Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus.

Rosa Estela Gazeta,Thamirys Cosmo Gillo Fajardo,Saulo Duarte Passos,Maria De Fátima Valente Rizzo,Francisco Max Damico,Nuria Sanchez Clemente,Antonio Fernandes Moron,Lucas Castro Pires,Dora Fix Ventura,Daniel T Catalan,Ana Laura De Sene Amâncio Zara,Ana Paula Antunes Pascalicchio Bertozzi,Rita De Cássia De Aguirre Bernardes Dezena Dezena,Valtenice De Cassia Rodrigues De Matos França França,Andrea Cristina Botelho Silva,Tania Quintella,Cohort Zika Vírus Jundiaí,Juliana Paula Gomes De Almeida,Antoni Soriano-Arandes

doi:10.3390/v13030523

Abstract

Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.

Highlights

Since Gregg uncovered the correlation between rubella infection during pregnancy and newborn congenital defects [1] innumerable studies have been conducted to establish the mechanisms behind feto–maternal transmission of congenital infections [2]
When we analyzed the exposed/positive children with developmental abnormalities, we found a mild cognitive delay in three cases, speech delay in three cases, autism spectrum disorder (ASD) in two cases, and one case of severe development impairment (CZS)
Of the 48 cases of microcephaly diagnosed in the cohort, only 3 (3.6%) cases were related to Zika virus (ZIKV) infection, a percentage that is similar to those of other regions with a low incidence of congenital infections by ZIKV Brady

Summary

Introduction

Since Gregg uncovered the correlation between rubella infection during pregnancy and newborn congenital defects [1] innumerable studies have been conducted to establish the mechanisms behind feto–maternal transmission of congenital infections [2]. Careful follow-up of these affected children is crucial, more studies to explore the longerterm manifestations of these congenital infections are needed. The correlation between ZIKV pregnancy infection and microcephaly in the newborn made the Brazilian Ministry of Health (BMH) declare, in 2015, a Public Health Emergency of National Concern, and later on, a Public Health Emergency of International Concern was declared by the World Health Organization (WHO) [3]. In December 2016 many South, Central and North American countries described congenital Zika syndrome (CZS) cases, with a total of 2525 confirmed cases, from which 2289 (90%) were in Brazil [6]

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Conclusion