples were processed. The frequency of viral agents was 439 (1.84%) for DENV, 257 (1.07%) for CHIKV and 10118 (42.38%) for ZIKV. Thirty-four (0.14%) cases of coinfection were identified. The CHIKV–ZIKV coinfection was present in 28 cases (82.3%), DENV–CHIKV in three (8.8%) and DENV–ZIKV in three (8.8%). Seven (20.6%) coinfection cases were fatal (two DENV–CHIKV cases and five CHIKV–ZIKV cases). Two cases were foetal deaths and the others were related to neurological syndrome and sepsis. In conclusion, the frequency of arbovirus coinfection during epidemic of ZIKV was low, and CHIKV–ZIKV coinfection was the most common. Mortality was high among coinfection patients. The role of each virus in the mortality cases of coinfection warrants further studies.
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27
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Anwar S, Taslem Mourosi J, Khan MF, Ullah MO, Vanakker OM, Hosen MJ. Chikungunya outbreak in Bangladesh (2017): Clinical and hematological findings. PLoS Negl Trop Dis 2020; 14:e0007466. [PMID: 32092073 PMCID: PMC7058364 DOI: 10.1371/journal.pntd.0007466] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 03/05/2020] [Accepted: 01/09/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction A massive outbreak of chikungunya virus (CHIKV) occurred in Bangladesh during the period of April-September 2017, and over two million people were at risk of getting infected by the virus. A prospective cohort of viremic patients was constituted and analyzed to define the clinical, hematological, and long-term aspects of this outbreak. Methods A 35-day long comprehensive survey was conducted in two major, neighboring cities, Dhaka and Mymensingh. One-hundred and eighty-seven laboratory-confirmed CHIKV cases were enrolled in the cross-sectional cohort study. Additionally, a smaller group of 48 chikungunya patients was monitored for post-infection effects for 12 months. Results Clinical data revealed that a combination of fever and arthralgia (oligoarthralgia and/or polyarthralgia) was the cardinal hallmark (97.9% of cases) of the infection. Hematological analysis showed that irrespective of age and sex groups, CHIKV patients had a decreased level of hemoglobin (n = 64, p < 0.01) and elevated erythrocyte sedimentation rate (n = 131, p < 0.01). Besides, a significant portion of the patients represented abnormal values for RBC (n = 38, p = 0.0005) and WBC (n = 63, p < 0.01) counts. The post-infection study revealed that children had an early recovery from the infection compared to the adults. Moreover, post-infection weakness, successive relapse of arthralgic pain, and memory problems were the most significant aftereffects, which had an impact on the daily activities of patients. Conclusions This study represents a comprehensive overview of clinical and epidemiological features of the 2017 outbreak of CHIKV in Bangladesh as well as its chronic outcomes till the 12th month. It provides insights into the natural history of this disease, which may help to improve the management of CHIKV patients. The clinical profile, epidemiology, and the economic impacts during the acute phase of chikungunya infection have been studied quite rigorously. However, studies regarding the hematological features and chronic consequences are infrequent. In this study, we analyzed the clinical and hematological features of 187 chikungunya patients in the acute phase of the infection. Also, we monitored a smaller group of 48 patients until 12 months to study its post-infection consequences. Clinical data revealed that a combination of fever and joint pain (arthralgia) was the cardinal hallmark in the acute phase of the infection. Hematological analysis showed that CHIKV infection features a significantly reduced hemoglobin and remarkably elevated erythrocyte sedimentation rate. Besides, RBC and WBC counts, especially in children and females, were beyond the reference values. The post-infection consequence study unveiled that children recovered better from the infection compared to the adults. Further, post-infection weakness, successive relapse of joint pain and memory problems were the most significant aftereffects. Overall, the infection had a moderate to severe impact on the daily activities of the respondents. This study provides insights into the clinical and hematological aspects of chikungunya infection during the acute phase as well as describes an account for its chronic outcomes, which puts forward to the knowledge for clinicians and epidemiologists regarding the infection diversity and to help improve patient management.
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Affiliation(s)
- Saeed Anwar
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Jarin Taslem Mourosi
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md. Fahim Khan
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Mohammad Ohid Ullah
- Department of Statistics, School of Physical Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Mohammad Jakir Hosen
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
- * E-mail:
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28
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Vouga M, Chiu YC, Pomar L, de Meyer SV, Masmejan S, Genton B, Musso D, Baud D, Stojanov M. Dengue, Zika and chikungunya during pregnancy: pre- and post-travel advice and clinical management. J Travel Med 2019; 26:taz077. [PMID: 31616923 PMCID: PMC6927317 DOI: 10.1093/jtm/taz077] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
RATIONALE FOR REVIEW Young adults of childbearing age and pregnant women are travelling more frequently to tropical areas, exposing them to specific arboviral infections such as dengue, zika and chikungunya viruses, which may impact ongoing and future pregnancies. In this narrative review, we analyse their potential consequences on pregnancy outcomes and discuss current travel recommendations. MAIN FINDINGS Dengue virus may be associated with severe maternal complications, particularly post-partum haemorrhage. Its association with adverse fetal outcomes remains unclear, but prematurity, growth retardation and stillbirths may occur, particularly in cases of severe maternal infection. Zika virus is a teratogenic infectious agent associated with severe brain lesions, with similar risks to other well-known TORCH pathogens. Implications of chikungunya virus in pregnancy are mostly related to intrapartum transmission that may be associated with severe neonatal infections and long-term morbidity. TRAVEL RECOMMENDATIONS Few agencies provide specific travel recommendations for travelling pregnant patients or couples trying to conceive and discrepancies exist, particularly regarding Zika virus prevention. The risks significantly depend on epidemiological factors that may be difficult to predict. Prevention relies principally on mosquito control measures. Couples trying to conceive and pregnant women should receive adequate information about the potential risks. It seems reasonable to advise pregnant women to avoid unnecessary travel to Aedes spp. endemic regions. The current rationale to avoid travel and delay conception is debatable in the absence of any epidemic. Post-travel laboratory testing should be reserved for symptomatic patients.
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Affiliation(s)
- Manon Vouga
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Yen-Chi Chiu
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Léo Pomar
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sara V de Meyer
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sophie Masmejan
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Blaise Genton
- Travel Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Didier Musso
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - David Baud
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Milos Stojanov
- Materno-fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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29
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Weger-Lucarelli J, Carrau L, Levi LI, Rezelj V, Vallet T, Blanc H, Boussier J, Megrian D, Coutermarsh-Ott S, LeRoith T, Vignuzzi M. Host nutritional status affects alphavirus virulence, transmission, and evolution. PLoS Pathog 2019; 15:e1008089. [PMID: 31710653 PMCID: PMC6872174 DOI: 10.1371/journal.ppat.1008089] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/21/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Malnourishment, specifically overweight/obesity and undernourishment, affects more than 2.5 billion people worldwide, with the number affected ever-increasing. Concurrently, emerging viral diseases, particularly those that are mosquito-borne, have spread dramatically in the past several decades, culminating in outbreaks of several viruses worldwide. Both forms of malnourishment are known to lead to an aberrant immune response, which can worsen disease outcomes and reduce vaccination efficacy for viral pathogens such as influenza and measles. Given the increasing rates of malnutrition and spread of arthropod-borne viruses (arboviruses), there is an urgent need to understand the role of host nutrition on the infection, virulence, and transmission of these viruses. To address this gap in knowledge, we infected lean, obese, and undernourished mice with arthritogenic arboviruses from the genus Alphavirus and assessed morbidity, virus replication, transmission, and evolution. Obesity and undernourishment did not consistently influence virus replication in the blood of infected animals except for reductions in virus in obese mice late in infection. However, morbidity was increased in obese mice under all conditions. Using Mayaro virus (MAYV) as a model arthritogenic alphavirus, we determined that both obese and undernourished mice transmit virus less efficiently to mosquitoes than control (lean) mice. In addition, viral genetic diversity and replicative fitness were reduced in virus isolated from obese compared to lean controls. Taken together, nutrition appears to alter the course of alphavirus infection and should be considered as a critical environmental factor during outbreaks. Over- and undernutrition, collectively known as malnutrition, affect over 2.5 billion people worldwide. Associations between malnutrition and mosquito-borne virus infection and resulting disease have been identified in epidemiological studies but have not been explored in controlled studies. Here, we infect obese or undernourished mice with different arthritis inducing viruses in the genus Alphavirus and measure disease symptoms, viral replication, transmission, and evolution. We found that markers of disease, namely weight loss and footpad swelling, were increased in obese mice. We also found that replication differences between mice fed different diets were minimal except late in infection for obese mice when levels of virus dropped significantly. When mosquitoes were allowed to feed on mice fed different diets, we observed reduced infection and transmission rates, depending on the diet. Finally, we found reduced genetic diversity and replicative fitness of virus isolated from obese mice. This study provides insights into the influence of nutrition on alphavirus pathogenesis and evolution.
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Affiliation(s)
- James Weger-Lucarelli
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France.,Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, United States of America
| | - Lucia Carrau
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Laura I Levi
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France.,Ecole doctorale BioSPC, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Veronica Rezelj
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Thomas Vallet
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Hervé Blanc
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
| | - Jérémy Boussier
- Institut Pasteur, Immunobiology of Dendritic Cells, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Daniela Megrian
- Institut Pasteur, Evolutionary Biology of the Microbial Cell, Department of Microbiology, Paris, France
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, United States of America
| | - Tanya LeRoith
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, VA-MD Regional College of Veterinary Medicine, Blacksburg, VA, United States of America
| | - Marco Vignuzzi
- Institut Pasteur, Viral Populations and Pathogenesis Unit, Paris, France
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30
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Rebora A, Ciccarese G, Herzum A, Parodi A, Drago F. Pityriasis rosea and other infectious eruptions during pregnancy: Possible life-threatening health conditions for the fetus. Clin Dermatol 2019; 38:105-112. [PMID: 32197740 DOI: 10.1016/j.clindermatol.2019.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Any infectious illness presenting with an eruption in a pregnant patient may be associated with an increased risk of fetal loss. The viruses that can infect the placenta during maternal infection and can be transmitted to the fetus and cause congenital disease include the rubella virus, the measles virus, the varicella zoster virus, parvovirus B19, human cytomegalovirus, arboviruses, and hepatitis E virus type 1. In addition, some bacteria responsible for exanthematous diseases, like Treponema pallidum, can be transmitted during pregnancy from the mother to the fetus and cause fetal loss. All these infectious agents can cause typical and/or atypical exanthems whose etiologic diagnosis is sometimes difficult but important to determine, especially in pregnant women because of the potential risk to the fetus. In the last 20 years, we have extensively studied pityriasis rosea from the clinical and laboratory perspectives, demonstrating the pathogenic role of human herpesvirus (HHV)-6 and -7. We synthesize the available evidence that PR may be associated with active HHV-6/7 infection and therefore with complications during pregnancy and fetal loss. We have also summarized the emerging infectious illnesses of dermatologic interest that may represent life-threatening health conditions for the fetus: measles, rubella, arbovirus infection, and syphilis.
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Affiliation(s)
- Alfredo Rebora
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Giulia Ciccarese
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy.
| | - Astrid Herzum
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Aurora Parodi
- DISSAL, Section of Dermatology, University of Genoa, Via Pastore, 1, 16132 Genoa, Italy
| | - Francesco Drago
- Dermatologic Clinic, Policlinico San Martino, Largo R. Benzi 10, 16132 Genoa, Italy
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Narang P, Dangi M, Sharma D, Khichi A, Chhillar AK. An Integrated Chikungunya Virus Database to Facilitate Therapeutic Analysis: ChkVDb. Curr Bioinform 2019. [DOI: 10.2174/1574893613666181029124848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background:
Chikungunya infection flare-ups have manifested in nations of Africa,
Asia, and Europe including Indian and Pacific seas. It causes fever and different side effects
include muscle torment, migraine, sickness, exhaustion and rash. It has turned into another,
startling general medical issue in numerous tropical African and Asian countries and is presently
being viewed as a genuine risk. No antiviral treatment or vaccine is yet available for this ailment.
The current treatment is centered just on mitigating its side effects.
Objective:
The objective was to encourage the study on this viral pathogen, by the development of
a database dedicated to Chikungunya Virus, that annotates and unifies the related data from
various resources.
associations while known disease-lncRNA associations are required only.
Method:
It undertook a consolidated approach for Chikungunya Virus genomic, proteomic,
phylogenetics and therapeutic learning, involving the entire genome sequences and their
annotation utilizing different in silico tools. Annotation included the information for CpG Island,
usage bias, codon context and phylogenetic analysis at both the genome and proteome levels.
Results:
This database incorporates information of 41 strains of virus causing Chikungunya
infection that can be accessed conveniently as well as downloaded effortlessly. Therapeutics
section of this database contains data about B and T cell Epitopes, siRNAs and miRNAs that can
be used as potential therapeutic targets.
Conclusion:
This database can be explored by specialists and established researchers around the
world to assist their research on this non-treatable virus. It is a public database available from
“www.chkv.in”.</P>
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Affiliation(s)
- Priya Narang
- Centre for Bioinformatics, M.D. University, Rohtak, India
| | - Mehak Dangi
- Centre for Bioinformatics, M.D. University, Rohtak, India
| | - Deepak Sharma
- Centre for Bioinformatics, M.D. University, Rohtak, India
| | - Alka Khichi
- Centre for Bioinformatics, M.D. University, Rohtak, India
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Simultaneous circulation of arboviruses and other congenital infections in pregnant women in Rio de Janeiro, Brazil. Acta Trop 2019; 192:49-54. [PMID: 30685232 DOI: 10.1016/j.actatropica.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Arboviruses (Zika, dengue and chikungunya) represent a major risk for pregnant women, especially because their vertical transmission can lead to neurological damage in newborns. Early diagnosis can be difficult due to similar clinical presentation with other congenital infections that are associated with congenital abnormalities. OBJECTIVES To investigate the circulation of arboviruses and other pathogens responsible for congenital infections, reporting clinical aspects and geographic distribution of maternal rash in a metropolitan region of Rio de Janeiro (Brazil). METHODS Cross-sectional study with pregnant women presenting rash attended at the Exanthematic Diseases Unit (Niterói, Rio de Janeiro) from 2015 to 2018. Diagnosis of arboviruses was performed by real-time PCR (RT-qPCR) and laboratorial screening for syphilis, toxoplasmosis, rubella, cytomegalovirus and HIV was assessed. Demographic data was used for georeferencing analysis. FINDINGS We included 121 pregnant women, of whom Zika virus was detected in 45 cases (37.2%), chikungunya in 33 (27.3%) and dengue in one (0.8%). Five patients presented syphilis, and we observed one case each of listeria, cytomegalovirus, and a syphilis-toxoplasmosis case. Similarity of clinical symptoms was observed in all groups; however, 84.8% of patients with chikungunya presented arthralgia. Following the decline of Zika cases, chikungunya infection was mostly observed during 2017-2018. Considering pregnant women infected with arboviruses and other infections, 41% resided in urban slums, mostly in Niterói. MAIN CONCLUSIONS Simultaneous circulation of arboviruses and other agents responsible for congenital infections were observed; however, we did not identify co-infections between arboviruses. In this scenario, we emphasize the importance of adequate prenatal care to provide an accurate diagnosis of maternal rash.
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Karesh JW, Mazzoli RA, Heintz SK. Ocular Manifestations of Mosquito-Transmitted Diseases. Mil Med 2019; 183:450-458. [PMID: 29635625 DOI: 10.1093/milmed/usx183] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
Of the 3,548 known mosquito species, about 100 transmit human diseases. Mosquitoes are distributed globally throughout tropical and temperate regions where standing water sources are available for egg laying and the maturation of larva. Female mosquitoes require blood meals for egg production. This is the main pathway for disease transmission. Mosquitoes carry several pathogenic organisms responsible for significant ocular pathology and vision loss including West Nile, Rift Valley, chikungunya, dengue viruses, various encephalitis viruses, malarial parasites, Francisella tularensis, microfilarial parasites, including Dirofilaria, Wuchereria, and Brugia spp., and human botfly larvae. Health care providers may not be familiar with many of these mosquito-transmitted diseases or their associated ocular findings delaying diagnosis, treatment, and recovery of visual function. This article aims to provide an overview of the ocular manifestations associated with mosquito-transmitted diseases.
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Affiliation(s)
- James W Karesh
- The Vision Center of Excellence, Walter Reed National Military Medical Center, 8960 Brown Drive, Building 2, 1st Floor, Room 1403-A, Bethesda, MD 20889-5629
| | - Robert A Mazzoli
- The Vision Center of Excellence, Walter Reed National Military Medical Center, 8960 Brown Drive, Building 2, 1 st Floor, Room 1403-A, Bethesda, MD 20889-5629.,Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431
| | - Shannon K Heintz
- The Vision Center of Excellence, Walter Reed National Military Medical Center, 8960 Brown Drive, Building 2, 1st Floor, Room 1403-A, Bethesda, MD 20889-5629
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Higuera A, Ramírez JD. Molecular epidemiology of dengue, yellow fever, Zika and Chikungunya arboviruses: An update. Acta Trop 2019; 190:99-111. [PMID: 30444971 DOI: 10.1016/j.actatropica.2018.11.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/10/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
Arboviruses are a group of viruses transmitted by arthropods. They are characterized by a wide geographic distribution, which is associated with the presence of the vector, and cause asymptomatic infections or febrile diseases in humans in both enzootic and urban cycles. Recent reports of human infections caused by viruses such as dengue, Zika, and chikungunya have raised concern regarding public health, and have led to the re-evaluation of surveillance mechanisms and measures to control the transmission of these arboviruses. Viruses such as Mayaro and Usutu are not currently responsible for a high number of symptomatic infections in humans, but should remain under epidemiological surveillance to avoid the emergence of new epidemics, as happened with Zika virus, that are associated with new or more severe symptoms. Additionally, significant variation has been observed in these viruses, giving rise to different lineages. Until recently, the emergence of new lineages has primarily been related to geographical distribution and dispersion, allowing us to ascertain the possible origins and direction of expansion of each virus type, and to make predictions regarding regions where active infections in humans are likely to occur. Therefore, this review is focused on untangling the molecular epidemiology of Dengue, Yellow fever, Zika and Chikungunya due to their recent epidemics in Latinamerica but provides an update on the geographical distribution globally of these viral variants, and outlines the need for further understanding of the genotypes/lineages assignment.
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Kakooza-Mwesige A, Tshala-Katumbay D, Juliano SL. Viral infections of the central nervous system in Africa. Brain Res Bull 2019; 145:2-17. [PMID: 30658129 DOI: 10.1016/j.brainresbull.2018.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022]
Abstract
Viral infections are a major cause of human central nervous system infection, and may be associated with significant mortality, and long-term sequelae. In Africa, the lack of effective therapies, limited diagnostic and human resource facilities are especially in dire need. Most viruses that affect the central nervous system are opportunistic or accidental pathogens. Some of these viruses were initially considered harmless, however they have now evolved to penetrate the nervous system efficiently and exploit neuronal cell biology thus resulting in severe illness. A number of potentially lethal neurotropic viruses have been discovered in Africa and over the course of time shown their ability to spread wider afield involving other continents leaving a devastating impact in their trail. In this review we discuss key viruses involved in central nervous system disease and of major public health concern with respect to Africa. These arise from the families of Flaviviridae, Filoviridae, Retroviridae, Bunyaviridae, Rhabdoviridae and Herpesviridae. In terms of the number of cases affected by these viruses, HIV (Retroviridae) tops the list for morbidity, mortality and long term disability, while the Rift Valley Fever virus (Bunyaviridae) is at the bottom of the list. The most deadly are the Ebola and Marburg viruses (Filoviridae). This review describes their epidemiology and key neurological manifestations as regards the central nervous system such as meningoencephalitis and Guillain-Barré syndrome. The potential pathogenic mechanisms adopted by these viruses are debated and research perspectives suggested.
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Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Paediatrics & Child Health, Makerere University College of Health Sciences and Mulago Hospital, Kampala, Uganda; Astrid Lindgren Children's Hospital, Neuropediatric Research Unit, Karolinska Institutet, Sweden.
| | - Desire Tshala-Katumbay
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, University of Kinshasa, and Institut National de Recherches Biomedicales, University of Kinshasa, Democratic Republic of the Congo.
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van Enter BJD, Huibers MHW, van Rooij L, Steingrover R, van Hensbroek MB, Voigt RR, Hol J. Perinatal Outcomes in Vertically Infected Neonates During a Chikungunya Outbreak on the Island of Curaçao. Am J Trop Med Hyg 2018; 99:1415-1418. [PMID: 30328407 PMCID: PMC6283481 DOI: 10.4269/ajtmh.17-0957] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
Recent outbreaks of Chikungunya virus (CHIKV) infection confirm the vulnerability of neonates after vertical transmission. In 2014, CHIKV was reported for the first time in the Americas, including the island of Curaçao. We describe the outcomes of symptomatic neonates with vertically transmitted CHIKV infection during the CHIKV epidemic, who were admitted in the Saint Elisabeth Hospital, Willemstad, Curaçao. There were three symptomatic neonates with serologically confirmed infection. Two neonates developed neurological complications, including convulsions and intracerebral bleeding. One newborn, in whom maternal infection occurred 7 weeks before delivery, had a fatal outcome after birth. Maternal-fetal transmission of CHIKV may cause severe neonatal complications. There is a need to share experiences and to implement protocols toward the management of perinatal CHIKV infection.
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Affiliation(s)
- Bert J. D. van Enter
- Department of Obstetrics and Gynecology, Saint Elisabeth Hospital, Willemstad, Curaçao
| | - Minke H. W. Huibers
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Global Child Health Group, Emma Children’s Hospital, Amsterdam Medical Centre (AMC), Amsterdam, The Netherlands
| | - Linda van Rooij
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Radjinkoemar Steingrover
- Department of Clinical Microbiology and Infection Prevention, Saint Elisabeth Hospital, Willemstad, Curaçao
- Analytic Diagnostic Center, Willemstad, Curaçao
| | - Michael Boele van Hensbroek
- Global Child Health Group, Emma Children’s Hospital, Amsterdam Medical Centre (AMC), Amsterdam, The Netherlands
| | - Ralph R. Voigt
- Department of Obstetrics and Gynecology, Saint Elisabeth Hospital, Willemstad, Curaçao
| | - Jeroen Hol
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Department of Pediatrics, Noordwest Ziekenhuis, Alkmaar, The Netherlands
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Mascarenhas M, Garasia S, Berthiaume P, Corrin T, Greig J, Ng V, Young I, Waddell L. A scoping review of published literature on chikungunya virus. PLoS One 2018; 13:e0207554. [PMID: 30496207 PMCID: PMC6264817 DOI: 10.1371/journal.pone.0207554] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/01/2018] [Indexed: 12/13/2022] Open
Abstract
Chikungunya virus (CHIKV) has caused several major epidemics globally over the last two decades and is quickly expanding into new areas. Although this mosquito-borne disease is self-limiting and is not associated with high mortality, it can lead to severe, chronic and disabling arthritis, thereby posing a heavy burden to healthcare systems. The two main vectors for CHIKV are Aedes aegypti and Aedes albopictus (Asian tiger mosquito); however, many other mosquito species have been described as competent CHIKV vectors in scientific literature. With climate change, globalization and unfettered urban planning affecting many areas, CHIKV poses a significant public health risk to many countries. A scoping review was conducted to collate and categorize all pertinent information gleaned from published scientific literature on a priori defined aspects of CHIKV and its competent vectors. After developing a sensitive and specific search algorithm for the research question, seven databases were searched and data was extracted from 1920 relevant articles. Results show that CHIKV research is reported predominantly in areas after major epidemics have occurred. There has been an upsurge in CHIKV publications since 2011, especially after first reports of CHIKV emergence in the Americas. A list of hosts and vectors that could potentially be involved in the sylvatic and urban transmission cycles of CHIKV has been compiled in this scoping review. In addition, a repository of CHIKV mutations associated with evolutionary fitness and adaptation has been created by compiling and characterizing these genetic variants as reported in scientific literature.
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Affiliation(s)
- Mariola Mascarenhas
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Sophiya Garasia
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Philippe Berthiaume
- National Microbiology Laboratory at St. Hyacinthe, Public Health Agency of Canada, St. Hyacinthe, Quebec, Canada
| | - Tricia Corrin
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Judy Greig
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Victoria Ng
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Ian Young
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada
| | - Lisa Waddell
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, Ontario, Canada
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Campos MC, Dombrowski JG, Phelan J, Marinho CRF, Hibberd M, Clark TG, Campino S. Zika might not be acting alone: Using an ecological study approach to investigate potential co-acting risk factors for an unusual pattern of microcephaly in Brazil. PLoS One 2018; 13:e0201452. [PMID: 30110370 PMCID: PMC6093667 DOI: 10.1371/journal.pone.0201452] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 07/16/2018] [Indexed: 01/14/2023] Open
Abstract
Zika virus infections can cause a range of neurologic disorders including congenital microcephaly. However, while Zika infections have been notified across all regions in Brazil, there has been an unusual number of congenital microcephaly case notifications concentrated in the Northeast of the country. To address this observation, we investigated epidemiological data (2014–2016) on arbovirus co-distribution, environmental and socio-economic factors for each region in Brazil. Data on arbovirus reported cases and microcephaly were collected from several Brazilian Ministry of Health databases for each Federal unit. These were complemented by environmental management, social economic and Aedes aegypti infestation index data, extracted from multiple databases. Spatial time “ecological” analysis on the number of arboviruses transmitted by Aedes mosquitoes in Brazil show that the distribution of dengue and Zika was widespread in the whole country, with higher incidence in the West-Central region. However, reported chikungunya cases were higher in the Northeast, the region also with the highest number of microcephaly cases registered. Social economic factors (human development index and poverty index) and environmental management (water supply/storage and solid waste management) pointed the Northeast as the less wealthy region. The Northeast is also the region with the highest risk of Aedes aegypti house infestation due to the man-made larval habitats. In summary, the results of our ecological analysis support the hypothesis that the unusual distribution of microcephaly might not be due to Zika infection alone and could be accentuated by poverty and previous or co-infection with other pathogens. Our study reinforces the link between poverty and the risk of disease and the need to understand the effect on pathogenesis of sequential exposure to arboviruses and co-viral infections. Comprehensive large-scale cohort studies are required to corroborate our findings. We recommend that the list of infectious diseases screened, particularly during pregnancy, be regularly updated to include and effectively differentiate all viruses from ongoing outbreaks.
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Affiliation(s)
- Monica C. Campos
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Jamille G. Dombrowski
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jody Phelan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Claudio R. F. Marinho
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Martin Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Taane G. Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Abstract
Chikungunya (CHIKV) is an emerging arboviral infection with recent spikes in transmission in the Americas. Chikungunya is most commonly transmitted by mosquitos, specifically Aedes aegypti and Aedes albopictus. These mosquitoes are found throughout many parts of the United States. The classic tetrad of symptoms for CHIKV is fever, symmetric polyarthralgia, maculopapular rash, and nonpurulent conjunctivitis. Although the majority (3 of 4) of infected people will be symptomatic, the viral illness generally runs a benign course. Nevertheless, when compared with infected adults, children more commonly have neurological and dermatological symptoms and are less likely to have arthralgia. The key differential diagnosis to consider is dengue, which has greater immediate morbidity and which can cause coinfection. Local health departments facilitate diagnostic testing, using either RNA polymerase chain reaction or antibody screening based on the timing of presentation. Management is supportive. The purpose of this review article is to provide readers basic knowledge regarding the microbiology, epidemiology, risk factors for transmission, and typical clinical presentation of CHIKV. A practical approach to diagnosis and management of infected children is provided.
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Contopoulos-Ioannidis D, Newman-Lindsay S, Chow C, LaBeaud AD. Mother-to-child transmission of Chikungunya virus: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006510. [PMID: 29897898 PMCID: PMC6075784 DOI: 10.1371/journal.pntd.0006510] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/03/2018] [Accepted: 05/08/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and may cause fetal and neonatal infections after maternal CHIKV-infections during gestation. METHODOLOGY We performed a systematic review to evaluate the risk for: a) mother-to-child transmission (MTCT), b) antepartum fetal deaths (APFD), c) symptomatic neonatal disease, and d) neonatal deaths from maternal CHIKV-infections during gestation. We also recorded the neonatal clinical manifestations after such maternal infections (qualitative data synthesis). We searched PubMed (last search 3/2017) for articles, of any study design, with any of the above outcomes. We calculated the overall risk of MTCT, APFDs and risk of symptomatic neonatal disease by simple pooling. For endpoints with ≥5 events in more than one study, we also synthesized the data by random-effect-model (REM) meta-analysis. PRINCIPAL FINDINGS Among 563 identified articles, 13 articles from 8 cohorts were included in the quantitative data synthesis and 33 articles in the qualitative data synthesis. Most cohorts reported data only on symptomatic rather than on all neonatal infections. By extrapolation also of these data, the overall pooled-MTCT-risk across cohorts was at least 15.5% (206/1331), (12.6% by REMs). The pooled APFD-risk was 1.7% (20/1203); while the risk of CHIKV-confirmed-APFDs was 0.3% (3/1203). Overall, the pooled-risk of symptomatic neonatal disease was 15.3% (203/1331), (11.9% by REMs). The pooled risk of symptomatic disease was 50.0% (23/46) among intrapartum vs 0% (0/712) among antepartum/peripartum maternal infections. Infected newborns, from maternal infections during gestation were either asymptomatic or presented within their first week of life, but not at birth, with fever, irritability, hyperalgesia, diffuse limb edema, rashes and occasionally sepsis-like illness and meningoencephalitis. The pooled-risk of neonatal death was 0.6% (5/832) among maternal infections and 2.8% (5/182) among neonatal infections; long-term neurodevelopmental delays occurred in 50% of symptomatic neonatal infections. CONCLUSIONS/SIGNIFICANCE Published cohorts with data on the risk to the fetus and/or newborn from maternal CHIKV-infections during gestation were sparse compared to the number of recently reported CHIKV-infection outbreaks worldwide; however perinatal infections do occur, at high rates during intrapartum period, and can be related to neonatal death and long-term disabilities.
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Affiliation(s)
- Despina Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Shoshana Newman-Lindsay
- Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Camille Chow
- Department of Internal Medicine, St. Agnes Medical Center, Fresno, CA, United States of America
| | - A. Desiree LaBeaud
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, United States of America
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41
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Wong KZ, Chu JJH. The Interplay of Viral and Host Factors in Chikungunya Virus Infection: Targets for Antiviral Strategies. Viruses 2018; 10:E294. [PMID: 29849008 PMCID: PMC6024654 DOI: 10.3390/v10060294] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/13/2018] [Accepted: 05/28/2018] [Indexed: 12/14/2022] Open
Abstract
Chikungunya virus (CHIKV) has re-emerged as one of the many medically important arboviruses that have spread rampantly across the world in the past decade. Infected patients come down with acute fever and rashes, and a portion of them suffer from both acute and chronic arthralgia. Currently, there are no targeted therapeutics against this debilitating virus. One approach to develop potential therapeutics is by understanding the viral-host interactions. However, to date, there has been limited research undertaken in this area. In this review, we attempt to briefly describe and update the functions of the different CHIKV proteins and their respective interacting host partners. In addition, we also survey the literature for other reported host factors and pathways involved during CHIKV infection. There is a pressing need for an in-depth understanding of the interaction between the host environment and CHIKV in order to generate potential therapeutics.
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Affiliation(s)
- Kai Zhi Wong
- Laboratory of Molecular RNA Virology & Antiviral Strategies, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University Health System, 5 Science Drive 2, National University of Singapore, Singapore 117597, Singapore.
| | - Justin Jang Hann Chu
- Laboratory of Molecular RNA Virology & Antiviral Strategies, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University Health System, 5 Science Drive 2, National University of Singapore, Singapore 117597, Singapore.
- Institute of Molecular & Cell Biology, Agency for Science, Technology & Research (A*STAR), 61 Biopolis Drive, Proteos #06-05, Singapore 138673, Singapore.
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Mehta R, Gerardin P, de Brito CAA, Soares CN, Ferreira MLB, Solomon T. The neurological complications of chikungunya virus: A systematic review. Rev Med Virol 2018; 28:e1978. [PMID: 29671914 PMCID: PMC5969245 DOI: 10.1002/rmv.1978] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/06/2023]
Abstract
We performed a systematic review on the neurological complications of chikungunya virus. Such complications are being reported increasingly, owing primarily to the scale of recent epidemics but also to a growing understanding of the virus' neurovirulence. We performed a thorough literature search using PubMed and Scopus databases, summating the data on all published reports of neurological disease associated with chikungunya virus. We appraised the data for each major condition in adults, children, and neonates, as well as evaluating the latest evidence on disease pathogenesis and management strategies. The review provides a comprehensive summary for clinicians, public health officials, and researchers tackling the challenges associated with this important emerging pathogen.
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Affiliation(s)
- Ravi Mehta
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic InfectionsUniversity of LiverpoolLiverpoolUK
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
| | - Patrick Gerardin
- INSERM CIC1410Centre Hospitalier Universitaire de la RéunionSaint PierreRéunionFrance
- UM 134 PIMIT CNRS 9192, INSERM U1187, IRD 249Université de la Réunion, CHU, CYROISaint PierreRéunionFrance
| | | | | | | | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic InfectionsUniversity of LiverpoolLiverpoolUK
- Department of NeurologyWalton Centre NHS Foundation TrustLiverpoolUK
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
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Escobar M, Nieto AJ, Loaiza-Osorio S, Barona JS, Rosso F. Pregnant Women Hospitalized with Chikungunya Virus Infection, Colombia, 2015. Emerg Infect Dis 2018; 23. [PMID: 29047427 PMCID: PMC5652420 DOI: 10.3201/eid2311.170480] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Personnel in charge of obstetric populations should watch for cases of chikungunya virus‒induced sepsis with hypoperfusion and organ dysfunction. In 2015 in Colombia, 60 pregnant women were hospitalized with chikungunya virus infections confirmed by reverse transcription PCR. Nine of these women required admission to the intensive care unit because of sepsis with hypoperfusion and organ dysfunction; these women met the criteria for severe acute maternal morbidity. No deaths occurred. Fifteen women delivered during acute infection; some received tocolytics to delay delivery until after the febrile episode and prevent possible vertical transmission. As recommended by a pediatric neonatologist, 12 neonates were hospitalized to rule out vertical transmission; no clinical findings suggestive of neonatal chikungunya virus infection were observed. With 36 women (60%), follow-up was performed 1 year after acute viremia; 13 patients had arthralgia in >2 joints (a relapse of infection). Despite disease severity, pregnant women with chikungunya should be treated in high-complexity obstetric units to rule out adverse outcomes. These women should also be followed up to treat potential relapses.
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Weger-Lucarelli J, Auerswald H, Vignuzzi M, Dussart P, Karlsson EA. Taking a bite out of nutrition and arbovirus infection. PLoS Negl Trop Dis 2018; 12:e0006247. [PMID: 29596427 PMCID: PMC5875747 DOI: 10.1371/journal.pntd.0006247] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Nutrition is a key factor in host–pathogen defense. Malnutrition can increase both host susceptibility and severity of infection through a number of pathways, and infection itself can promote nutritional deterioration and further susceptibility. Nutritional status can also strongly influence response to vaccination or therapeutic pharmaceuticals. Arthropod-borne viruses (arboviruses) have a long history of infecting humans, resulting in regular pandemics as well as an increasing frequency of autochthonous transmission. Interestingly, aside from host-related factors, nutrition could also play a role in the competence of vectors required for transmission of these viruses. Nutritional status of the host and vector could even influence viral evolution itself. Therefore, it is vital to understand the role of nutrition in the arbovirus lifecycle. This Review will focus on nutritional factors that could influence susceptibility and severity of infection in the host, response to prophylactic and therapeutic strategies, vector competence, and viral evolution. As the old adage goes, you are what you eat. Proper nutrition is a cornerstone of health, and malnutrition can seriously impair the function of the immune system, resulting in increased infections or a more severe disease. Imbalanced or inadequate nutrition can also affect responses to vaccines or drugs that are vital for protection and treatment against viruses. A mosquito is also a product of what it eats. Nutrition during development and adult lifecycle can affect the feeding behavior of mosquitoes, thereby affecting transmission of viral diseases. Arthropod-borne viruses (arboviruses) are a major global health concern, especially in areas impacted by malnutrition. Understanding how nutrition can affect both humans and mosquitoes in the context of these viruses is vital to combating these diseases.
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Affiliation(s)
- James Weger-Lucarelli
- Viral Populations and Pathogenesis Unit, Institut Pasteur, Centre National de la Recherche Scientifique, Paris, France
| | - Heidi Auerswald
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Marco Vignuzzi
- Viral Populations and Pathogenesis Unit, Institut Pasteur, Centre National de la Recherche Scientifique, Paris, France
| | - Phillipe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Erik A. Karlsson
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
- * E-mail:
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Abstract
PURPOSE OF REVIEW Zika virus (ZIKV), a mosquito-borne flavivirus, has gained recognition over the past few years as an important new cause of congenital infection. As a result, it is critical that pediatricians understand its epidemiology, clinical presentation, clinical sequelae, and management. RECENT FINDINGS The recent ZIKV epidemiology, clinical presentation of acute infection in children and complications, perinatal infection, and congenital infection will be summarized in this ZIKV review. This will be followed by a brief summary on ZIKV diagnosis, management, treatment, and prevention. SUMMARY The field of clinical research in ZIKV has rapidly evolved over recent months. It is critical that pediatricians continue to stay up-to-date with the continuously evolving understanding of the clinical aspects of ZIKV to ensure optimal identification and management of affected infants and children. Given the recent changes in Centers for Disease Control and Prevention guidelines to limit screening of asymptomatic pregnant women in the United States with possible ZIKV exposure, comprehensive ZIKV clinical knowledge becomes even more crucial.
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Affiliation(s)
- Kristina Adachi
- David Geffen UCLA School of Medicine, Los Angeles, CA 90095-1406, U.S
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Bautista LE. Maternal Zika virus infection and newborn microcephaly-an analysis of the epidemiological evidence. Ann Epidemiol 2017; 28:111-118. [PMID: 29277550 DOI: 10.1016/j.annepidem.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/16/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate whether existing data and evidence support a causal link between maternal Zika virus (ZIKV) infection and newborn microcephaly. METHODS I quantified and compared the prevalence of all and severe microcephaly in Brazil, during and before 2015-2016, to assess whether an outbreak has occurred, used time series analysis to evaluate if the presumed outbreak was linked to a previous outbreak of ZIKV infections, and quantitatively synthesized published data from observational studies testing this association. RESULTS The prevalences of microcephaly in 2015-2016 were similar or lower than background levels (prevalence ratio [PR] for all microcephaly: 0.19; 95% confidence intervals [CI]: 0.17, 0.20). Changes in the number of cases of ZIKV infections at times matching 11-18 weeks of pregnancy were not followed by changes in the number of microcephaly cases (PR for infection at 12 weeks: 1.02; 95% CI: 0.99, 1.05). In observational studies, the prevalence of microcephaly was not significantly increased in newborns of Zika-infected mothers (average PR: 1.30; 95% CI: 0.84, 2.02). CONCLUSIONS Existing evidence is insufficient to claim maternal ZIKV infection causes microcephaly. Although a public health response seems sensible, it should be consistent with existing knowledge and consider risks, potential benefits and harm, and competing priorities.
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Affiliation(s)
- Leonelo E Bautista
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin at Madison.
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Chan Y, Ng LFP. Age has a role in driving host immunopathological response to alphavirus infection. Immunology 2017; 152:545-555. [PMID: 28744856 PMCID: PMC5680050 DOI: 10.1111/imm.12799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/15/2017] [Accepted: 07/21/2017] [Indexed: 12/11/2022] Open
Abstract
Alphaviruses are a group of arthropod-borne pathogens capable of causing a wide spectrum of clinical symptoms, ranging from milder symptoms like rashes, fever and polyarthralgia, to life-threatening encephalitis. This genus of viruses is prevalent globally, and can infect patients across a wide age range. Interestingly, disease severity of virus-infected patients is wide-ranging. Definitions of the pathogenesis of alphaviruses, as well as the host factors influencing disease severity, remain limited. The innate and adaptive immune systems are important host defences against alphavirus infections. Several reports have highlighted the roles of specific immune subsets in contributing to the immune pathogenesis of these viruses. However, immunosenescence, a gradual deterioration of the immune system brought about by the natural advancement of age, affects the functional roles of these immune subsets. This phenomenon compromises the host's ability to defend against alphavirus infection and pathogenesis. In addition, the lack of maturity in the immune system in newborns and infants also results in more severe disease outcomes. In this review, we will summarize the subtle yet diverse physiological changes in the immune system during aging, and how these changes underlie the differences in disease severity for common alphaviruses.
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Affiliation(s)
- Yi‐Hao Chan
- Singapore Immunology NetworkAgency for ScienceTechnology and Research (A*STAR)Singapore
- NUS Graduate School for Integrative Sciences and EngineeringNational University of SingaporeSingapore
| | - Lisa F. P. Ng
- Singapore Immunology NetworkAgency for ScienceTechnology and Research (A*STAR)Singapore
- Department of BiochemistryYong Loo Lin School of MedicineNational University of SingaporeSingapore
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
- Present address:
8A Biomedical Grove, Biopolis#04‐06 Immunos138648Singapore
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Arragain L, Dupont-Rouzeyrol M, O'Connor O, Sigur N, Grangeon JP, Huguon E, Dechanet C, Cazorla C, Gourinat AC, Descloux E. Vertical Transmission of Dengue Virus in the Peripartum Period and Viral Kinetics in Newborns and Breast Milk: New Data. J Pediatric Infect Dis Soc 2017; 6:324-331. [PMID: 27760799 DOI: 10.1093/jpids/piw058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/01/2016] [Indexed: 11/13/2022]
Abstract
SUMMARY We investigated 10 mother-newborn pairs and found a 90% rate of dengue virus (DENV) transmission during the perinatal period. Here, we describe DENV kinetics in the sera of newborns before the onset of disease. Of the breast-milk samples analyzed, 75% tested positive for DENV. BACKGROUND Dengue is the most common mosquito-borne viral disease in humans. With this study, we aimed to investigate the risk of vertical (DENV) transmission during the peripartum period and to describe its viral kinetics in serum and breast milk. METHODS We carried out a prospective study during the 2012-2013 dengue epidemic in New Caledonia, its most severe on record. All mothers hospitalized at the Centre Hospitalier Territorial in Nouméa, New Caledonia, with symptoms of dengue infection between 7 days before and 2 days after delivery and/or whose infant was infected during breastfeeding were investigated. DENV was detected and quantified by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) in sera and breast milk (mothers), sera and gastric fluid (newborns), cord blood, and placentas. DENV kinetics and sequences in sera and breast milk were studied. Clinical presentation and biological evolution in mother-newborn pairs were analyzed. RESULTS Ten mother-newborn pairs were investigated over an 11-month period. One premature birth, 3 hemorrhagic complications, and 1 maternal death occurred. Nine newborns were infected and symptomatic. One case of deep thrombocytopenia and 1 case of anoxic encephalopathy occurred. DENV was detected in breast milk samples from 9 (75%) of 12 infected breastfeeding mothers. Original DENV kinetics in sera and breast milk were described. CONCLUSIONS The occurrence of vertical DENV transmission was high (90%) in viremic mothers at delivery, and these mothers and their infants were at major risk for obstetric and neonatal complications. The modes of viral transmission are difficult to clarify. The risk of DENV transmission through breast milk seems plausible. Close follow-up of mothers and prolonged surveillance of their newborns are required for minimizing complications. Complementary studies are needed to elaborate preventive recommendations.
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Affiliation(s)
| | - Myrielle Dupont-Rouzeyrol
- Department of Dengue and Arboviruses Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network
| | - Olivia O'Connor
- Department of Dengue and Arboviruses Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network
| | - Nathalie Sigur
- Department of Neonatology, Centre Hospitalier Territorial
| | - Jean-Paul Grangeon
- Health Department, Direction of Health and Social Affairs of New Caledonia
| | - Emilie Huguon
- Department of Pediatrics, Centre Hospitalier Territorial
| | | | - Cécile Cazorla
- Internal Medicine and Infectious Diseases, Centre Hospitalier Territorial
| | - Ann-Claire Gourinat
- Immuno-Serology and Molecular Biology Lab, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa
| | - Elodie Descloux
- Internal Medicine and Infectious Diseases, Centre Hospitalier Territorial
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Dengue virus infection during pregnancy increased the risk of adverse fetal outcomes? An updated meta-analysis. J Clin Virol 2017; 94:42-49. [DOI: 10.1016/j.jcv.2017.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 01/11/2023]
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50
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Nascimento LB, Siqueira CM, Coelho GE, Siqueira JB. Symptomatic dengue infection during pregnancy and livebirth outcomes in Brazil, 2007–13: a retrospective observational cohort study. THE LANCET. INFECTIOUS DISEASES 2017; 17:949-956. [DOI: 10.1016/s1473-3099(17)30169-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/07/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
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