High Incidence of Zika or Chikungunya Infection among Pregnant Women Hospitalized Due to Obstetrical Complications in Northeastern Brazil-Implications for Laboratory Screening in Arbovirus Endemic Area.

Iracema J A A Jacques,Maria De Fátima P M Albuquerque,Paula A S Oliveira,Rafael F O França,Marília A Sena,Camila A M C De Albuquerque,Yasmim L Silva,Ernesto T A Marques,Maria Almerice L Silva,Marli T Cordeiro,Ana B G Guimarães,Cynthia Braga,Leila Katz,Raisa O Pereira,Gabriela D M Albuquerque,Celina M T Martelli,Priscila M S Castanha

doi:10.3390/v13050744

Abstract

The diagnostic of arbovirus-related obstetric complications in high-risk pregnancy and childbirth care is challenging, especially in endemic areas. We conducted a prospective study to track active or recent Zika (ZIKV), dengue (DENV), or chikungunya (CHIKV) virus infection among hospitalized pregnant women (PW) with obstetric complications in a hospital at the epicenter of Zika outbreak and ZIKV-related microcephaly in Brazil. Clinical data and blood samples were collected at enrollment and 10 days after the admission of study participants, between October 2018 and May 2019. Further clinical data were extracted from medical records. Samples were screened by molecular and serological tests. Out of 780 participants, 93.1% (95% CI: 91.1–94.7%) presented previous DENV exposure (IgG). ZIKV, CHIKV, and/or DENV laboratory markers of recent or active infection were detected in 130 PW, yielding a prevalence of 16.6% (95% CI: 14.2–19.5%); 9.4% (95% CI: 7.4–11.7%), 7.4% (95% CI: 5.7–9.7%), and 0.38% (95% CI: 0.1–1.2%) of CHIKV, ZIKV, and DENV infections, respectively. Most ZIKV infections were detected by molecular assays (89.6%), while CHIKV infections were detected by serology (95.9%). Our findings highlight the need for arbovirus infections screening in PW with obstetrical complications, potentially associated to these infections in endemic areas regardless of the signs or symptoms suggestive of arboviral disease.

Highlights

We found that around 17% of the pregnant women (PW) with obstetric complications had laboratory markers of active or recent arbovirus infections (CHIKV, ZIKV, or DENV) at the time of hospitalization
The clinical suspicion of obstetric complication attributed to maternal arbovirus infection was not raised by the clinical staff in all cases, which were only identified after exhaustive laboratory investigation using different diagnostic methods
Our findings highlight the need for laboratory screening of arboviral infections in PW with complications throughout pregnancy and during childbirth, among those who reside in or travel to endemic areas

Summary

Introduction

It is estimated that half of the world population is at risk of being infected by the dengue virus (DENV, genus Flavivirus, family Flaviviridae) every year [1,2]. The recent circulation of Zika virus (ZIKV, genus Flavivirus, family Flaviviridae) in the Pacific region, the Americas, Africa, and Southeast Asia has led to an unprecedented increase in disease-related complications, including Guillain–Barré syndrome and congenital Zika syndrome [3]. In recent decades chikungunya virus (CHIKV, genus Alphavirus, family Togaviridae) has become the focus of attention, due to its rapid spread and the high magnitude of outbreaks in Africa, Asia, Indian Ocean islands, and Europe, and more recently in the Americas, where more than two million suspected cases have been recorded [4,5]

Methods

Discussion

Conclusion