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Mukhopadhyay K, Sengupta M, Misra SC, Majee K. Trends in emerging vector-borne viral infections and their outcome in children over two decades. Pediatr Res 2024; 95:464-479. [PMID: 37880334 DOI: 10.1038/s41390-023-02866-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
This review utilizes quatitative methods and bibliometric data to analyse the trends of emerging and re-emerging vector-borne diseases, with a focus on their impact on pediatric population. To conduct this analysis, a systematic search of PubMed articles from the past two decades was performed, specifically looking at 26 different vector-borne viruses listed in WHO and CDC list of vector-borne viruses. The review found that diseases like Dengue, Zika, West Nile, and Chikungunya were frequently discussed in the literature. On the other hand, diseases such as Tick-borne encephalitis, Rift Valley fever, Venezuelan equine encephalitis, Sindbis fever, Venezuelan equine encephalitis, Ross River virus, and Eastern equine encephalitis showed an upward trend in publications, indicating potential resurgence. In addition to discussing trends and patterns, the review delves into the clinical manifestations and long-term effects of the top 10 viruses in children. It highlights various factors including deforestation, urbanization, global travel, and immunosuppression that contribute to disease emergence and resurgence. To effectively combat these vector-borne diseases, continuous surveillance is crucial. The review also emphasizes the importance of increased vaccination efforts and targeted research to address the health challenges they pose. IMPACT: This review employs quantitative analysis of publications to elucidate trends in emerging pediatric vector-borne viral diseases over two decades. Dengue, the most prevalent of these diseases, has spread to new regions. New strains of Japanese Encephalitis have caused outbreaks. Resurgence of Tick-borne Encephalitis, West Nile, and Yellow Fever due to vaccine hesitancy has also transpired. Continuous global surveillance, increased vaccination, and research into novel therapeutics are imperative to combat the substantial morbidity and mortality burden these diseases pose for children worldwide.
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Affiliation(s)
| | - Mallika Sengupta
- Microbiology, AIIMS Kalyani, Basantapur, Saguna, West Bengal, India
| | | | - Kiranmay Majee
- Student, AIIMS Kalyani, Basantapur, Saguna, West Bengal, India
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2
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Hoffman SA, Maldonado YA. Emerging and re-emerging pediatric viral diseases: a continuing global challenge. Pediatr Res 2024; 95:480-487. [PMID: 37940663 PMCID: PMC10837080 DOI: 10.1038/s41390-023-02878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
The twenty-first century has been marked by a surge in viral epidemics and pandemics, highlighting the global health challenge posed by emerging and re-emerging pediatric viral diseases. This review article explores the complex dynamics contributing to this challenge, including climate change, globalization, socio-economic interconnectedness, geopolitical tensions, vaccine hesitancy, misinformation, and disparities in access to healthcare resources. Understanding the interactions between the environment, socioeconomics, and health is crucial for effectively addressing current and future outbreaks. This scoping review focuses on emerging and re-emerging viral infectious diseases, with an emphasis on pediatric vulnerability. It highlights the urgent need for prevention, preparedness, and response efforts, particularly in resource-limited communities disproportionately affected by climate change and spillover events. Adopting a One Health/Planetary Health approach, which integrates human, animal, and ecosystem health, can enhance equity and resilience in global communities. IMPACT: We provide a scoping review of emerging and re-emerging viral threats to global pediatric populations This review provides an update on current pediatric viral threats in the context of the COVID-19 pandemic This review aims to sensitize clinicians, epidemiologists, public health practitioners, and policy stakeholders/decision-makers to the role these viral diseases have in persistent pediatric morbidity and mortality.
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Affiliation(s)
- Seth A Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yvonne A Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Topuz K, Davazdahemami B, Delen D. A Bayesian belief network-based analytics methodology for early-stage risk detection of novel diseases. ANNALS OF OPERATIONS RESEARCH 2023:1-25. [PMID: 37361089 PMCID: PMC10189691 DOI: 10.1007/s10479-023-05377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/28/2023]
Abstract
During a pandemic, medical specialists have substantial challenges in discovering and validating new disease risk factors and designing effective treatment strategies. Traditionally, this approach entails several clinical studies and trials that might last several years, during which strict preventive measures are enforced to manage the outbreak and limit the death toll. Advanced data analytics technologies, on the other hand, could be utilized to monitor and expedite the procedure. This research integrates evolutionary search algorithms, Bayesian belief networks, and innovative interpretation techniques to provide a comprehensive exploratory-descriptive-explanatory machine learning methodology to assist clinical decision-makers in responding promptly to pandemic scenarios. The proposed approach is illustrated through a case study in which the survival of COVID-19 patients is determined using inpatient and emergency department (ED) encounters from a real-world electronic health record database. Following an exploratory phase in which genetic algorithms are used to identify a set of the most critical chronic risk factors and their validation using descriptive tools based on the concept of Bayesian Belief Nets, the framework develops and trains a probabilistic graphical model to explain and predict patient survival (with an AUC of 0.92). Finally, a publicly available online, probabilistic decision support inference simulator was constructed to facilitate what-if analysis and aid general users and healthcare professionals in interpreting model findings. The results widely corroborate intensive and expensive clinical trial research assessments.
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Affiliation(s)
- Kazim Topuz
- Collins College of Business, School of Finance and Operations Management, The University of Tulsa, Tulsa, USA
| | - Behrooz Davazdahemami
- Department of IT and Supply Chain Management, University of Wisconsin-Whitewater, 809 W. Starin Rd., Hyland Hall 1222, Whitewater, USA
| | - Dursun Delen
- Center for Health Systems Innovation, Spears School of Business, Oklahoma State University, Stillwater, USA
- Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Turkey
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4
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Raper J, Chahroudi A. Clinical and Preclinical Evidence for Adverse Neurodevelopment after Postnatal Zika Virus Infection. Trop Med Infect Dis 2021; 6:tropicalmed6010010. [PMID: 33445671 PMCID: PMC7838975 DOI: 10.3390/tropicalmed6010010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Although the Zika virus (ZIKV) typically causes mild or no symptoms in adults, during the 2015−2016 outbreak, ZIKV infection in pregnancy resulted in a spectrum of diseases in infants, including birth defects and neurodevelopmental disorders identified in childhood. While intense clinical and basic science research has focused on the neurodevelopmental outcomes of prenatal ZIKV infection, less is known about the consequences of infection during early life. Considering the neurotropism of ZIKV and the rapidly-developing postnatal brain, it is important to understand how infection during infancy may disrupt neurodevelopment. This paper reviews the current knowledge regarding early postnatal ZIKV infection. Emerging clinical evidence supports the hypothesis that ZIKV infection during infancy can result in negative neurologic consequences. However, clinical data regarding postnatal ZIKV infection in children are limited; as such, animal models play an important role in understanding the potential complications of ZIKV infection related to the vulnerable developing brain. Preclinical data provide insight into the potential behavioral, cognitive, and motor domains that clinical studies should examine in pediatric populations exposed to ZIKV during infancy.
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Affiliation(s)
- Jessica Raper
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA;
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ann Chahroudi
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA;
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA
- Correspondence:
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Lindsey NP, Porse CC, Potts E, Hyun J, Sandhu K, Schiffman E, Cervantes KB, White JL, Mason K, Owens K, Holsinger C, Fischer M, Staples JE. Postnatally Acquired Zika Virus Disease Among Children, United States, 2016-2017. Clin Infect Dis 2021; 70:227-231. [PMID: 30855072 DOI: 10.1093/cid/ciz195] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical findings among children with postnatally acquired Zika virus disease are not well characterized. We describe and compare clinical signs and symptoms for children aged <18 years. METHODS Zika virus disease cases were included if they met the national surveillance case definition, had illness onset in 2016 or 2017, resided in a participating state, and were reported to the Centers for Disease Control and Prevention. Pediatric cases were aged <18 years; congenital and perinatal infections were excluded. Pediatric cases were matched to adult cases (18‒49 years). Clinical information was compared between younger and older pediatric cases and between children and adults. RESULTS A total of 141 pediatric Zika virus disease cases were identified; none experienced neurologic disease. Overall, 28 (20%) were treated in an emergency department, 1 (<1%) was hospitalized; none died. Of the 4 primary clinical signs and symptoms associated with Zika virus disease, 133 (94%) children had rash, 104 (74%) fever, 67 (48%) arthralgia, and 51 (36%) conjunctivitis. Fever, arthralgia, and myalgia were more common in older children (12‒17 years) than younger children (1‒11 years). Arthralgia, arthritis, edema, and myalgia were more common in adults compared to children. CONCLUSIONS This report supports previous findings that Zika virus disease is generally mild in children. The most common symptoms are similar to other childhood infections, and clinical findings and outcomes are similar to those in adults. Healthcare providers should consider a diagnosis of Zika virus infection in children with fever, rash, arthralgia, or conjunctivitis, who reside in or have traveled to an area where Zika virus transmission is occurring.
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Affiliation(s)
- Nicole P Lindsey
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | - Emily Potts
- Indiana State Department of Health, Indianapolis
| | - Judie Hyun
- Maryland Department of Health, Baltimore
| | | | | | | | | | | | | | | | - Marc Fischer
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - J Erin Staples
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado
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Romaní N, Frick MA, Sulleiro E, Rodó C, Espiau M, Pou D, Silgado A, Suy A, Pumarola T, Soler-Palacín P, Soriano-Arandes A. Zika Virus Infection in Tourists Travelling to Thailand: Case Series Report. Trop Med Infect Dis 2020; 6:3. [PMID: 33379281 PMCID: PMC7838810 DOI: 10.3390/tropicalmed6010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022] Open
Abstract
Thailand is a popular tourist destination where Zika virus (ZIKV) transmission is currently active. To our knowledge, there are no reports of ZIKV infection imported from Thailand and affecting children. Here, we describe the clinical and microbiological findings in three cases of vector-borne ZIKV infection: An 11-year-old boy, a 2-year-old girl, and her pregnant mother, this last case leading to the prenatal exposure of her second baby to ZIKV in the second trimester of pregnancy. All patients were diagnosed after traveling to Thailand between September 2019 and January 2020. No complications were detected in any patient at follow-up, and the prenatally exposed fetus showed no abnormalities during intensive antenatal health care monitoring. On postnatal study, there were no clinical signs or microbiological findings of mother-to-child ZIKV transmission. ZIKV IgG was initially positive, but seroreversion occurred at 4 months of life. This report describes the clinical and serological evolution of vector-borne ZIKV infection occurring in dengue-naïve tourists returning from Thailand. The World Health Organization currently recommends that pre-travel advice to prevent arbovirus infection should be maintained in travelers to Southeast Asia.
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Affiliation(s)
- Natàlia Romaní
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (N.R.); (M.A.F.); (M.E.); (P.S.-P.)
| | - Marie Antoinette Frick
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (N.R.); (M.A.F.); (M.E.); (P.S.-P.)
| | - Elena Sulleiro
- Department of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.S.); (A.S.); (T.P.)
| | - Carlota Rodó
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (C.R.); (A.S.)
| | - María Espiau
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (N.R.); (M.A.F.); (M.E.); (P.S.-P.)
| | - Diana Pou
- Center of International Health and Transmissible Diseases Drassanes-Vall d’Hebron, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
| | - Aroa Silgado
- Department of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.S.); (A.S.); (T.P.)
| | - Anna Suy
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (C.R.); (A.S.)
| | - Tomás Pumarola
- Department of Microbiology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (E.S.); (A.S.); (T.P.)
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (N.R.); (M.A.F.); (M.E.); (P.S.-P.)
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (N.R.); (M.A.F.); (M.E.); (P.S.-P.)
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Ramond A, Lobkowicz L, Clemente NS, Vaughan A, Turchi MD, Wilder-Smith A, Brickley EB. Postnatal symptomatic Zika virus infections in children and adolescents: A systematic review. PLoS Negl Trop Dis 2020; 14:e0008612. [PMID: 33006989 PMCID: PMC7556487 DOI: 10.1371/journal.pntd.0008612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/14/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. However, little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence. METHODS We conducted a systematic review on the clinical presentation and complications of children and adolescents aged 0 to 18 years with a robust diagnosis of ZIKV infection. We searched PubMed, Web of Science, LILACs, and EMBASE until 13 February 2020 and screened reference lists of eligible articles. We assessed the studies' risk of bias using pre-specified criteria. FINDINGS Our review collated the evidence from 2543 pediatric ZIKV cases representing 17 countries and territories, identified in 1 cohort study, 9 case series and 22 case reports. The most commonly observed signs and symptoms of ZIKV infection in children and adolescents were mild and included fever, rash, conjunctivitis and arthralgia. The frequency of neurological complications was reported only in the largest case series (identified in 1.0% of cases) and in an additional 14 children identified from hospital-based surveillance studies and case reports. ZIKV-related mortality was primarily accompanied by co-morbidity and was reported in one case series (<0.5% of cases) and three case reports. One death was attributed to complications of Guillain-Barré Syndrome secondary to ZIKV infection. CONCLUSIONS AND RELEVANCE Based on the current evidence, the clinical presentation of ZIKV infection in children and adolescents appears to be primarily mild and similar to the presentation in adults, with rare instances of severe complications and/or mortality. However, reliable estimation of the risks of ZIKV complications in these age groups is limited by the scarcity and quality of published data. Additional prospective studies are needed to improve understanding of the relative frequency of the signs, symptoms, and complications associated with pediatric ZIKV infections and to investigate any potential effects of early life ZIKV exposure on neurodevelopment.
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Affiliation(s)
- Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ludmila Lobkowicz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aisling Vaughan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil (Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil)
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Raper J, Kovacs-Balint Z, Mavigner M, Gumber S, Burke MW, Habib J, Mattingly C, Fair D, Earl E, Feczko E, Styner M, Jean SM, Cohen JK, Suthar MS, Sanchez MM, Alvarado MC, Chahroudi A. Long-term alterations in brain and behavior after postnatal Zika virus infection in infant macaques. Nat Commun 2020; 11:2534. [PMID: 32439858 PMCID: PMC7242369 DOI: 10.1038/s41467-020-16320-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/21/2020] [Indexed: 12/18/2022] Open
Abstract
Zika virus (ZIKV) infection has a profound impact on the fetal nervous system. The postnatal period is also a time of rapid brain growth, and it is important to understand the potential neurobehavioral consequences of ZIKV infection during infancy. Here we show that postnatal ZIKV infection in a rhesus macaque model resulted in long-term behavioral, motor, and cognitive changes, including increased emotional reactivity, decreased social contact, loss of balance, and deficits in visual recognition memory at one year of age. Structural and functional MRI showed that ZIKV-infected infant rhesus macaques had persistent enlargement of lateral ventricles, smaller volumes and altered functional connectivity between brain areas important for socioemotional behavior, cognitive, and motor function (e.g. amygdala, hippocampus, cerebellum). Neuropathological changes corresponded with neuroimaging results and were consistent with the behavioral and memory deficits. Overall, this study demonstrates that postnatal ZIKV infection in this model may have long-lasting neurodevelopmental consequences.
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Affiliation(s)
- Jessica Raper
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Maud Mavigner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Sanjeev Gumber
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Mark W Burke
- Department of Physiology and Biophysics, Howard University, Washington, DC, USA
| | - Jakob Habib
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Cameron Mattingly
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Damien Fair
- Oregon Health and Science University, Portland, OR, USA
| | - Eric Earl
- Oregon Health and Science University, Portland, OR, USA
| | - Eric Feczko
- Oregon Health and Science University, Portland, OR, USA
| | - Martin Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Sherrie M Jean
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Joyce K Cohen
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mehul S Suthar
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
- Emory Vaccine Center, Atlanta, GA, 30329, USA
| | - Mar M Sanchez
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria C Alvarado
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Ann Chahroudi
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA.
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Martins MM, Prata‐Barbosa A, Cunha AJLAD. Arboviral diseases in pediatrics. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Abstract
OBJECTIVES To present the currently available evidence on transmission, clinical, diagnostic methods, treatment, and prevention methods of major arboviruses that occur in childhood. SOURCE OF DATA Non-systematic review carried out in MEDLINE (PubMed), LILACS (VHL), Scopus, Web of Science, Cochrane, CAPES Portal, and Google Scholar databases for the past five years using the search terms arboviruses, dengue, chikungunya, Zika, Mayaro, and West Nile fever, as well as child, newborn, and adolescent. SYNTHESIS OF DATA The main characteristic of arboviruses is the fact that part of their replication cycle occurs inside insect vectors, thus being classically transmitted to humans through the bite of mosquitoes (hematophagous arthropods), although non-vector transmission of these viruses is also possible in specific situations. These diseases remain a major public health challenge, due to the lack of specific antiviral treatment, the co-circulation of different arboviruses in endemic/epidemic regions, the lack of effective and safe immunizations for the vast majority of these viruses, and the great difficulty in vector control, especially in large urban centers. CONCLUSIONS Children are especially vulnerable to this group of diseases due to characteristics that facilitate the development of the most severe forms. More detailed knowledge of this group of diseases allows the pediatrician to diagnose them earlier, implement the correct treatment, monitor warning signs for the most severe forms, and establish effective preventive measures.
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Burger-Calderon R, Bustos Carrillo F, Gresh L, Ojeda S, Sanchez N, Plazaola M, Katzelnick L, Mercado BL, Monterrey JC, Elizondo D, Arguello S, Nuñez A, Gordon A, Balmaseda A, Kuan G, Harris E. Age-dependent manifestations and case definitions of paediatric Zika: a prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2020; 20:371-380. [PMID: 31870907 PMCID: PMC7085943 DOI: 10.1016/s1473-3099(19)30547-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/01/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Paedeatric Zika remains an understudied topic. WHO and the Pan American Health Organization (PAHO) Zika case definitions have not been assessed in children. We aimed to characterise clinical profiles and evaluate the diagnostic performance of the WHO and PAHO case definitions in a large cohort of paediatric Zika cases. METHODS From January, 2016 to February, 2017, encompassing the major 2016 Zika epidemic, participants in the Pediatric Dengue Cohort Study (PDCS) in Managua, Nicaragua, were encouraged to visit the study health centre at first indication of any illness. PDCS participants were aged 2-14 years, healthy at enrolment, and recruited before the initiation of the present study. Molecular and serological assays were used to test participants exhibiting any of four broad clinical profiles suspected of resulting from a symptomatic Zika virus infection. These clinical profiles were: fever and at least two of headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations, and leukopenia; fever and at least two of nausea or vomiting, rash, aches and pains, positive tourniquet test, leukopenia, and any dengue warning sign; undifferentiated fever without evident cause, with or without any other clinical finding; and afebrile rash with or without any other clinical finding. We characterised acute clinical findings (signs, symptoms, and complete blood counts) in both Zika cases and non-Zika cases. FINDINGS We prospectively followed a cohort of about 3700 children, of which 1110 were deemed eligible for inclusion. Four participants with laboratory-confirmed Zika (three co-infections with dengue virus, one missing complete blood count data) and two participants who were non-Zika cases (missing complete blood count data) were excluded from analysis. We analysed 556 laboratory-confirmed Zika and 548 non-Zika cases. The WHO case definition captured 176 confirmed Zika cases, and the PAHO definition 109 confirmed Zika cases, who presented with the most clinical findings and a dengue-like clinical profile. The remaining two thirds of Zika cases, principally characterised by undifferentiated fever or afebrile rash, were missed. Among Zika cases, rash (n=440)-particularly generalised erythematous rash (n=334)-fever (n=333), leukopenia (n=217), and headache (n=203) were most common and peaked within 3 days of illness onset. The most common Zika presentation over the first week of illness was rash only (n=80). The sensitivity of Zika case definitions increased across paediatric age (from 11·3% to 56·1% for the WHO case definition and from 6·0% to 36·6% for the PAHO case definition), as the prevalence of most clinical findings (particularly arthralgia) increased with age, irrespective of previous dengue virus infection. Consequently, Zika manifested differently across paediatric age; older Zika cases presented with a dengue-like clinical profile while younger Zika cases presented with undifferentiated fever or afebrile rash. INTERPRETATION We provide the most thorough description of paediatric Zika to date. Most paediatric Zika cases go undetected under the WHO and PAHO case definitions, suggesting that current standards for Zika case ascertainment require revision. Zika manifests with mild but differing clinical profiles across paediatric age, presenting major challenges to diagnosis, surveillance, and efforts to control future Zika epidemics. FUNDING US National Institutes of Health.
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Affiliation(s)
- Raquel Burger-Calderon
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Sustainable Sciences Institute, Managua, Nicaragua
| | - Fausto Bustos Carrillo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Leah Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | | | | | | | - Andrea Nuñez
- Sustainable Sciences Institute, Managua, Nicaragua; National Virology Laboratory, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua; National Virology Laboratory, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Guillermina Kuan
- Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
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12
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Teixeira FME, Pietrobon AJ, Oliveira LDM, Oliveira LMDS, Sato MN. Maternal-Fetal Interplay in Zika Virus Infection and Adverse Perinatal Outcomes. Front Immunol 2020; 11:175. [PMID: 32117303 PMCID: PMC7033814 DOI: 10.3389/fimmu.2020.00175] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/22/2020] [Indexed: 12/26/2022] Open
Abstract
During pregnancy, the organization of complex tolerance mechanisms occurs to assure non-rejection of the semiallogeneic fetus. Pregnancy is a period of vulnerability to some viral infections, mainly during the first and second trimesters, that may cause congenital damage to the fetus. Recently, Zika virus (ZIKV) infection has gained great notoriety due to the occurrence of congenital ZIKV syndrome, characterized by fetal microcephaly, which results from the ability of ZIKV to infect placental cells and neural precursors in the fetus. Importantly, in addition to the congenital effects, studies have shown that perinatal ZIKV infection causes a number of disorders, including maculopapular rash, conjunctivitis, and arthralgia. In this paper, we contextualize the immunological aspects involved in the maternal-fetal interface and vulnerability to ZIKV infection, especially the alterations resulting in perinatal outcomes. This highlights the need to develop protective maternal vaccine strategies or interventions that are capable of preventing fetal or even neonatal infection.
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Affiliation(s)
- Franciane Mouradian Emidio Teixeira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna Julia Pietrobon
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luana de Mendonça Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Luanda Mara da Silva Oliveira
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Maria Notomi Sato
- Laboratory of Dermatology and Immunodeficiencies, LIM-56, Department of Dermatology, School of Medicine and Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil.,Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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13
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Endy TP. Viral Febrile Illnesses and Emerging Pathogens. HUNTER'S TROPICAL MEDICINE AND EMERGING INFECTIOUS DISEASES 2020. [PMCID: PMC7151808 DOI: 10.1016/b978-0-323-55512-8.00036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emerging or emerged diseases and viral pathogens are responsible historically and currently for large epidemics, global pandemics, and significant morbidity and mortality. Our civilization will continue to face the emergence of new pathogens and viruses: viruses will continue to evolve and adapt to new environments at a high rate; our population continues to grow through birth rate, land development, and migration; climate change will continue to increase the vector burden and spread and change the migratory pattern of animals; and our societal mobility will continue to increase through rapid transportation. The clinical evaluation of the febrile patient with a potential emerging viral pathogen involves documenting the likelihood for an infection by a detailed travel history, calculation of an incubation time by exposure, and an understanding of the disease progression though the clinical illness, which drives the differential diagnosis and the type of diagnostics ordered. Ultimately, the proper identification and diagnosis of a patient with a viral febrile illness due to an emerging pathogen will elicit the appropriate precautions to protect health care providers and communities, deliver appropriate therapeutic interventions, and initiate a targeted public health response. The majority of emerging diseases are caused by viruses, with many that are transmitted by insect vectors or are zoonotic. RNA viruses in particular have high mutation rates and can evolve rapidly in new and changing environments. This, in combination with societal factors, climate change, and rapid travel, has increased the number of epidemics from emerging pathogens in the last several decades. Understanding the travel history, incubation time of potential viruses, and the clinical presentation by illness day is essential in making the right diagnosis and identifying the infecting virus.
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14
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Wu YH, Cui XY, Yang W, Fan DY, Liu D, Wang PG, An J. Zika Virus Infection in Hypothalamus Causes Hormone Deficiencies and Leads to Irreversible Growth Delay and Memory Impairment in Mice. Cell Rep 2019; 25:1537-1547.e4. [PMID: 30404008 DOI: 10.1016/j.celrep.2018.10.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022] Open
Abstract
Zika virus (ZIKV) can cause microcephaly in the fetus. However, its effects on body growth and the development of children with postnatal ZIKV infection are largely unknown. To examine this, we intraperitoneally challenged mouse pups with ZIKV. Infection causes an irreversible growth delay and deficits in spatial learning and memory, with growth-relevant hormones significantly reduced during infection. These effects are associated with ZIKV RNA expression in the hypothalamus, blood, and brain but not in the pituitary and thyroid. Infection is also associated with hypothalamic inflammation, and ZIKV antigen is detectable in neuroendocrine cells producing thyrotropin-releasing hormone. Moreover, early administration of growth hormone could significantly improve growth delay. Our results demonstrate that ZIKV can infect the hypothalamus, causing multi-hormone deficiencies and delayed growth and development in a mouse model. Therefore, prospective multidisciplinary follow-up of ZIKV-infected children may be necessary to understand potential effects of this virus on childhood development.
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Affiliation(s)
- Yan-Hua Wu
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Xiao-Yun Cui
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Wei Yang
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Dong-Ying Fan
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - Dong Liu
- Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China
| | - Pei-Gang Wang
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China.
| | - Jing An
- Department of Microbiology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing 100093, China.
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15
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Salgado DM, Vega R, Rodríguez JA, Niño Á, Rodríguez R, Ortiz Á, DeLaura I, Bosch I, Narváez CF. Clinical, laboratory and immune aspects of Zika virus-associated encephalitis in children. Int J Infect Dis 2019; 90:104-110. [PMID: 31678190 DOI: 10.1016/j.ijid.2019.10.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the clinical, laboratory, and immune characteristics of Zika virus (ZIKV)-associated encephalitis in pediatric patients after the epidemic in Huila, southern Colombia. METHODS A pediatric neuro-surveillance hospital study was conducted in a referral health center in southern Colombia, from October 2016 to October 2017. Cases of encephalitis were confirmed by nucleic acid amplification tests and serological methods in cerebrospinal fluid (CSF), plasma, and/or urine. Levels of six cytokines were evaluated by flow cytometry. Patients underwent daily clinical and laboratory follow-up. RESULTS Twenty children with probable encephalitis were included for further studies and 16 of them were confirmed. Four cases of bacterial meningoencephalitis (Streptococcus pneumoniae, group B Streptococcus, Staphylococcus epidermidis, and Escherichia coli) and 12 cases of viral encephalitis were identified, six of them associated with ZIKV infection. Other viral encephalitis cases were caused by herpes viruses (n=3), enterovirus (n=2), and dengue virus type 2 (DENV-2; n=1) infections. ZIKV-associated encephalitis symptoms subsided faster than those of patients with encephalitis caused by other agents. CSF analysis revealed lymphocytic pleocytosis. Compared to healthy controls, children with ZIKV-associated encephalitis presented modest plasma interleukin (IL)-10 but not IL-2, IL-4, IL-6, interferon gamma (IFN-γ), or tumor necrosis factor alpha (TNF-α). Cytokine expression was differentially regulated, as dramatically elevated IL-6, IL-10, and IFN-γ levels were observed in CSF but not in paired plasma samples in one of the patients with ZIKV detectable in CSF. CONCLUSIONS This study provides evidence that ZIKV is responsible for pediatric encephalitis in endemic areas, and the local presence of the virus may induce cephalic but not systemic expression of cytokines.
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Affiliation(s)
- Doris M Salgado
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - Rocío Vega
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Jairo Antonio Rodríguez
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Ángela Niño
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Rocío Rodríguez
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Ángela Ortiz
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia
| | - Isabel DeLaura
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Harvard College, Cambridge, MA 02138, USA
| | - Irene Bosch
- E25Bio Inc., The Engine of MIT, 501 Massachusetts Ave., Cambridge, MA 02139, USA; Mount Sinai School of Medicine, Department of Medicine, New York, NY 10029-6500, USA
| | - Carlos F Narváez
- Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia.
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16
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Mavigner M, Raper J, Kovacs-Balint Z, Gumber S, O'Neal JT, Bhaumik SK, Zhang X, Habib J, Mattingly C, McDonald CE, Avanzato V, Burke MW, Magnani DM, Bailey VK, Watkins DI, Vanderford TH, Fair D, Earl E, Feczko E, Styner M, Jean SM, Cohen JK, Silvestri G, Johnson RP, O'Connor DH, Wrammert J, Suthar MS, Sanchez MM, Alvarado MC, Chahroudi A. Postnatal Zika virus infection is associated with persistent abnormalities in brain structure, function, and behavior in infant macaques. Sci Transl Med 2019; 10:10/435/eaao6975. [PMID: 29618564 DOI: 10.1126/scitranslmed.aao6975] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/07/2018] [Indexed: 12/22/2022]
Abstract
The Zika virus (ZIKV) epidemic is associated with fetal brain lesions and other serious birth defects classified as congenital ZIKV syndrome. Postnatal ZIKV infection in infants and children has been reported; however, data on brain anatomy, function, and behavioral outcomes following infection are absent. We show that postnatal ZIKV infection of infant rhesus macaques (RMs) results in persistent structural and functional alterations of the central nervous system compared to age-matched controls. We demonstrate ZIKV lymphoid tropism and neurotropism in infant RMs and histopathologic abnormalities in the peripheral and central nervous systems including inflammatory infiltrates, astrogliosis, and Wallerian degeneration. Structural and resting-state functional magnetic resonance imaging (MRI/rs-fMRI) show persistent enlargement of lateral ventricles, maturational changes in specific brain regions, and altered functional connectivity (FC) between brain areas involved in emotional behavior and arousal functions, including weakened amygdala-hippocampal connectivity in two of two ZIKV-infected infant RMs several months after clearance of ZIKV RNA from peripheral blood. ZIKV infection also results in distinct alterations in the species-typical emotional reactivity to acute stress, which were predicted by the weak amygdala-hippocampal FC. We demonstrate that postnatal ZIKV infection of infants in this model affects neurodevelopment, suggesting that long-term clinical monitoring of pediatric cases is warranted.
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Affiliation(s)
- Maud Mavigner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jessica Raper
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Zsofia Kovacs-Balint
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Sanjeev Gumber
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | | | - Siddhartha K Bhaumik
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Xiaodong Zhang
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Jakob Habib
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Cameron Mattingly
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Victoria Avanzato
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mark W Burke
- Department of Physiology and Biophysics, Howard University, Washington, DC 20060, USA
| | - Diogo M Magnani
- Department of Pathology, University of Miami, Miami, FL 33146, USA
| | - Varian K Bailey
- Department of Pathology, University of Miami, Miami, FL 33146, USA
| | - David I Watkins
- Department of Pathology, University of Miami, Miami, FL 33146, USA
| | - Thomas H Vanderford
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Damien Fair
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Eric Earl
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Eric Feczko
- Oregon Health and Science University, Portland, OR 97239, USA
| | - Martin Styner
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Sherrie M Jean
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Joyce K Cohen
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Guido Silvestri
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - R Paul Johnson
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - David H O'Connor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Jens Wrammert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mehul S Suthar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.,Emory Vaccine Center, Atlanta, GA 30329, USA
| | - Mar M Sanchez
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Maria C Alvarado
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA. .,Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
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17
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Findings and lessons from establishing Zika virus surveillance in southern Viet Nam, 2016. Western Pac Surveill Response J 2019; 10:22-30. [PMID: 31720051 PMCID: PMC6831960 DOI: 10.5365/wpsar.2018.9.2.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective To document the evolution and optimization of the Zika virus (ZIKV) disease surveillance system in southern Viet Nam in 2016 and to describe the characteristics of the identified ZIKV-positive cases. Methods We established a sentinel surveillance system to monitor ZIKV transmission in eight sites in eight provinces and expanded the system to 71 sites in 20 provinces in southern Viet Nam in 2016. Blood and urine samples from patients who met the case definition at the sentinel sites were tested for ZIKV using real-time reverse transcription polymerase chain reaction at the Pasteur Institute in Ho Chi Minh City (PI-HCMC). We conducted descriptive analysis and mapped the ZIKV-positive cases. Results In 2016, 2190 specimens from 20 provinces in southern Viet Nam were tested for ZIKV at PI-HCMC; 626 (28.6%), 484 (22.1%), 35 (1.6%) and 1045 (47.7%) tests were conducted in the first, second, third and fourth quarters of the year, respectively. Of these tested specimens, 214 (9.8%) were ZIKV positive with 212 (99.1%) identified in the fourth quarter. In the fourth quarter, the highest positivity rate was those in age groups 30–39 years (30.0%) and 40–59 years (31.6%). Of the 214 ZIKV-positive patients, 210 (98.1%) presented with rash, 194 (90.7%) with fever, 149 (69.6%) with muscle pain, 123 (57.5%) with joint pain and 66 (30.8%) with conjunctivitis. Discussion The surveillance system for ZIKV disease underwent several phases of optimization in 2016, guided by the most up-to-date local data. Here we demonstrate an adaptable surveillance system that detected ZIKV-positive cases in southern Viet Nam.
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18
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Freeman MC, Coyne CB, Green M, Williams JV, Silva LA. Emerging arboviruses and implications for pediatric transplantation: A review. Pediatr Transplant 2019; 23:e13303. [PMID: 30338634 DOI: 10.1111/petr.13303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/29/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
Recent years have brought a rise in newly emergent viral infections, primarily in the form of previously known arthropod-transmitted viruses that have increased significantly in both incidence and geographical range. Of particular note are DENV, CHIKV, and ZIKV, which are transmitted mostly by Aedes species of mosquitoes that exhibit a wide and increasing global distribution. Being important pathogens for the general population, these viruses have the potential to be devastating in the international transplant community, with graft rejection and death as possible outcomes of infection. In this review, we discuss the current state of knowledge for these viruses as well as repercussions of infection in the solid organ and HSCT population, with a focus, when possible, on pediatric patients.
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Affiliation(s)
- Megan Culler Freeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carolyn B Coyne
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Green
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V Williams
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laurie A Silva
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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19
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Abstract
Zika virus is a mosquito-borne Flavivirus responsible for symptomatic and asymptomatic infections in humans. Zika was first identified in Africa as a cause of sporadic febrile illness. Beginning in 2015, Zika virus infection was identified in Brazil and linked with several symptomatic infections. Notably, congenital infections were observed with marked neurologic abnormalities. Diagnosis relies on detection of Zika virus by real-time polymerase chain reaction or by the presence of anti-Zika antibodies. Treatment of this viral illness remains supportive; however, proactive screening and interventions are indicated in the treatment of infants with symptomatic congenital infection.
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Affiliation(s)
- David Taylor Hendrixson
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis, St. Louis Children's Hospital, Campus Box 8116, 1 Children's Place, St Louis, MO 63110, USA.
| | - Jason G Newland
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis, St. Louis Children's Hospital, Campus Box 8116, 1 Children's Place, St Louis, MO 63110, USA
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20
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Gong Z, Xu X, Han GZ. The Diversification of Zika Virus: Are There Two Distinct Lineages? Genome Biol Evol 2018; 9:2940-2945. [PMID: 29069354 PMCID: PMC5714212 DOI: 10.1093/gbe/evx223] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 12/18/2022] Open
Abstract
Zika virus (ZIKV) has caused explosive epidemics in the Pacific and the Americas, posing a serious threat to public health. Conventional opinion advocates that ZIKV evolved into two distinct lineages, namely, African and Asian. Descendants of this latter lineage dispersed globally causing major epidemics. However, based on shared amino acid replacements and phylogenetic analyses, it was recently contentiously proposed that the Asian lineage was a direct descendant of the African lineage. To address this contentious issue, we reconstructed a phylogenetic tree of ZIKV using the method based on shared amino acid replacements and found that ZIKV evolved into two distinct lineages. This supports the conventional phylogenetic divergence pattern of ZIKV. Evidence of recombination and sequencing errors was identified among the large collection of ZIKV. As such problematic sequences could confound the phylogenetic analyses, they were removed. Bayesian phylogenetic analyses using the improved sequence data enabled estimates for the divergence time in the past of the African and Asian lineages of ∼180 years ago. Moreover, we found that the Asian lineage viruses did not evolve at an elevated rate. Our findings provide additional support for the conventional opinion that the Asian lineage of ZIKV diverged from the African lineage.
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Affiliation(s)
- Zhen Gong
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Microbiology, College of Life Sciences, Nanjing Normal University, Jiangsu, China
| | - Xiaoyu Xu
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Microbiology, College of Life Sciences, Nanjing Normal University, Jiangsu, China
| | - Guan-Zhu Han
- Jiangsu Key Laboratory for Microbes and Functional Genomics, Jiangsu Engineering and Technology Research Center for Microbiology, College of Life Sciences, Nanjing Normal University, Jiangsu, China
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21
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Read JS, Torres-Velasquez B, Lorenzi O, Rivera Sanchez A, Torres-Torres S, Rivera LV, Capre-Franceschi SM, Garcia-Gubern C, Munoz-Jordan J, Santiago GA, Alvarado LI. Symptomatic Zika Virus Infection in Infants, Children, and Adolescents Living in Puerto Rico. JAMA Pediatr 2018; 172:686-693. [PMID: 29813148 PMCID: PMC6137503 DOI: 10.1001/jamapediatrics.2018.0870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Little information is available regarding Zika virus (ZIKV) infection in children. OBJECTIVE To describe patients younger than 18 years who were infected with ZIKV and were enrolled in the Sentinel Enhanced Dengue and Acute Febrile Illness Surveillance System (SEDSS). DESIGN, SETTING, AND PARTICIPANTS Children infected with ZIKV with 7 or fewer days of fever or emancipated minors aged 14 to 17 years with a generalized maculopapular rash, arthritis or arthralgia, or nonpurulent conjunctivitis were eligible for enrollment on or before December 31, 2016, in Puerto Rico. Patients were evaluated using ZIKV polymerase chain reaction testing at 7 or fewer days after the onset of symptoms. Available ZIKV polymerase chain reaction-positive specimens were evaluated to determine viral loads. EXPOSURES Confirmed polymerase chain reaction-positive ZIKV infection. MAIN OUTCOMES AND MEASURES Clinical characteristics and viral loads of symptomatic children with confirmed ZIKV infection. RESULTS Of 7191 children enrolled in SEDSS on or before December 31, 2016, only those with confirmed ZIKV infection (351 participants) were included in this study. Participants who had confirmed ZIKV infection included 25 infants (7.1%), 69 children (19.7%) aged 1 to 4 years, 95 (27.1%) aged 5 to 9 years, and 162 (46.1%) aged 10 to 17 years. Among these, 260 patients (74.1%) presented for evaluation of ZIKV infection at fewer than 3 days after the onset of symptoms, 340 (96.9%) were discharged to home after evaluation, and 349 (99.4%) had fever, 280 (79.8%) had a rash, 243 (69.2%) had facial or neck erythema, 234 (66.7%) had fatigue, 223 (63.5%) had headache, 212 (60.4%) had chills, 206 (58.7%) had pruritus, and 204 (58.1%) had conjunctival hyperemia. Of 480 specimens collected (317 serum and 163 urine specimens) from 349 children, the median number of days after the onset of symptoms was lower for children who had serum specimens (1 day [interquartile range (IQR), 1-2 days]) than for children who had urine specimens (2 [1-3] days) (P < .001). Of 131 children who had both serum and urine specimens collected on the same day, the median viral load was higher in serum than in urine (median [IQR], 23 098 [8784-88 242] copies/mL for serum vs 9966 [2815-52 774] copies/mL for urine; P = .02). When a single serum sample from each of 317 patients was analyzed, there were no statistically significant differences in median viral loads according to age, sex, or disposition. However, the median serum viral load varied significantly according to the number of days after the onset of symptoms (0 days, 106 778 [IQR, 9772-1 571 718] copies/mL; 1 day, 46 299 [10 663-255 030] copies/mL; 2 days, 20 678 [8763-42 458] copies/mL; and ≥3 days, 15 901 [5135-49 248] copies/mL; P = .001). CONCLUSIONS AND RELEVANCE This study represents the largest study to date of ZIKV infection in the pediatric population. Most children infected with ZIKV had fever, rash, and conjunctival hyperemia. The children usually presented for evaluation at fewer than 3 days after the onset of symptoms. Viral loads for ZIKV were higher in serum vs urine specimens. Median viral loads in serum specimens differed significantly according to the number of days after the onset of symptoms.
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Affiliation(s)
- Jennifer S. Read
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico,Now with Department of Pediatrics, University of Vermont Medical Center, Burlington
| | - Brenda Torres-Velasquez
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Olga Lorenzi
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aidsa Rivera Sanchez
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Sanet Torres-Torres
- Department of Pediatrics, St Luke’s Episcopal Hospital–Ponce Health Sciences University Consortium, Ponce, Puerto Rico
| | - Lillian V. Rivera
- Department of Pediatrics, St Luke’s Episcopal Hospital–Ponce Health Sciences University Consortium, Ponce, Puerto Rico,Department of Pediatrics, School of Medicine, Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico
| | - Sheila M. Capre-Franceschi
- Department of Pediatrics, St Luke’s Episcopal Hospital–Ponce Health Sciences University Consortium, Ponce, Puerto Rico
| | - Carlos Garcia-Gubern
- Department of Emergency Medicine, St. Luke’s Episcopal Hospital–Ponce Health Sciences University Consortium, Ponce, Puerto Rico
| | - Jorge Munoz-Jordan
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gilberto A. Santiago
- Dengue Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Luisa I. Alvarado
- Department of Pediatrics, St Luke’s Episcopal Hospital–Ponce Health Sciences University Consortium, Ponce, Puerto Rico
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Affiliation(s)
- Edwin J Asturias
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.,Children's Hospital Colorado, Aurora.,Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora
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Abstract
PURPOSE OF REVIEW Zika virus (ZIKV), a mosquito-borne flavivirus, has gained recognition over the past few years as an important new cause of congenital infection. As a result, it is critical that pediatricians understand its epidemiology, clinical presentation, clinical sequelae, and management. RECENT FINDINGS The recent ZIKV epidemiology, clinical presentation of acute infection in children and complications, perinatal infection, and congenital infection will be summarized in this ZIKV review. This will be followed by a brief summary on ZIKV diagnosis, management, treatment, and prevention. SUMMARY The field of clinical research in ZIKV has rapidly evolved over recent months. It is critical that pediatricians continue to stay up-to-date with the continuously evolving understanding of the clinical aspects of ZIKV to ensure optimal identification and management of affected infants and children. Given the recent changes in Centers for Disease Control and Prevention guidelines to limit screening of asymptomatic pregnant women in the United States with possible ZIKV exposure, comprehensive ZIKV clinical knowledge becomes even more crucial.
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Affiliation(s)
- Kristina Adachi
- David Geffen UCLA School of Medicine, Los Angeles, CA 90095-1406, U.S
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24
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MacDonald PDM, Holden EW. Zika and Public Health: Understanding the Epidemiology and Information Environment. Pediatrics 2018; 141:S137-S145. [PMID: 29437046 DOI: 10.1542/peds.2017-2038b] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Because Zika is a newly emerging infectious disease with little previous information known about it, there are many epidemiologic and clinical questions. The complexity of providing care to those who are at risk for infection or are already infected with Zika in this evidence-scarce environment cannot be understated. In this article, we provide an overview of the Zika virus (ZIKV) in the context of public health and pediatric health care. A broad public health focus is used to provide relevant information for addressing important questions about the epidemic and to facilitate communication with patients, parents, and caregivers within the current information environment. We explore issues regarding the epidemiology of the virus (including why ZIKV outbreaks are occurring), what has changed since the sporadic case reports before the outbreaks, why the true incidence is difficult to estimate, why attack rates vary by population and geography, and why the association between Zika and congenital Zika syndrome and Guillain-Barré syndrome have only come to light recently. Additionally, challenges related to the current information environment, traditional and informal information sources about the ZIKV, and examples of Zika public health communication campaigns are discussed. Importantly, we review the existing findings regarding the US population's Zika-related knowledge, attitudes, beliefs, and behavior by highlighting variations and gaps. We conclude by identifying related research questions that remain critical.
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Affiliation(s)
| | - E Wayne Holden
- RTI International, Research Triangle Park, North Carolina
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25
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Mulkey SB, Vezina G, Bulas DI, Khademian Z, Blask A, Kousa Y, Cristante C, Pesacreta L, du Plessis AJ, DeBiasi RL. Neuroimaging Findings in Normocephalic Newborns With Intrauterine Zika Virus Exposure. Pediatr Neurol 2018; 78:75-78. [PMID: 29167058 DOI: 10.1016/j.pediatrneurol.2017.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Congenital Zika infection can result in a spectrum of neurological abnormalities in the newborn. Newborns exposed to Zika virus in utero often have neuroimaging as part of their clinical evaluation. METHODS Through the Congenital Zika Program at Children's National Health System in Washington DC, we performed fetal or neonatal neuroimaging, including magnetic resonance imaging and ultrasound, on over 70 fetuses or neonates with intrauterine Zika exposure. Novel findings on neonatal brain magnetic resonance imaging were observed in two instances. RESULTS Gadolinium-contrast magnetic resonance imaging showed enhancement of multiple cranial nerves at three days of age on one infant. Another infant underwent magnetic resonance imaging at 16 days of age and was shown to have a chronic ischemic cerebral infarction. This infant had previously normal fetal magnetic resonance imaging. CONCLUSION Cranial nerve enhancement and cerebral infarction may be among the expanding list of neurological findings in congenital Zika infection. Postnatal brain magnetic resonance imaging should be considered for newborns exposed to Zika virus in utero.
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Affiliation(s)
- Sarah B Mulkey
- Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
| | - Gilbert Vezina
- Division of Radiology, Children's National Health System, Washington, District of Columbia
| | - Dorothy I Bulas
- Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia; Division of Radiology, Children's National Health System, Washington, District of Columbia
| | - Zarir Khademian
- Division of Radiology, Children's National Health System, Washington, District of Columbia
| | - Anna Blask
- Division of Radiology, Children's National Health System, Washington, District of Columbia
| | - Youssef Kousa
- Division of Neurology, Children's National Health System, Washington, District of Columbia
| | - Caitlin Cristante
- Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
| | - Lindsay Pesacreta
- Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia
| | - Adre J du Plessis
- Division of Fetal and Transitional Medicine, Children's National Health System, Washington, District of Columbia; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Roberta L DeBiasi
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Division of Infectious Diseases, Children's National Health System, Washington, District of Columbia; Department of Microbiology, Immunology and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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26
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da Silva Pone MV, Moura Pone S, Araujo Zin A, Barros Mendes PH, Senra Aibe M, Barroso de Aguiar E, de Oliveira Gomes da Silva T. Zika virus infection in children: epidemiology and clinical manifestations. Childs Nerv Syst 2018; 34:63-71. [PMID: 29110197 DOI: 10.1007/s00381-017-3635-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this review is to comprehensively review Congenital Zika Syndrome in regard to their epidemiology and clinical manifestations. METHODS This subject review of congenital Zika syndrome was composed after conducting a thorough review of the available literature on this topic using PubMed and other primary sources. RESULTS The first epidemic of Zika virus infection in Brazil was followed by an unexpected sharp increase in the incidence of infants born with microcephaly and the description of a new disease, the congenital Zika syndrome. This review focuses on the epidemiological and clinical aspects of Zika infection in children. We conducted a brief historical account of the virus description in 1947, the rare cases of Zika infection occurring up to 2007, and the first epidemics in the Pacific between 2007 and 2014. We also discussed the isolation of the virus in Brazil in 2015 and its spread in the Americas, the microcephaly outbreak in Brazil and its association with Zika virus, and the current epidemiological panorama. We address the known clinical spectrum of Zika virus infection in the pediatric population, including manifestations of acute infection and congenital Zika syndrome, with emphasis on cranial, ophthalmic, and orthopedic abnormalities. CONCLUSION While much has been learned about congenital Zika syndrome, the full spectrum of this infection is not yet known. This review is based on current, limited data about Zika vírus infection. As more information becomes available, we will have a more accurate picture of this new disease.
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Affiliation(s)
- Marcos Vinicius da Silva Pone
- Pediatric Infectious Diseases Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF)/Oswaldo Cruz Foundation (FIOCRUZ), Av. Rui Barbosa 716, Rio de Janeiro, 22250-020, Brazil.
| | - Sheila Moura Pone
- Pediatric Infectious Diseases Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF)/Oswaldo Cruz Foundation (FIOCRUZ), Av. Rui Barbosa 716, Rio de Janeiro, 22250-020, Brazil
| | - Andrea Araujo Zin
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF)/Oswaldo Cruz Foundation (FIOCRUZ), Av. Rui Barbosa 716, Rio de Janeiro, 22250-020, Brazil
| | - Pedro Henrique Barros Mendes
- Orthopedic Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF)/Oswaldo Cruz Foundation (FIOCRUZ), Av. Rui Barbosa 716, Rio de Janeiro, 22250-020, Brazil
| | - Mitsue Senra Aibe
- Pediatric Infectious Diseases Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF)/Oswaldo Cruz Foundation (FIOCRUZ), Av. Rui Barbosa 716, Rio de Janeiro, 22250-020, Brazil
| | - Elisa Barroso de Aguiar
- Pediatric Infectious Diseases Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF)/Oswaldo Cruz Foundation (FIOCRUZ), Av. Rui Barbosa 716, Rio de Janeiro, 22250-020, Brazil
| | - Tallita de Oliveira Gomes da Silva
- Pediatric Infectious Diseases Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF)/Oswaldo Cruz Foundation (FIOCRUZ), Av. Rui Barbosa 716, Rio de Janeiro, 22250-020, Brazil
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27
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Griffin I, Zhang G, Fernandez D, Cordero C, Logue T, White SL, Llau A, Thomas L, Moore E, Noya-Chaveco P, Etienne M, Rojas M, Goldberg C, Rodriguez G, Mejia-Echeverry A, Rico E, Gillis LD, Cone M, Jean R, Rivera L. Epidemiology of Pediatric Zika Virus Infections. Pediatrics 2017; 140:peds.2017-2044. [PMID: 29093135 DOI: 10.1542/peds.2017-2044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In July 2016, local transmission of Zika virus (ZIKV) was announced in Miami-Dade County, Florida. In this report, we describe the epidemiology of pediatric ZIKV infections in locally acquired and travel-associated cases. METHODS All children aged 1 to 17 years tested for ZIKV between October 1, 2015, and March 29, 2017, were included. SAS 9.4 was used to analyze age, sex, race and/or ethnicity, origin of exposure, onset date, affiliation with a household cluster, clinical symptoms, hospitalizations, viremia, viruria, and antibody detection in specimens. RESULTS Among 478 confirmed ZIKV cases in Miami-Dade County, 33 (6.9%) occurred in children (1-17 years). Twenty-seven (82.3%) cases were travel-associated. The median age of a pediatric Zika case patient was 11 years. Seventeen (51.5%) case patients were boys, and 23 (69.9%) were Hispanic. Among 31 symptomatic cases, all reported having rash, 25 (80.6%) reported fever, 9 (29.0%) reported conjunctivitis, and 7 (22.6%) reported arthralgia. Sixteen (48.5%) cases reported 2 of 4 and 8 (24.2%) reported 3 of 4 main symptoms. CONCLUSIONS This report found that the majority of children identified during the 2016 ZIKV outbreak only presented with 2 of the 4 main symptoms. In addition, pediatric ZIKV cases were frequently associated with symptomatic household members.
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Affiliation(s)
- Isabel Griffin
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Guoyan Zhang
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Danielle Fernandez
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Christina Cordero
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Teresa Logue
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Stephen L White
- Division of Disease Control and Health Protection, Bureau of Public Health Laboratories, Miami, Florida
| | - Anthoni Llau
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Lakisha Thomas
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Emily Moore
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Pedro Noya-Chaveco
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Marie Etienne
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Mercedes Rojas
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Cynthia Goldberg
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Genevie Rodriguez
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Alvaro Mejia-Echeverry
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Edhelene Rico
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Leah D Gillis
- Division of Disease Control and Health Protection, Bureau of Public Health Laboratories, Miami, Florida
| | - Marshall Cone
- Division of Disease Control and Health Protection, Bureau of Public Health Laboratories, Miami, Florida
| | - Reynald Jean
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
| | - Lillian Rivera
- Department of Epidemiology, Disease Control, and Immunization Services, Florida Department of Health in Miami-Dade County, Miami, Florida; and
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28
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Harville EW. Paediatric Zika - Beyond Pregnant Women. Paediatr Perinat Epidemiol 2017; 31:546-548. [PMID: 28806481 DOI: 10.1111/ppe.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emily W Harville
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, Louisiana, LA
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29
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Tolosa N, Tinker SC, Pacheco O, Valencia D, Botero DS, Tong VT, Mercado M, Gilboa SM, Gonzalez M, Nelson CA, Pardo L, Rao CY, Rico A, Moore M, Parra E, Honein MA, Ospina Martínez ML. Zika Virus Disease in Children in Colombia, August 2015 to May 2016. Paediatr Perinat Epidemiol 2017; 31:537-545. [PMID: 28806479 DOI: 10.1111/ppe.12391] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children are considered a potentially vulnerable population for Zika virus infection. However, data on paediatric Zika virus infection are sparse. METHODS We analysed data from Colombia's national surveillance system during the 2015-2016 Zika virus outbreak on patients meeting the clinical case definition of Zika virus disease (ZVD) among children aged 1 month to 18 years to estimate incidence by demographic characteristics and characterize the occurrence of selected complications. RESULTS Between August 14, 2015, and May 28, 2016, there were 18 576 reported cases of postnatal ZVD among children aged 1 month to 18 years. Laboratory testing was prioritized for high-risk patients (infants, pregnant women, adults aged ≥65 years, and persons with serious co-morbidities); among 1655 that were tested by real-time reverse transcriptase polymerase chain reaction, 1207 (72.9%) were positive. The cumulative incidence of reported ZVD was 114.4 per 100 000. The incidence differed by sex, depending on age group; the largest difference was observed for 15-18 year olds, with females having a higher incidence than males (cumulative incidence ratio 2.5, 95% confidence interval 2.3, 2.7). At the time of report to the surveillance system, 631 patients (3.4%) were hospitalised and 96 (0.5%) had a report of an accompanying neurological diagnosis, including Guillain-Barré syndrome in 40 patients. CONCLUSIONS Only a small proportion of reported paediatric ZVD cases in Colombia were hospitalized or had reported neurological conditions following ZVD. However, the potential for some serious outcomes demonstrates the importance of preventing Zika virus infection in children.
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Affiliation(s)
| | | | | | | | | | - Van T Tong
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | - Carol Y Rao
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Edgar Parra
- Instituto Nacional de Salud, Bogota, Colombia
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30
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Abstract
Zika virus is a mosquito-borne Flavivirus. It has emerged as an important infectious agent in the recent past, mainly because of its teratogenic effects on the fetus. This review highlights the epidemiology, diagnosis, and treatment of this emerging infection.
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31
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Abstract
PURPOSE OF REVIEW While the Zika virus (ZIKV) has been noted for its distinct neurotropism and identified as a significant cause for a congenital infection syndrome, there has been increased recognition of the importance to better understand the clinical impact of non-congenital ZIKV infection in infants and children. This article reviews reports of perinatal and breast milk transmission of ZIKV and summarizes current clinical outcome data of pediatric non-congenital ZIKV infection. RECENT FINDINGS Perinatal transmission and presence of infective ZIKV particles in breast milk have been reported. Most symptomatic non-congenital ZIKV infection in infants and children is mild and self-limited, but long-term follow-up studies are lacking. The mechanism and impact of perinatal and breast milk transmission is unclear. The current WHO infant feeding guidelines in areas of ZIKV transmission support breastfeeding. Unless any scientific data raise concern regarding transmission via breastfeeding, the current guidelines should continue to be followed. Prospective population-based cohort studies to investigate maternal, perinatal, infant, and child outcomes are needed.
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Affiliation(s)
- Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA.
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32
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Abstract
In less than 2 years since entry into the Americas, we have witnessed the emergent spread of Zika virus into large subsets of immunologically naïve human populations and then encountered the devastating effects of microcephaly and brain anomalies that can arise from in utero infection with the virus. Diagnostic evaluation and management of affected infants continues to evolve as our understanding of Zika virus rapidly advances. The development of a safe and effective vaccine holds the potential to attenuate the spread of infection and limit the impact of congenital infection.
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33
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Affiliation(s)
- Mobeen H Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES), 910 North Jefferson Street, Jacksonville, FL 32209, USA; Infectious Diseases and Immunology, Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL 32207, USA.
| | - Jonathan Runyon
- Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA
| | - Tanveer-Ul Haque
- Infectious Diseases and Immunology, Wolfson Children's Hospital, 800 Prudential Drive, Jacksonville, FL 32207, USA
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34
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Zika Virus Infection. Pediatr Emerg Care 2017; 33:e6. [PMID: 28441244 DOI: 10.1097/pec.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Green RJ. Emerging Zoonotic and Vector-Borne Viral Diseases. VIRAL INFECTIONS IN CHILDREN, VOLUME I 2017. [PMCID: PMC7114986 DOI: 10.1007/978-3-319-54033-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Many vector-borne and zoonotic diseases are considered to be emerging; since they are either newly reported to cause human disease, or are causing disease in geographical locations or species not previously documented. In the past 15 years, significant outbreaks of Severe Acute Respiratory Syndrome (or SARS) and Middle Eastern Respiratory Syndrome (or MERS), Nipah and Hendra, Ebola virus disease and Zika fever and others have been reported. In this chapter the clinical characteristics, epidemiological aspects, treatment and prevention and information related to the laboratory investigation of important zoonotic and vector-borne diseases that have emerged in the past 10 years, and how this affects children, will be discussed. Furthermore rabies, considered a neglected viral disease with the majority of victims in Africa being children, will also be addressed.
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Affiliation(s)
- Robin J. Green
- Department of Paediatrics and Child Health, University of Pretoria, School of Medicine, Pretoria, ZA, South Africa
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