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Blanco S, Marín ÁL, Frutos MC, Barahona NY, Rivarola ME, Carrizo LH, Spinsanti L, Gallego SV. Haemovigilance survey and screening strategy for arthropod-borne viruses in blood donors from Argentina. J Med Virol 2024; 96:e29476. [PMID: 38373210 DOI: 10.1002/jmv.29476] [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: 12/09/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
Arthropod-borne viruses (arboviruses) count among emerging infections, which represent a major challenge for transfusion safety worldwide. To assess the risk of arboviruses-transmission by transfusion (ATT), we performed a survey to evaluate the potential threat for transfusion safety. Samples were retrospectively and randomly collected from donors who donated during the peak of dengue incidence in Cordoba (years: 2016 and 2019-2022). A cost-efficient strategy for molecular screening was implemented with a nucleic acid test (NAT) configured with Flavivirus and Alphavirus-universal degenerated primers targeting conserved gene regions. Besides, we evaluated the neutralizing antibody (NAb) prevalence by plaque reduction neutralization test (PRNT). A total of 1438 samples were collected. Among the NAT-screened samples, one resulted positive for Flavivirus detection. Subsequent sequencing of the PCR product revealed Saint Louis Encephalitis Virus (SLEV) infection (GeneBank accession number OR236721). NAb prevalence was 2.95% for anti-Dengue, 9.94% anti-SLEV, 1.09% anti-West Nile Virus, and 0% anti-Chikungunya. One of the NAb-positive samples also resulted positive for IgM against SLEV but negative by ARN detection. This is the first haemovigilance study developed in Argentina that evaluates the potential risk of ATT and the first research to determine the prevalence of NAb against Flavivirus through PNRT to avoid possible cross-reactions between Ab against Flavivirus. Herein, the finding of one SLEV-viremic donor and the detection of anti-SLEV IgM in a different donor demonstrated a potential threat for transfusion safety and emphasized the need for increased vigilance and proactive measures to ensure the safety of blood supplies.
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Affiliation(s)
- Sebastián Blanco
- Fundación Banco Central de Sangre, Córdoba, Argentina
- Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ángeles Lorena Marín
- Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - María Celia Frutos
- Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- CONICET (Consejo Nacional deInvestigaciones Científicas y Técnicas), Buenos Aires, Argentina
| | - Nubia Yandar Barahona
- Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - María Elisa Rivarola
- Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Lorena Spinsanti
- Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Sandra Verónica Gallego
- Fundación Banco Central de Sangre, Córdoba, Argentina
- Instituto de Virología Dr. J.M. Vanella, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
- CONICET (Consejo Nacional deInvestigaciones Científicas y Técnicas), Buenos Aires, Argentina
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de Oliveira FN, Ferreira SC, Nishiya AS, Mendrone-Junior A, Batista MV, Rocha V, Costa SF. Evaluation of Dengue, Zika virus, and Chikungunya virus transmission by blood components in recipients of haematopoietic stem cell transplantation. Transfus Med 2023; 33:403-408. [PMID: 37525935 DOI: 10.1111/tme.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/12/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Brazil has a high prevalence of arboviruses, especially Dengue (DENV), Zika (ZKV), and Chikungunya (CHKV). OBJECTIVES To study the risk of DENV, ZKV, and CHKV transmission by blood components in the haematopoietic stem cell transplantation (HSCT) population. METHODS Prospective cohort of HSCT recipients and donors performed at the Hospital das Clinicas da FMUSP, São Paulo-Brazil. Patients were evaluated by serology and RT-PCR for DENV, ZKV, and CHKV pre-transplantation and once a week until neutrophil grafting. In positive cases (positive RT-PCR and/or serology conversion), an investigation was carried out on the blood components that the patient received to evaluate the possibility of it being transfusion transmitted. RESULTS A total of 93 patients were included during the study period. The mean age was 52 years with a predominance of males (56.9%). We considered five (5.3%) DENV cases positive by seroconversion in our study. One patient had IgM seroconversion and the other four presented IgG seroconversion to DENV. In the investigation of the blood components, 145 individual samples were analysed. None of the investigated blood components showed a positive RT-PCR. CONCLUSION We observed a low prevalence of DENV, ZKV, and CHKV in HSCT donors and recipients by serology and RT-PCR, and no case of blood transfusion transmission by RT-PCR.
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Affiliation(s)
- Fernando Nivaldo de Oliveira
- Laboratório de Investigação Médica (LIM-49), Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Departamento de Biologia Molecular, Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, SP, Brazil
| | - Suzete Cleusa Ferreira
- Laboratório de Investigação Médica em Patogênese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anna Shoko Nishiya
- Laboratório de Investigação Médica em Patogênese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alfredo Mendrone-Junior
- Laboratório de Investigação Médica em Patogênese e Terapia dirigida em Onco-Imuno-Hematologia (LIM-31), Departamento de Hematologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marjorie Vieira Batista
- Laboratório de Investigação Médica (LIM-49), Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Departamento de Biologia Molecular, Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, SP, Brazil
| | - Vanderson Rocha
- Bone Marrow Transplantation Unit, Hospital das Clinicas da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia Figueiredo Costa
- Laboratório de Investigação Médica (LIM-49), Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Departamento de Biologia Molecular, Fundação Pró-Sangue/Hemocentro de São Paulo, São Paulo, SP, Brazil
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Lamarão LM, Corrêa ASM, de Castro RBH, de Melo Amaral CE, Monteiro PDJ, Palmeira MK, Lopes LN, Oliveira AN, de Lima MSM, Moreira-Nunes CA, Burbano RR. Prevalence of Dengue, Chikungunya and Zika Viruses in Blood Donors in the State of Pará, Northern Brazil: 2018-2020. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010079. [PMID: 36676703 PMCID: PMC9866458 DOI: 10.3390/medicina59010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Arboviruses have been reported over the years as constant threats to blood transfusion recipients, given the high occurrence of asymptomatic cases and the fact that the presence of viremia precedes the onset of symptoms, making it possible that infected blood from donors act as a source of dissemination. This work aims to identify the prevalence of dengue virus (DENV), Zika virus (ZIKV) and Chikungunya virus (CHIKV) infection in blood donors during epidemic and non-epidemic periods; classify the donor as symptomatic or asymptomatic; and verify the need to include DENV, CHIKV and ZIKV in the nucleic acid test (NAT) platform in northern Brazil. We investigated 36,133 thousand donations in two years of collection in Northern Brazil. One donor was positive for DENV and one for CHIKV (0.002% prevalence). As the prevalence for arboviruses was low in this study, it would not justify the individual screening of samples from donors in a blood bank. Thus, DENV- and CHIKV-positive samples were simulated in different amounts of sample pools, and both were safely detected by molecular biology even in a pool of 14 samples, which would meet the need to include these three viruses in the routine of blood centers in endemic countries such as Brazil.
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Affiliation(s)
- Leticia Martins Lamarão
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | - Angelita Silva Miranda Corrêa
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | | | - Carlos Eduardo de Melo Amaral
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | - Patricia Danin Jordão Monteiro
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | - Mauricio Koury Palmeira
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | - Luane Nascimento Lopes
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | - Angela Neves Oliveira
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | - Maria Salete Maciel de Lima
- Foundation Center for Hemotherapy and Hematology of Pará, Nucleic Acid Test (NAT) Department, Belém 66033-000, PA, Brazil
| | - Caroline Aquino Moreira-Nunes
- Pharmacogenetics Laboratory, Drug Research and Development Center, Department of Medicine, Federal University of Ceará, Fortaleza 60430-275, CE, Brazil
- Oncology Research Center, Department of Biological Sciences, Federal University of Pará, Belém 66073-005, PA, Brazil
- Correspondence: (C.A.M.-N.); (R.R.B.)
| | - Rommel Rodríguez Burbano
- Molecular Biology Laboratory, Ophir Loyola Hospital, Belém 66063-240, PA, Brazil
- Human Cytogenetics Laboratory, Biological Science Institute, Federal University of Pará, Belém 66075-110, PA, Brazil
- Correspondence: (C.A.M.-N.); (R.R.B.)
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Giménez-Richarte Á, de Salazar MO, Arbona C, Giménez-Richarte MP, Collado M, Fernández PL, Quiles F, Clavijo C, Marco P, Ramos-Rincon JM. Prevalence of Chikungunya, Dengue and Zika viruses in blood donors: a systematic literature review and meta-analysis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2022; 20:267-280. [PMID: 34694219 PMCID: PMC9256504 DOI: 10.2450/2021.0106-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/20/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Blood transfusion centres should understand the epidemiology of emerging diseases that are transmissible through the transfusion of blood components. The risk of transmission of arboviruses through this route has become apparent in recent years. The aim of our study is to summarise the reported prevalence (viraemic rate, seroprevalence and/or antigen detection) of Chikungunya (CHIKV), Dengue (DENV) and Zika (ZIKV) viruses in blood donors according to screening test used and world region. MATERIALS AND METHODS We conducted a systematic literature review and meta-analysis having searched for information in the main bibliographic databases (MEDLINE, Embase, and Scopus). The prevalence for each of the viruses was calculated according to the screening test used and geographic location. RESULTS We included 18 records on CHIKV, 71 on DENV, and 27 on ZIKV. The highest prevalences of RNA for CHIKV were 1.9% in Puerto Rico (2014), 1.0% in Thailand (2009), and 1.0% in French Polynesia (2014-15). The highest prevalences of RNA for DENV were 5.5% in Saudi Arabia (2015-16), 2.3% in Madeira, Portugal (2012-13), and 0.6% in Brazil (2012). The highest prevalences of RNA for ZIKV were 2.8% in French Polynesia (2013-14), 2.7% in Brazil (2015-16), and 1.8% in Martinique (2016). Overall seroprevalence, as assessed by IgG antibodies, was 21.6% for CHIKV, 24.0% for DENV, and 5.1% for ZIKV. DISCUSSION Our study shows a high proportion of donors who are viraemic and asymptomatic, especially during outbreaks, with prevalences surpassing 5% for DENV, 1% for CHIKV, and 2% for ZIKV. These data confirm a clear threat to blood transfusion safety. The elevated seroprevalence for these three arboviruses is also indicative of their wide circulation in populations, correlating with an increased risk of infected but asymptomatic donors. Health centres and institutions must address this threat, especially in tropical regions where the biggest outbreaks occur.
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Affiliation(s)
| | | | - Cristina Arbona
- Valencian Community Blood Transfusion Centre, Valencian Community, Spain
| | | | - Miriam Collado
- Valencian Community Blood Transfusion Centre, Valencian Community, Spain
| | - Pedro L Fernández
- Valencian Community Blood Transfusion Centre, Valencian Community, Spain
| | - Francisco Quiles
- Valencian Community Blood Transfusion Centre, Valencian Community, Spain
| | - Carlos Clavijo
- Valencian Community Blood Transfusion Centre, Valencian Community, Spain
| | - Pascual Marco
- Service of Haematology, General University Hospital of Alicante-ISABIAL, Alicante, Spain
- Clinical Medicine Department, Miguel Hernandez University of Elche, Alicante, Spain
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Hofmann A, Spahn DR, Holtorf AP. Making patient blood management the new norm(al) as experienced by implementors in diverse countries. BMC Health Serv Res 2021; 21:634. [PMID: 34215251 PMCID: PMC8249439 DOI: 10.1186/s12913-021-06484-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/06/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient blood management (PBM) describes a set of evidence-based practices to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This concepts aims to detect and treat anemia, minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process. In combination with blood loss, anemia is the main driver for transfusion and all three are independent risk factors for adverse outcomes including morbidity and mortality. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds. METHODS Semi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country and underwent qualitative content analysis. Clustering the resulting implementation measures by levels of intervention for PBM implementation informed a PBM implementation framework. RESULTS A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration. CONCLUSION The implementation matrix resulting from this research helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to design, initiate and develop strategies and plans to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.
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Affiliation(s)
- Axel Hofmann
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
- University of Western Australia Faculty of Health and Medical Sciences, Perth, Australia
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, CH4055 Basel, Switzerland
- Faculty of the College of Pharmacy, University of Utah, Salt Lake City, UT USA
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Zika circulation, congenital syndrome, and current guidelines: making sense of it all for the traveller. Curr Opin Infect Dis 2020; 32:381-389. [PMID: 31305494 DOI: 10.1097/qco.0000000000000575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Zika virus (ZIKV) swept through the Americas and led to recognition of its neurotropism. Zika circulation elsewhere in the world, nonvector transmission including maternal-fetal/sexual/transfusion routes, and additional reports on congenital Zika syndrome (CZS) and Guillain-Barré syndrome (GBS) have been published. RECENT FINDINGS In 2018-2019, ZIKV transmission occurred in Cuba, India, and is suspected to appear sporadically in other countries. Maternal-fetal ZIKV transmission appears to occur in about 26% of ZIKV-infected pregnant women. The US ZIKV Pregnancy and Infant Registry identified 6% of live births to have at least one ZIKV-associated birth defect; 9% had at least one neurodevelopmental abnormality; 1% had both. Infectious virus was rarely isolated from semen of ZIKV-infected male patients beyond day 38 after symptom onset. Brazilian blood donations had low ZIKV prevalence in 2015-2016; in the United States, screening donations was cost-effective only in the high mosquito season in Puerto Rico. SUMMARY ZIKV transmission continues; many countries with competent mosquitoes are at risk. Transmission can occur without detection where surveillance is poor and laboratory capacity limited. Travelers are important sentinels. Variations exist among ZIKV strains and Aedes mosquitoes that influence competence for transmission. Maternal-fetal transmission results in significant rates of abnormality. Identification of infectious virus in semen clarifies sexual transmission risk, with updated recommendations for preconception planning. ZIKV neurotropism requires further research and long-term follow-up.
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Zheng X, Zeng J, Xu X, Liu Y, Heng L, Wen X, Li S, Xu M, Wu S, Chen Y, Chen L. A preliminary survey of Zika virus infection by nucleic acid test in the volunteer blood donor samples in Shenzhen China. J Med Virol 2020; 92:1326-1329. [PMID: 31829444 DOI: 10.1002/jmv.25654] [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: 09/08/2019] [Accepted: 12/10/2019] [Indexed: 11/09/2022]
Abstract
Although Zika virus (ZIKV) infection is mainly transmitted through mosquito bite, it can also be transmitted through blood transfusion. More than 500 000 cases of ZIKV infection were reported in the Americas from 2015 to 2016. Up till now, over 10 cases of imported ZIKV infection have been reported due to frequent international exchanges in the Shenzhen city of Guangdong Province, China. Unfortunately, there were no data on ZIKV infection in Chinese blood donors because it has not been included in routine screening for volunteer blood donors. As such, we performed a preliminary survey of the prevalence of ZIKV infection among volunteer blood donors in Shenzhen, China, to assess the potential risk of ZIKV infection through transfusion. A total of 9626 blood donor samples were collected and ZIKA RNA was detected by transcription-mediated amplification (TMA) nucleic acid amplification method with the Panther nucleic acid automatic analysis system of Grifols, Spain, including Procleix ZIKV Assay reagent. All the experiments in this study were conducted in accordance with the standard operating procedure of the blood center. Of the 9626 donor blood samples tested, none of these samples was Zika RNA reactive. There was no positive case from ZIKV RNA screening in this preliminary survey. There was no ZIKV presence in blood donors in Shenzhen, China, from this preliminary survey. The potential risk of ZIKV infection by transfusion is low in Shenzhen at this moment. Therefore, there is no need to add ZIKV nucleic acid test as a routine screening for blood donors.
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Affiliation(s)
- Xin Zheng
- Department of Blood Transfusion, Shenzhen Blood Center, Shenzhen, China
| | - Jingfeng Zeng
- Department of Blood Transfusion, Shenzhen Blood Center, Shenzhen, China
| | - Xiaoxuan Xu
- Department of Blood Transfusion, Shenzhen Blood Center, Shenzhen, China
| | - Yizhong Liu
- Department of Blood Transfusion, Shenzhen Bao'an District Central Blood Station, Shenzhen, China
| | - Liu Heng
- Department of Blood Transfusion, Shenzhen Blood Center, Shenzhen, China
| | - Xiong Wen
- Department of Blood Transfusion, Shenzhen Blood Center, Shenzhen, China
| | - Shilin Li
- Provincial Key Laboratory for Transfusion-Transmitted Infectious Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Min Xu
- Provincial Key Laboratory for Transfusion-Transmitted Infectious Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Shaobo Wu
- Provincial Key Laboratory for Transfusion-Transmitted Infectious Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Yongjun Chen
- Provincial Key Laboratory for Transfusion-Transmitted Infectious Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Limin Chen
- Provincial Key Laboratory for Transfusion-Transmitted Infectious Diseases, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China.,Toronto General Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Peters R, Stevenson M. Immunological detection of Zika virus: A summary in the context of general viral diagnostics. J Microbiol Methods 2020. [DOI: 10.1016/bs.mim.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Brady OJ, Osgood-Zimmerman A, Kassebaum NJ, Ray SE, de Araújo VEM, da Nóbrega AA, Frutuoso LCV, Lecca RCR, Stevens A, Zoca de Oliveira B, de Lima JM, Bogoch II, Mayaud P, Jaenisch T, Mokdad AH, Murray CJL, Hay SI, Reiner RC, Marinho F. The association between Zika virus infection and microcephaly in Brazil 2015-2017: An observational analysis of over 4 million births. PLoS Med 2019; 16:e1002755. [PMID: 30835728 PMCID: PMC6400331 DOI: 10.1371/journal.pmed.1002755] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/28/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In 2015, high rates of microcephaly were reported in Northeast Brazil following the first South American Zika virus (ZIKV) outbreak. Reported microcephaly rates in other Zika-affected areas were significantly lower, suggesting alternate causes or the involvement of arboviral cofactors in exacerbating microcephaly rates. METHODS AND FINDINGS We merged data from multiple national reporting databases in Brazil to estimate exposure to 9 known or hypothesized causes of microcephaly for every pregnancy nationwide since the beginning of the ZIKV outbreak; this generated between 3.6 and 5.4 million cases (depending on analysis) over the time period 1 January 2015-23 May 2017. The association between ZIKV and microcephaly was statistically tested against models with alternative causes or with effect modifiers. We found no evidence for alternative non-ZIKV causes of the 2015-2017 microcephaly outbreak, nor that concurrent exposure to arbovirus infection or vaccination modified risk. We estimate an absolute risk of microcephaly of 40.8 (95% CI 34.2-49.3) per 10,000 births and a relative risk of 16.8 (95% CI 3.2-369.1) given ZIKV infection in the first or second trimester of pregnancy; however, because ZIKV infection rates were highly variable, most pregnant women in Brazil during the ZIKV outbreak will have been subject to lower risk levels. Statistically significant associations of ZIKV with other birth defects were also detected, but at lower relative risks than that of microcephaly (relative risk < 1.5). Our analysis was limited by missing data prior to the establishment of nationwide ZIKV surveillance, and its findings may be affected by unmeasured confounding causes of microcephaly not available in routinely collected surveillance data. CONCLUSIONS This study strengthens the evidence that congenital ZIKV infection, particularly in the first 2 trimesters of pregnancy, is associated with microcephaly and less frequently with other birth defects. The finding of no alternative causes for geographic differences in microcephaly rate leads us to hypothesize that the Northeast region was disproportionately affected by this Zika outbreak, with 94% of an estimated 8.5 million total cases occurring in this region, suggesting a need for seroprevalence surveys to determine the underlying reason.
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Affiliation(s)
- Oliver J. Brady
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (OJB); (FM)
| | - Aaron Osgood-Zimmerman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Nicholas J. Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, United States of America
| | - Sarah E. Ray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Aglaêr A. da Nóbrega
- Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília, Brazil
| | - Livia C. V. Frutuoso
- Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília, Brazil
| | - Roberto C. R. Lecca
- Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília, Brazil
| | - Antony Stevens
- Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília, Brazil
| | | | - José M. de Lima
- Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília, Brazil
| | - Isaac I. Bogoch
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
- Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada
| | - Philippe Mayaud
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Thomas Jaenisch
- Section of Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Robert C. Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Fatima Marinho
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Secretariat of Health Surveillance, Ministry of Health of Brazil, Brasília, Brazil
- * E-mail: (OJB); (FM)
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