Prolonged Detection of Zika Virus Nucleic Acid Among Symptomatic Pregnant Women: A Cohort Study

Lozier, Matthew; Rosenberg, Eli S.; Doyle, Kate; Adams, Laura; Klein, Liore; Muñoz‐Jordán, Jorge L.; Alvarado, Luisa I.; Sharp, Tyler M.; Paz–Bailey, Gabriela

doi:10.1093/cid/ciy209

Cited by 25 publications

(24 citation statements)

References 11 publications

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“…Interestingly, one contact had a serum VL of 6.7 log 10 copies/ml two days before symptom onset (data point excluded from Fig 4 ). Previous reports suggest prolonged maternal viremia in pregnant women [ 57 – 60 ]. While our sample size was very small, the four ZIKV rRT-PCR confirmed pregnant women in our study had a mean VL of 4.4 log 10 copies/ml ZIKV in urine (up to 7 days post-symptom onset) and mean VL of 3.5 log 10 copies/ml in serum/plasma (up to 5 days), comparable to non-pregnant subjects; however, the women were only followed for 21 days.…”

Section: Resultsmentioning

confidence: 99%

Zika virus infection in Nicaraguan households

et al. 2018

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Zika virus (ZIKV) infection recently caused major epidemics in the Americas and is linked to congenital birth defects and Guillain-Barré Syndrome. A pilot study of ZIKV infection in Nicaraguan households was conducted from August 31 to October 21, 2016, in Managua, Nicaragua. We enrolled 33 laboratory-confirmed Zika index cases and their household members (109 contacts) and followed them on days 3–4, 6–7, 9–10, and 21, collecting serum/plasma, urine, and saliva specimens along with clinical, demographic, and socio-economic status information. Collected samples were processed by rRT-PCR to determine viral load (VL) and duration of detectable ZIKV RNA in human bodily fluids. At enrollment, 11 (10%) contacts were ZIKV rRT-PCR-positive and 23 (21%) were positive by IgM antibodies; 3 incident cases were detected during the study period. Twenty of 33 (61%) index households had contacts with ZIKV infection, with an average of 1.9 (range 1–6) positive contacts per household, and in 60% of these households, ≥50% of the members were positive for ZIKV infection. Analysis of clinical information allowed us to estimate the symptomatic to asymptomatic (S:A) ratio of 14:23 (1:1.6) among the contacts, finding 62% of the infections to be asymptomatic. The maximum number of days during which ZIKV RNA was detected was 7 days post-symptom onset in saliva and serum/plasma and 22 days in urine. Overall, VL levels in serum/plasma, saliva, and urine specimens were comparable, with means of 5.6, 5.3 and 4.5 log10 copies/ml respectively, with serum attaining the highest VL peak at 8.1 log10 copies/ml. Detecting ZIKV RNA in saliva over a similar time-period and level as in serum/plasma indicates that saliva could potentially serve as a more accessible diagnostic sample. Finding the majority of infections to be asymptomatic emphasizes the importance of silent ZIKV transmission and helps inform public health interventions in the region and globally.

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Section: Resultsmentioning

confidence: 99%

Zika virus infection in Nicaraguan households

et al. 2018

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“…Dengue and Zika virus RNA are likely to be detected in serum from approximately 2 days before to 1 week after illness onset (4,5,35,36). However, detection of Zika virus nucleic acid might be prolonged in some patients, especially pregnant women (5,(37)(38)(39)(40)(41). Zika virus RNA also can be detected in other body fluids (e.g., whole blood, urine, saliva, amniotic fluid, semen, and breast milk), and some reports suggest that viral RNA might be found at higher levels or for longer duration in some of these specimens (7,(42)(43)(44)(45)(46)(47)(48).…”

Section: Dengue and Zika Virus Infections And Immune Responsementioning

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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“…Serum specimens collected four or more days post-illness onset were tested by anti-ZIKV IgM antibody capture enzyme-linked immunosorbent assay (MAC ELISA) [24], as well as by anti-DENV MAC ELISA (InBios International, Inc., Seattle, WA) as resources allowed. Because viremia is extended in pregnant women [25,26] and ZIKV RNA is detectable in urine [27], both serum and urine specimens from symptomatic pregnant women were tested by RT-PCR regardless of day post-illness onset of specimen collection. All serum specimens from symptomatic pregnant women that tested negative by RT-PCR were tested by anti-ZIKV MAC ELISA, and those that tested positive or equivocal by anti-ZIKV MAC ELISA were prioritized for further testing by anti-DENV MAC ELISA.…”

Section: Diagnostic Testingmentioning

confidence: 99%

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

et al. 2020

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Background After Zika virus (ZIKV) emerged in the Americas, laboratory-based surveillance for arboviral diseases in Puerto Rico was adapted to include ZIKV disease. Methods and findings Suspected cases of arboviral disease reported to Puerto Rico Department of Health were tested for evidence of infection with Zika, dengue, and chikungunya viruses by RT-PCR and IgM ELISA. To describe spatiotemporal trends among confirmed ZIKV disease cases, we analyzed the relationship between municipality-level socio-demographic, climatic, and spatial factors, and both time to detection of the first ZIKV disease case and the midpoint of the outbreak. During November 2015-December 2016, a total of 71,618 suspected arboviral disease cases were reported, of which 39,717 (55.5%; 1.1 cases per 100 residents) tested positive for ZIKV infection. The epidemic peaked in August 2016, when 71.5% of arboviral disease cases reported weekly tested positive for ZIKV infection. Incidence of ZIKV disease was highest among 20-29-year-olds (1.6 cases per 100 residents), and most (62.3%) cases were female. The most frequently reported symptoms were rash (83.0%), headache (64.6%), and myalgia (63.3%). Few patients were hospitalized (1.2%), and 13 (<0.1%) died. Early detection of ZIKV disease cases was associated with increased population size (log hazard ratio [HR]:-0.22 [95% confidence interval-0.29,-0.14]), eastern longitude (log HR:-1.04 [-1.17,-0.91]), and proximity to a city (spline estimated degrees of freedom [edf] = 2.0). Earlier midpoints of the outbreak were associated with northern latitude (log HR:-0.30 [-0.32,-0.29]), eastern longitude (spline edf = 6.5), and higher mean monthly temperature PLOS NEGLECTED TROPICAL DISEASES

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Prolonged Detection of Zika Virus Nucleic Acid Among Symptomatic Pregnant Women: A Cohort Study

Cited by 25 publications

References 11 publications

Zika virus infection in Nicaraguan households

Zika virus infection in Nicaraguan households

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

Epidemiologic and spatiotemporal trends of Zika Virus disease during the 2016 epidemic in Puerto Rico

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