), Centre Pluridisciplinaire de Diagnostic Prénatal (C.R. Méta analyse sur 2941 cas : 2,3% de microcéphalies soit 10 fois plus que dans la population générale. Defects were more common among fetuses and infants whose mothers had been infected early in pregnancy. Women were included in this analysis if they met all of the following criteria: ongoing pregnancy at any gestational stage; clinical symptoms consistent with acute ZIKV infection, with at least one symptom of pruritic rash, fever, conjunctival hyperemia, arthralgia, or myalgia; and laboratory confirmation of recent ZIKV infection, on the basis of a positive result on a reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay performed on a specimen of blood, urine, or both. Case Records of the Massachusetts General Hospital, Injuries from Less-Lethal Weapons during the George Floyd Protests in Minneapolis, Convalescent Plasma Antibody Levels and the Risk of Death from Covid-19, (A Little) Clarity on Convalescent Plasma for Covid-19, CMS Innovation Center at 10 Years — Progress and Lessons Learned, Interim Results of a Phase 1–2a Trial of Ad26.COV2.S Covid-19 Vaccine. During the enrollment visit, sociodemographic data were collected for each woman. In addition, the results were consistent across the two territories in which the largest numbers of women were recruited (Martinique and Guadeloupe). Data on BMI are missing for 90 women (16.5%). L’OMS a ainsi décrit le syndrome congénital associé à l’infection ZIKV : disproportion crânio-faciale, spasticité, convulsions, irritabilité, troubles de l’alimentation, anomalies oculaires, malformations à l’imagerie. ), and Pôle Parent-Enfant (E.J. First, the 2013–14 French Polynesian outbreak was the initial report of neurological and congenital complications in people infected by Zika virus, with an increase in incidence of Guillain-Barré syndrome and eight reported cases of neurological congenital malformations. Among the 555 fetuses and infants in the 546 pregnancies included in the analysis, 28 (5.0%) were not carried to term or were stillborn, and 527 were born alive. La transmission par le lait maternel est exceptionnelle. Stay connected to what's important in medical research and clinical practice, Subscribe to the most trusted and influential source ofmedical knowledge. ), CHU Martinique, Fort-de-France, Martinique; the Emerging Diseases Epidemiology Unit (A.L.F., Y.M., A.F.) France was in a unique position to evaluate and respond to the situation for a number of reasons. Virus Zika et femme enceinte en âge de procréer. The main findings of this cohort study are twofold. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort. ), Cellule d’Intervention en Région (CIRE) Antilles, Santé Publique France (S.C.), Laboratoire de Microbiologie (C.H.-S.), Service de Gynécologie Obstétrique (P.K. Among the 527 live births, 69 infants (13.1%) were small for gestational age, and 75 infants (14.2%) were delivered through emergency cesarean section. Neurologic and ocular abnormalities were more common when ZIKV infection had occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it had occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001). 16. ), Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne (B.H., K.S. Neurologic and ocular defects possibly associated with ZIKV infection were seen in 39 fetuses and infants (7.0%; 95% confidence interval, 5.0 to 9.5); of these, 10 were not carried to term because of termination of pregnancy for medical reasons, 1 was stillborn, and 28 were live-born. This study is part of the ZIKAlliance consortium project. The clinical implications of these findings in Brazil are not yet known and will be determined only through longer-term follow-up of infants. Shapiro-Mendoza CK, Rice ME, Galang RR, et al. Supported by the French Ministry of Health (Soutien Exceptionnel à la Recherche et à l’Innovation), by a grant (ANR-10-LABX-62-IBEID) from Laboratoire d’Excellence Integrative Biology of Emerging Infectious Diseases project, by the ZIKAlliance consortium (the European Union’s Horizon 2020 Research and Innovation Program), and by INSERM. Virus peu connu jusqu’à la récente épidémie, les premières études ont rapidement fait apparaître la possibilité de malformations cérébrales fœtales notamment à type de microcéphalies. All karyotypes were normal except for one pericentric inversion of chromosome 2, and RT-PCR for ZIKV in an amniotic-fluid specimen was positive in 7 cases. Ultrasound Obstet Gynecol 2017;49:729-736. Surveillance des grossesses en cas d’épidémie : mise en place de mesures drastiques contre les moustiques, Lutte anti-vectorielle collective et individuelle, Protection individuelle : vêtements longs, répulsifs, moustiquaires. C'est une première en France métropolitaine : deux cas autochtones de Zika ont été signalés à Hyères dans le Var.Les deux personnes qui résident dans le même quartier et qui ont présenté leurs premiers symptômes en août n'avaient pas voyagé et ont été piquées en France métropolitaine. Ces modules sont actualisés et enrichis en fonction des données scientifiques les plus récentes sur la connaissance du vi… Defects occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy. Chez les nouveau-nés de mamans atteintes de la maladie, les malformations fœtales retrouvées durant les dernières années comptent notamment parmi elles la microcéphalie . ‡ These results are possibly associated with ZIKV infection. These percentages did not differ by trimester of infection. Prevent mosquito bites when traveling:. 20 janvier 2016 (https://www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=hcspa20160105_zikaactualisationmodpec.pdf). 3. Treatment involves taking pain killers to relieve the painful symptoms. ), Pointe-à-Pitre, Guadeloupe; Centre Pluridisciplinaire de Diagnostic Prénatal, Maison de la Femme de la Mère et de l’Enfant (B.S. * Plus–minus values are means ±SD. AtouSante is a French website about occupational health administered by physicians with a deep expertise in the working environment. Thus, 561 women with symptomatic, PCR-confirmed, ZIKV infection were included in the analysis in this study. It was estimated to be higher than 40% in a prospective observational study in Brazil involving women who had symptomatic ZIKV infection during pregnancy.3 In the U.S. Zika Pregnancy Registry, the estimate was 6% overall and 11% when ZIKV exposure occurred during the first trimester.5 The latter estimate has been updated recently to 15%.6. Maternal Zika virus disease severity, virus load, prior dengue antibodies, and their relationship to birth outcomes. For live-born infants, maternal and cord-blood specimens were obtained on the day of delivery, and serum specimens were frozen. Zika virus is a teratogenic infectious agent associated with severe brain lesions, with similar risks to other well-known TORCH pathogens. Results of ZIKV and TORCH Testing in the 546 Women with Symptomatic, PCR-Confirmed ZIKV Infection. Prospective Maternal Cohort and Pregnancy Outcomes. The percentage of fetuses and infants with neurologic birth defects (7%) in this study is similar to the 6% observed in the cohort of women in the United States5 and the 5% reported more recently in the U.S. territories,15 but it is much lower than the 42% observed in the Brazilian cohort.3 The difference is not attributable to the percentage of infants and fetuses with microcephaly — which is similar in the current study in French territories in the Americas, in the study in the United States, and in the study in Brazil (5.8%, 4.1%, and 3.4%, respectively) — but rather to the percentage with wider neurologic birth defects. Valuable tools for building a rewarding career in health care. We were therefore able to describe outcomes in 555 fetuses and infants (Figure 1). Pregnancy outcomes included delivery of a live-born child (with or without abnormalities) or pregnancy loss through miscarriage, termination of pregnancy, or stillbirth. On 9 October 2019, the French authorities reported an autochthonous Zika virus (ZIKV) case in Hyeres, Var department, France. Indeed, it has been reported that when ZIKV infection occurs during the first trimester or early second trimester, all brain abnormalities can be detected with ultrasonography before 28 weeks of gestation.10 Another study showed that none of 103 infants with normal prenatal ultrasonographic findings and normal clinical examinations at birth had anomalies attributable to ZIKV when MRI of the head was performed after birth.17 Still, the absence of microcephaly at birth does not exclude the possibility of delayed development of microcephaly or other ZIKV-related brain and other abnormalities.18 This information is now being collected as part of a cohort study of the infants (ClinicalTrials.gov number, NCT02810210); the study includes regular clinical examinations with specialized hearing and ophthalmologic testing. Zika et grossesse : un risque de malformation fœtale ... En France, celle-ci devrait être acceptée sans problème si le retard mental est avéré au vu des anomalies constatées à l’échographie. Laboratory tests included RT-PCR for the detection of ZIKV (RealStar Zika Virus RT-PCR Kit 1.0, Altona Diagnostics) in blood, urine, or both at baseline in all women and at the end of pregnancy in the case of fetal death, termination of pregnancy, or stillbirth. Zika virus was first discovered in 1947 and is named after the Zika Forest in Uganda. The study protocol was prepared with the help of the INSERM Research and Action Targeting Emerging Infectious Disease (REACTing) network. When the mother is symptomatic, the infection is confirmed by a positive reverse transcription polymerase chain reaction (RT‐PCR) test of the blood or urine 15 and/or by detection of anti‐ZIKV antibodies. Issues de grossesse et anomalies congénitales dans une cohorte de 546 femmes ayant présenté une infection symptomatique à virus Zika (ZIKV) au cours de l'épidémie de Zika dans les TFA B. Hoen, A. Cabié, A. Funk, C. Herrmann-Storck, F. Najioullah, K. Schepers, M. Douine, S. Stegmann-Planchard, D. Rousset, A. Fontanet Longer-term follow-up of infants is required to assess for late-onset manifestations not detected at birth. Arch Dis Child Educ Pract Ed 2013;98:93-98. 8. Pregnancy Outcomes after ZIKV Infection in French Territories in the Americas. Nouvelle maladie infectieuse potentiellement grave pour les fœtus dont l’éventail géographique va s’étendre en raison de la diffusion du moustique vecteur par le réchauffement climatique. Ms. Funk reports receiving salary from Institut Carnot-Pasteur Maladies Infectieuses (ANR 11-CARN 017-01) through the Pasteur-Paris University International Ph.D. program. When ultrasonographic findings were used instead of autopsy data, microcephaly was defined as a head circumference more than 3 SD below the mean. We thank the women who participated in this study; all the physicians, midwives, clinical research assistants, health officers, and epidemiologists who helped conduct this study in each of the French territories in the Americas: Myriam Atine, Lyderic Aubert, Marie Barrau, Kebe Beavogui, Christelle Celeste, Joelle Colat-Peyron, Elvire Couchy, Véronique Davidas, Lucetta Delver, Jacqueline Dubois, Stanie Gaete, Dorothée Harrois, Marie-Laure Lalanne-Mistrih, Mathilde Melin, Marie-France Mirane, Francelise Nadessein, Marie-Josée Pelczar, Véronique Plantier, Céline Rocquet, Magdalena Saint-Marc, Patrick Saint-Martin, Valérie Soter, Ingrid Soubdhan, Jennifer Taillefond, Lambo Velonasy, and Véronique Walter (Guadeloupe); Nicole Ambroisine, Gilda Belrose, Alain Blateau, Patricia Blondel, Isabelle Calmont, Valérie Decatrelle, Michèle Gueneret, Eugénie Jolivet, Isabelle Komla-Soukha, Corinne Plavonil, Marie-andrée Pyram, and Jean-Luc Voluménie (Martinique); Antoine Adenis, Audrey Andrieu, Luisiane Carvalho, Sandy Dabrowski, Céline Delorme, Maryvonne Dueymes, Aniza Fahrasmane, Arthur Felix, Hélène Hilderal, Anne Jolivet, Justine Krajewsky, Véronique Lambert, Thomas Lemaitre, Myriam Livain, Jérémie Pasquier, Marion Petit-Sinturel, Céline Pomar, Léo Pomar, and Stéphanie Rogier (French Guiana); and David Baud (University of Lausanne, Switzerland) and Rebecca Grant (Institut Pasteur de Paris, France) for their critical review of an earlier version of the manuscript. First, we found a 7.0% overall risk of neurologic and ocular defects possibly associated with ZIKV infection that were evident at birth in the offspring of women in French territories in the Americas who had acute, symptomatic, PCR-confirmed ZIKV infection during pregnancy. Virus Zika : toute l'actualité en direct, soyez informé de toute l'info en continu, en images et en vidéos. The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. Atteintes congénitales liéesau virus Zika Comparison de trois études internationales Brasil (n=126) Honein (n=442) Hoen (n=555) Issuesdegrossesses Fausses couches / morts-nés/ interruptions de grossesse 9 (7.1) 47 (10.6) 28 (5.0) Naissances vivantes 117 (92.9) 395 (89.6) 527 (95.0) Anomalies congénitales Microcéphalie 4 (3.2) 18 (4.1) 32(5.8) MMWR Morb Mortal Wkly Rep 2017;66:615-621. le 23 octobre 2019 à 16h17 Rechercher. Mes favoris. - Tang H et al :Cell Stel Cell 2016 18 ; 587-90, - Pomar L et al : Ultrasound Obstet Gynecol 2017 ; 6 ;729-36, Si vous êtes intéressés par notre association, si vous souhaitez nous aider ou nous proposer des projets, contactez nous à l'aide de la fiche ci-dessous, © 2023 by Mother & More. Avis relatif à l’actualisation de l’avis du HCSP du 28 Juillet 2015 relatif à la prise en charge médicale des personnes atteintes par le virus Zika. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Declaration of Zika virus infection is now mandatory in France. Celle-ci possède un neurotropisme dont il nous faut connaitre les signes échographiques. MMWR Morb Mortal Wkly Rep 2016;65:1343-1348. Once women were enrolled, they underwent monthly clinical and ultrasonographic examinations until they had a pregnancy outcome. Partagez et commentez en temps réel, à tout moment de la journée. Reynolds MR, Jones AM, Petersen EE, et al. Haut Conseil de la Santé Publique. Les études en cours vont préciser les conséquences fœtales réelles, l’évolutivité possible après la naissance et les facteurs de risques. The study was conducted in well-defined geographic areas, and high standards of care were available to all pregnant women living in these territories. 13. de Jong EP, Vossen AC, Walther FJ, Lopriore E. How to use … neonatal TORCH testing. The same was true for severe microcephaly (3.7%, 0.8%, and 0.0%, respectively; P=0.02) and the congenital Zika syndrome (6.9%, 1.2%, and 0.9%, respectively; P=0.002). Aux Antilles-Guyane : 5,1% de pertes fœtales et 13% en cas d’infection au 1er trimestre chez les patientes symptomatiques. Description of 13 infants born during October 2015–January 2016 with congenital Zika virus infection without microcephaly at birth — Brazil. Table 1 shows the main characteristics of the 546 women (mean age, 29.7 years) with known pregnancy outcomes, and Table 2 shows the main characteristics of ZIKV infection in these women. It spreads through bites from an infected Aedes species mosquito, which are the same ones that spread dengue and chikunyunya viruses. ¶ In the case of live birth, microcephaly was defined as a head circumference more than 2 SD below the mean, on the basis of INTERGROWTH-21st standards (http://intergrowth21.ndog.ox.ac.uk/) for sex and gestational age. In conclusion, among pregnant women with PCR-confirmed, symptomatic ZIKV infection, birth defects possibly associated with ZIKV infection were present in 7% of fetuses and infants. All participants provided written informed consent. Among the 546 women whose pregnancy outcome was known, there were 9 twin pregnancies. Prepare to become a physician, build your knowledge, lead a health care organization, and advance your career with NEJM Group information and services. Of these, 6 women (1.1%) were excluded after it was determined that they did not meet specific eligibility criteria regarding clinical or PCR results, and 9 women (1.6%) were lost to follow-up. The percentage of infants who were small for gestational age was similar in French territories in the Americas and in the Brazilian cohort (13.1% and 9%, respectively), but differences between those two cohorts are apparent when we examine the percentage of infants who were admitted to neonatal intensive care immediately after birth (1.3% in the French territories and 21% in Brazil) and the percentage of infants with abnormal neurologic findings from the clinical examination at birth (0.6% and 26.5%, respectively). N Engl J Med 2017;377:1399-1400. Microcephaly was considered moderate when the head circumference was between 3 SD and 2 SD below the mean and severe when the head circumference was more than 3 SD below the mean. 1 November 2019. The risk of birth defects included in the current definition of the congenital Zika syndrome was also similar in the two territories (3.6% and 2.8%, respectively). Ultrasound Obstet Gynecol 2016;47:6-7. 18. van der Linden V, Pessoa A, Dobyns W, et al. Vital signs: update on Zika virus–associated birth defects and evaluation of all U.S. infants with congenital Zika virus exposure — U.S. Zika Pregnancy Registry, 2016. éruption maculo-papuleuse peu visible sur peau noire, autres : arthralgies, céphalées, asthénie, œdèmes, diarrhée…. Pregnancy outcomes after maternal Zika virus infection during pregnancy — U.S. 10. No fetal abnormality or birth defect was observed in any of the women who had coinfection with syphilis (4 women), human immunodeficiency virus (2), toxoplasmosis (3), or cytomegalovirus (1). Il en va sans doute de même pour Zika. ), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y. Implications of chikungunya virus in pregnancy are mostly related to intrapartum transmission that may be associated with … In highly febrile women, a reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay for dengue virus was performed on blood specimens. † Among the 527 live births, 96 infants (18.2%) did not undergo prenatal ultrasonography after the mother had been infected with ZIKV (7.9% when ZIKV infection occurred in the first trimester, 11.3% when infection occurred in the second trimester, and 48.3% when infection occurred in the third trimester). Schaub B, Gueneret Ml, Jolivet En, et al. CAT en cas d’infection à ZIKV durant la grossesse : recherche des principaux diagnostics différentiels potentiellement graves : dengue, paludisme, examen obstétrical : recherche de métrorragies, de menace de FCS…, recherche de virus zika par PCR (dans le sang dans les 5 j et dans les urines dans les 10j à partir des 1ers signes, sérologie zika et associer une recherche de dengue, traitement symptomatique : paracétamol si fièvre ou douleur, échographie mensuelle par échographiste référent, à la naissance : PCR cordon et urines, sérologie zika. 9. Toutefois, la prise d’aspirine est à éviter tant que le diagnostic n’a pas clairement écarté la possibilité d’une infection par le virus de la dengue, car dans ce cas l’action anticoagulante du médicament pourrait induire des saignements. 1. Le virus zika est transmis à l’homme par la piqûre d’un moustique du genre Aedes (A.aegypti et A.albopictus) largement réparti dans le monde et dont la période d’activité est surtout diurne. ), Institut Pasteur, INSERM, IAME (Infection, Antimicrobials, Modeling, Evolution), Paris Diderot University (C.L. NEW! For the purpose of comparison with other studies,5 miscarriage was defined as intrauterine fetal death that occurred before a gestational age of 20 weeks. In the case of pregnancy loss or termination of pregnancy for medical reasons, autopsy measurements when available and findings from the last ultrasonographic examination were used to assess for microcephaly. Ultrasound imaging for identification of cerebral damage in congenital Zika virus syndrome: a case series. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort. ‖ This infant had Down’s syndrome with severe microcephaly. In accordance with the guidelines of the French High Council for Public Health7 and the French National College of Gynecologists and Obstetricians8 that were released on July 28, 2015, and February 5, 2016, respectively, whenever a pregnant woman presented to the outpatient clinic or emergency department of a participating center with symptoms consistent with acute ZIKV infection, she underwent a clinical examination, and blood and urine specimens were obtained for confirmation of recent ZIKV infection. It provides employers, employees and physicians with information to better prevent occupational diseases. DOI: 10.1056/NEJMoa1709481, Tap into groundbreaking research and clinically relevant insights. Coinfections with TORCH microorganisms are shown in Table 3. In 3 of the 527 live births (0.6%), clinical abnormalities other than microcephaly were detected at birth. Mejdoubi M, Monthieux A, Cassan T, Lombard C, Flechelles O, Adenet C. Brain MRI in infants after maternal Zika virus infection during pregnancy. Le traitement va consister à atténuer les symptômes douloureux, par la prise d’antalgiques. Les 1ères études brésiliennes ont rapporté une incidence importante de microcéphalies. Concise summaries and expert physician commentary that busy clinicians need to enhance patient care. Lorsque des symptômes apparaissent, ils sont le plus souvent de type grippal (fièvre, maux de tête, courbatures) avec des éruptions cutanées et se manifestent dans les 3 à 12 jours qui suivent la piqûre par le moustique. * TORCH includes testing for toxoplasmosis, other (syphilis, varicella, parvovirus infection, human immunodeficiency virus infection), rubella, cytomegalovirus infection, and herpes simplex virus infection. If a fetal abnormality was identified during a follow-up ultrasonographic examination, magnetic resonance imaging (MRI) of the fetus was performed, and the woman was followed up monthly with laboratory testing and ultrasonography, as reported elsewhere.9-11 The end point for each woman enrolled in the study was the pregnancy outcome: delivery of a live-born infant with or without birth defects, miscarriage, termination of pregnancy for medical reasons, or stillbirth. Pregnancy Outcomes after Zika Virus Infection Zika virus was recently linked to birth defects, especially microcephaly. Diagnostic clinique différentiel : dengue, chikungunya, paludisme…, Complications chez l’adulte : syndrome de Guillain et Barré, encéphalites, Diagnostic direct : détection du génome viral par RT-PCR, sang : dans les 5 premiers jours des symptômes, urines : dans les 10 jours suivant l’apparition des symptômes, Diagnostic sérologique : apparition des IgM au 5ème jour et des IgG au 8ème jour, Possibilité de réaction croisée avec la dengue. § The mother of one of these infants also had parvovirus B19 infection. Pour répondre aux interrogations des femmes et des couples, des modules interactifs personnalisés sont proposés, afin que chacun puisse, en fonction de sa propre situation, évaluer son risque et trouver des réponses pratiques. Although the rate of complications would be expected to be higher among women with symptomatic infection than among those who were asymptomatic, an observational study involving U.S. women did not show any significant difference in the rate of birth defects between the offspring of women who had symptomatic ZIKV infection and the offspring of women who had asymptomatic ZIKV infection during pregnancy.5 A recent study also showed no significant association between disease severity or viral load and adverse outcomes.16 Second, we were not able to fully assess the presence of birth defects possibly associated with ZIKV infection in the case of the 11 miscarriages, 2 of the 6 stillbirths, and the 1 voluntary abortion, as well as in the 96 live-born infants (18.2% of the 527 live-born infants) who did not undergo prenatal ultrasonography after ZIKV infection. Premiers cas de Zika en France métropolitaine : ce qu'il faut savoir pour se protéger du virus. Territories, January 1, 2016–April 25, 2017. Neurologic and ocular abnormalities possibly associated with ZIKV infection were observed in 39 fetuses and infants (7.0%; 95% confidence interval [CI], 5.0 to 9.5): 28 live-born infants, 10 fetuses that were not carried to term because of termination of pregnancy for medical reasons, and 1 stillborn baby. No other potential conflict of interest relevant to this article was reported. Optimism for Interstitial Lung Disease–Associated Pulmonary Hypertension? Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. 12. Likewise, to allow for comparison with other studies, we summarized our data in two mutually exclusive categories: birth defects possibly associated with ZIKV infection5 (brain abnormalities with or without microcephaly regardless of the presence of additional birth defects); and neural-tube defects and other early brain malformations (e.g., anencephaly, acrania, encephalocele, holoprosencephaly, or arhinencephaly), eye abnormalities, and other consequences of central nervous system dysfunction among fetuses and infants who had neither evident brain abnormalities nor microcephaly.