The Factors Associated with Prevention and Control Practices against Zika Virus Infection among Pregnant Women in Malaysia, a Dengue-Endemic Country.

Febrile or Exanthematous Illness Associated with Zika, Dengue, and Chikungunya Viruses, Panama.

Zika virus in the dock

OBJECTIVES: To characterize maternal Zika virus (ZIKV) infection\n and complement the evidence base for the WHO interim guidance on\n pregnancy management in the context of ZIKV infection. METHODS:\n We searched the relevant database from inception until March\n 2016. Two review authors independently screened and assessed\n full texts of eligible reports and extracted data from relevant\n studies. The quality of studies was assessed using the\n Newcastle-Ottawa Scale (NOS) and the National Institute of\n Health (NIH) tool for observational studies and case\n series/reports, respectively. RESULTS: Among 142 eligible\n full-text articles, 18 met the inclusion criteria (13 case\n series/reports and five cohort studies). Common symptoms among\n pregnant women with suspected/confirmed ZIKV infection were\n fever, rash, and arthralgia. One case of Guillain-Barre syndrome\n was reported among ZIKV-infected mothers, no other case of\n severe maternal morbidity or mortality reported. Complications\n reported in association with maternal ZIKV infection included a\n broad range of fetal and newborn neurological and ocular\n abnormalities; fetal growth restriction, stillbirth, and\n perinatal death. Microcephaly was the primary neurological\n complication reported in eight studies, with an incidence of\n about 1% among newborns of ZIKV infected women in one study.\n CONCLUSION: Given the extensive and variable fetal and newborn\n presentations/complications associated with prenatal ZIKV\n infection, and the dearth of information provided, knowledge\n gaps are evident. Further research and comprehensive reporting\n may provide a better understanding of ZIKV infection in\n pregnancy and attendant maternal/fetal complications. This\n knowledge could inform the creation of effective and\n evidence-based strategies, guidelines and recommendations aimed\n at the management of maternal ZIKV infection. Adherence to\n current best practice guidelines for prenatal care among health\n providers is encouraged, in the context of maternal ZIKV\n infection.

Zika virus (ZIKV) infection during pregnancy can cause severe birth defects in the fetus and is associated with neurodevelopmental abnormalities in childhood. Our objective was to describe ZIKV knowledge and attitudes among pregnant women in Colombia while ZIKV was circulating and whether they predicted the adoption of behaviors to prevent ZIKV mosquito-borne and sexual transmission. We used self-reported data from Zika en Embarazadas y Niños (ZEN), a cohort study of women in early pregnancy across three regions of Colombia during 2017-2018. We used Poisson regression to estimate associations between knowledge, attitudes and previous experience with mosquito-borne infection and preventative behaviors. Among 1519 women, knowledge of mosquito-borne transmission was high (1480; 97.8%) and 1275 (85.5%) participants were worried about ZIKV infection during pregnancy. The most common preventive behavior was wearing long pants (1355; 89.4%). Regular mosquito repellent use was uncommon (257; 17.0%). While ZIKV knowledge and attitudes were not associated with the adoption of ZIKV prevention behaviors, previous mosquito-borne infection was associated with increased condom use (prevalence ratio 1.4, 95% CI 1.1 to 1.7). Participants were well informed about ZIKV transmission and its health consequences. However, whether this knowledge resulted in behavior change is less certain.

Zika virus is a flavivirus transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes, and infection can be asymptomatic or result in an acute febrile illness with rash (1). Zika virus infection during pregnancy is a cause of microcephaly and other severe birth defects (2). Infection has also been associated with Guillain-Barré syndrome (GBS) (3) and severe thrombocytopenia (4,5). In December 2015, the Puerto Rico Department of Health (PRDH) reported the first locally acquired case of Zika virus infection. This report provides an update to the epidemiology of and public health response to ongoing Zika virus transmission in Puerto Rico (6,7). A confirmed case of Zika virus infection is defined as a positive result for Zika virus testing by reverse transcription-polymerase chain reaction (RT-PCR) for Zika virus in a blood or urine specimen. A presumptive case is defined as a positive result by Zika virus immunoglobulin M (IgM) enzyme-linked immunosorbent assay (MAC-ELISA)* and a negative result by dengue virus IgM ELISA, or a positive test result by Zika IgM MAC-ELISA in a pregnant woman. An unspecified flavivirus case is defined as positive or equivocal results for both Zika and dengue virus by IgM ELISA. During November 1, 2015-July 7, 2016, a total of 23,487 persons were evaluated by PRDH and CDC Dengue Branch for Zika virus infection, including asymptomatic pregnant women and persons with signs or symptoms consistent with Zika virus disease or suspected GBS; 5,582 (24%) confirmed and presumptive Zika virus cases were identified. Persons with Zika virus infection were residents of 77 (99%) of Puerto Rico's 78 municipalities. During 2016, the percentage of positive Zika virus infection cases among symptomatic males and nonpregnant females who were tested increased from 14% in February to 64% in June. Among 9,343 pregnant women tested, 672 had confirmed or presumptive Zika virus infection, including 441 (66%) symptomatic women and 231 (34%) asymptomatic women. One patient died after developing severe thrombocytopenia (4). Evidence of Zika virus infection or recent unspecified flavivirus infection was detected in 21 patients with confirmed GBS. The widespread outbreak and accelerating increase in the number of cases in Puerto Rico warrants intensified vector control and personal protective behaviors to prevent new infections, particularly among pregnant women.

In-utero exposure to Zika virus (ZIKV) could lead to miscarriage, preterm birth and congenital Zika syndrome. This study aimed at estimating the burden of ZIKV and Dengue virus (DENV) infections among pregnant women in Bojude, Nigeria. A total of 200 blood samples were collected from pregnant women between February and April 2022. Using the updated CDC guidelines for the diagnosis of ZIKV infections, including ELISA and microneutralization test (MNT), we found that 16.5% of participants were positive for ZIKV IgM, 10% were positive for IgG, and 23% had nAb in their serum. Among the 46 ZIKV nAb-positive women, 52.2% and 10.9% were recent and previous ZIKV infections, respectively, while 6.5% had previous DENV infections. Although no recent DENV infection was detected, recent and previous ZIKV/DENV co-infections were 13.0% and 17.4%, respectively. Two participants had recent secondary ZIKV infections, while 39.1% had prolonged lifelong immunity. Recent ZIKV infection rates were significantly higher among sexually active females aged 20–29 years than other age groups, with the highest risk observed in the first trimester of pregnancy. In addition, the grand-multiparous women are at higher risk of ZIKV infections than other categories. Monotypic recent, secondary and past ZIKV infections, as well as DENV and ZIKV co-infections, were detected in both the asymptomatic and symptomatic pregnant women. These findings highlight that ZIKV infection is prevalent among pregnant women in Nigeria and underscore the associated risk factors, providing evidence-based information on the burden of ZIKV infections in DENV-endemic region.

BackgroundIn the French Territories in the Americas (FTA), the risk of birth defects possibly associated with Zika virus (ZIKV) infection was estimated at 7% among fetuses/infants in a cohort of 546 women who developed a symptomatic RT-PCR confirmed ZIKV infection during pregnancy (NEJM 2018;378:985–94). There was no concomitant prospective cohort of pregnant women without ZIKV infection to use as a control group.MethodsIn Guadeloupe, one of the 3 FTAs that participated in the FTA cohort study, pregnant women were recruited at the time of delivery and tested for ZIKV infection. Women who had a confirmed negative IgG serology test for ZIKV at delivery and no other positive ZIKV test during pregnancy were considered to be ZIKV noninfected. Information on the course of the pregnancy was collected retrospectively and outcomes of live born infants of ZIKV noninfected women were analyzed, using the same definition criteria as those used for the FTA cohort study. Pregnancy outcomes were compared with those of the 241 ZIKV-exposed live born infants in Guadeloupe, extracted from the FTA cohort.ResultsOf the 490 live born infants without in-utero exposure to ZIKV, 42 infants (8.6%) had neurological abnormalities that were described as “potentially linked to ZIKV infection”; all but one of these were microcephaly without any other brain or clinical abnormalities. The proportion of such abnormalities was not statistically different from that observed in the 241 live born infants with ZIKV exposure (6.6%, P = 0.36). When re-considering the combined 8 fetuses and 241 infants of women with confirmed ZIKV infection in Guadeloupe from the FTA cohort, only two (0.8%) live born infants and three (1.2%) medically aborted fetuses had birth defects that could still be linked to ZIKV infection.ConclusionIsolated anthropometric and other mild neurological abnormalities had the same prevalence among live born infants with and without in utero ZIKV exposure. The high prevalence of isolated microcephaly among ZIKV noninfected women in our study population suggests that the sensitive definition for microcephaly, using a −2 SD cut-off with international growth curves, may lead to an overestimate of the rate of neurological complications of ZIKV infection during pregnancy.DisclosuresAll Authors: No reported Disclosures.

Following the 2015 Zika virus (ZIKV) outbreaks in the South Pacific, Caribbean, and Americas, ZIKV has emerged as a serious threat due to its association with infantile microcephaly and other neurologic disorders. Despite an international effort to develop a safe and effective vaccine to combat congenital Zika syndrome and ZIKV infection, only DNA and mRNA vaccines encoding the precursor membrane (prM) and envelope (E) proteins, an inactivated-ZIKV vaccine, and a measles virus-based ZIKV vaccine are currently in phase I or II (prM/E DNA) clinical trials. A ZIKV vaccine based on a nonreplicating, recombinant subunit platform offers a higher safety profile than other ZIKV vaccine candidates but is still highly immunogenic, inducing high virus-neutralizing antibody titers. Here, we describe the production and purification of Drosophila melanogaster S2 insect cell-derived, soluble ZIKV E protein and evaluate its immunogenicity and efficacy in three different mouse strains. As expected, significant virus-specific antibody titers were observed when using formulations containing clinically relevant adjuvants. Immunized mice challenged with live virus demonstrate inhibition of virus replication. Importantly, plaque reduction neutralization tests (PRNTs) indicate the high-titer production of neutralizing antibodies, a correlate of protection in the defense against ZIKV infection. ZIKV challenge of immunocompetent mice led to full protection against viremia with two doses of adjuvanted vaccine candidates. These data demonstrate a proof of concept and establish recombinant subunit immunogens as an effective vaccine candidate against ZIKV infection. IMPORTANCE The recent outbreaks of Zika virus (ZIKV) infection in French Polynesia, the Caribbean, and the Americas have highlighted the severe neuropathological sequelae that such an infection may cause. The development of a safe, effective ZIKV vaccine is critical for several reasons: (i) the difficulty in diagnosing an active infection due to common nonspecific symptoms, (ii) the lack of a specific antiviral therapy, and (iii) the potentially devastating pathological effects of in utero infection. Moreover, a vaccine with an excellent safety profile, such as a nonreplicating, noninfectious vaccine, would be ideal for high-risk people (e.g., pregnant women, immunocompromised patients, and elderly individuals). This report describes the development of a recombinant subunit protein vaccine candidate derived from stably transformed insect cells expressing the ZIKV envelope protein in vitro, the primary antigen to which effective virus-neutralizing antibodies are engendered by immunized animals for several other flaviviruses; the vaccine candidate elicits effective virus-neutralizing antibodies against ZIKV and provides protection against ZIKV infection in mice.

ABSTRACT.Serological cross-reactivity has proved to be a challenge to diagnose Zika virus (ZIKV) infections in dengue virus (DENV) endemic countries. Confirmatory testing of ZIKV IgM positive results by plaque reduction neutralization tests (PRNTs) provides clarification in only a minority of cases because most individuals infected with ZIKV were previously exposed to DENV. The goal of this study was to evaluate the performance of a ZIKV/DENV DUO IgM antibody capture ELISA (MAC-ELISA) for discriminating between DENV and ZIKV infections in endemic regions. Our performance evaluation included acute and convalescent specimens from patients with real-time reverse transcription polymerase chain reaction (RT-PCR)-confirmed DENV or ZIKV from the Sentinel Enhanced Dengue Surveillance System in Ponce, Puerto Rico. The ZIKV/DENV DUO MAC-ELISA specificity was 100% for DENV (N = 127) and 98.4% for ZIKV (N = 275) when specimens were tested during the optimal testing window (days post-onset of illness [DPO] 6–120). The ZIKV/DENV DUO MAC-ELISA sensitivity of RT-PCR confirmed specimens reached 100% for DENV by DPO 6 and for ZIKV by DPO 9. Our new ZIKV/DENV DUO MAC-ELISA was also able to distinguish ZIKV and DENV regardless of previous DENV exposure. We conclude this novel serologic diagnostic assay can accurately discriminate ZIKV and DENV infections. This can potentially be useful considering that the more labor-intensive and expensive PRNT assay may not be an option for confirmatory diagnosis in areas that lack PRNT capacity, but experience circulation of both DENV and ZIKV.

Background: Zika virus (ZIKV) infection is a public health concern. The first ZIKV outside Africa was detected in mosquito in Malaysia. More than six decades ago, serological surveys indicated the presence of human infection with ZIKV in the Malaysian Borneo state of Sabah. It has also been demonstrated that orangutans in Sabah have antibodies against ZIKV. Several years ago, a case of human ZIKV infection was reported in a traveler who visited Sabah. Therefore, it is thought that ZIKV is endogenous to Sabah and is widely distributed. During the recent global epidemic of ZIKV, the first autochthonous case and two subsequent autochthonous cases were detected in Sabah. Because ZIKV infection is mainly asymptomatic or mildly symptomatic, the extent of ZIKV infection in the population of Sabah is not known. Furthermore, the presence of ZIKV in vector mosquitoes and animals has not been investigated. Therefore, the present study was performed to analyze the outbreak cases of ZIKV infection and to determine their relationship with the burden of ZIKV infection in the local population, mosquitoes, and wild nonhuman primates in Sabah. Methods: Serum and urine samples were collected from two local patients with ZIKV infection, their household members, and those who resided within 400m of the patients’ residences. Serum samples were also collected from four wild Maca fascicularis. Mosquito samples, mostly female Aedes albopictus, were collected from 30 sites in Kota Kinabalu. The presence of ZIKV was assessed by RT-qPCR and RT-PCR. Phylogenetic analysis was performed using the neighbor-joining method. Results: Two cases of ZIKV infection were identified by reverse-transcription quantitative PCR (RT-qPCR) in residents of Kota Kinabalu, and the Taiwanese health authorities reported one case in an individual who visited Kota Kinabalu during the study period. All household members of both local patients and people living within a 400 m radius of the patients were negative for ZIKV. Furthermore, mosquitoes collected from the surroundings of the residences and places visited by the patients and four serum samples from M. fascicularis were also negative for ZIKV. A phylogenetic tree constructed using the nucleotide sequences of the envelope genes of ZIKV showed that the strains from Sabah formed a cluster with strains from Thailand and Cambodia, and belong to the Asian lineage. Conclusions: Our study revealed that ZIKVs in Sabah is of Asian lineage and are not related to the recent outbreak strains in the Americas and Singapore. ZIKV infection in Sabah is sporadic, possibly because of limited transmission of the virus. Further studies are needed to characterize the evolutionary history of ZIKV in Sabah to understand the epidemiology of this infection in Borneo.

Pregnancy outcomes after maternal Zika virus infection in a non-endemic region: prospective cohort study

Zika virus is one Flavi virus, which is similar to dengue virus. At present, Zika virus infection occurs in some countries located in Central and South America. It is carried by Aedes aegypti mosquitoes, which are not living in Korea. However, Aedes albopictus has been spotted in Jeju Island and now this particular mosquito is known for carrying the virus, but at the current moment this mosquito is not carrying the Zika virus in Korea (1). Zika virus was initially discovered in rhesus monkeys in Zika forest, Tanzania in 1947 (2). After that, the virus sporadically spread in Asia and Africa. Aside from the two continents, the first report of the outbreak came from Yap Island in the Federated States of Micronesia. At that time, it was recorded that 14.6 per 10 million people were infected by the virus (3). From this time on, French Polynesia in the South Pacific reported the largest outbreak of Zika virus infection in 2013; a rise was recorded where 28,000 people (approximately 11% of the population) had been infected in 2013-2014 (4). On 1 February 2016, the World Health Organization declared a Public Health Emergency of International Concern to encourage prevention of international spreading of Zika virus infection. In Central and South America, including Brazil, about 1.5 million people were estimated to be infected by the virus in 2015. With the outbreak of Zika virus from 2015 to 16 January 2016, 3,893 babies with microcephaly or underdeveloped brains and skulls were born in Brazil and 49 babies died. Zika virus was confirmed in the amniotic fluid of pregnant women and the brain and body tissues of dead or stillborn children (5,6). However, it is unknown how Zika virus causes microcephaly when pregnant women are infected by the virus. The prevalence of Guillain-Barre syndrome also increases in endemic areas of Zika virus infection but relation of that syndrome and the infection is not proven (6,7). Nations where Zika virus is found recently are summarized in Table 1 (8). Table 1 Nations that Zika virus has been found from 2015. Zika virus is rarely transferred between people. It is assumed that the virus could spread through blood transfusion. When an outbreak of Zika virus was reported in French Polynesia between 2013 and 2014, 3% of blood donations tested positive by PCR (9). There was a report that Zika virus could be transmitted through sexual contact. When an outbreak happened in French Polynesia in 2013, semen samples of patients who were believed to be infected tested positive for Zika virus by PCR (10). Moreover, after a person travelled to Senegal, Zika virus was found in his semen and his wife was observed to have Zika virus infection symptoms after 4 days of having sexual contact (11). However, this is very rare. Further research will be needed to determine whether Zika virus could be transmitted by sexual contact. Although Zika virus was found in patients' urine or saliva, it is not confirmed transmittable through these kinds of body fluid (12, 13). Zika fever is officially specified as a group 4 legal infectious disease by Korean Center for Disease Control and Prevention (KCDC) on 29 January 2016 (14). All medical staffs were directed to report to KCDC when they find patients who are suspected to have Zika virus infection or those who are confirmed to have the Zika virus infection. KCDC recommends that pregnant women do not visit nations where Zika virus is reported to have occurred in the last 2 months. KCDC started to promote means of preventing Zika virus infection to travelers who will visit the identified countries. Since there is a possibility for Zika virus infection among travelers who visit high-risk countries, there is a need to monitor travelers coming from the countries identified to be at risk. Additionally, due to global warming, the ecosystem of mosquitoes in Korea has been changed. Monitoring the mosquitoes' habitat as well as research on the possibility of domestic occurrence should be continued. Many climate scientists and infectious disease specialists have said that environment destruction, industrial developments, and global warming are the major reasons for the spread of mosquito-borne infections. Since 1970, destruction of tropical forests due to development of large-scale resorts, plantations, and industries has been happening in Southeast Asia and South America. Because of the urbanization of tropical forests and global warming, mosquitoes' growth condition is at its peak. This causes the outbreak of dengue fever in Southeast Asia and Zika fever in South America. Environmental destruction leads to a potential disaster that could totally change our life. Zika virus infection is a new disease that threatens global public health, as WHO declared. It is the time to come up with a long-term perspective and systematic preparations to control this disease.

Zika virus (ZIKV) infection in pregnant women during the third trimester can cause neurodevelopmental delays and cryptorchidism in children without microcephaly. However, the consequences of congenital ZIKV infection on fertility in these children remain unclear. Here, using an immunocompetent mouse model, we reveal that congenital ZIKV infection can cause hormonal disorders of the hypothalamic-pituitary-gonadal axis, leading to reduced fertility and decreased sexual preference. Our study has for the first time linked the hypothalamus to the reproductive system and social behaviors after ZIKV infection. Although the extent to which these observations in mice translate to humans remains unclear, these findings did suggest that the reproductive health and hormone levels of ZIKV-exposed children should receive more attention to improve their living quality.

BackgroundCXCL10 has been shown to increase up to 200-fold during ZIKV infection in pregnant women and is associated with the pathogenesis of ZIKV. This research aimed to investigate the relationship...

Association between Guillain-Barré syndrome and Zika virus infection