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Zika virus infection in French Polynesia
Jean-Marie Jouannic
, Stephanie Friszer
, Isabelle Leparc-Goffart
, Catherine Garel
, Dominique Eyrolle-Guignot
Published Online: 01 March 2016
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00625-5
Article Info
...
In 2014, 13 cases of fetal cerebral anomaly were diagnosed, compared with four in 2013 and three in 2012. In addition, five neonates are currently under investigation for neurological signs of brainstem dysfunction. As part of the prenatal evaluation of the 13 cases of fetal cerebral anomaly, amniocentesis was offered to all women for fetal karyotype and cytomegalovirus detection by PCR, and performed in ten cases. Following the Brazilian alert on possible fetal cerebral damage secondary to maternal Zika infection, we retrospectively tested six available stored amniotic fluid samples using PCR. Among those, four were positive for Zika virus. The fetal brain anomalies depicted in these cases are presented in the table. Microcephaly (head circumference less than the third centile) was constant, but was observed after 28 weeks of gestation in two cases. In case 1, ventriculomegaly was present at the second trimester routine scan. In case 3, the first scan was done at 29+2 weeks of gestation. Severe abnormalities of midline structures and the cerebellum as well as abnormal gyration were observed, which could reflect an early embryologic hit of the developing brain. A common maternal viral history during the first trimester of pregnancy was reported in three of four cases.
...
Only two observations of severe fetal brain damage were reported in the Brazilian population in January, 2016.5 Our population-based experience should raise awareness regarding the fetal risks of Zika maternofetal infection. It is likely that the true incidence of severe forms of fetal infection has been underestimated in our Polynesian population as we were unable to test all cases retrospectively.
Because of the potential severity of fetal lesions, fetal neurosonography should be considered from the second trimester in cases of maternal proven Zika virus infection, to detect subtle cerebral anomalies that might precede the onset of microcephaly. As we do not know the natural history of Zika virus fetal congenital infection, repeated ultrasonography should be considered.
We declare no competing interests.
References
Zika virus infection in French Polynesia
Jean-Marie Jouannic
, Stephanie Friszer
, Isabelle Leparc-Goffart
, Catherine Garel
, Dominique Eyrolle-Guignot
Published Online: 01 March 2016
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00625-5
Article Info...
In 2014, 13 cases of fetal cerebral anomaly were diagnosed, compared with four in 2013 and three in 2012. In addition, five neonates are currently under investigation for neurological signs of brainstem dysfunction. As part of the prenatal evaluation of the 13 cases of fetal cerebral anomaly, amniocentesis was offered to all women for fetal karyotype and cytomegalovirus detection by PCR, and performed in ten cases. Following the Brazilian alert on possible fetal cerebral damage secondary to maternal Zika infection, we retrospectively tested six available stored amniotic fluid samples using PCR. Among those, four were positive for Zika virus. The fetal brain anomalies depicted in these cases are presented in the table. Microcephaly (head circumference less than the third centile) was constant, but was observed after 28 weeks of gestation in two cases. In case 1, ventriculomegaly was present at the second trimester routine scan. In case 3, the first scan was done at 29+2 weeks of gestation. Severe abnormalities of midline structures and the cerebellum as well as abnormal gyration were observed, which could reflect an early embryologic hit of the developing brain. A common maternal viral history during the first trimester of pregnancy was reported in three of four cases.
...
Only two observations of severe fetal brain damage were reported in the Brazilian population in January, 2016.5 Our population-based experience should raise awareness regarding the fetal risks of Zika maternofetal infection. It is likely that the true incidence of severe forms of fetal infection has been underestimated in our Polynesian population as we were unable to test all cases retrospectively.
Because of the potential severity of fetal lesions, fetal neurosonography should be considered from the second trimester in cases of maternal proven Zika virus infection, to detect subtle cerebral anomalies that might precede the onset of microcephaly. As we do not know the natural history of Zika virus fetal congenital infection, repeated ultrasonography should be considered.
We declare no competing interests.
References
- WHO. WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. http://www.who.int/mediacentre/news/...ittee-zika/en/. ((accessed Feb 8, 2016).)
- Schuler-Faccini, L, Ribeiro, EM, Feitosa, IML et al. Possible association between Zika virus infection and microcephaly?Brazil, 2015. Morb Mortal Wkly Rep. 2016; 65: 59?62
- View in Article
- | CrossRef
- | PubMed
- Petersen, EE, Staples, JE, Meaney-Delman, D et al. Interim guidelines for pregnant women during a Zika virus outbreak?United States, 2016. Morb Mortal Wkly Rep. 2016; 65: 30?33
- View in Article
- | CrossRef
- | PubMed
- European Center for Disease Prevention and Control. Rapid risk assessment: Zika virus infection outbreak. EDCD, French Polynesia; 2014http://ecdc.europa.eu/en/publication...ruary-2016.pdf. ((accessed Feb 8, 2016).)
- Oliveira Melo, AS, Malinger, G, Ximenes, R, Szejnfeld, PO, Alves Sampaio, S, and Bispo de Filippis, AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg?. Ultrasound Obstet Gynecol. 2016; 47: 6?7
- http://www.thelancet.com/journals/la...625-5/fulltext