Probable Sexually Transmitted Zika Virus Infection in a Pregnant Woman

Desclaux, A.; Lamballerie, Xavier de; Leparc-Goffart, Isabelle; Vilain-Parce, Alice; Coatleven, F.; Fleury, Hervé; Malvy, Denis

doi:10.1056/nejmc1710453

Cited by 20 publications

(17 citation statements)

References 5 publications

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“…We included 67 reports about ZIKV sexual transmission; measurement of ZIKV infection status using RT-PCR or viral culture in samples of semen, vaginal fluid, or saliva; or both [ 6 , 20 , 74 – 138 ]. Twenty-four of these studies reported on 36 couples in which a primary partner with ZIKV infection, who returned from a ZIKV endemic area, is suspected to have transmitted ZIKV to a secondary partner [ 6 , 78 , 79 , 82 , 84 , 85 , 87 , 88 , 90 , 91 , 96 , 100 , 102 , 105 , 113 , 115 , 119 – 121 , 123 , 124 , 127 , 131 , 137 ] ( Table 3 ). Thirty-four of 36 episodes of transmission were from man to woman (94%), 1 (3%) was from woman to man [ 96 ], and 1 (3%) was from man to man [ 85 ].…”

Section: Resultsmentioning

confidence: 99%

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Sexual transmission of Zika virus and other flaviviruses: A living systematic review

et al. 2018

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BackgroundHealth authorities in the United States and Europe reported an increasing number of travel-associated episodes of sexual transmission of Zika virus (ZIKV) following the 2015–2017 ZIKV outbreak. This, and other scientific evidence, suggests that ZIKV is sexually transmissible in addition to having its primary mosquito-borne route. The objective of this systematic review and evidence synthesis was to clarify the epidemiology of sexually transmitted ZIKV.Methods and findingsWe performed a living (i.e., continually updated) systematic review of evidence published up to 15 April 2018 about sexual transmission of ZIKV and other arthropod-borne flaviviruses in humans and other animals. We defined 7 key elements of ZIKV sexual transmission for which we extracted data: (1) rectal and vaginal susceptibility to infection, (2) incubation period following sexual transmission, (3) serial interval between the onset of symptoms in a primary and secondary infected individuals, (4) duration of infectiousness, (5) reproduction number, (6) probability of transmission per sex act, and (7) transmission rate. We identified 1,227 unique publications and included 128, of which 77 presented data on humans and 51 presented data on animals. Laboratory experiments confirm that rectal and vaginal mucosae are susceptible to infection with ZIKV and that the testis serves as a reservoir for the virus in animal models. Sexual transmission was reported in 36 human couples: 34/36 of these involved male-to-female sexual transmission. The median serial symptom onset interval in 15 couples was 12 days (interquartile range: 10–14.5); the maximum was 44 days. We found evidence from 2 prospective cohorts that ZIKV RNA is present in human semen with a median duration of 34 days (95% CI: 28–41 days) and 35 days (no CI given) (low certainty of evidence, according to GRADE). Aggregated data about detection of ZIKV RNA from 37 case reports and case series indicate a median duration of detection of ZIKV of 40 days (95% CI: 30–49 days) and maximum duration of 370 days in semen. In human vaginal fluid, median duration was 14 days (95% CI: 7–20 days) and maximum duration was 37 days (very low certainty). Infectious virus in human semen was detected for a median duration of 12 days (95% CI: 1–21 days) and maximum of 69 days. Modelling studies indicate that the reproduction number is below 1 (very low certainty). Evidence was lacking to estimate the incubation period or the transmission rate. Evidence on sexual transmission of other flaviviruses was scarce. The certainty of the evidence is limited because of uncontrolled residual bias.ConclusionsThe living systematic review and sexual transmission framework allowed us to assess evidence about the risk of sexual transmission of ZIKV. ZIKV is more likely transmitted from men to women than from women to men. For other flaviviruses, evidence of sexual transmissibility is still absent. Taking into account all available data about the duration of detection of ZIKV in culture and from the serial interval, our fi...

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Section: Resultsmentioning

confidence: 99%

“…No diagnostic method was stated for 29/72 (40%) individuals. In 5/36 (14%) couples, the secondary partner also had a history of travel to an endemic region [ 88 , 91 , 115 , 124 , 137 ].…”

Section: Resultsmentioning

confidence: 99%

Sexual transmission of Zika virus and other flaviviruses: A living systematic review

et al. 2018

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“…Sexual transmission in humans was first reported in 2008 (10) and from 2015-2018, 52 cases of sexually transmitted ZIKV were reported in the United States (11). Sexual transmission of ZIKV has been described from a male to pregnant female as well (12,13). ZIKV RNA and infectious virus have been detected in human semen (up to 10 7 copies/ml) (14) , considerably longer than detection in blood, saliva and urine (6).…”

Section: Introductionmentioning

confidence: 99%

Maternal Zika Virus (ZIKV) Infection following Vaginal Inoculation with ZIKV-Infected Semen in Timed-Pregnant Olive Baboons

Gurung

Nadeau

Maxted

et al. 2020

J Virol

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Zika virus (ZIKV) infection is now firmly linked to congenital Zika syndrome (CZS), including fetal microcephaly. While Aedes species of mosquito are the primary vector for ZIKV, sexual transmission of ZIKV is a significant route of infection. ZIKV has been documented in human, mouse, and nonhuman primate (NHP) semen. It is critical to establish NHP models of the vertical transfer of ZIKV that recapitulate human pathogenesis. We hypothesized that vaginal deposition of ZIKV-infected baboon semen would lead to maternal infection and vertical transfer in the olive baboon (Papio anubis). Epidemiological studies suggest an increased rate of CZS in the Americas compared to the original link to CZS in French Polynesia; therefore, we also compared the French Polynesian (FP) ZIKV isolate to the Puerto Rican (PR) isolate. Timed-pregnant baboons (n = 6) were inoculated via vaginal deposition of baboon semen containing 106 focus-forming units (FFU) of ZIKV (n = 3 for FP isolate H/PF/2013; n = 3 for PR isolate PRVABC59) at midgestation (86 to 95 days of gestation [dG]; term, 183 dG) on day 0 (all dams) and then at 7-day intervals through 3 weeks. Maternal blood, saliva, and cervicovaginal wash (CVW) samples were obtained. Animals were euthanized at 28 days (n = 5) or 39 days (n = 1) after the initial inoculation, and maternal/fetal tissues were collected. Viremia was achieved in 3/3 FP ZIKV-infected dams and 2/3 PR ZIKV-infected dams. ZIKV RNA was detected in CVW samples of 5/6 dams. ZIKV RNA was detected in lymph nodes but not the ovaries, uterus, cervix, or vagina in FP isolate-infected dams. ZIKV RNA was detected in lymph nodes (3/3), uterus (2/3), and vagina (2/3) in PR isolate-infected dams. Placenta, amniotic fluid, and fetal tissues were ZIKV RNA negative in the FP isolate-infected dams, whereas 2/3 PR isolate-infected dam placentas were ZIKV RNA positive. We conclude that ZIKV-infected semen is a means of ZIKV transmission during pregnancy in primates. The PR isolate appeared more capable of widespread dissemination to tissues, including reproductive tissues and placenta, than the FP isolate. IMPORTANCE Zika virus remains a worldwide health threat, with outbreaks still occurring in the Americas. While mosquitos are the primary vector for the spread of the virus, sexual transmission of Zika virus is also a significant means of infection, especially in terms of passage from an infected to an uninfected partner. While sexual transmission has been documented in humans, and male-to-female transmission has been reported in mice, ours is the first study in nonhuman primates to demonstrate infection via vaginal deposition of Zika virus-infected semen. The latter is important since a recent publication indicated that human semen inhibited, in a laboratory setting, Zika virus infection of reproductive tissues. We also found that compared to the French Polynesian isolate, the Puerto Rican Zika virus isolate led to greater spread throughout the body, particularly in reproductive tissues. The American isolates of Zika virus appear to have acquired mutations that increase their efficacy.

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“…Parmi les MIE du début du 21 e siècle classées comme Urgence de santé publique de portée internationale (USPPI), l'une, la MVE [45][46][47] a confirmé sa capacité à être transmise par voie sexuelle et l'autre, l'infection par l'arbovirus Zika, ont démontré leur capacité à être transmise par voie sexuelle [48][49][50][51][52]. Leurs agents pathogènes respectifs sont principalement transmis à partir du sperme de patients convalescents au cours des semaines suivant la résolution de la phase aiguë de la maladie virale.…”

Section: La Transmission Sexuelle Des Virus éMergents à Potentiel éPiunclassified

“…Dans ce cas, seule la recherche d'anticorps neutralisants, lourde et non adaptée au dépistage ou diagnostic de proximité, avait rendu a posteriori un résultat positif chez le patient-source. En 2019, plusieurs tests candidats à la qualification de l'infectivité du virus Zika dans les fluides, déclinés à partir de l'expertise de l'évaluation de l'infectiosité d'autres arbovirus d'importance humaine, sont attendus pour compléter l'arsenal des outils et méthodes pour la prévention et la prise en charge de la transmission sexuelle, marginale, mais emblématique des virus émergents à potentiel épidémique et menaçant [50].…”

Section: Figureunclassified