Zorrilla Carmen D, Rivera-Viñas Juana I, De La Vega-Pujols Alberto, Garcia-Garcia Inés, Rabionet Silvia E, Mosquera Ana M
Department of Obstetrics and Gynecology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
Department of Pediatrics, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
P R Health Sci J. 2018 Dec;37(Spec Issue):S66-S72.
The world has encountered a new and serious epidemic which has disproportionately affected fetuses and infants. What makes the Zika virus (ZIKV) epidemic such a threat in our times, is that a whole generation can be affected by birth defects caused by a seemingly innocuous maternal infection, which in most cases go unnoticed and undiagnosed. Spreading to over 80 countries and affecting millions, it is associated with severe birth defects known as congenital Zika syndrome (CZS), which include fetal brain development abnormalities (microcephaly and brain calcifications), retinal abnormalities, and contractures and hypertonia of the extremities. Testing strategies are challenging because of the lack of symptoms and cross reactivity with other viral infections. Obstetrical complications include fetal loss and the need for an emergency cesarean delivery. The rate of CZS has been described as ranging from 5 to 6% among cohorts in the US, reaching 11% for 1st trimester exposure. Prolonged viremia during pregnancy has been documented in a few cases, reaching 89 days after the onset of symptoms in one case and 109 days after such onset in another. If the ZIKV can infect, multiply in, and persist in diverse placental cells, then movement across the placenta, the fetal brain, and the maternal peripheral blood is possible. There is a sense of urgency, and we need safe and effective vaccines and treatments, particularly for pregnant women. If we do not expand testing and develop methods for early diagnosis and treatment, thousands of infants will be exposed to a neurotropic virus that causes severe birth defects and that could also affect the lives of those who form the next generation.
世界遭遇了一种新的严重流行病，这种病对胎儿和婴儿的影响尤为严重。寨卡病毒（ZIKV）疫情在我们这个时代构成如此威胁的原因在于，看似无害的母体感染所导致的出生缺陷可能会影响整整一代人，而在大多数情况下，这些感染并未被注意到或诊断出来。该病毒已传播至80多个国家，影响了数百万人，它与被称为先天性寨卡综合征（CZS）的严重出生缺陷有关，这些缺陷包括胎儿脑部发育异常（小头畸形和脑钙化）、视网膜异常以及四肢挛缩和张力亢进。由于缺乏症状以及与其他病毒感染存在交叉反应，检测策略颇具挑战性。产科并发症包括胎儿死亡以及需要紧急剖宫产。在美国的队列研究中，CZS的发生率据描述在5%至6%之间，孕早期感染时这一比例可达11%。少数病例记录了孕期病毒血症持续时间延长的情况，其中一例在症状出现后89天仍有病毒血症，另一例则为109天。如果ZIKV能够感染多种胎盘细胞、在其中繁殖并持续存在，那么它就有可能穿过胎盘、进入胎儿大脑以及母体外周血。现在有一种紧迫感，我们需要安全有效的疫苗和治疗方法，尤其是针对孕妇的。如果我们不扩大检测范围并开发早期诊断和治疗方法，数千名婴儿将暴露于一种嗜神经病毒之下，这种病毒会导致严重的出生缺陷，还可能影响下一代人的生活。
