Department of Pediatrics, Centre Hospitalier Territorial.
Department of Dengue and Arboviruses Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network.
J Pediatric Infect Dis Soc. 2017 Nov 24;6(4):324-331. doi: 10.1093/jpids/piw058.
We investigated 10 mother-newborn pairs and found a 90% rate of dengue virus (DENV) transmission during the perinatal period. Here, we describe DENV kinetics in the sera of newborns before the onset of disease. Of the breast-milk samples analyzed, 75% tested positive for DENV.
Dengue is the most common mosquito-borne viral disease in humans. With this study, we aimed to investigate the risk of vertical (DENV) transmission during the peripartum period and to describe its viral kinetics in serum and breast milk.
We carried out a prospective study during the 2012-2013 dengue epidemic in New Caledonia, its most severe on record. All mothers hospitalized at the Centre Hospitalier Territorial in Nouméa, New Caledonia, with symptoms of dengue infection between 7 days before and 2 days after delivery and/or whose infant was infected during breastfeeding were investigated. DENV was detected and quantified by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) in sera and breast milk (mothers), sera and gastric fluid (newborns), cord blood, and placentas. DENV kinetics and sequences in sera and breast milk were studied. Clinical presentation and biological evolution in mother-newborn pairs were analyzed.
Ten mother-newborn pairs were investigated over an 11-month period. One premature birth, 3 hemorrhagic complications, and 1 maternal death occurred. Nine newborns were infected and symptomatic. One case of deep thrombocytopenia and 1 case of anoxic encephalopathy occurred. DENV was detected in breast milk samples from 9 (75%) of 12 infected breastfeeding mothers. Original DENV kinetics in sera and breast milk were described.
The occurrence of vertical DENV transmission was high (90%) in viremic mothers at delivery, and these mothers and their infants were at major risk for obstetric and neonatal complications. The modes of viral transmission are difficult to clarify. The risk of DENV transmission through breast milk seems plausible. Close follow-up of mothers and prolonged surveillance of their newborns are required for minimizing complications. Complementary studies are needed to elaborate preventive recommendations.
我们调查了 10 对母婴，发现围产期登革热病毒（DENV）的传播率为 90%。在此，我们描述了疾病发作前新生儿血清中 DENV 的动态变化。在所分析的母乳样本中，75%检测出 DENV 呈阳性。
登革热是人类最常见的虫媒病毒病。通过这项研究，我们旨在调查围产期垂直（DENV）传播的风险，并描述其在血清和母乳中的病毒动力学。
我们在新喀里多尼亚 2012-2013 年登革热流行期间进行了一项前瞻性研究，这是该地区有记录以来最严重的一次。所有在新喀里多尼亚努美阿地区医院因登革热感染症状住院的母亲，这些症状在分娩前 7 天至分娩后 2 天，以及/或其婴儿在母乳喂养期间感染的母亲都接受了调查。通过定量逆转录聚合酶链反应（qRT-PCR）在血清和母乳（母亲）、血清和胃液（新生儿）、脐血和胎盘检测和定量 DENV。研究了血清和母乳中 DENV 的动态变化和序列。分析了母婴对的临床表现和生物学演变。
在 11 个月的时间里，对 10 对母婴进行了调查。发生 1 例早产、3 例出血性并发症和 1 例母亲死亡。9 名新生儿感染并出现症状。1 例发生深度血小板减少症，1 例发生缺氧性脑病。在 12 名感染母乳喂养的母亲中，有 9 名（75%）的母乳样本中检测到 DENV。描述了血清和母乳中原始 DENV 的动态变化。
在分娩时病毒血症的母亲中，垂直 DENV 传播的发生率很高（90%），这些母亲及其婴儿极易发生产科和新生儿并发症。病毒传播方式难以明确。通过母乳传播 DENV 的风险似乎是合理的。需要对母亲进行密切随访，并对其新生儿进行长期监测，以尽量减少并发症。需要进行补充研究以制定预防建议。
