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.
Highlights
The chikungunya virus (CHIKV) is an enveloped, positivestrand RNA alphavirus belonging to the Togaviridae family and transmitted by Aedes mosquito bites [1]
In June 2005, we identified the first case of mother-to-child chikungunya virus transmission at the Groupe Hospitalier Sud-Reunion level-3 maternity department
Mother-to-child chikungunya virus transmission is frequent in the context of intrapartum maternal viremia, and often leads to severe neonatal infection
Summary
The chikungunya virus (CHIKV) is an enveloped, positivestrand RNA alphavirus belonging to the Togaviridae family and transmitted by Aedes mosquito bites [1] It causes a dengue-like illness, characterized by fever, rash, painful myalgia, and arthralgia, and sometimes arthritis [2]. Its current geographic distribution covers subSaharan Africa, Southeast Asia, India, and the Western Pacific where numerous outbreaks have been reported [4,5,6,7,8] In these areas, upsurges of re-emergence occur at intervals of 7 to 20 years [9]. The virus causes fever, rash, severe joint and muscle pains, and sometimes arthritis (joint inflammation) These symptoms develop within 3–7 days of being bitten by an infected mosquito. Preventative measures include covering arms and legs and using insecticides to avoid insect bites and depriving the mosquitoes of their breeding sites by draining standing water from man-made containers near human dwellings
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