Dengue in pregnancy and maternal mortality: a cohort analysis using routine data

Paixão, Enny S.; Harron, Katie; Campbell, Oona M. R.; Teixeira, Maria Glória; Costa, Maria da Conceição Nascimento; Barreto, Maurício L.; Rodrigues, Laura C.

doi:10.1038/s41598-018-28387-w

Cited by 40 publications

(66 citation statements)

References 15 publications

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“…Pregnant women face potential complications from infection with either dengue or Zika virus (72). Dengue virus infection might increase the risk for maternal death or obstetric complications (e.g., hemorrhage, preeclampsia, eclampsia, and vertical transmission) during the peripartum period (73)(74)(75). Zika virus infection during pregnancy can result in fetal loss, microcephaly, or serious birth defects including structural abnormalities of the brain and eye (30,72).…”

Section: Clinical and Epidemiologic Criteria For Testingmentioning

confidence: 99%

Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses

et al. 2019

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Dengue and Zika viruses are closely related mosquitoborne flaviviruses with similar transmission cycles, distribution throughout the tropics and subtropics, and disease manifestations including fever, rash, myalgia, and arthralgia. For patients with suspected dengue or Zika virus disease, nucleic acid amplification tests (NAATs) are the preferred method of diagnosis. Immunoglobulin M (IgM) antibody testing can identify additional infections and remains an important tool for the diagnosis of these diseases, but interpreting the results is complicated by cross-reactivity, and determining the specific timing of infection can be difficult. These limitations are a particular challenge for pregnant women in determining whether Zika virus infection occurred during or before the pregnancy. This report summarizes existing and new guidance on dengue and Zika virus diagnostic testing for patients with a clinically compatible illness who live in or recently traveled to an area where there is risk for infection with both viruses. CDC recommendations for screening of asymptomatic pregnant women with possible Zika virus exposure are unchanged. For symptomatic nonpregnant persons, dengue and Zika virus NAATs should be performed on serum collected ≤7 days after symptom onset. Dengue and Zika virus IgM antibody testing should be performed on NAAT-negative serum specimens or serum collected >7 days after onset of symptoms. For symptomatic pregnant women, serum and urine specimens should be collected as soon as possible within 12 weeks of symptom onset for concurrent dengue and Zika virus NAATs and IgM antibody testing. Positive IgM antibody test results with negative NAAT results should be confirmed by neutralizing antibody tests when clinically or epidemiologically indicated, including for all pregnant women. Data on the epidemiology of viruses known to be circulating at the location of exposure and clinical findings should be considered when deciding which tests to perform and for interpreting results. Patients with clinically suspected dengue should receive appropriate management to monitor and treat shock and hemorrhage. Women with laboratory evidence of possible Zika virus infection during pregnancy and their infants should be evaluated and managed for possible adverse outcomes. Dengue and Zika virus disease are nationally notifiable conditions, and cases should be reported to public health authorities.

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Section: Clinical and Epidemiologic Criteria For Testingmentioning

confidence: 99%

Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses

et al. 2019

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“…Pregnant women and neonates are considered to be at increased risk of a more severe disease [22,23]. Although there is no consensus regarding the effects of the disease on this vulnerable group, some studies indicate that vertical transmission may occur and cause serious consequences, such as preterm delivery and fetal death [24,25,26,27,28].…”

Section: Introductionmentioning

confidence: 99%

A Stillborn Multiple Organs’ Investigation from a Maternal DENV-4 Infection: Histopathological and Inflammatory Mediators Characterization

Nunes

Nogueira

Coelho

et al. 2019

Viruses

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Dengue virus (DENV) is an emerging virus involved in outbreaks in Brazil. The association between the virus and vertical transmission, with disorders in the placenta, has raised a worldwide concern. On the 29th gestational week, a pregnant woman presented severe complications due to a DENV infection leading to maternal and fetus death. Postmortem analysis of fetal organs demonstrated the presence of DENV using reverse transcriptase polymerase chain reaction (RT-PCR) in the fetal brain and DENV non-structural protein 3 (NS3) staining in placenta and several peripheral fetal tissues, such as the brain, liver, lungs, and spleen. Histological analysis of the placenta and fetal organs revealed different types of tissue abnormalities, which included inflammation, hemorrhage, edema, and necrosis in placenta and tissue disorganization in the fetus, such as spongiform parenchyma, microglial inflammation, steatosis, hyalinose arteriolar, inflammatory cells in the alveolar septa, and disorganization of the lymphoid follicle. Increased cellularity (macrophage, Hofbauer cells and TCD8+ lymphocytes) and up-regulation of inflammatory mediators such as IFN-γ, TNF-α, RANTES/CCL5, MCP1/CCL2, and VEGF/R2 were detected in the liver, lung, spleen, brain, and placenta, supporting placental and fetus peripheral tissues inflammation. Maternal infection leading to the production of those vascular mediators may alter the vascular permeability, facilitating the virus entry and tissue and barrier dysfunction.

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“…Third, the longitudinal structure of the data used is methodologically sound, enabling the addition of new exposures or outcomes, the study of outcomes at different times of exposure, including over the long-term, and the evaluation of various social protection policies on health outcomes. Fourth, large sample sizes enable the analysis of small groups and rare events in ways not possible in projects dependent on the collection of new primary data [14,38]. Fifth, linkage is conducted with powerful and accurate software developed in-house (AtyImo and CIDACS-RL).…”

Section: Discussionmentioning

confidence: 99%

The Center for Data and Knowledge Integration for Health (CIDACS)

Barreto

Ichihara

Almeida

et al. 2019

IJPDS

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The Center for Data and Knowledge Integration for Health (CIDACS) was created in 2016 in Salvador (Bahia, Brazil). This paper aims to present a profile of CIDACS, including its current databases. CIDACS aims to conduct interdisciplinary studies and research, develop new scientific methodology and promote professional training using linked large-scale databases and high-performance computational resources in a secure environment. Administrative data is at the core of the activities conducted by CIDACS. The advantages of administrative data include significantly larger sample sizes, an inherent longitudinal structure and high-quality information. The center’s research projects are primarily focused on enhancing the understanding surrounding the impact of social protection policies (e.g., public cash-transfer and housing programs) on health outcomes in low-income populations throughout Brazil. CIDACS’ primary data source is citizens who register with the Cadastro Único program, which encompasses individuals eligible to receive benefits from over 20 governmental social programs. CIDACS has two separate environments for data handling: 1) Data Production Center, a secure room housing the computational infrastructure for ingesting, storing, cleaning, processing and linking original databases, as well as extracting research-ready datasets and 2) Data Analysis Environment, a computational infrastructure based on data safe haven principles, which allows researchers to access and process requested datasets. Brazil has a large public health community that uses national health and social databases for research programs, and the linkage of different databases has been a widely employed practice in the country. CIDACS is the result of efforts by researchers, policymakers and public health officials to use and improve the quality of Brazilian health databases. CIDACS is expected to be an important resource for researchers and policymakers interested in improving the evidence base in different aspects of health, as well as with regard to the social determinants of health and the effects of social and environmental policies on health in general.

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Dengue in pregnancy and maternal mortality: a cohort analysis using routine data

Cited by 40 publications

References 15 publications

Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses

Dengue and Zika Virus Diagnostic Testing for Patients with a Clinically Compatible Illness and Risk for Infection with Both Viruses

A Stillborn Multiple Organs’ Investigation from a Maternal DENV-4 Infection: Histopathological and Inflammatory Mediators Characterization

The Center for Data and Knowledge Integration for Health (CIDACS)

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