Use of #mosquito #repellents to protect against #Zika virus infection among #pregnant women in #Brazil (Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Public Health. 2019 May 17;171:89-96. doi: 10.1016/j.puhe.2019.04.002. [Epub ahead of print]

Use of mosquito repellents to protect against Zika virus infection among pregnant women in Brazil.

Dantas Melo VA1, Santos Silva JR2, La Corte R3.

Author information: 1 Graduate Program in Parasitic Biology, Federal University of Sergipe, Avenue Marechal Rondon S/n. Jardim Rosa Elze, University City Professor José Aloísio de Campos São Cristovão, Brazil. 2 Graduate Program in Parasitic Biology, Federal University of Sergipe, Avenue Marechal Rondon S/n. Jardim Rosa Elze, University City Professor José Aloísio de Campos São Cristovão, Brazil; Department of Statistics and Actuarial Sciences, Federal University of Sergipe, Avenue Marechal Rondon S/n. Jardim Rosa Elze, University City Professor José Aloísio de Campos São Cristovão, Brazil. 3 Graduate Program in Parasitic Biology, Federal University of Sergipe, Avenue Marechal Rondon S/n. Jardim Rosa Elze, University City Professor José Aloísio de Campos São Cristovão, Brazil; Department of Morphology, Federal University of Sergipe, Avenue Marechal Rondon S/n. Jardim Rosa Elze, University City Professor José Aloísio de Campos São Cristovão, Brazil. Electronic address: rlacorte@ufs.br.

 

Abstract

OBJECTIVES:

To evaluate the use of repellents among pregnant women as a protective measure against infection with the Zika virus.

STUDY DESIGN:

Pregnant women (n = 177) were interviewed between November 2016 and February 2017 at Basic Health Units in the city of Propriá, state of Sergipe, Brazil. Two units were located in rural areas and eight in urban regions.

METHODS:

Data were analysed using descriptive statistical methods, the Chi-squared test or Fisher’s exact test and odds ratios. The independent variables were grouped by analysis of the main components, and adherence to the use of the repellent was analysed by the logistic regression method.

RESULTS:

A total of 100 women reported using repellents at the time of the interview (56%). The use of repellents was greater among women with higher levels of education (83%) than those with only high school (68%) or elementary school (36%) education. Women assisted by the income transfer programme (Bolsa Família) presented a 2.27 times greater chance of not using repellents compared with pregnant women who were not receiving benefits of the programme. Regarding the logistic regression model, we observed that low economic and social conditions of pregnant women, as well as their lack of advice, had a negative effect on the use of repellents.

CONCLUSIONS:

Repellents were generally used as a preventive measure in pregnant women with higher levels of schooling and fewer children. The relatively high cost of repellents was the main reason for non-use.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Aedes aegypti; Pregnant women; Repellents; Vector control; Zika virus

PMID: 31112836 DOI: 10.1016/j.puhe.2019.04.002

Keywords: Zika Virus; Pregnancy; Society; Poverty; Mosquitoes repellents.

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Development of Secondary #Microcephaly After #Delivery: Possible Consequence of #Mother- #Baby #Transmission of #Zika Virus in #Breast #Milk (Am J Case Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Case Rep. 2019 May 21;20:723-725. doi: 10.12659/AJCR.915726.

Development of Secondary Microcephaly After Delivery: Possible Consequence of Mother-Baby Transmission of Zika Virus in Breast Milk.

Siqueira Mello A1, Pascalicchio Bertozzi APA2, Rodrigues MMD2, Gazeta RE2, Moron AF3, Soriano-Arandes A4, Sarmento SGP3, Vedovello D1, Silva ACB1, Grillo Fajardo TC1, Witkin SS5, Passos SD2,1.

Author information: 1 Laboratory of Pediatric Infectology, Department of Pediatrics, Jundiaí School of Medicine, São Paulo, SP, Brazil. 2 Department of Pediatrics, Jundiaí School of Medicine, São Paulo, SP, Brazil. 3 Department of Obstetrics, Federal University of São Paulo (UNIFESP) – Paulista School of Medicine and Paulista Center for Fetal Medicine, São Paulo, SP, Brazil. 4 Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain. 5 Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, NY, USA.

 

Abstract

BACKGROUND

The Zika virus is an arbovirus that has as main source of transmission the bite of infected insects of the genus Aedes and has been associated with cases of congenital malformation and microcephaly in neonates. However, other sources of transmission have been identified since the emergence of this virus in the world population, such as vertical transmission by semen and possibly other body fluids such as vaginal secretion and breast milk.

CASE REPORT

An infant, born to a mother whose previous delivery was a baby with severe microcephaly, was normal and was negative for Zika virus at birth but developed secondary microcephaly 1 month later, that persisted. The baby was exclusively breast-fed and Zika virus was present in the mother’s milk.

CONCLUSIONS

We report the detection of Zika virus exclusively in the breast milk of a woman after her second delivery of an infant, who later developed microcephaly. This case is consistent with possible vertical transmission.

PMID: 31110169 DOI: 10.12659/AJCR.915726

Keywords: Zika Virus; Pregnancy; Microcephaly.

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#Epidemiological and #clinical suspicion of #congenital #Zika virus #infection: #serological findings in #mothers and #children from #Brazil (J Med Virol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Med Virol. 2019 May 15. doi: 10.1002/jmv.25504. [Epub ahead of print]

Epidemiological and clinical suspicion of congenital Zika virus infection: serological findings in mothers and children from Brazil.

Venturi G1, Fortuna C1, Alves RM2, Passos do Prado Paschoal AG2, da Silva Júnior PJ3, Remoli ME1, Benedetti E1, Amendola A1, da Silva Batista E3, Gama DVN2, Barros DH3, Fiorentini C1, Rezza G1, Leite Primo Chagas JR2,3.

Author information: 1 Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy. 2 Pediatric Neurology Service, S. Antonio das Obras Sociais Irmã Dulce Hospital(HSA/OSID), Salvador, Bahia, Brazil. 3 Neurologia Pediátrica, Universidade Salvador (UNIFACS), Salvador, Bahia, Brazil.

 

Abstract

The emergence of Zika virus in the Americas has caused an increase of babies born with microcephaly or other neurological malformations. The differential diagnosis of Zika infection, particularly serological diagnosis, is an important but complex issue. In this study, we describe clinical manifestations of 94 suspected cases of congenital Zika from Bahia state, Brazil, and the results of serological tests performed on children and/or their mothers at an average of 71 days after birth. Anti-Zika IgM antibodies were detected in 44.4% and in 7.1% of samples from mothers and children, respectively. Nearly all the IgM, and 92% of IgG positive results were confirmed by neutralization test. Zika specific neutralizing antibodies were detected in as much as 90.4 % of the cases. Moreover, dengue specific neutralizing antibodies were detected in 79.0% of Zika seropositive mothers. In conclusion, Zika IgM negative results should be considered with caution, due to a possible rapid loss of sensitivity after birth, while the NS1-based Zika IgM ELISA test we have used has demonstrated to be highly specific. In a high percentage of cases, Zika specific neutralizing antibodies were detected, which are indicative of a past Zika infection, probably occurred during pregnancy in this population.

This article is protected by copyright. All rights reserved.

KEYWORDS: Congenital infection; Flavivirus; diagnosis; microcephaly; neutralization test; serological tests

PMID: 31090222 DOI: 10.1002/jmv.25504

Keywords: Zika Virus; Zika  Congenital Infection; Serology; Pregnancy; Brazil.

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#Prophylactic #antibiotics in the #prevention of #infection after operative vaginal #delivery (#ANODE): a multicentre #RCT (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial

Prof Marian Knight, DPhil, Virginia Chiocchia, MSc, Christopher Partlett, PhD, Oliver Rivero-Arias, DPhil, Xinyang Hua, PhD, Kim Hinshaw, MBChB, Prof Derek Tuffnell, MBChB, Louise Linsell, DPhil, Edmund Juszczak, MSc, on behalf of theANODE collaborative group †

Open Access / Published: May 13, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30773-1

 

Summary

Background

Risk factors for maternal infection are clearly recognised, including caesarean section and operative vaginal birth. Antibiotic prophylaxis at caesarean section is widely recommended because there is clear systematic review evidence that it reduces incidence of maternal infection. Current WHO guidelines do not recommend routine antibiotic prophylaxis for women undergoing operative vaginal birth because of insufficient evidence of effectiveness. We aimed to investigate whether antibiotic prophylaxis prevented maternal infection after operative vaginal birth.

Methods

In a blinded, randomised controlled trial done at 27 UK obstetric units, women (aged ≥16 years) were allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo (saline) following operative vaginal birth at 36 weeks gestation or later. The primary outcome was confirmed or suspected maternal infection within 6 weeks of delivery defined by a new prescription of antibiotics for specific indications, confirmed systemic infection on culture, or endometritis. We did an intention-to-treat analysis. This trial is registered with ISRCTN, number 11166984, and is closed to accrual.

Findings

Between March 13, 2016, and June 13, 2018, 3427 women were randomly assigned to treatment: 1719 to amoxicillin and clavulanic acid, and 1708 to placebo. Seven women withdrew, leaving 1715 in the amoxicillin and clavulanic acid group and 1705 in the placebo groups. Primary outcome data were missing for 195 (6%) women. Significantly fewer women allocated to amoxicillin and clavulanic acid had a confirmed or suspected infection (180 [11%] of 1619) than women allocated to placebo (306 [19%] of 1606; risk ratio 0·58, 95% CI 0·49–0·69; p<0·0001). One woman in the placebo group reported a skin rash and two women in the amoxicillin and clavulanic acid reported other allergic reactions, one of which was reported as a serious adverse event. Two other serious adverse events were reported, neither was considered causally related to the treatment.

Interpretation

This trial shows benefit of a single dose of prophylactic antibiotic after operative vaginal birth and guidance from WHO and other national organisations should be changed to reflect this.

Funding

NIHR Health Technology Assessment programme.

Keywords: Antibiotics; Pregnancy.

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#Maternal #infection with #Zika virus and #prevalence of #congenital disorders in #infants: systematic review and meta-analysis (Can J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Can J Public Health. 2019 May 10. doi: 10.17269/s41997-019-00215-2. [Epub ahead of print]

Maternal infection with Zika virus and prevalence of congenital disorders in infants: systematic review and meta-analysis.

Nithiyanantham SF1, Badawi A2,3.

Author information: 1 Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada. 2 Public Health Risk Sciences Division, Public Health Agency of Canada, 180 Queen Street West, Rm 8-15, Toronto, ON, M5V 3L7, Canada. alaa.badawi@canada.ca. 3 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. alaa.badawi@canada.ca.

 

Abstract

OBJECTIVE:

Zika virus (ZIKV) infection is a vector-borne disease that can be transmitted sexually and vertically. The vertical transmission of the virus may lead to congenital Zika syndrome in infants. The aim of this study is to conduct a systematic review and meta-analysis of published reports documenting the prevalence of congenital Zika-related disorders in infants of mothers infected with ZIKV during pregnancy.

METHODS:

We conducted a comprehensive search in Ovid MEDLINE, Ovid MEDLINE (R) Epub ahead of print, Embase, Embase Classic and Web of Science databases to identify human studies reporting prevalence of congenital disorders in infants of ZIKV-infected mothers.

RESULTS:

We identified 25 reports selected for inclusion in the current study (n = 4683 subjects). The majority of the studies were from South American high-risk countries. Only one third of the identified studies were conducted in the United States. Clinical maternal symptoms included maculopapular rash (76.9%), arthralgia (46.4%), fever (45.5%) and headache (31.8%) with myalgia and conjunctivitis only presented in 25% of the cases. The most prevalent congenital disorder in the newborns was brain calcifications (42.6; 95% CI, 30.8-54.4), followed by ventriculomegaly (21.8; 95% CI, 15.2-28.4), joint abnormalities (13.2; 95% CI, 9.4-18.2), ocular abnormalities (4.2; 95% CI, 1.0-7.5) and microcephaly (3.9; 95% CI, 2.4-5.4).

CONCLUSION:

The current study highlights the high prevalence of a range of congenital disorders in newborns of mothers infected with ZIKV. It warrants developing studies to further clarify the mechanisms by which each of these disorders occurs in response to the viral infection during pregnancy and its vertical transmission to the infants.

KEYWORDS: Brain calcification; Congenital disease; Microcephaly; Systematic review; Zika virus

PMID: 31077071 DOI: 10.17269/s41997-019-00215-2

Keywords: Zika Virus; Pregnancy; Zika Congenital Syndrome.

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#Reproductive #health #sequelae among women who survived #Ebola virus disease in #Liberia (Int J Gynaecol Obstet., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Gynaecol Obstet. 2019 May 10. doi: 10.1002/ijgo.12858. [Epub ahead of print]

Reproductive health sequelae among women who survived Ebola virus disease in Liberia.

Godwin CL1,2, Wohl DA3, Fischer Nd WA4, Singh K1, Hawks DA5, Devore EE6, Brown J7.

Author information: 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA. 2 FHI 360, Durham, USA. 3 Division of Infectious Disease, University of North Carolina School of Medicine, Chapel Hill, USA. 4 Division of Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, USA. 5 Institute for Global Health & Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, USA. 6 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA. 7 Eternal Love Winning Africa Hospital, Monrovia, Liberia.

 

Abstract

OBJECTIVE:

To estimate the incidence of failed pregnancy and menstrual irregularities among Liberian women who had survived Ebola virus disease (EVD) and to identify host-specific and disease-specific factors associated with these outcomes.

METHODS:

A cross-sectional questionnaire-based study was conducted between August 10, 2016, and February 7, 2017. The study population comprised 111 women aged 18-45 years who had survived EVD and were enrolled in the Longitudinal Liberian Ebola Survivor study based at the Eternal Love Winning Africa Hospital, Monrovia, Liberia. Self-reported data on outcomes related to pregnancy and menstrual changes since recovery from EVD were collected.

RESULTS:

In all, 29 (26.1%) of the participants had become pregnant since surviving EVD. Of the 23 women whose pregnancies continued to term, 10 (43.4%) reported live birth, 11 (47.8%) reported spontaneous abortion, and two (8.7%) reported stillbirth. Of the 105 women who reported having regular menstruation before EVD, 27 (29.0%) reported experiencing irregular menstruation for unknown reasons after EVD. In bivariate logistic models, no associations were found between failed pregnancy or irregular menstruation and any of the factors of interest.

CONCLUSIONS:

Adverse pregnancy outcomes and irregular menstruation were frequently reported among EVD survivors in Liberia.

This article is protected by copyright. All rights reserved.

KEYWORDS: Ebola virus disease; Liberia; Menstruation; Post-Ebola sequelae; Pregnancy; Spontaneous abortion; Stillbirth; Survivor

PMID: 31074837 DOI: 10.1002/ijgo.12858

Keywords: Ebola; Pregnancy; Liberia.

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Cross- #Protection of #Dengue Virus #Infection against #Congenital #Zika #Syndrome, Northeastern #Brazil (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 8—August 2019 / Research

Cross-Protection of Dengue Virus Infection against Congenital Zika Syndrome, Northeastern Brazil

Celia Pedroso1, Carlo Fischer1, Marie Feldmann1, Manoel Sarno, Estela Luz, Andrés Moreira-Soto, Renata Cabral, Eduardo Martins Netto, Carlos Brites, Beate M. Kümmerer, and Jan Felix Drexler

Author affiliations: Universidade Federal de Bahia, Salvador, Brazil (C. Pedroso, M. Sarno, E. Luz, R. Cabral, E. Martins Netto, C. Brites); Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humbolt-Universität zu Berlin and Berlin Institute of Health, Institute of Virology, Berlin, Germany (C. Fischer, A. Moreira-Soto, J.F. Drexler); University of Bonn Medical Centre, Bonn, Germany (M. Feldmann, B.M. Kümmerer); German Centre for Infection Research (B.M. Kümmerer, J.F. Drexler)

 

Abstract

The Zika virus outbreak in Latin America resulted in congenital malformations, called congenital Zika syndrome (CZS). For unknown reasons, CZS incidence was highest in northeastern Brazil; one potential explanation is that dengue virus (DENV)–mediated immune enhancement may promote CZS development. In contrast, our analyses of historical DENV genomic data refuted the hypothesis that unique genome signatures for northeastern Brazil explain the uneven dispersion of CZS cases. To confirm our findings, we performed serotype-specific DENV neutralization tests in a case–control framework in northeastern Brazil among 29 Zika virus–seropositive mothers of neonates with CZS and 108 Zika virus–seropositive control mothers. Neutralization titers did not differ significantly between groups. In contrast, DENV seroprevalence and median number of neutralized serotypes were significantly lower among the mothers of neonates with CZS. Supported by model analyses, our results suggest that exposure to multitypic DENV infection may protect from, rather than enhance, development of CZS.

Keywords: Flavivirus; Dengue Fever; Zika Virus; A.D.E.; Congenital Zika Syndrome; Pregnancy; Brazil; Seroprevalence.

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