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Neelam V, Woodworth KR, Chang DJ, Roth NM, Reynolds MR, Akosa A, Carr CP, Anderson KN, Mulkey SB, DeBiasi RL, Biddle C, Lee EH, Elmore AL, Scotland SJ, Sowunmi S, Longcore ND, Ahmed M, Langlois PH, Khuwaja S, Browne SE, Lind L, Shim K, Gosciminski M, Blumenfeld R, Khuntia S, Halai UA, Locklear A, Chan M, Willabus T, Tonzel J, Marzec NS, Barreto NA, Sanchez C, Fornoff J, Hale S, Nance A, Iguchi L, Adibhatla SN, Potts E, Schiffman E, Raman D, McDonald MF, Stricklin B, Ludwig E, Denson L, Contreras D, Romitti PA, Ferrell E, Marx M, Signs K, Cook A, Leedom VO, Beauregard S, Orantes LC, Cronquist L, Roush L, Godfred-Cato S, Gilboa SM, Meaney-Delman D, Honein MA, Moore CA, Tong VT. Outcomes up to age 36 months after congenital Zika virus infection-U.S. states. Pediatr Res 2024; 95:558-565. [PMID: 37658124 PMCID: PMC10913023 DOI: 10.1038/s41390-023-02787-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. METHODS From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. RESULTS Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. CONCLUSION Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. IMPACT We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.
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Affiliation(s)
- Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel J Chang
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Nicole M Roth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Megan R Reynolds
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Akosa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kayla N Anderson
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah B Mulkey
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Roberta L DeBiasi
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Cara Biddle
- Children's National Hospital, Washington, D. C., USA
- The George Washington University School of Medicine and Health Sciences, Washington, D. C., USA
| | - Ellen H Lee
- New York City Department of Health & Mental Hygiene, New York City, NY, USA
| | | | | | | | | | | | | | | | | | - Leah Lind
- Pennsylvania Department of Health, Pittsburgh, PA, USA
| | - Kyoo Shim
- Dallas County Health and Human Services, Dallas, TX, USA
| | | | | | - Shreya Khuntia
- District of Columbia Department of Health, Washington, D. C, USA
| | - Umme-Aiman Halai
- Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Autumn Locklear
- North Carolina Department of Health and Human Services, Chapel Hill, NC, USA
| | - Mary Chan
- Washington State Department of Health, Seattle, WA, USA
| | | | - Julius Tonzel
- Louisiana Department of Health, New Orleans, LA, USA
| | - Natalie S Marzec
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | - Connie Sanchez
- Hidalgo County Health & Human Services Department, Hidalgo, TX, USA
| | - Jane Fornoff
- Illinois Department of Public Health, Springfield, IL, USA
| | - Shelby Hale
- Ohio Department of Health, Columbus, OH, USA
| | - Amy Nance
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | | | | | - Emily Potts
- Indiana Department of Health, Indianapolis, IN, USA
| | | | - Devin Raman
- Southern Nevada Health District, Las Vegas, NV, USA
| | | | | | - Elizabeth Ludwig
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Lindsay Denson
- Oklahoma State Department of Health, Oklahoma City, OK, USA
| | | | - Paul A Romitti
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Emily Ferrell
- Kentucky Department for Public Health, Georgetown, KY, USA
| | - Meghan Marx
- South Dakota Department of Health, Pierre, SD, USA
| | - Kimberly Signs
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Amie Cook
- Kansas Department of Health and Environment, Topeka, KS, USA
| | - Vinita Oberoi Leedom
- South Carolina Department of Health and Environmental Control, Florence, SC, USA
| | - Suzann Beauregard
- New Hampshire Department of Health and Human Services, Concord, NH, USA
| | | | | | - Lesley Roush
- West Virginia Bureau for Public Health, Charleston, WV, USA
| | - Shana Godfred-Cato
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana Meaney-Delman
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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2
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Alger J, Cafferata ML, López R, Wiggins LD, Callejas A, Castillo M, Fúnes J, Rico F, Valencia D, Varela D, Alvarez Z, Berrueta M, Bock H, Bustillo C, Calderón A, Ciganda A, García-Aguilar J, García K, Gibbons L, Gilboa SM, Harville EW, Hernández G, López W, Lorenzana I, Luque MT, Maldonado C, Moore C, Ochoa C, Parham L, Pastrana K, Paternina-Caicedo A, Rodríguez H, Stella C, Tannis AF, Wesson DM, Zúniga C, Tong VT, Buekens P. Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people. Pediatr Res 2024; 95:566-572. [PMID: 38057577 PMCID: PMC11045253 DOI: 10.1038/s41390-023-02951-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/12/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.
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Affiliation(s)
- Jackeline Alger
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras.
| | | | - Raquel López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Callejas
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Mario Castillo
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Jenny Fúnes
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Fátima Rico
- Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas Varela
- Servicio de Neurología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Zulma Alvarez
- Unidad de Vigilancia de la Salud, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Harry Bock
- Dirección General, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Dra. Nerza Paz, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Carolina Bustillo
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Alejandra Calderón
- Centro de Salud Alonso Suazo, Región Sanitaria Metropolitana del Distrito Central, currently Centro de Salud Villanueva, Región Sanitaria Metropolitana del Distrito Central, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Alvaro Ciganda
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Jorge García-Aguilar
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Kimberly García
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Gustavo Hernández
- Departamento de Pediatría, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Wendy López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Marco T Luque
- Servicio de Infectología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Carlos Maldonado
- Servicio de Oftalmología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Cynthia Moore
- Goldbelt Professional Services, LLC, Chesapeake, VA, USA
| | - Carlos Ochoa
- Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Leda Parham
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Karla Pastrana
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Angel Paternina-Caicedo
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Heriberto Rodríguez
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras
| | - Candela Stella
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | | | - Dawn M Wesson
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Concepción Zúniga
- Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Van T Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pierre Buekens
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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3
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Godoi JTAM, Negrini SFBM, Aragon DC, Rocha PRH, Amaral FR, Negrini BVM, Teixeira SR, Yamamoto AY, Bettiol H, Mussi-Pinhata MM. Normocephalic Children Exposed to Maternal Zika Virus Infection Do Not Have a Higher Risk of Neurodevelopmental Abnormalities around 24 Months of Age than Unexposed Children: A Controlled Study. Pathogens 2023; 12:1219. [PMID: 37887735 PMCID: PMC10609945 DOI: 10.3390/pathogens12101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
Although very few controlled studies are available, in utero Zika virus (ZIKV)-exposed children are considered at risk for neurodevelopmental abnormalities. We aimed to identify whether there is an excess risk of abnormalities in non-microcephalic children born to mothers with confirmed ZIKV infection compared with ZIKV-unexposed children from the same population. In a cross-sectional study nested in two larger cohorts, we compared 324 ZIKV-exposed children with 984 unexposed controls. Outcomes were assessed using the Bayley Screening Test III applied around 24 months of age. Relative risks for classifying children as emergent or at-risk for neurodevelopmental delay in at least one of five domains were calculated, adjusting for covariates. In four of the five domains, few children were classified as emergent (4-12%) or at-risk (0.3-2.16%) but for the expressive communication domain it was higher for emergent (19.1-42.9%). ZIKV-exposed children were half as frequently classified as emergent, including after adjusting for covariates [RR = 0.52 (CI 95% 0.40; 0.66)]. However, no difference was detected in the at-risk category [RR = 0.83 (CI 95% 0.48; 1.44)]. Normocephalic children exposed to the Zika virus during pregnancy do not have a higher risk of being classified as at risk for neurodevelopmental abnormalities at two years of age.
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Affiliation(s)
- Juannicelle T. A. M. Godoi
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Silvia F. B. M. Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Davi C. Aragon
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Paulo R. H. Rocha
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Fabiana R. Amaral
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Bento V. M. Negrini
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Sara R. Teixeira
- Department of Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto CEP 14049-900, São Paulo, Brazil;
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Aparecida Y. Yamamoto
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Heloisa Bettiol
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
| | - Marisa M. Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil, Av. Bandeirantes 3009, Campus USP, Ribeirão Preto CEP 14049-900, São Paulo, Brazil; (J.T.A.M.G.); (S.F.B.M.N.); (D.C.A.); (P.R.H.R.); (F.R.A.); (B.V.M.N.); (A.Y.Y.); (H.B.)
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4
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Estupiñan-Perez VH, Jiménez-Urrego AM, Cruz-Mosquera FE, Botero-Carvajal A. Developmental assessment of children with intrauterine exposure to Zika virus: cross-sectional observational study. Rev Peru Med Exp Salud Publica 2023; 40:333-339. [PMID: 37991037 PMCID: PMC10959516 DOI: 10.17843/rpmesp.2023.403.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/01/2023] [Indexed: 11/23/2023] Open
Abstract
Zika virus infection affects the development of the nervous system. This study describes the cognitive, adaptative, communicative, social and motor neurodevelopment of children exposed to Zika virus in utero. We used the Batelle scale to assess neurodevelopment three years after birth. Thirty children were included, who had a mean age at evaluation of 37.5 (IQR: 35.7-39.2) months. We found the following equivalent ages in months for each area: motor 25.8 (SD: 7.8), adaptive 26.7 (SD: 5.8), communicative 30.2 (SD: 6.9), social personal 33.5 (SD: 8.3) and cognitive 35.6 (SD: 5.9). Children showed development delay for their chronological age, 25 children were delayed in one of the five areas assessed. A high rate of children exposed to Zika virus during gestation presented delayed developmental age, mainly regarding the adaptive and motor areas.
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5
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Martinez E, Max R, Bucardo F, Stringer EM, Becker-Dreps S, Toval-Ruíz C, Chavarria M, Meléndez-Balmaceda MJ, Nuñez C, Collins MH, Boivin M, Ortiz-Pujols S, Zepeda O, Cross K, Gower EW, Bowman NM, Grace SF. Visual findings in children exposed to Zika in utero in Nicaragua. PLoS Negl Trop Dis 2023; 17:e0011275. [PMID: 37205701 PMCID: PMC10234517 DOI: 10.1371/journal.pntd.0011275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/30/2023] [Indexed: 05/21/2023] Open
Abstract
Knowledge regarding the frequency of ocular abnormalities and abnormal visual function in children exposed to Zika virus (ZIKV) in utero but born without congenital Zika syndrome (CZS) is limited. We hypothesized that children exposed to ZIKV in utero born without CZS may have visual impairments in early childhood. We performed ophthalmic examination between 16 and 21 months of age and neurodevelopment assessment at 24 months of age with the Mullen Scales of Early Learning test (MSEL) on children enrolled in a cohort born to women pregnant during and shortly after the ZIKV epidemic in Nicaragua (2016-2017). ZIKV exposure status was defined based on maternal and infant serological testing. Visual impairment was defined as abnormal if the child had an abnormal ophthalmic exam and/or low visual reception score in the MSEL assessment. Of 124 children included in the analysis, 24 (19.4%) were classified as ZIKV-exposed and 100 (80.6%) unexposed according to maternal or cord blood serology. Ophthalmic examination showed that visual acuity did not differ significantly between groups, thus, 17.4% of ZIKV-exposed and 5.2% of unexposed had abnormal visual function (p = 0.07) and 12.5% of the ZIKV-exposed and 2% of the unexposed had abnormal contrast testing (p = 0.05). Low MSEL visual reception score was 3.2-fold higher in ZIKV-exposed than unexposed children, but not statistically significant (OR 3.2, CI: 0.8-14.0; p = 0.10). Visual impairment (a composite measure of visual function or low MESL visual reception score) was present in more ZIKV-exposed than in unexposed children (OR 3.7, CI: 1.2, 11.0; p = 0.02). However, the limited sample size warrants future investigations to fully assess the impact of in utero ZIKV exposure on ocular structures and visual function in early childhood, even in apparently healthy children.
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Affiliation(s)
- Evelin Martinez
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León, Managua), Nicaragua
| | - Ryan Max
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Filemón Bucardo
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León, Managua), Nicaragua
| | - Elizabeth M Stringer
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Christian Toval-Ruíz
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León, Managua), Nicaragua
| | - Meylin Chavarria
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León, Managua), Nicaragua
| | - María J Meléndez-Balmaceda
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León, Managua), Nicaragua
| | - Carlos Nuñez
- Ophthalmology Clinic, Victoria Mota Hospital, Jinotega, Nicaragua
| | - Matthew H Collins
- Department of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Michael Boivin
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, United States of America
| | - Shiara Ortiz-Pujols
- Obesity Medicine Medical Director at Med Express/Optum, Minneapolis, Minnesota, United States of America
| | - Omar Zepeda
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León, Managua), Nicaragua
| | - Kaitlyn Cross
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Natalie M Bowman
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sara F Grace
- North Carolina Eye Ear Nose and Throat/Duke health Durham, North Carolina, United States of America
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6
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Coler B, Wu TY, Carlson L, Burd N, Munson J, Dacanay M, Cervantes O, Esplin S, Kapur RP, Feltovich H, Adams Waldorf KM. Diminished antiviral innate immune gene expression in the placenta following a maternal SARS-CoV-2 infection. Am J Obstet Gynecol 2023; 228:463.e1-463.e20. [PMID: 36126729 PMCID: PMC9482164 DOI: 10.1016/j.ajog.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 is caused by the SARS-CoV-2 virus and is associated with critical illness requiring hospitalization, maternal mortality, stillbirth, and preterm birth. SARS-CoV-2 has been shown to induce placental pathology. However, substantial gaps exist in our understanding of the pathophysiology of COVID-19 disease in pregnancy and the long-term impact of SARS-CoV-2 on the placenta and fetus. To what extent a SARS-CoV-2 infection of the placenta alters the placental antiviral innate immune response is not well understood. A dysregulated innate immune response in the setting of maternal COVID-19 disease may increase the risk of inflammatory tissue injury or placental compromise and may contribute to deleterious pregnancy outcomes. OBJECTIVE We sought to determine the impact of a maternal SARS-CoV-2 infection on placental immune response by evaluating gene expression of a panel of 6 antiviral innate immune mediators that act as biomarkers of the antiviral and interferon cytokine response. Our hypothesis was that a SARS-CoV-2 infection during pregnancy would result in an up-regulated placental antiviral innate immune response. STUDY DESIGN We performed a case-control study on placental tissues (chorionic villous tissues and chorioamniotic membrane) collected from pregnant patients with (N=140) and without (N=24) COVID-19 disease. We performed real-time quantitative polymerase chain reaction and immunohistochemistry, and the placental histopathology was evaluated. Clinical data were abstracted. Fisher exact test, Pearson correlations, and linear regression models were used to examine proportions and continuous data between patients with active (<10 days since diagnosis) vs recovered COVID-19 (>10 days since diagnosis) at the time of delivery. Secondary regression models adjusted for labor status as a covariate and evaluated potential correlation between placental innate immune gene expression and other variables. RESULTS SARS-CoV-2 viral RNA was detected in placental tissues from 5 women with COVID-19 and from no controls (0/24, 0%). Only 1 of 5 cases with detectable SARS-CoV-2 viral RNA in placental tissues was confirmed to express SARS-CoV-2 nucleocapsid and spike proteins in syncytiotrophoblast cells. We detected a considerably lower gene expression of 5 critical innate immune mediators (IFNB, IFIT1, MXA, IL6, IL1B) in the chorionic villi and chorioamniotic membranes from women with active or recovered COVID-19 than controls, which remained significant after adjustment for labor status. There were minimal correlations between placental gene expression and other studied variables including gestational age at diagnosis, time interval between COVID-19 diagnosis and delivery, prepregnancy body mass index, COVID-19 disease severity, or placental pathology. CONCLUSION A maternal SARS-CoV-2 infection was associated with an impaired placental innate immune response in chorionic villous tissues and chorioamniotic membranes that was not correlated with gestational age at COVID-19 diagnosis, time interval from COVID-19 diagnosis to delivery, maternal obesity, disease severity, or placental pathology.
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Affiliation(s)
- Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Tsung-Yen Wu
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Lindsey Carlson
- Women and Newborn Research, Intermountain Health Care, Salt Lake City, UT
| | - Nicole Burd
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Jeff Munson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matthew Dacanay
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Sean Esplin
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT
| | - Raj P Kapur
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA; Department of Pathology, Seattle Children's Hospital, Seattle, WA
| | - Helen Feltovich
- Department of Obstetrics and Gynecology, Intermountain Health Care, Salt Lake City, UT.
| | - Kristina M Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA.
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Zepeda O, Espinoza DO, Martinez E, Cross KA, Becker-Dreps S, de Silva AM, Bowman NM, Premkumar L, Stringer EM, Bucardo F, Collins MH. Antibody Immunity to Zika Virus among Young Children in a Flavivirus-Endemic Area in Nicaragua. Viruses 2023; 15:v15030796. [PMID: 36992504 PMCID: PMC10052059 DOI: 10.3390/v15030796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 03/31/2023] Open
Abstract
Objective: To understand the dynamics of Zika virus (ZIKV)-specific antibody immunity in children born to mothers in a flavivirus-endemic region during and after the emergence of ZIKV in the Americas. Methods: We performed serologic testing for ZIKV cross-reactive and type-specific IgG in two longitudinal cohorts, which enrolled pregnant women and their children (PW1 and PW2) after the beginning of the ZIKV epidemic in Nicaragua. Quarterly samples from children over their first two years of life and maternal blood samples at birth and at the end of the two-year follow-up period were studied. Results: Most mothers in this dengue-endemic area were flavivirus-immune at enrollment. ZIKV-specific IgG (anti-ZIKV EDIII IgG) was detected in 82 of 102 (80.4%) mothers in cohort PW1 and 89 of 134 (66.4%) mothers in cohort PW2, consistent with extensive transmission observed in Nicaragua during 2016. ZIKV-reactive IgG decayed to undetectable levels by 6-9 months in infants, whereas these antibodies were maintained in mothers at the year two time point. Interestingly, a greater contribution to ZIKV immunity by IgG3 was observed in babies born soon after ZIKV transmission. Finally, 43 of 343 (13%) children exhibited persistent or increasing ZIKV-reactive IgG at ≥9 months, with 10 of 30 (33%) tested demonstrating serologic evidence of incident dengue infection. Conclusions: These data inform our understanding of protective and pathogenic immunity to potential flavivirus infections in early life in areas where multiple flaviviruses co-circulate, particularly considering the immune interactions between ZIKV and dengue and the future possibility of ZIKV vaccination in women of childbearing potential. This study also shows the benefits of cord blood sampling for serologic surveillance of infectious diseases in resource-limited settings.
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Affiliation(s)
- Omar Zepeda
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Daniel O Espinoza
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Evelin Martinez
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Kaitlyn A Cross
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sylvia Becker-Dreps
- Department of Family Medicine and Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Aravinda M de Silva
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Natalie M Bowman
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Elizabeth M Stringer
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Filemón Bucardo
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León 21000, Nicaragua
| | - Matthew H Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
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Susceptibility to endemic Aedes-borne viruses among pregnant women in Risaralda, Colombia. Int J Infect Dis 2022; 122:832-840. [PMID: 35817285 DOI: 10.1016/j.ijid.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Aedes-borne viruses (ABV) affect humans on every inhabited continent and frequently cause epidemics. Recent epidemics of chikungunya and Zika viruses highlight that preparedness for future epidemics requires assessment of susceptibility, particularly among high-risk groups. We sought to determine immunity against the three major circulating ABV among pregnant women in an ABV-endemic area of Colombia. METHODS A cross-sectional seroprevalence study was performed, enrolling women presenting to Labor and Delivery. Cord blood and maternal peripheral blood was obtained. IgG seroprevalence to flaviviruses and chikungunya was determined by ELISA. An abbreviated neutralization test was used to estimate the frequency and magnitude of immunity to Zika and four dengue serotypes. Cluster analyses explored epidemiologic factors associated with seroprevalence. RESULTS Most women exhibited high levels of neutralizing antibodies to one or more ABV; however, nearly 20% were seronegative for flaviviruses. Our research took place after the epidemic peak of the ZIKV outbreak in Colombia in 2016, but only 20% of pregnant women had high levels of Zika-neutralizing antibodies consistent with likely protective immunity to ZIKV. CONCLUSIONS Hence, a high proportion pregnant women in Risaralda remain susceptible to one or more ABV including the teratogenic ZIKV, indicating risk for future epidemics in this region.
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Interferon Lambda Signals in Maternal Tissues to Exert Protective and Pathogenic Effects in a Gestational Stage-Dependent Manner. mBio 2022; 13:e0385721. [PMID: 35471083 PMCID: PMC9239100 DOI: 10.1128/mbio.03857-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Interferon lambda (IFN-λ) (type III IFN) is constitutively secreted from human placental cells in culture and reduces Zika virus (ZIKV) transplacental transmission in mice. However, the roles of IFN-λ during healthy pregnancy and in restricting congenital infection remain unclear. Here, we used mice lacking the IFN-λ receptor (Ifnlr1-/-) to generate pregnancies lacking either maternal or fetal IFN-λ responsiveness and found that the antiviral effect of IFN-λ resulted from signaling exclusively in maternal tissues. This protective effect depended on gestational stage, as infection earlier in pregnancy (E7 rather than E9) resulted in enhanced transplacental transmission of ZIKV. In Ifnar1-/- dams, which sustain robust ZIKV infection, maternal IFN-λ signaling caused fetal resorption and intrauterine growth restriction. Pregnancy pathology elicited by poly(I·C) treatment also was mediated by maternal IFN-λ signaling, specifically in maternal leukocytes, and also occurred in a gestational stage-dependent manner. These findings identify an unexpected effect of IFN-λ signaling, specifically in maternal (rather than placental or fetal) tissues, which is distinct from the pathogenic effects of IFN-αβ (type I IFN) during pregnancy. These results highlight the complexity of immune signaling at the maternal-fetal interface, where disparate outcomes can result from signaling at different gestational stages. IMPORTANCE Pregnancy is an immunologically complex situation, which must balance protecting the fetus from maternal pathogens with preventing maternal immune rejection of non-self fetal and placental tissue. Cytokines, such as interferon lambda (IFN-λ), contribute to antiviral immunity at the maternal-fetal interface. We found in a mouse model of congenital Zika virus infection that IFN-λ can have either a protective antiviral effect or cause immune-mediated pathology, depending on the stage of gestation when IFN-λ signaling occurs. Remarkably, both the protective and pathogenic effects of IFN-λ occurred through signaling exclusively in maternal immune cells rather than in fetal or placental tissues or in other maternal cell types, identifying a new role for IFN-λ at the maternal-fetal interface.
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Díaz-Martínez LA, Rojas MA, Pinilla-García LS, Becerra-Mojica CH, Pérez-Vera LA, Gutiérrez-Sánchez LÁ, Contreras-García GA, Rueda-Ordoñez CG, Villar L. Neurodevelopmental outcome of infants without central nervous system anomalies born to symptomatic RT-PCR ZIKV positive women. PLoS Negl Trop Dis 2022; 16:e0009854. [PMID: 35255097 PMCID: PMC8929705 DOI: 10.1371/journal.pntd.0009854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/17/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
An epidemic of Zika virus (ZIKV) infection began in Colombia in October 2015. Previous studies have identified a cause-effect relationship between fetal exposure to the ZIKV and the development of microcephaly and other central nervous system (CNS) anomalies with variable degrees of neurodevelopmental delay. Less is known about the neurodevelopmental outcome of infants without CNS anomalies born to symptomatic ZIKV RT-PCR-positive women. We aimed to compare the neurodevelopmental outcome of these infants to a control group of infants without CNS anomalies born to asymptomatic ZIKV RT-PCR negative women who did not seroconvert during pregnancy. Participating infants were categorized according to ZIKV maternal exposure. Women with symptomatology suggestive of ZIKV infection and a positive RT-PCR for ZIKV were categorized as ZIKV-exposed. Maternal controls (ZIKV unexposed) from the same geographic area were subsequently captured during the tail end of the epidemic through a partner project, the ZIKAlliance, whose aim was to determine the prevalence of ZIKV in pregnant women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). The ZIKV-exposed women were found to be older, had less subsidized health care, had a higher percentage of women in middle-class socioeconomic strata, had higher technical and university education, were less likely to be living with a partner, and had higher rates of pregnancy comorbidity and premature births than ZIKV unexposed women. Compared to infants born to ZIKV unexposed women (unexposed), infants born to ZIKV exposed women (exposed) were of lower gestational age and required more speech and occupational therapy services. No differences between groups were observed in the proportion of cut-off scores <70 on the Bayley-III Scale at 12, 18, and 24 months for motor, language, and cognitive domains. When a cut-off of <85 was used, a higher percentage of motor and cognitive impairment was observed in unexposed infants at 12 and 24 months CA, respectively. Median and IQR score on the Bayley-III scale showed higher scores in favor of exposed infants for motor development at 12 and 18 months CA, language at 12 months, and cognitive domain at 12, 18, and 24 months. The adjusted median and IQR compound score of the difference between exposed and unexposed was higher in favor of exposed infants at 12 to 24 months CA for motor (3.8 [95% CI 1.0 to 6.7]) and cognitive domains (10.6 [95% CI 7.3 to 13.9]). We observed no differences in the language domain (1.9 [95% CI -1.2 to 5.0]). We conclude that infants with no evidence of microcephaly or other CNS anomalies born to ZIKV-exposed women had normal neurodevelopment up to 24 months of CA, supporting an all-or-nothing effect with maternal ZIKV exposure. Long-term follow-up to evaluate school performance is required. Clinical Trial Registration:www.clinicaltrials.gov, NCT02943304. Previous studies have identified a cause-effect relationship between fetal exposure to the Zika virus (ZIKV) and the development of central nervous system (CNS) anomalies and variable degrees of neurodevelopmental delay. This study aimed to compare the neurodevelopmental outcome of infants without CNS anomalies from two groups. One born to symptomatic ZIKV exposed women and another to asymptomatic ZIKV unexposed women. The ZIKV-exposed women were older, had a higher percentage of women in middle-class socioeconomic strata, had a higher level of education, were more likely to be single, and had higher rates of pregnancy comorbidity and premature births compared to ZIKV unexposed women. Infant survivors from these two groups of pregnant women had a neurodevelopmental evaluation at 12, 18, and 24 months corrected age (CA). Infants born to symptomatic ZIKV exposed women had higher motor and cognitive scores at 12 and 24 months CA, respectively, than infants born to ZIKV unexposed women. We conclude that infants without CNS anomalies born to ZIKV exposed women had normal neurodevelopment up to 24 months of CA than infants born to ZIKV unexposed women, supporting an all-or-nothing effect with maternal ZIKV exposure. School performance evaluation is required.
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Affiliation(s)
| | - Mario Augusto Rojas
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Colombian Association of Neonatology (ASCON), Colombian Neonatal Research Network (CNRN), Bogotá, Colombia
- * E-mail:
| | | | - Carlos Hernán Becerra-Mojica
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Maternal-fetal Medicine Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
| | - Luis Alfonso Pérez-Vera
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Colombian Association of Neonatology (ASCON), Colombian Neonatal Research Network (CNRN), Bogotá, Colombia
- Neonatal Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
| | - Luz Ángela Gutiérrez-Sánchez
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- Maternal-fetal Medicine Unit, Hospital Universitario de Santander, Bucaramanga, Colombia
- Clínica Materno Infantil San Luis, Bucaramanga, Colombia
| | | | | | - Luis Villar
- School of Medicine, Health Faculty, Universidad Industrial de Santander, Bucaramanga, Colombia
- ZIKAlliance Consortium, Bucaramanga, Colombia
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11
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Hsu DC, Chumpolkulwong K, Corley MJ, Hunsawong T, Inthawong D, Schuetz A, Imerbsin R, Silsorn D, Nadee P, Sopanaporn J, Phuang-Ngern Y, Klungthong C, Reed M, Fernandez S, Ndhlovu LC, Paul R, Lugo-Roman L, Michael NL, Modjarrad K, Vasan S. Neurocognitive impact of Zika virus infection in adult rhesus macaques. J Neuroinflammation 2022; 19:40. [PMID: 35130924 PMCID: PMC8822695 DOI: 10.1186/s12974-022-02402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Zika virus (ZIKV) is a mosquito-transmitted flavivirus that affects many regions of the world. Infection, in utero, causes microcephaly and later developmental and neurologic impairments. The impact of ZIKV infection on neurocognition in adults has not been well described. The objective of the study was to assess the neurocognitive impact of ZIKV infection in adult rhesus macaques. Methods Neurocognitive assessments were performed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) via a touch screen and modified Brinkman Board before and after subcutaneous ZIKV inoculation. Immune activation markers were measured in the blood and cerebral spinal fluid (CSF) by multiplex assay and flow cytometry. Results All animals (N = 8) had detectable ZIKV RNA in plasma at day 1 post-inoculation (PI) that peaked at day 2 PI (median 5.9, IQR 5.6–6.2 log10 genome equivalents/mL). In all eight animals, ZIKV RNA became undetectable in plasma by day 14 PI, but persisted in lymphoid tissues. ZIKV RNA was not detected in the CSF supernatant at days 4, 8, 14 and 28 PI but was detected in the brain of 2 animals at days 8 and 28 PI. Elevations in markers of immune activation in the blood and CSF were accompanied by a reduction in accuracy and reaction speed on the CANTAB in the majority of animals. Conclusions The co-occurrence of systemic and CSF immune perturbations and neurocognitive impairment establishes this model as useful for studying the impact of neuroinflammation on neurobehavior in rhesus macaques, as it pertains to ZIKV infection and potentially other pathogens. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02402-4.
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Affiliation(s)
- Denise C Hsu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA. .,Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA.
| | | | - Michael J Corley
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, USA
| | - Taweewun Hunsawong
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Dutsadee Inthawong
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Alexandra Schuetz
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA.,Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA
| | - Rawiwan Imerbsin
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Decha Silsorn
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Panupat Nadee
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Jumpol Sopanaporn
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | | | | | - Matthew Reed
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Stefan Fernandez
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Lishomwa C Ndhlovu
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, USA.,Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri, St. Louis, MO, 63143, USA
| | - Luis Lugo-Roman
- Armed Forces Research Institute of Medical Sciences, Bangkok, 10400, Thailand
| | - Nelson L Michael
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Kayvon Modjarrad
- Emerging Infectious Disease Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
| | - Sandhya Vasan
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, 20817, USA.,Emerging Infectious Disease Branch, Walter Reed Army Institute of Research, Silver Spring, MD, 20910, USA
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12
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Piontkivska H, Wales-McGrath B, Miyamoto M, Wayne ML. ADAR Editing in Viruses: An Evolutionary Force to Reckon with. Genome Biol Evol 2021; 13:evab240. [PMID: 34694399 PMCID: PMC8586724 DOI: 10.1093/gbe/evab240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 02/06/2023] Open
Abstract
Adenosine Deaminases that Act on RNA (ADARs) are RNA editing enzymes that play a dynamic and nuanced role in regulating transcriptome and proteome diversity. This editing can be highly selective, affecting a specific site within a transcript, or nonselective, resulting in hyperediting. ADAR editing is important for regulating neural functions and autoimmunity, and has a key role in the innate immune response to viral infections, where editing can have a range of pro- or antiviral effects and can contribute to viral evolution. Here we examine the role of ADAR editing across a broad range of viral groups. We propose that the effect of ADAR editing on viral replication, whether pro- or antiviral, is better viewed as an axis rather than a binary, and that the specific position of a given virus on this axis is highly dependent on virus- and host-specific factors, and can change over the course of infection. However, more research needs to be devoted to understanding these dynamic factors and how they affect virus-ADAR interactions and viral evolution. Another area that warrants significant attention is the effect of virus-ADAR interactions on host-ADAR interactions, particularly in light of the crucial role of ADAR in regulating neural functions. Answering these questions will be essential to developing our understanding of the relationship between ADAR editing and viral infection. In turn, this will further our understanding of the effects of viruses such as SARS-CoV-2, as well as many others, and thereby influence our approach to treating these deadly diseases.
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Affiliation(s)
- Helen Piontkivska
- Department of Biological Sciences, Kent State University, Ohio, USA
- School of Biomedical Sciences, Kent State University, Ohio, USA
- Brain Health Research Institute, Kent State University, Ohio, USA
| | | | - Michael Miyamoto
- Department of Biology, University of Florida, Gainesville, Florida, USA
| | - Marta L Wayne
- Department of Biology, University of Florida, Gainesville, Florida, USA
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Bohm EK, Vangorder-Braid JT, Jaeger AS, Moriarty RV, Baczenas JJ, Bennett NC, O’Connor SL, Fritsch MK, Fuhler NA, Noguchi KK, Aliota MT. Zika Virus Infection of Pregnant Ifnar1-/- Mice Triggers Strain-Specific Differences in Fetal Outcomes. J Virol 2021; 95:e0081821. [PMID: 34379510 PMCID: PMC8513483 DOI: 10.1128/jvi.00818-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/03/2021] [Indexed: 01/22/2023] Open
Abstract
Zika virus (ZIKV) is a flavivirus that causes a constellation of adverse fetal outcomes collectively termed congenital Zika syndrome (CZS). However, not all pregnancies exposed to ZIKV result in an infant with apparent defects. During the 2015 to 2016 American outbreak of ZIKV, CZS rates varied by geographic location. The underlying mechanisms responsible for this heterogeneity in outcomes have not been well defined. Therefore, we sought to characterize and compare the pathogenic potential of multiple Asian-/American-lineage ZIKV strains in an established Ifnar1-/- pregnant mouse model. Here, we show significant differences in the rate of fetal demise following maternal inoculation with ZIKV strains from Puerto Rico, Panama, Mexico, Brazil, and Cambodia. Rates of fetal demise broadly correlated with maternal viremia but were independent of fetus and placenta virus titer, indicating that additional underlying factors contribute to fetal outcome. Our results, in concert with those from other studies, suggest that subtle differences in ZIKV strains may have important phenotypic impacts. With ZIKV now endemic in the Americas, greater emphasis needs to be placed on elucidating and understanding the underlying mechanisms that contribute to fetal outcome. IMPORTANCE Zika virus (ZIKV) transmission has been reported in 87 countries and territories around the globe. ZIKV infection during pregnancy is associated with adverse fetal outcomes, including birth defects, microcephaly, neurological complications, and even spontaneous abortion. Rates of adverse fetal outcomes vary between regions, and not every pregnancy exposed to ZIKV results in birth defects. Not much is known about how or if the infecting ZIKV strain is linked to fetal outcomes. Our research provides evidence of phenotypic heterogeneity between Asian-/American-lineage ZIKV strains and provides insight into the underlying causes of adverse fetal outcomes. Understanding ZIKV strain-dependent pathogenic potential during pregnancy and elucidating underlying causes of diverse clinical sequelae observed during human infections is critical to understanding ZIKV on a global scale.
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Affiliation(s)
- Ellie K. Bohm
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Jennifer T. Vangorder-Braid
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Anna S. Jaeger
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Ryan V. Moriarty
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - John J. Baczenas
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Natalie C. Bennett
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
| | - Shelby L. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael K. Fritsch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicole A. Fuhler
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kevin K. Noguchi
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, St. Paul, Minnesota, USA
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Mercado-Reyes M, Gilboa SM, Valencia D, Daza M, Tong VT, Galang RR, Winfield CM, Godfred-Cato S, Benavides M, Villanueva JM, Thomas JD, Daniels J, Zaki S, Reagan-Steiner S, Bhatnagar J, Schiffer J, Steward-Clark E, Ricaldi JN, Osorio J, Sancken CL, Pardo L, Tinker SC, Anderson KN, Rico A, Burkel VK, Hojnacki J, Delahoy MJ, González M, Osorio MB, Moore CA, Honein MA, Ospina Martinez ML. Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016-2018. Trop Med Infect Dis 2021; 6:183. [PMID: 34698287 PMCID: PMC8544689 DOI: 10.3390/tropicalmed6040183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/18/2021] [Accepted: 10/07/2021] [Indexed: 01/16/2023] Open
Abstract
Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May-November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia's existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.
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Affiliation(s)
- Marcela Mercado-Reyes
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Marcela Daza
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Van T. Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Romeo R. Galang
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Christina M. Winfield
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Mónica Benavides
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Julie M. Villanueva
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jennifer D. Thomas
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jonathan Daniels
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sherif Zaki
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sarah Reagan-Steiner
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Julu Bhatnagar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jarad Schiffer
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Evelene Steward-Clark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Jessica N. Ricaldi
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Johana Osorio
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Christina L. Sancken
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Lissethe Pardo
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Kayla N. Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Angelica Rico
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | | | - Jacob Hojnacki
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA;
| | | | - Maritza González
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - May B. Osorio
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Margaret A. Honein
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Martha Lucia Ospina Martinez
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
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Neonatal Development in Prenatally Zika Virus-Exposed Infant Macaques with Dengue Immunity. Viruses 2021; 13:v13091878. [PMID: 34578459 PMCID: PMC8473338 DOI: 10.3390/v13091878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023] Open
Abstract
Infants exposed to Zika virus (ZIKV) prenatally may develop birth defects, developmental deficits, or remain asymptomatic. It is unclear why some infants are more affected than others, although enhancement of maternal ZIKV infection via immunity to an antigenically similar virus, dengue virus (DENV), may play a role. We hypothesized that DENV immunity may worsen prenatal ZIKV infection and developmental deficits in offspring. We utilized a translational macaque model to examine how maternal DENV immunity influences ZIKV-exposed infant macaque neurodevelopment in the first month of life. We inoculated eight macaques with prior DENV infection with ZIKV, five macaques with ZIKV, and four macaques with saline. DENV/ZIKV-exposed infants had significantly worse visual orientation skills than ZIKV-exposed infants whose mothers were DENV-naive, with no differences in motor, sensory or state control development. ZIKV infection characteristics and pregnancy outcomes did not individually differ between dams with and without DENV immunity, but when multiple factors were combined in a multivariate model, maternal DENV immunity combined with ZIKV infection characteristics and pregnancy parameters predicted select developmental outcomes. We demonstrate that maternal DENV immunity exacerbates visual orientation and tracking deficits in ZIKV-exposed infant macaques, suggesting that human studies should evaluate how maternal DENV immunity impacts long-term neurodevelopment.
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