Newborn virological outcome after intrauterine ZIKV exposure

Terzian, Ana Carolina Bernardes; Estofolete, C. F; Nery Junior, Nivison Ruy Rocha; Silva, G. Celestino Dutra da; Guimarães, G. F; Rahal, Paula; Vasconcelos, Pedro Fernando da Costa; Mattos, C. C. Brandão de; Mattos, L. C. de; Vasilakis, Nikos; Oliani, A. Helio; Oliani, D. C. Mós Vaz; Ko, A. Icksang; Nogueira, M. Lacerda

Background:

Zika virus (ZIKV) infection has been associated with severe birth defects, including microcephaly and neurological complications. Intrauterine abnormalities have also been associated with ZIKV, reflecting the teratogenic effect of this arbovirus and are referred to as Congenital Zika Syndrome (CZS). The aimed was to report the virological outcomes in newborns exposed intrauterine to ZIKV in a cohort of ZIKV-infected pregnant women. Methods & Materials From February to October 2016, the Public Health Authority of São José do Rio Preto, SP, Brazil, detected pregnant women with acute ZIKV-like symptoms. After, 54 of them, with 5 to 38 weeks in their pregnancies, were enrolled in the study. All patients were tested to TORCHS and were monitored by a multidisciplinary medical team. After the delivery, newborns umbilical cord blood and/or urine were collected and tested to ZIKV by RT-qPCR and ELISA.

Results:

Evidence of ZIKV exposure was detected in 18 of the 51 newborns (35%) evaluated at birth. The ZIKV RT-qPCR in the umbilical cord blood of 48 newborns showed positivity of 29% (14/48; mean Ct 36.5; IQR 36-37), while the urine of 46 newborns showed a positivity of 9% (4/46; mean Ct 36.5; IQR 31-36.6). Sixteen of 18 newborns (89%) had been exposed in the second or third trimester. ZIKV NS1 was reactive in the umbilical cord blood (12/15; 80%). ZIKV IgM was non-reactive. The most common symptoms reported by the mothers were rash, pruritus, and headache. Conjunctivitis/conjunctival hyperemia were not a prominent finding. Seven pregnant women had ZIKV and other infections as determined by laboratory testing. All the pregnant women from the study delivered by the time of this study, and there were no miscarriages, fetal deaths or microcephaly. Only one newborn was born pre-term.

Conclusion:

The link to ZIKV may not be clearly established, but the only infectious agent detected in this case was ZIKV in an umbilical cord blood. More studies are necessary to understand the dynamics of the ZIKV infection during pregnancy. Thus, the monitoring of ZIKV infection during prenatal and postnatal care is extremely important to monitor the clinical outcome of the disease and the future consequences for the fetus.

BVS IEC

Instituto Evandro Chagas

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