Abstract
BackgroundChikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and may cause fetal and neonatal infections after maternal CHIKV-infections during gestation.MethodologyWe performed a systematic review to evaluate the risk for: a) mother-to-child transmission (MTCT), b) antepartum fetal deaths (APFD), c) symptomatic neonatal disease, and d) neonatal deaths from maternal CHIKV-infections during gestation. We also recorded the neonatal clinical manifestations after such maternal infections (qualitative data synthesis). We searched PubMed (last search 3/2017) for articles, of any study design, with any of the above outcomes. We calculated the overall risk of MTCT, APFDs and risk of symptomatic neonatal disease by simple pooling. For endpoints with ≥5 events in more than one study, we also synthesized the data by random-effect-model (REM) meta-analysis.Principal findingsAmong 563 identified articles, 13 articles from 8 cohorts were included in the quantitative data synthesis and 33 articles in the qualitative data synthesis. Most cohorts reported data only on symptomatic rather than on all neonatal infections. By extrapolation also of these data, the overall pooled-MTCT-risk across cohorts was at least 15.5% (206/1331), (12.6% by REMs). The pooled APFD-risk was 1.7% (20/1203); while the risk of CHIKV-confirmed-APFDs was 0.3% (3/1203). Overall, the pooled-risk of symptomatic neonatal disease was 15.3% (203/1331), (11.9% by REMs). The pooled risk of symptomatic disease was 50.0% (23/46) among intrapartum vs 0% (0/712) among antepartum/peripartum maternal infections. Infected newborns, from maternal infections during gestation were either asymptomatic or presented within their first week of life, but not at birth, with fever, irritability, hyperalgesia, diffuse limb edema, rashes and occasionally sepsis-like illness and meningoencephalitis. The pooled-risk of neonatal death was 0.6% (5/832) among maternal infections and 2.8% (5/182) among neonatal infections; long-term neurodevelopmental delays occurred in 50% of symptomatic neonatal infections.Conclusions/SignificancePublished cohorts with data on the risk to the fetus and/or newborn from maternal CHIKV-infections during gestation were sparse compared to the number of recently reported CHIKV-infection outbreaks worldwide; however perinatal infections do occur, at high rates during intrapartum period, and can be related to neonatal death and long-term disabilities.
Highlights
IntroductionChikungunya virus (CHIKV) is a remerging arbovirus[1,2,3,4,5] in the family of Togaviridae, genus Alphavirus that is transmitted by the Aedes spp. mosquitos A. aegyptii and A. albopictus [6] causing a crippling musculoskeletal inflammatory disease in humans characterized by fever, polyarthralgia, myalgia, rash, and headache.[7]
We evaluated the risk for mother-to-child transmission (MTCT), antepartum fetal deaths (APFD) and symptomatic neonatal disease from maternal Chikungunya virus (CHIKV)-infections during gestation
We recorded the list of clinical manifestations of neonatal infections after maternal infections during gestation
Summary
Chikungunya virus (CHIKV) is a remerging arbovirus[1,2,3,4,5] in the family of Togaviridae, genus Alphavirus that is transmitted by the Aedes spp. mosquitos A. aegyptii and A. albopictus [6] causing a crippling musculoskeletal inflammatory disease in humans characterized by fever, polyarthralgia, myalgia, rash, and headache.[7]. CHIKV infection became a nationally notifiable condition in 2015.[4] The number of CHIKV-infections reported in the US, declined after 2015 and in 2017 there were only 36 reported cases from the US, with no locally transmitted cases, and 30 cases from US territories where local transmission continues.[35]. Chikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and may cause fetal and neonatal infections after maternal CHIKV-infections during gestation
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