Zika Virus Infection in a Cohort of Pregnant Women with Exanthematic Disease in Manaus, Brazilian Amazon
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Definitions
2.3. Patient Care
2.4. Laboratory Testing
2.5. Ethics
2.6. Statistical Analysis
3. Results
3.1. Case Incidence in Manaus
3.2. Temporal Distribution of Cases
3.3. Clinical Courses
3.3.1. Case Characteristics and Presentation
3.3.2. Testing for Infections that Produce TORCH Syndrome
3.3.3. Pregnancy Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics of a Cohort of Pregnant Women | ZIKV + | ZIKV Not + | All No. (%) | RR | [CI 95%] | p |
---|---|---|---|---|---|---|
No. 337 (100.0%) | No. 485 (100.0%) | No. 822 (100.0) | ||||
Lost to follow-up before birth of infant | 15/337 (4.5) | 45/485 (9.3) | 60/822 (7.3) | 0.8 | (0.5–0.2) | <0.001 |
Pregnancies followed until delivery | 322/337 (95.5) | 440/485 (90.7) | 762/822 (92.7) | |||
Age Median ± SD (years) | 27.0 ± 6.4 | 27.6 ± 6.4 | 27.3 ± 6.4 | >0.05 | ||
Parity | 2.4 ± 1.5 | 2.3 ± 1.4 | 2.4 ± 1.4 | >0.05 | ||
First pregnancy | 90 (28.0) | 124 (28.2) | 214 (28.1) | >0.05 | ||
Time of symptoms evolution (days) | 2.7 ± 2.9 | 2.9 ± 4.3 | 3.4 ± 3.8 | <0.001 | ||
Week of pregnancy at the onset of symptoms | 22.7 ± 8.8 | 22.2 ± 9.8 | 22.4 ± 6.4 | >0.05 | ||
infected in 1st Trim | 62/322 (19.3) | 112/440 (25.5) | 174/762 (22.8) | |||
infected in 2nd trim | 146/322 (45.3) | 177/440 (40.2) | 323/762 (42.4) | |||
infected in 3rd trim | 114/322 (35.4) | 151/440 (34.3) | 265/762 (34.8) | |||
Fetal Loss | 10/322 (3.1) | 7/440 (1.6) | 17/762 (2.2) | 2.0 * | (0.8–5.1) | >0.05 |
in 1st trim | 7/62 (11.3) | 5/112 (4.5) | 12/174 (6.9) | 2.5 * | (0.8–7.6) | >0.05 |
in 2nd trim | 2/146 (1.4) | 2/177 (1.1) | 4/323 (1.2) | 1.2 * | (0.2–8.5) | >0.05 |
in 3rd trim | 1/114 (0.9) | 0/151 (0.0) | 1/265 (0.4) | |||
Live births | 312/322 (96.9) | 433/440 (98.4) | 745/762 (97.8) | |||
infected in 1st trim | 55/62 (88.7) | 107/112 (95.5) | 162/174 (93.1) | |||
infected in 2nd trim | 144/146 (98.6) | 175/177 (98.9) | 319/323 (98.8) | |||
infected in 3rd trim | 113/114 (99.1) | 151/151 (100.0) | 264/265 (99.6) |
Variable | All | Single ZIKVi | Single DENVi | Coinfection ZIKV & DENV | ZIKVi & Other Infection | Other Infection | NONE |
---|---|---|---|---|---|---|---|
762 (100.0%) | 269 (35.5%) | 16 (2.1%) | 16 (2.1%) | 37 (4.9%) | 45 (5.9%) | 379 (49.7%) | |
Rash | 96.8 | 99.1 | 100.0 | 100.0 | 100.0 | 95.5 | 94.5 |
Pruritus | 92.0 | 93.5 | 100.0 | 87.5 | 91.9 | 95.5 | 90.2 |
Lymphadenopathies | 7.1 | 6.2 | 14.3 | 12.5 | 15.2 | 8.1 | 5.4 |
Contact | 64.9 | 72.9 | 66.7 | 43.8 | 41.7 | 41.0 | 44.3 |
Hand arthralgia | 61.2 | 39.0 | 44.4 | 62.5 | 58.3 | 41.0 | 61.2 |
Odynophagia | 6.9 | 4.4 | 0.0 | 13.3 | 14.3 | 5.3 | 7.8 |
Headache | 57.5 | 54.3 | 72.7 | 40.0 | 38.9 | 58.5 | 63.2 |
Foot arthralgia | 54.0 | 56.0 | 33.3 | 68.8 | 55.6 | 33.3 | 55.7 |
Myalgia | 52.5 | 49.4 | 55.6 | 68.8 | 42.9 | 45.0 | 56.5 |
Vaginal bleeding | 5.4 | 5.9 | 0.0 | 6.3 | 3.0 | 2.6 | 6.2 |
Fever | 49.8 | 47.0 | 66.7 | 43.8 | 32.4 | 47.7 | 54.2 |
Eye burning | 48.0 | 50.3 | 70.0 | 56.3 | 40.0 | 42.5 | 48.0 |
Conjunctivitis | 47.0 | 52.2 | 66.7 | 43.8 | 41.7 | 41.0 | 44.3 |
Hand edema | 45.3 | 54.5 | 37.5 | 56.3 | 61.1 | 35.1 | 35.7 |
Foot edema | 43.9 | 49.0 | 37.5 | 53.3 | 52.8 | 35.1 | 37.8 |
Asthenia adynamia | 42.5 | 38.7 | 33.3 | 40.0 | 45.7 | 52.6 | 43.6 |
Vomiting | 23.0 | 22.2 | 0.0 | 0.0 | 0.0 | 33.3 | 26.7 |
Uterine contractions | 19.7 | 21.8 | 0.0 | 18.8 | 17.6 | 16.7 | 19.9 |
Diarrhea | 18.5 | 19.6 | 12.5 | 18.8 | 17.7 | 20.5 | 17.5 |
Ocular pruritus | 15.6 | 15.5 | 0.0 | 33.3 | 14.3 | 6.9 | 17.2 |
Variable | Single ZIKVi | Single DENVi | Coinfection ZIKV & DENV | ZIKVi & Other Infection | Other Infection | NONE | All |
---|---|---|---|---|---|---|---|
269 (35.5%) | 16 (2.1%) | 16 (2.1%) | 37 (4.9%) | 45 (5.9%) | 379 (49.7%) | 762 (100.0%) | |
Adverse pregnancy outcome | 19.0 | 0.0 | 12.5 | 8.1 | 13.3 | 11.6 | 13.9 |
PTD and LBW | 4.6 | 0.0 | 6.3 | 5.4 | 6.8 | 5.1 | 5.0 |
Premature delivery | 7.3 | 0.0 | 0.0 | 0.0 | 2.3 | 3.2 | 4.3 |
Low birth weight | 1.5 | 0.0 | 6.3 | 2.7 | 2.3 | 1.6 | 1.8 |
Miscarriage | 2.6 | 0.0 | 0.0 | 0.0 | 2.2 | 0.5 | 1.3 |
Microcephaly | 2.2 | 0.0 | 0.0 | 0.0 | 0.0 | 0.3 | 0.9 |
Stillbirth | 1.1 | 0.0 | 0.0 | 0.0 | 0.0 | 1.1 | 0.9 |
Pregnancy Outcomes | ZIKV + No. (%) | ZIKV − No. (%) | All No. (%) | RR | [CI 95%] | p |
---|---|---|---|---|---|---|
No.322 (100.0%) | No. 440 (100.0%) | No. 762 (100.0) | ||||
Live births | 312/322 (96.9) | 433/440 (98.4) | 745/762 (97.8) | |||
infected in 1st trim | 55/62 (88.7) | 107/112 (95.5) | 162/174 (93.1) | |||
infected in 2nd trim | 144/146 (98.6) | 175/177 (98.9) | 319/323 (98.8) | |||
infected in 3rd trim | 113/114 (99.1) | 151/151 (100.0) | 264/265 (99.6) | |||
Male sex No. (%) | 160 (51.3) | 234 (54.0) | 394 (52.9) | >0.05 | ||
Birth weight (g) | 3248.8 ± 575.0 | 3292.9 ± 522.1 | 3274.5 ± 545.0 | >0.05 | ||
Only PB | 19/312 (6.1) | 13/433 (3.0) | 32/745 (4.3) | 2.1 § | (1.03–4.1) | <0.05 |
infected in 1st trim | 4/55 (7.2) | 2/107 (1.9) | 6/162 (3.7) | 4.6 § | (0.9–28.4) | >0.05 |
infected in 2nd trim | 5/144 (3.5) | 9/175 (5.1) | 14/319 (4.3) | 0.7 § | (0.2–2.0) | >0.05 |
infected in 3rd trim | 10/113 (8.8) | 2/151 (1.3) | 12/264 (4.5) | 6.6 § | (1.4–29.5) | <0.01 |
Only LBW | 6/312 (1.0) | 7/433 (1.6) | 13/745 (1.7) | 1.3 § | (0.4–3.7) | >0.05 |
infected in 1st trim | 1/55 (1.8) | 1/107 (0.9) | 2/162 (1.2) | 2.5 § | (0.03–198.2) | >0.05 |
infected in 2nd trim | 3/144 (2.1) | 1/175 (0.6) | 4/319 (1.3) | 3.5 § | (0.4–32.7) | >0.05 |
infected in 3rd trim | 2/113 (1.8) | 5/151 (3.3) | 7/264 (2.7) | 0.6 § | (0.11–3.0) | >0.05 |
Both PB & LBW | 15/312 (4.8) | 22/433 (5.0) | 37/745 (5.0) | 1.0 § | (0.5–1.9) | >0.05 |
infected in 1st trim | 5/55 (9.1) | 4/107 (3.7) | 9/162 (5.6) | 2.9 § | (0.8–10.3) | >0.05 |
infected in 2nd trim | 6/144 (4.2) | 12/175 (6.9) | 18/319 (5.6) | 0.6 § | (0.2–1.6) | >0.05 |
infected in 3rd trim | 4/113 (3.5) | 6/151 (4.0) | 10/264 (3.8) | 1.0 § | (0.3–3.3) | >0.05 |
Microcephaly | 6/312 (1.9) | 1/433 (0.2) | 7/745 (0.9) | 8.6 § | (1.04–71.2) | <0.05 |
infected in 1st trim | 5/55 (9.1) | 0/151 (0.0) | 5/162 (3.1) | |||
infected in 2nd trim | 0/144 (0.0) | 1/175 (0.6) | 1/319 (0.3) | |||
infected in 3rd trim | 1/113 (0.9) | 0/151 (0.0) | 1/264 (0.4) | |||
Any Adverse pregnancy outcome | 56/322 (17.4) | 50/440 (11.4) | 106/762 (13.9) | 1.6 * | (1.1–2.5) | <0.05 |
infected in 1st trim | 22/62 (35.4) | 12/112 (10.7) | 34/174 (19.5) | 3.3 * | (1.7–6.2) | <0.001 |
infected in 2nd trim | 16/146 (11.0) | 25/177 (14.1) | 41/323 (12.7) | 0.8 * | (0.4–1.4) | >0.05 |
infected in 3rd trim | 18/114 (15.8) | 13/151 (8.6) | 31/265 (11.7) | 1.8 * | (0.9–3.6) | >0.05 |
Severe Pregnancy outcome | 16/322 (5.0) | 8/440 (1.8) | 24/762 (3.1) | 3.1 * | (1.4–7.3) | <0.01 |
infected in 1st trim | 12/62 | 5/112 | 17/174 | 4.8 * | (1.8–13.0) | <0.005 |
infected in 2nd trim | 2/146 | 3/177 | 7/323 | 0.8 * | (0.1–4.6) | >0.05 |
infected in 3rd trim | 2/114 | 0/151 | 2/265 | - | - | - |
Moderate Pregnancy outcome | 40/322 (12.4) | 42/440 (9.6) | 82/762 (10.8) | 1.3 * | (0.9–2.0) | >0.05 |
infected in 1st trim | 10/62 | 7/112 | 17/174 | 3.1 * | (1.2–7.5) | <0.05 |
infected in 2nd trim | 14/146 | 22/177 | 36/323 | 0.8 * | (0.4–1.4) | >0.05 |
infected in 3rd trim | 16/114 | 13/151 | 29/265 | 1.7 * | (0.8–3.3) | >0.05 |
Healthy new born babies | 266/322 (82.6) | 390/440 (88.6) | 656/762 (86.1) | |||
infected in 1st trim | 40/62 (64.5) | 100/112 (89.3) | 140/174 (80.5) | |||
infected in 2nd trim | 130/146 (89.0) | 152/177 (85.9) | 282/323 (88.4) | |||
infected in 3rd Trim | 96/114 (84.2) | 138/151 (91.4) | 234/265 (88.6) |
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Redivo, E.d.F.; Bôtto Menezes, C.; da Costa Castilho, M.; Brock, M.; da Silva Magno, E.; Gomes Saraiva, M.d.G.; Alvarez Fernandes, S.S.; Costa Antony de Andrade, A.B.; Costa Alecrim, M.d.G.; Martinez-Espinosa, F.E. Zika Virus Infection in a Cohort of Pregnant Women with Exanthematic Disease in Manaus, Brazilian Amazon. Viruses 2020, 12, 1362. https://doi.org/10.3390/v12121362
Redivo EdF, Bôtto Menezes C, da Costa Castilho M, Brock M, da Silva Magno E, Gomes Saraiva MdG, Alvarez Fernandes SS, Costa Antony de Andrade AB, Costa Alecrim MdG, Martinez-Espinosa FE. Zika Virus Infection in a Cohort of Pregnant Women with Exanthematic Disease in Manaus, Brazilian Amazon. Viruses. 2020; 12(12):1362. https://doi.org/10.3390/v12121362
Chicago/Turabian StyleRedivo, Elijane de Fátima, Camila Bôtto Menezes, Márcia da Costa Castilho, Marianna Brock, Evela da Silva Magno, Maria das Graças Gomes Saraiva, Salete Sara Alvarez Fernandes, Anny Beatriz Costa Antony de Andrade, Maria das Graças Costa Alecrim, and Flor Ernestina Martinez-Espinosa. 2020. "Zika Virus Infection in a Cohort of Pregnant Women with Exanthematic Disease in Manaus, Brazilian Amazon" Viruses 12, no. 12: 1362. https://doi.org/10.3390/v12121362
APA StyleRedivo, E. d. F., Bôtto Menezes, C., da Costa Castilho, M., Brock, M., da Silva Magno, E., Gomes Saraiva, M. d. G., Alvarez Fernandes, S. S., Costa Antony de Andrade, A. B., Costa Alecrim, M. d. G., & Martinez-Espinosa, F. E. (2020). Zika Virus Infection in a Cohort of Pregnant Women with Exanthematic Disease in Manaus, Brazilian Amazon. Viruses, 12(12), 1362. https://doi.org/10.3390/v12121362