Multidisciplinary Prospective Study of Mother-to-Child Chikungunya Virus Infections on the Island of La Réunion

Abstract

BackgroundAn outbreak of chikungunya virus affected over one-third of the population of La Réunion Island between March 2005 and December 2006. In June 2005, we identified the first case of mother-to-child chikungunya virus transmission at the Groupe Hospitalier Sud-Réunion level-3 maternity department. The goal of this prospective study was to characterize the epidemiological, clinical, biological, and radiological features and outcomes of all the cases of vertically transmitted chikungunya infections recorded at our institution during this outbreak.Methods and FindingsOver 22 mo, 7,504 women delivered 7,629 viable neonates; 678 (9.0%) of these parturient women were infected (positive RT-PCR or IgM serology) during antepartum, and 61 (0.8%) in pre- or intrapartum. With the exception of three early fetal deaths, vertical transmission was exclusively observed in near-term deliveries (median duration of gestation: 38 wk, range 35–40 wk) in the context of intrapartum viremia (19 cases of vertical transmission out of 39 women with intrapartum viremia, prevalence rate 0.25%, vertical transmission rate 48.7%). Cesarean section had no protective effect on transmission. All infected neonates were asymptomatic at birth, and median onset of neonatal disease was 4 d (range 3–7 d). Pain, prostration, and fever were present in 100% of cases and thrombocytopenia in 89%. Severe illness was observed in ten cases (52.6%) and mainly consisted of encephalopathy (n = 9; 90%). These nine children had pathologic MRI findings (brain swelling, n = 9; cerebral hemorrhages, n = 2), and four evolved towards persistent disabilities.ConclusionsMother-to-child chikungunya virus transmission is frequent in the context of intrapartum maternal viremia, and often leads to severe neonatal infection. Chikungunya represents a substantial risk for neonates born to viremic parturients that should be taken into account by clinicians and public health authorities in the event of a chikungunya outbreak.

Reporte de caso de transmisión vertical de la infección por virus chikungunya

“…In the present case the patient had fever, rash, thrombocytopenia and elevation of transaminases, which are alterations that have been described in a high proportion in patients with chikungunya infection 2 , the presence of irritability, pain and edema in the limbs has also been frequently described, although not observed in this case 7 .…”

“…The epidemic on La Reunión Island revealed the possibility of mother-to-child transmission of the chikungunya virus when they had the infection 4 days before or 2 days postpartum 3,7 . Chikungunya virus infection can occur in any trimester of pregnancy, but placental histological lesions are uncommon outside the peripartum period, thence fetal involve-ment with unfavorable outcomes is rare.…”

“…It is believed that vertical transmissions occur due to placental microtransfusions during labor in mothers with active viremia 5,8 . The infection is also possible during the passage through the birth canal, but in cesarean delivery patients have not been considered as a protective factor 7 . There is no evidence that the virus is transmitted through breast milk 3 .…”

Household survey of container–breeding mosquitoes and climatic factors influencing the prevalence of Aedes aegypti (Diptera: Culicidae) in Makkah City, Saudi Arabia

“…Potential insect-based bio-terrorism [2] and recurrent outbreaks of mosquito-borne diseases such as Chikungunya infection [3][4][5] are indications of the continuous threat of diseases transmitted by insects, as does the rise in dengue virus infections during the last decade, worldwide [6,7] .…”

Le virus Zika

“…Du virus réplicatif a également été mis en évidence dans du lait maternel d'une femme infectée en Nouvelle Calédonie [47]. Ces modes de transmission (périnatal et/ou par allaitement maternel) ont aussi été rapportés pour d'autres arbovirus tels que le CHIKV [48], le DENV [49] ou le WNV [50]. Plusieurs cas rapportés suggèrent une possible transmission sexuelle du ZIKV, une voie de transmission jamais décrite à ce jour pour un arbovirus.…”