Children Born to Mothers with Rash During Zika Virus Epidemic in Brazil: First 18 Months of Life

Abstract

Objective To better understand the clinical spectrum and course of congenital Zika syndrome (CZS) during the first 18 months of life of children whose mothers had rash during pregnancy. Methods This longitudinal observational study evaluated the clinical progress from birth until 18 months of life of children of mothers who developed rash during or up to 3 months before gestation. Maternal rash occurred from November 2015 to May 2017. The study subjects were divided into three groups: children whose mothers tested positive by RT-qPCR for Zika virus (ZIKV) (Group 1), children whose mothers tested negative by RT-qPCR for ZIKV (Group 2), and children whose mothers did not undergo any testing for ZIKV (Group 3) but tested negative for other congenital infections. Results Between April 2016 and July 2018, we studied 108 children: 43 in Group 1, 26 in Group 2 and 39 in Group 3. The majority of children were admitted into the study within 6 months of life. CZS was diagnosed in 26 children, equally distributed in Groups 1 and 3. Of 18 children with microcephaly, 6 were in Group 1 (1 postnatal) and 12 were in Group 3 (5 postnatal). Maternal rash frequency was 10 times higher during the first trimester than in the other trimesters (OR: 10.35; CI 95%: 3.52–30.41). CZS was diagnosed during the follow-up period in 14 (54%) cases. Developmental delays and motor abnormalities occurred in all children and persisted up to 18 months. Epilepsy occurred in 18 (69%) of the cases. Conclusions Infants born of mothers exposed to ZIKV during pregnancy showed progression of developmental, motor and neurologic abnormalities even if they were born asymptomatic. Continued postnatal monitoring of such newborns is necessary to preclude disability-associated complications.

Repercussões da emergência do vírus Zika na saúde da população do estado do Tocantins, 2015 e 2016: estudo descritivo*

“…27 Although the results of this study do not enable any affirmation to be made about the existence of a relationship between the period when a pregnant woman is infected with ZIKV and the severity of neurological outcomes, this possibility cannot be ruled out, given that in the three cases of microcephaly/CZS for which this information was available, possible maternal infection (presence of rash) occurred in the first trimester of pregnancy. This finding is in agreement with those of other authors, 28,29 thus strengthening the hypothesis of the existence of this relationship. We highlight the need for caution in interpreting the results of this study, due to the similarity between the clinical pictures of Zika, dengue and chikungunya, high frequency of inconclusive cases, and the fact that Zika virus disease only became a compulsorily notifiable condition with effect from February 2016.…”

Cellular Imprinting Proteomics Assay: A Novel Method for Detection of Neural and Ocular Disorders Applied to Congenital Zika Virus Syndrome

“…Clinical examination was performed by a multidisciplinary team, and all infants included in this study are part of a clinical follow up program currently in progress. 30 CZS clinical diagnosis was based on the Brazilian Ministry of Health guidelines. Retrieved information is assembled in Tables 1 and 2 and Table S1 .…”

A Review of Hearing Loss Associated with Zika, Ebola, and Lassa Fever

“…Across studies, 56 (21.2%) of 264 individuals were found to have some degree of HL. 18,[22][23][24][25][26][27][28][29][30][31][32][33][34] Four of the fourteen articles described acquired HL in adults following Zika infection ( Table 1). The HL in these cases varied from moderate to severe and was reported as both unilateral and bilateral, with most patients experiencing recovery to normal or previous thresholds.…”

“…[22][23][24]30 Ten articles presented complication data of congenital Zika syndrome related to HL (Table 1). 18,22,[25][26][27][28][29][33][34][35] The majority of these studies used standard HL screening methods for infants, including measurement of auditory brainstem response and otoacoustic emission, which assesses cochlear function. 18,[25][26][27][28][29]31,33,34 The proportion of infants with reported HL in these studies varied from 6% to 68%.…”