Serologic surveillance of maternal Zika infection in a prospective cohort in Leon, Nicaragua during the peak of the Zika epidemic

Background Zika virus caused thousands of congenital anomalies during a recent epidemic. Because Zika emerged in areas endemic for dengue and these related flaviviruses elicit cross-reactive antibodies, it is challenging to serologically monitor pregnant women for Zika infection. Methods A prospective cohort of 253 pregnant women was established in León, Nicaragua. Women were followed during prenatal care through delivery. Serologic specimens were obtained at each visit, and birth outcome was recorded. Established flavivirus serologic methods were adapted to determine Zika seroprevalence, and a stepwise testing algorithm estimated timing of Zika infection in relation to pregnancy. Results Zika seroprevalence was approximately 59% among women tested. Neutralization testing was highly concordant with Zika NS1 BOB results. Per study algorithm, 21% (40/187) of women were classified as experiencing Incident ZIKV infection during pregnancy. Importantly, the Incident ZIKV group included mostly women pregnant during the 2016 Zika epidemic peak and the only 3 subjects in the cohort with RT-PCR-confirmed infections. Approximately 17% of births had complications; 1.5% (3/194) manifesting clinical criteria of congenital Zika syndrome, one was RT-PCR-confirmed as a case of congenital Zika syndrome. Adverse birth outcome did not correlate with timing of Zika infection. Conclusions By leveraging prenatal care systems, we developed a simple algorithm for identifying women who were likely infected by Zika during pregnancy.

[1]  P. Nouvellet,et al.  Potential inconsistencies in Zika surveillance data and our understanding of risk during pregnancy , 2018, PLoS neglected tropical diseases.

[2]  E. Harris,et al.  Seroprevalence, risk factor, and spatial analyses of Zika virus infection after the 2016 epidemic in Managua, Nicaragua , 2018, Proceedings of the National Academy of Sciences.

[3]  E. Harris,et al.  Longitudinal Analysis of Antibody Cross-neutralization Following Zika Virus and Dengue Virus Infection in Asia and the Americas , 2018, The Journal of infectious diseases.

[4]  A. Wilder-Smith,et al.  Asymptomatic Prenatal Zika Virus Infection and Congenital Zika Syndrome , 2018, Open forum infectious diseases.

[5]  E. Harris,et al.  Diagnosis of Zika Virus Infection by Peptide Array and Enzyme-Linked Immunosorbent Assay , 2018, mBio.

[6]  G. Comach,et al.  Development and evaluation of a novel high-throughput image-based fluorescent neutralization test for detection of Zika virus infection , 2018, PLoS neglected tropical diseases.

[7]  E. Harris,et al.  Comparison of Four Serological Methods and Two Reverse Transcription-PCR Assays for Diagnosis and Surveillance of Zika Virus Infection , 2018, Journal of Clinical Microbiology.

[8]  Saira,et al.  Comparison of four serological methods and two RT-PCR assays for diagnosis and surveillance of Zika , 2018 .

[9]  A. Sette,et al.  Development of Envelope Protein Antigens To Serologically Differentiate Zika Virus Infection from Dengue Virus Infection , 2017, Journal of Clinical Microbiology.

[10]  C. Moore,et al.  Health and Development at Age 19–24 Months of 19 Children Who Were Born with Microcephaly and Laboratory Evidence of Congenital Zika Virus Infection During the 2015 Zika Virus Outbreak — Brazil, 2017 , 2017, MMWR. Morbidity and mortality weekly report.

[11]  J. Cherry,et al.  Maternal Zika Virus Disease Severity, Virus Load, Prior Dengue Antibodies, and Their Relationship to Birth Outcomes , 2017, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  B. Duncan,et al.  Infection-related microcephaly after the 2015 and 2016 Zika virus outbreaks in Brazil: a surveillance-based analysis , 2017, The Lancet.

[13]  Emanuele Giorgi,et al.  Surveillance in easy to access population subgroups as a tool for evaluating malaria control progress: A systematic review , 2017, PloS one.

[14]  T. Perkins,et al.  Assessing the population at risk of Zika virus in Asia – is the emergency really over? , 2017, BMJ Global Health.

[15]  F. Rovida,et al.  Antibody-based assay discriminates Zika virus infection from other flaviviruses , 2017, Proceedings of the National Academy of Sciences.

[16]  R. Baric,et al.  Lack of Durable Cross-Neutralizing Antibodies Against Zika Virus from Dengue Virus Infection , 2017, Emerging infectious diseases.

[17]  Eli Schwartz,et al.  Sensitivity and Kinetics of an NS1-Based Zika Virus Enzyme-Linked Immunosorbent Assay in Zika Virus-Infected Travelers from Israel, the Czech Republic, Italy, Belgium, Germany, and Chile , 2017, Journal of Clinical Microbiology.

[18]  L. Kramer,et al.  A Multiplex Microsphere Immunoassay for Zika Virus Diagnosis , 2017, EBioMedicine.

[19]  John S Brownstein,et al.  Potential for Zika virus introduction and transmission in resource-limited countries in Africa and the Asia-Pacific region: a modelling study. , 2016, The Lancet. Infectious diseases.

[20]  C. Coyne,et al.  Zika virus — reigniting the TORCH , 2016, Nature Reviews Microbiology.

[21]  C. Woods,et al.  Unsuspected Dengue as a Cause of Acute Febrile Illness in Children and Adults in Western Nicaragua , 2016, PLoS neglected tropical diseases.

[22]  M. Castro,et al.  Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation , 2016, The Lancet.

[23]  T. Pierson,et al.  Diagnostics for Zika virus on the horizon , 2016, Science.

[24]  A. Powers,et al.  Zika Virus Disease in Colombia - Preliminary Report. , 2016, The New England journal of medicine.

[25]  S. Hills,et al.  Interim Guidance for Interpretation of Zika Virus Antibody Test Results. , 2016, MMWR. Morbidity and mortality weekly report.

[26]  A. Siqueira,et al.  Zika Virus Infection in Pregnant Women in Rio de Janeiro—Preliminary Report , 2016 .

[27]  G. Saade,et al.  Zika virus: History, emergence, biology, and prospects for control. , 2016, Antiviral research.

[28]  Didier Musso,et al.  Zika Virus , 2016, Clinical Microbiology Reviews.

[29]  R. DeBiasi,et al.  Zika Virus Infection with Prolonged Maternal Viremia and Fetal Brain Abnormalities , 2016 .

[30]  L. Rodrigues,et al.  Initial Description of the Presumed Congenital Zika Syndrome. , 2016, American journal of public health.

[31]  A. Act,et al.  Zika Virus Infection in Pregnant Women in Rio de Janeiro - Preliminary Report. , 2016 .

[32]  R. Charrel,et al.  Complete Coding Sequence of Zika Virus from a French Polynesia Outbreak in 2013 , 2014, Genome Announcements.

[33]  Rosanna W. Peeling,et al.  Evaluation of diagnostic tests: dengue , 2010, Nature Reviews Microbiology.

[34]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[35]  A. Barrett,et al.  Guidelines for Plaque-Reduction Neutralization Testing of Human Antibodies to Dengue Viruses. , 2008, Viral immunology.

[36]  N. Simister Placental transport of immunoglobulin G. , 2003, Vaccine.

[37]  Denise A. Martin,et al.  Standardization of Immunoglobulin M Capture Enzyme-Linked Immunosorbent Assays for Routine Diagnosis of Arboviral Infections , 2000, Journal of Clinical Microbiology.