Is Zika Virus an Emerging TORCH Agent? An Invited Commentary

Mehrjardi, Mohammad Zare

doi:10.1177/1178122x17708993

Cited by 22 publications

(15 citation statements)

References 22 publications

(44 reference statements)

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“…Subsequently, a serious ZIKV epidemic began in Brazil in early 2015, which outspread rapidly throughout the South American and Caribbean countries. More importantly, a causal relationship between prenatally acquired ZIKV infection and neonatal microcephaly has been confirmed during the recent outbreak in South America [9].…”

Section: Introductionmentioning

confidence: 87%

“…The increased number of neonatal neurodevelopmental defects during ZIKV outbreak, and isolation of the virus from cerebral tissue of the aborted fetuses suggest vertical transmission of the virus as the main pathogenesis of fetal CNS abnormalities [9].…”

Section: Vertical Transmission In the Humanmentioning

confidence: 99%

“…ZIKV infection is less benign in the prenatal period, and can lead to severe fetal abnormalities (called as congenital Zika syndrome) in about 1-13% of pregnant women infected during the first trimester. Maternal infection during the early pregnancy has been associated with stillbirth, miscarriage, fetal growth restriction, fetal central nervous system (CNS) abnormalities (particularly severe microcephaly), and ocular abnormalities [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Postnatally acquired ZIKV infection is horizontally transmitted by the mosquito bite (Aedes aegypti as the main vector), but other routes including sexual transmission have been reported as well. Prenatally acquired infection, on the other hand, is vertically transmitted from infected mother to fetus [9]. A detailed knowledge about the pathomechanisms of ZIKV vertical transmission and the placental changes caused by this virus is of paramount importance for preventing ZIKV transmission to the fetus, and ameliorating fetal prognosis.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The role of the placenta in prenatally acquired Zika virus infection

Mehrjardi

Shobeirian

2017

VirusDis.

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Zika virus (ZIKV) is an arthropod-borne from the family, which has been recently confirmed to cause severe neurological abnormalities (such as microcephaly, brain parenchymal calcification, hydrocephalus, and malformations of cortical development) in the infected fetuses. The Placenta plays a multifold role in prenatally acquired ZIKV infection. It serves as a port of virus transmission to the fetus, and also can be directly affected by ZIKV leading to a diminished fetal blood supply or a disrupted/changed biological mediators' synthesis. It is crucial to have a detailed knowledge about these pathomechanisms for preventing virus transmission in the infected pregnant women, as well as for prohibiting or reversing placental changes.

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Section: Introductionmentioning

confidence: 87%

Section: Vertical Transmission In the Humanmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The role of the placenta in prenatally acquired Zika virus infection

Mehrjardi

Shobeirian

2017

VirusDis.

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“…Sporadic outbreaks followed until 2015, when the virus was identified in Brazil and linked to an alarming increase in the incidence of microcephaly and other adverse birth outcomes [1][2][3][4]. Researchers began to list ZIKV with other infectious teratogens, exposures that harm a developing embryo or fetus, which include pathogens known by the acronym TORCH-Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, and Herpes Simplex [5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of alternative endpoints for ZIKV vaccine efficacy trials

Mercaldo

Bellan

2019

Vaccine

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Zika virus (ZIKV) infection during pregnancy is associated with microcephaly and other birth defects, collectively termed Congenital Zika Syndrome (CZS). During the epidemic in 2015-16, ZIKV spread through the Americas and quickly joined the list of other known teratogenic pathogens, TORCH. Multiple ZIKV vaccines have been developed for protection of pregnant women and women of childbearing age. However, ZIKV infection incidence has since waned substantially, and adverse birth outcomes are rare outcomes of infection. Studying a vaccine's protective efficacy against CZS in a large phase III clinical trial may be infeasible in such times of low incidence. Should trials be initiated, researchers may resort to alternative clinical endpoints. In this study, we simulate a variety of vaccine clinical trial scenarios to evaluate the feasibility of the CZS endpoint in vaccine studies and compare CZS to other potential outcomes: ZIKV infection detected through weekly, biweekly, or monthly testing and laboratory-confirmed, symptomatic Zika Virus Disease. We compare the sample size required for 80% statistical power to detect vaccine efficacy and trial duration for each scenario. Our results show the feasibility of CZS clinical endpoints depends on the timing of simulated clinical trials in the course of a seasonal epidemic, due to CZS risk varying with trimester of infection. This result highlights additional considerations needed when designing vaccine efficacy trials of protection against teratogenic pathogens.

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Placental infection by Zika virus in French Guiana

Pomar

Lambert

Madec

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To describe placental findings on prenatal ultrasound and anatomopathological examination in women with Zika virus (ZIKV) infection, and to assess their association with congenital ZIKV infection and severe adverse outcome, defined as fetal loss or congenital Zika syndrome (CZS). Methods This was a prospective study of pregnancies undergoing testing for maternal ZIKV infection at a center in French Guiana during the ZIKV epidemic. In ZIKV‐positive women, congenital infection was defined as either a positive reverse transcription polymerase chain reaction result or identification of ZIKV‐specific immunoglobulin‐M in at least one placental, fetal or neonatal sample. Placental ZIKV‐infection status was classified as non‐exposed (placentae from non‐infected women), exposed (placentae from ZIKV‐infected women without congenital infection) or infected (placentae from ZIKV‐infected women with proven congenital infection). Placentae were assessed by monthly prenatal ultrasound examinations, measuring placental thickness and umbilical artery Doppler parameters, and by anatomopathological examination after live birth or intrauterine death in women with ZIKV infection. The association of placental thickness during pregnancy and anatomopathological findings with the ZIKV status of the placenta was assessed. The association between placental findings and severe adverse outcome (CZS or fetal loss) in the infected group was also assessed. Results Among 291 fetuses/neonates/placentae from women with proven ZIKV infection, congenital infection was confirmed in 76 cases, of which 16 resulted in CZS and 11 resulted in fetal loss. The 215 remaining placentae from ZIKV‐positive women without evidence of congenital ZIKV infection represented the exposed group. A total of 334 placentae from ZIKV‐negative pregnant women represented the non‐exposed control group. Placentomegaly (placental thickness > 40 mm) was observed more frequently in infected placentae (39.5%) than in exposed placentae (17.2%) or controls (7.2%), even when adjusting for gestational age at diagnosis and comorbidities (adjusted hazard ratio (aHR), 2.02 (95% CI, 1.22–3.36) and aHR, 3.23 (95% CI, 1.86–5.61), respectively), and appeared earlier in infected placentae. In the infected group, placentomegaly was observed more frequently in cases of CZS (62.5%) or fetal loss (45.5%) than in those with asymptomatic congenital infection (30.6%) (aHR, 5.43 (95% CI, 2.17–13.56) and aHR, 4.95 (95% CI, 1.65–14.83), respectively). Abnormal umbilical artery Doppler was observed more frequently in cases of congenital infection resulting in fetal loss than in those with asymptomatic congenital infection (30.0% vs 6.1%; adjusted relative risk (aRR), 4.83 (95% CI, 1.09–20.64)). Infected placentae also exhibited a higher risk for any pathological anomaly than did exposed placentae (62.8% vs 21.6%; aRR, 2.60 (95% CI, 1.40–4.83)). Conclusions Early placentomegaly may represent the first sign of congenital infection in ZIKV‐infected women, and should prompt enhanced follo...

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Is Zika Virus an Emerging TORCH Agent? An Invited Commentary

Cited by 22 publications

References 22 publications

The role of the placenta in prenatally acquired Zika virus infection

The role of the placenta in prenatally acquired Zika virus infection

Evaluation of alternative endpoints for ZIKV vaccine efficacy trials

Placental infection by Zika virus in French Guiana

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