Cited by 831Mosquito-borne diseases and controlInfectious Encephalopathies and EncephalitisViral Infections and Vectors

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Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

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Driggers, Rita W., Ho, Cheng-Ying, Korhonen, Essi M., Kuivanen, Suvi, Jääskeläinen, Anne J., Smura, Teemu, Rosenberg, Avi, Hill, D. Ashley, DeBiasi, Roberta L., Vezina, Gilbert, Timofeev, Julia, Rodriguez, Fausto J., Levanov, Lev, Razak, Jennifer, Iyengar, Preetha, Hennenfent, Andrew, Kennedy, Richard, Lanciotti, Robert, du Plessis, Adre, Vapalahti, Olli·2016·New England Journal of Medicine

DOI 10.1056/nejmoa1601824

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Abstract

Summ a r yThe current outbreak of Zika virus (ZIKV) infection has been associated with an apparent increased risk of congenital microcephaly.We describe a case of a pregnant woman and her fetus infected with ZIKV during the 11th gestational week.The fetal head circumference decreased from the 47th percentile to the 24th percentile between 16 and 20 weeks of gestation.ZIKV RNA was identified in maternal serum at 16 and 21 weeks of gestation.At 19 and 20 weeks of gestation, substantial brain abnormalities were detected on ultrasonography and magnetic resonance imaging (MRI) without the presence of microcephaly or intracranial calcifications.On postmortem analysis of the fetal brain, diffuse cerebral cortical thinning, high ZIKV RNA loads, and viral particles were detected, and ZIKV was subsequently isolated.Z ika virus (ZIKV), a mosquito-borne flavivirus and member of the Flaviviridae family, was originally isolated from a sentinel primate in Uganda in 1947. 1 ZIKV was associated with mild febrile disease and maculopapular rash in tropical Africa and some areas of Southeast Asia.Since 2007, ZIKV has caused several outbreaks outside its former distribution area in islands of the Pacific: in 2007 on Yap island in Micronesia, in 2013 and 2014 in French Polynesia, and in 2015 in South America, where ZIKV had not been identified previously.[2][3][4][5] There are separate African and Asian lineages of the virus, 6 and the latter strains have caused the outbreaks in the Pacific and the Americas.7 As in the transmission of dengue and chikungunya viruses, the main transmission cycle of ZIKV occurs between urban aedes mosquitoes and humans.One striking feature of the current ZIKV outbreak is the apparent increased risk of intrauterine or perinatal transmission of the virus as well as the marked increase in the number of newborns with microcephaly reported in Brazil.[8][9][10][11][12][13][14][15][16][17] A recent prospective study showed fetal ultrasonographic abnormalities in 12 of 42 women (29%) with ZIKV infection during pregnancy; 7 of the 42 fetuses (17%) that were studied had microcephaly, cerebral atrophy, or brain calcifications.11 Because of the association between ZIKV infection and microcephaly and other neurologic disorders, the World Health Organization has declared the ZIKV epidemic a public health emergency of international concern.13 Early in this particular outbreak, investigations into the viral pathogenesis, vertical transmission rates, potential viral cofactors, and sensitivity and specificity of diagnostic testing have presented more questions than answers.Nevertheless, the Centers for Disease Control and Prevention (CDC) has issued a travel advisory The authors' full names, academic degrees, and affiliations are listed in the Appendix.

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Authors: Driggers, R. W., Ho, C.-Y., Korhonen, E. M., Kuivanen, S., Jääskeläinen, A. J., Smura, T., Rosenberg, A., Hill, D. A., DeBiasi, R. L., Vezina, G., Timofeev, J., Rodriguez, F. J., Levanov, L., Razak, J., Iyengar, P., Hennenfent, A., Kennedy, R., Lanciotti, R., du Plessis, A., & Vapalahti, O.
Affiliations: Children's National (US)
Centers for Disease Control and Prevention (US)
ORCID: Ho, Cheng-Ying
Korhonen, Essi M.
Kuivanen, Suvi
Smura, Teemu
Rosenberg, Avi
DeBiasi, Roberta L.
Levanov, Lev
Hennenfent, Andrew
Kennedy, Richard
Vapalahti, Olli
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2016-06-02
Volume: 374
Issue: 22
Pages: 2142-2151
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa1601824
OpenAlex: W2333018296
Cited by: 831
References: 21
Citations by year: 2026: 13 · 2025: 22 · 2024: 29 · 2023: 29 · 2022: 43 · 2021: 56 · 2020: 79 · 2019: 95 · 2018: 119 · 2017: 195 · 2016: 150
FWCI: 184.75
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
Health Sciences › Medicine › Infectious Diseases › Viral Infections and Vectors
Keywords: Zika virus infection, congenital Zika syndrome, microcephaly, maternal viremia, fetal brain anomalies, intrauterine transmission, perinatal transmission, fetal head circumference, flavivirus, Zika virus outbreak, pregnancy complications, fetal brain MRI
MeSH terms: Zika Virus Infection, Zika Virus, Adult, Brain, Disease Outbreaks, Female, Fetus, Humans, Magnetic Resonance Imaging, Microcephaly, Pregnancy, Pregnancy Complications, Infectious, Viremia, Ultrasonography, Prenatal

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Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities

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