Clinical Outcomes of a Zika Virus Mother–Child Pair Cohort in Spain

Abstract

Background: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. Methods: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. Results: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4–6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4–39.6%). Conclusions: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations.

Time to Evaluate the Clinical Repercussions of Zika Virus Vertical Transmission? A Systematic Review

“…All studies that performed ophthalmological evaluations exposed some alteration, such as microphthalmia, fundoscopic alterations, macular atrophy, optic nerve abnormalities, strabismus and visual acuity defects (12,14,27,36,45,50,51,56,60,61,67,68,(73)(74)(75)(76)(77)(78)(79). Twelve of 14 papers that evaluated audiological manifestations in children reported hearing disorders (11,14,27,36,37,39,43,51,56,60,62,64) and two did not observe any abnormalities (30,41).…”

Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus

“…In this work, we verified the occurrence of few cases with early clinical manifestations, such as microcephaly and CZS, with the late manifestations prevailing, normally related to sensorineural hearing loss and neuropsychomotor development. The incidence and severity of the impairment of children exposed to gestational ZIKV varies significantly according to the study location and the selection criteria of the studied population [ 40 , 41 , 42 ]. In general, the most serious cases occurred in poor areas with fewer health resources, which usually present a great proliferation of Aedes aegypti , thus increasing the risk of exposure to ZIKV and, consequently, to other arboviruses, especially dengue [ 43 ].…”

Health outcomes of children born/suspected with ZIKV: Protocol for the ZIKAction Paediatric Registry in Latin America and the Caribbean

“…Reported vertical transmission rates range from 9% to 35% in studies with PCRcon rmed ZIKV infection (12)(13)(14)(15)(16)(17), whilst a recent evidence synthesis estimated the mean risk of vertical transmission to be 47% in the rst trimester, decreasing to 25% in the third (18). Major cohort studies estimate the risk of congenital abnormalities in ZIKV infection of 4-10% (12,13,(19)(20)(21)(22).…”

“…The current literature has reported a range of clinical and neurodevelopmental manifestations in children with congenital ZIKV infection including abnormalities in muscle tone and severe motor impairment, neurological abnormalities, profound developmental delays, ocular manifestations, epilepsy, arthrogryposis, hearing abnormalities, feeding challenges, and sleeping di culties (11,22,(29)(30)(31)(32)(33)(34) . In addition, there is some evidence of the presence of comorbidities such as pneumonia and urinary tract infections (35).…”