Thailand Ministry of Public Health, Department of Disease Control, Nonthaburi, Thailand.
Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
PLoS Negl Trop Dis. 2024 May 17;18(5):e0012176. doi: 10.1371/journal.pntd.0012176. eCollection 2024 May.
In response to the 2015-2016 Zika virus (ZIKV) outbreak and the causal relationship established between maternal ZIKV infection and adverse infant outcomes, we conducted a cohort study to estimate the incidence of ZIKV infection in pregnancy and assess its impacts in women and infants.
METHODOLOGY/PRINCIPAL FINDINGS: From May 2018-January 2020, we prospectively followed pregnant women recruited from 134 participating hospitals in two non-adjacent provinces in northeastern Thailand. We collected demographic, clinical, and epidemiologic data and blood and urine at routine antenatal care visits until delivery. ZIKV infections were confirmed by real-time reverse transcriptase polymerase chain reaction (rRT-PCR). Specimens with confirmed ZIKV underwent whole genome sequencing. Among 3,312 women enrolled, 12 (0.36%) had ZIKV infections, of which two (17%) were detected at enrollment. Ten (83%, 3 in 2nd and 7 in 3rd trimester) ZIKV infections were detected during study follow-up, resulting in an infection rate of 0.15 per 1,000 person-weeks (95% CI: 0.07-0.28). The majority (11/12, 91.7%) of infections occurred in one province. Persistent ZIKV viremia (42 days) was found in only one woman. Six women with confirmed ZIKV infections were asymptomatic until delivery. Sequencing of 8 ZIKV isolates revealed all were of Asian lineage. All 12 ZIKV infected women gave birth to live, full-term infants; the only observed adverse birth outcome was low birth weight in one (8%) infant. Pregnancies in 3,300 ZIKV-rRT-PCR-negative women were complicated by 101 (3%) fetal deaths, of which 67 (66%) had miscarriages and 34 (34%) had stillbirths. There were no differences between adverse fetal or birth outcomes of live infants born to ZIKV-rRT-PCR-positive mothers compared to live infants born to ZIKV-rRT-PCR-negative mothers.
CONCLUSIONS/SIGNIFICANCE: Confirmed ZIKV infections occurred infrequently in this large pregnancy cohort and observed adverse maternal and birth outcomes did not differ between mothers with and without confirmed infections.
为应对 2015-2016 年寨卡病毒（ZIKV）疫情以及母婴 ZIKV 感染与不良婴儿结局之间的因果关系，我们开展了一项队列研究，旨在估算妊娠期间 ZIKV 感染的发生率并评估其对孕妇和婴儿的影响。
方法/主要发现：2018 年 5 月至 2020 年 1 月，我们前瞻性随访了来自泰国东北部两个非毗邻省份的 134 家参与医院招募的孕妇。我们收集了人口统计学、临床和流行病学数据以及在常规产前保健就诊时的血样和尿样，直至分娩。通过实时逆转录聚合酶链反应（rRT-PCR）确认 ZIKV 感染。经确认感染 ZIKV 的标本进行全基因组测序。在纳入的 3312 名女性中，有 12 名（0.36%）发生 ZIKV 感染，其中 2 名（17%）在入组时被检出。10 名（83%，2 名在第 2 孕期，7 名在第 3 孕期）在研究随访期间检出 ZIKV 感染，导致每 1000 人周感染率为 0.15（95%CI：0.07-0.28）。大多数（11/12，91.7%）感染发生在一个省。仅 1 名女性存在持续的 ZIKV 病毒血症（42 天）。直到分娩，6 名确诊 ZIKV 感染的女性均无症状。对 8 个 ZIKV 分离株的测序显示均属于亚洲谱系。12 名 ZIKV 感染的孕妇均产下活产足月婴儿；唯一观察到的不良分娩结局是 1 名（8%）婴儿出生体重低。在 3300 名 ZIKV-rRT-PCR 阴性的孕妇中，有 101 名（3%）胎儿死亡，其中 67 名（66%）发生流产，34 名（34%）发生死胎。与 ZIKV-rRT-PCR 阴性孕妇所生的存活婴儿相比，ZIKV-rRT-PCR 阳性孕妇所生的存活婴儿的不良胎儿或出生结局无差异。
在这个大型妊娠队列中，确诊的 ZIKV 感染并不常见，且在有和无确诊感染的母亲中，观察到的不良母婴结局并无差异。
