Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: an individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortiumby Ricardo Arraes de Alencar Ximenes et al.
Summary Background Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies. Methods We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks. Findings Of the 1548 ZIKV-exposed pregnancies, the risk of miscarriage was 0.9%, while the risk of stillbirth was 0.3%. Among the pregnancies with liveborn children, the risk of prematurity was 10,5%, the risk of low birth weight was 7.7, and the risk of small for gestational age (SGA) was 16.2%. For other abnormalities, the absolute risks were: 2.6% for microcephaly at birth or first evaluation, 4.0% for microcephaly at any time during follow-up, 7.9% for neuroimaging abnormalities, 18.7% for functional neurological abnormalities, 4.0% for ophthalmic abnormalities, 6.4% for auditory abnormalities, 0.6% for arthrogryposis, and 1.5% for dysphagia. This risk was similar in all sites studied and in different socioeconomic conditions, indicating that there are not likely to be other factors modifying this association. Interpretation This study based on prospectively collected data generates the most robust evidence to date on the risks of congenital ZIKV infections over the early life course. Overall, approximately one-third of liveborn children with prenatal ZIKV exposure presented with at least one abnormality compatible with congenital infection, while the risk to present with at least two abnormalities in combination was less than 1.0%. Funding National Council for Scientific and Technological Development - Brazil (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq); Wellcome Trust and the United Kingdom's Department for International Development; European Union's Horizon 2020 research and innovation program; Medical Research Council on behalf of the Newton Fund and Wellcome Trust; National Institutes of Health/National Institute of Allergy and Infectious Diseases; Foundation Christophe et Rodolphe Mérieux; Coordination for the improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Capes); Ministry of Health of Brazil; Brazilian Department of Science and Technology; Foundation of Research Support of the State of São Paulo (Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP); Foundation of Research Support of the State of Rio de Janeiro (Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro – FAPERJ); Foundation of Support for Research and Scientific and Technological Development of Maranhão; Evandro Chagas Institute/Brazilian Ministry of Health (Instituto Evandro Chagas/Ministério da Saúde); Foundation of Research Support of the State of Goiás (Fundação de Amparo à Pesquisa do Estado de Goiás – FAPEG); Foundation of Research Support of the State of Rio Grande do Sul (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul – FAPERGS); Foundation to Support Teaching, Research and Assistance at Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto (Fundação de Apoio ao Ensino, Pesquisa e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto); São Paulo State Department of Health (Secretaria de Saúde do Estado de São Paulo); Support Foundation of Pernambuco Science and Technology (Fundação de Amparo à Ciência e Tecnologia de Pernambuco – FACEPE).
Field validation of the performance of paper-based tests for the detection of the Zika and chikungunya viruses in serum samplesby Margot Karlikow et al.
In low-resource settings, resilience to infectious disease outbreaks can be hindered by limited access to diagnostic tests. Here we report the results of double-blinded studies of the performance of paper-based diagnostic tests for the Zika and chikungunya viruses in a field setting in Latin America. The tests involved a cell-free expression system relying on isothermal amplification and toehold-switch reactions, a purpose-built portable reader and onboard software for computer vision-enabled image analysis. In patients suspected of infection, the accuracies and sensitivities of the tests for the Zika and chikungunya viruses were, respectively, 98.5% (95% confidence interval, 96.2–99.6%, 268 serum samples) and 98.5% (95% confidence interval, 91.7–100%, 65 serum samples) and approximately 2 aM and 5 fM (both concentrations are within clinically relevant ranges). The analytical specificities and sensitivities of the tests for cultured samples of the viruses were equivalent to those of the real-time quantitative PCR. Cell-free synthetic biology tools and companion hardware can provide de-centralized, high-capacity and low-cost diagnostics for use in low-resource settings.
*Portuguese content* Com objetivo de avaliar como as famílias dessas crianças foram impactadas, a pesquisa Impactos econômicos e sociais do vírus Zika foi realizada no IFF-Fiocruz, hospital público federal situado no Rio de Janeiro, que atua em ensino, pesquisa e atendimento a mulheres, crianças e adolescentes.
Within the Zika virus (ZIKV) research community, a new and remarkable kind of collaboration is taking placeby EU Zika Consortia
Re-visiting the evolution, dispersal and epidemiology of Zika virus in Asia. A commentary from the authors.by Pettersson et al.
Pettersson et al provide a short commentary on their research article Re-visiting the evolution, dispersal and epidemiology of Zika virus in Asia published in Emerging Microbes & Infections in May 2018. This work was supported by the European Union’s Horizon 2020 Research and Innovation Programme under ZIKAlliance Grant Agreement no. 734548 and ZikaPLAN Grant Agreement no. 734584.
Successful technology transfer of a Zika vaccine developed by Institut Pasteur Shanghai-Chinese Academy of Sciences (IPS-CAS) to Chongqing Zhifei Biological Products Co., Ltd.by ZIKAlliance
Institut Pasteur Shanghai-Chinese Academy of Sciences (IPS-CAS), a partner of the ZIKAlliance consortium, announced that it has entered into a collaborative research agreement with Chongqing Zhifei Biological Products Stock Co., Ltd. (Zhifei) for the clinical studies and commercialization of a recombinant Zika virus subunit vaccine developed by IPS-CAS.
The key message from this study is that the large uncertainty around the risk estimate needs to be further investigated because of a) the possible existence of co-factors that are yet to be validated, b) the assumptions that the authors needed to make in the absence of good data for the proportion of women who were infected during pregnancy.
This pioneering study provides a precise follow-up of incident cases and seroprevalence in blood donors, and it also provides important insights into the management of blood donations during ZIKV outbreaks and into the natural history of ZIKV infection in adults. It suggests that the study of blood donors during outbreaks of emerging pathogens has become a key element of epidemiological surveillance.
A study performed by the Institut National de la Santé et de la Recherche Médicale (INSERM) team of Dr Ali Amara (U944, Paris, France) and published in Cell Reports sheds new light on the mechanisms allowing ZIKV to infect cells within the human nervous system. Amara et al. showed that the protein Axl is expressed in a number of brain glial cells and that the entry of ZIKV into these cells requires another protein, Gas6, to act as a bridge between the ZIKV particles and the glial cells.
The Zika virus appears to have emerged from nowhere, causing widespread health concerns throughout the world after decades of relative silence.