ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain.
Eur J Obstet Gynecol Reprod Biol. 2021 Oct;265:162-168. doi: 10.1016/j.ejogrb.2021.07.012. Epub 2021 Jul 9.
Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) transmitted primarily by Aedes mosquitoes. ZIKV can be transmitted to humans by non-vector borne mechanisms such as sexual intercourse, maternal-foetal transmission or blood transfusion. In 2015, ZIKV emerged in the Americas, and spread to 87 countries and territories with autochthonous transmission, distributed across four of the six WHO regions. Most ZIKV infections in pregnancy are asymptomatic, but mother to child transmission of the virus can occur in 20 to 30% of cases and cause severe foetal and child defects. Children exposed to ZIKV while in utero might develop a pattern of structural anomalies and functional disabilities secondary to central nervous system damage, known as congenital Zika syndrome, and whose most common clinical feature is microcephaly. Normocephalic children born to mothers with ZIKV infection in pregnancy, and with no observable Zika-associated birth defects, may also present with later neurodevelopmental delay or post-natal microcephaly. Screening and detection of ZIKV infection in pregnancy is essential, because most women with ZIKV infection are asymptomatic and clinical manifestations are non-specific. However, the diagnosis of ZIKV infection poses multiple challenges due to limited resources and scarce laboratory capabilities in most affected areas, the narrow window of time that the virus persists in the bloodstream, the large proportion of asymptomatic infections, and the cross-reactivity with other flaviviruses such as Dengue virus (DENV). Molecular methods (RT-PCR) are the most reliable tool to confirm ZIKV infection, as serodiagnosis requires confirmation with neutralization tests in case of inconclusive or positive serology results. Prenatal ultrasound assessment is essential for monitoring foetal development and early detection of possible severe anomalies. A mid- and long-term follow-up of children exposed to ZIKV while in utero is necessary to promptly detect clinical manifestations of possible neurological impairment. Tweetable abstract: Zika virus infection during pregnancy is a cause of pregnancy loss and disability in children. Protection against mosquito bites, access to sexual and reproductive health services, prompt screening and detection of ZIKV infection in pregnancy, and prenatal ultrasound monitoring are key control strategies whilst a vaccine is not available.
Zika 病毒（ZIKV）是一种虫媒病毒（arbovirus），主要通过埃及伊蚊传播。ZIKV 可以通过性传播、母婴传播或输血等非媒介传播机制传播给人类。2015 年，ZIKV 在美洲出现，并传播到 87 个有本地传播的国家和地区，分布在世界卫生组织的六个区域中的四个区域。大多数孕妇感染 ZIKV 无症状，但病毒可在 20%至 30%的病例中通过母婴传播，并导致严重的胎儿和儿童缺陷。在子宫内暴露于 ZIKV 的儿童可能会因中枢神经系统损伤而出现结构异常和功能障碍，称为先天性 Zika 综合征，其最常见的临床特征是小头畸形。在怀孕期间感染 ZIKV 的母亲所生的正常头围儿童，且无明显与 Zika 相关的出生缺陷，也可能出现神经发育迟缓或产后小头畸形。在怀孕期间筛查和检测 ZIKV 感染至关重要，因为大多数 ZIKV 感染的妇女无症状，临床表现不特异。然而，由于大多数受影响地区资源有限且实验室能力有限、病毒在血液中持续的时间窗口狭窄、无症状感染比例高以及与登革热病毒（DENV）等其他黄病毒的交叉反应，ZIKV 感染的诊断存在诸多挑战。分子方法（RT-PCR）是确认 ZIKV 感染的最可靠工具，因为血清学诊断需要在不确定或阳性血清学结果的情况下通过中和试验进行确认。产前超声评估对于监测胎儿发育和早期发现可能的严重异常至关重要。对子宫内暴露于 ZIKV 的儿童进行中-长期随访对于及时发现可能的神经损伤的临床表现是必要的。可推文摘要：怀孕期间感染 Zika 病毒是导致妊娠丢失和儿童残疾的原因。预防蚊虫叮咬、获得性和生殖健康服务、及时筛查和检测怀孕期间的 ZIKV 感染以及产前超声监测是在没有疫苗的情况下的关键控制策略。
