今日の臨床サポート

ジカウイルス感染症

著者: 忽那賢志 国立国際医療研究センター病院 国際感染症センター

著者校正/監修レビュー済:2019/11/21

概要・推奨   

  1. 疫学:
  1. ジカウイルス感染症は、主にネッタイシマカ(Aedes aegypti) とヒトスジシマカ(Aedes albopictus)で媒介し[1]、近年、急速に流行地域を拡大し、現在も中南米で400万人規模と言われる大流行を起こしている。
  1. なお、ヒトスジシマカは北海道を除いた日本全土に分布し、日本でも、今後アウトブレイクを起こす可能性がある。
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  1. 妊婦のジカウイルス感染と胎児の小頭症発症の関連が示されている[2]。また、CDCは、ジカウイルス感染症流行地域に渡航歴のある妊婦に対する小頭症のスクリーニング法についての推奨を発表している。
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  1. 8割は不顕性感染で、残りの2割が症状を認めると推察されている[3]。また症状が出たとしても、ジカウイルス感染症の症状自体は、軽症で、重篤化することはまれである。
  1. 潜伏期は2~7日であり、症状を認めた場合、皮疹(90%)、微熱を含む発熱(65%)、関節痛(65%)、眼球結膜充血(55%)、筋肉痛(48%)、頭痛(45%)などの症状を呈する[4][5]
  1. 厚生労働省は、2016年2月24日の事務連絡にて以下の場合は、ジカウイルス感染症を疑う症例として扱うとした[6](ただし、ジカウイルス感染症の診断のために必ずしもこの条件を満たす必要はなく、臨床的にジカウイルス感染症が疑われた場合には保健所に相談することが望ましい)。
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  1. ※1発熱は、ほとんどの症例で38.5℃以下との報告がある[7]
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
忽那賢志 : 講演料(Yahoo!JAPAN),研究費・助成金など(武田薬品,株式会社キアゲン)[2021年]

改訂のポイント:
  1. 定期レビューを行い、用語の統一、情報の追加・更新を行った。 

病態・疫学・診察

疾患情報(疫学・病態)  
疾患のポイント:
  1. ジカウイルス感染症とは、フラビウイルス科フラビウイルス属のジカウイルスによって起こる蚊媒介性感染症である。
 
病原体:
  1. ジカウイルスはフラビウイルス科フラビウイルス属に属する。同じくフラビウイルス科に属するウイルスとして、デングウイルス、黄熱ウイルス、日本脳炎ウイルス、ダニ媒介性脳炎ウイルスなどがある[8]
  1. デング熱のように複数の血清型はなく、単一の血清型のみである。
 
感染経路:
  1. ジカウイルス感染症を媒介する蚊は、主にネッタイシマカ(Aedes aegypti)とヒトスジシマカ(Aedes albopictus)である[1]。日本にはネッタイシマカは生息していないが、ヒトスジシマカは北海道を除いた日本全土に分布している。このため、日本国内でも輸入例を発端とした流行が起こり得る。
  1. 性交渉によって男性から女性[9]、女性から男性[10]、男性から男性[11]に感染したと思われる症例も報告されているが、症例の大半は蚊の刺咬による感染例であり、性交渉による感染例は全体の一部と考えられる。
  1. 輸血による感染例も報告がある。
 
疫学:
  1. ジカウイルスは、1947年にウガンダのジカ森林のアカゲザルから初めて分離され、ヒトからは1968年にナイジェリアで分離された[12]。実際のジカウイルス感染症例はこれまでにウガンダ、ナイジェリア、カンボジア、マレーシア、インドネシアからの報告があった。また、2007年ミクロネシア連邦のヤップ島でジカウイルス感染症の最初の大規模なアウトブレイクがあり、約300名の感染者が出ている[13]
  1. 2013年9月より仏領ポリネシアで始まったジカウイルス感染症の大流行は、ニューカレドニア、クック諸島にも波及し、感染者は3万人以上にも上ると推計されている[14]
  1. 2015年6月にブラジルで渡航歴のないジカウイルス感染症例が報告され[15]、その後急激に中南米で流行が広がった。その後、中南米での症例数は減少している。
  1. 2019年11月の時点で日本では11例の症例が報告されている。2013年12月および2014年1月の症例は仏領ポリネシアから帰国後の症例[16]であり、2014年8月の症例はタイのサムイ島から帰国後の症例であった[17]。また、2016年2月26日はブラジルからの帰国後の症例であった。
  1. またアジアでは、タイ、インドネシア、ベトナム、シンガポール、フィリピン、ミャンマー、インドなどでもジカウイルス感染症の症例が報告されている。
問診・診察のポイント  
  1. ポイント:
  1. ジカウイルスに感染した者のうち、約20%の患者が2~7日の潜伏期間を経て症状を呈する[3]。また、残りの約80%が不顕性感染で症状を認めない[3]
  1. ジカウイルス感染症の臨床症状として頻度が高いのは、微熱を含む発熱、関節痛、皮疹(紅斑・紅丘疹)、眼球結膜充血である[5]。これ以外にも頭痛、筋肉痛、後眼窩痛などの症状がみられることもある。発熱は微熱程度のことが多く、まったく発熱を呈さないここともあり、発熱がないからといってジカウイルス感染症を除外することはできない点に注意が必要である。
  1. 一般的に軽症例が多く、入院を要することはまれであり、死亡例の報告もまれである。

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文献 

著者: S Ioos, H-P Mallet, I Leparc Goffart, V Gauthier, T Cardoso, M Herida
雑誌名: Med Mal Infect. 2014 Jul;44(7):302-7. doi: 10.1016/j.medmal.2014.04.008. Epub 2014 Jul 4.
Abstract/Text The Zika virus (ZIKV) is a mosquito-borne flavivirus (Aedes), similar to other arboviruses, first identified in Uganda in 1947. Few human cases were reported until 2007, when a Zika outbreak occurred in Yap, Micronesia, even though ZIKV activity had been reported in Africa and in Asia through virological surveillance and entomological studies. French Polynesia has recorded a large outbreak since October 2013. A great number of cases and some with neurological and autoimmune complications have been reported in a context of concurrent circulation of dengue viruses. The clinical presentation is a "dengue-like syndrome". Until the epidemic in French Polynesia, no severe ZIKV disease had been described so far. The diagnosis is confirmed by viral genome detection by genomic amplification (RT- PCR) and viral isolation. These two large outbreaks occurred in a previously unaffected area in less than a decade. They should raise awareness as to the potential for ZIKV to spread especially since this emergent disease is not well known and that some questions remain on potential reservoirs and transmission modes as well as on clinical presentations and complications. ZIKV has the potential to spread to new areas where the Aedes mosquito vector is present and could be a risk for Southern Europe. Strategies for the prevention and control of ZIKV disease should include the use of insect repellent and mosquito vector eradication.

Copyright © 2014 Elsevier Masson SAS. All rights reserved.
PMID 25001879  Med Mal Infect. 2014 Jul;44(7):302-7. doi: 10.1016/j.me・・・
著者: Sonja A Rasmussen, Denise J Jamieson, Margaret A Honein, Lyle R Petersen
雑誌名: N Engl J Med. 2016 May 19;374(20):1981-7. doi: 10.1056/NEJMsr1604338. Epub 2016 Apr 13.
Abstract/Text
PMID 27074377  N Engl J Med. 2016 May 19;374(20):1981-7. doi: 10.1056/・・・
著者: Mark R Duffy, Tai-Ho Chen, W Thane Hancock, Ann M Powers, Jacob L Kool, Robert S Lanciotti, Moses Pretrick, Maria Marfel, Stacey Holzbauer, Christine Dubray, Laurent Guillaumot, Anne Griggs, Martin Bel, Amy J Lambert, Janeen Laven, Olga Kosoy, Amanda Panella, Brad J Biggerstaff, Marc Fischer, Edward B Hayes
雑誌名: N Engl J Med. 2009 Jun 11;360(24):2536-43. doi: 10.1056/NEJMoa0805715.
Abstract/Text BACKGROUND: In 2007, physicians on Yap Island reported an outbreak of illness characterized by rash, conjunctivitis, and arthralgia. Although serum from some patients had IgM antibody against dengue virus, the illness seemed clinically distinct from previously detected dengue. Subsequent testing with the use of consensus primers detected Zika virus RNA in the serum of the patients but no dengue virus or other arboviral RNA. No previous outbreaks and only 14 cases of Zika virus disease have been previously documented.
METHODS: We obtained serum samples from patients and interviewed patients for information on clinical signs and symptoms. Zika virus disease was confirmed by a finding of Zika virus RNA or a specific neutralizing antibody response to Zika virus in the serum. Patients with IgM antibody against Zika virus who had a potentially cross-reactive neutralizing-antibody response were classified as having probable Zika virus disease. We conducted a household survey to estimate the proportion of Yap residents with IgM antibody against Zika virus and to identify possible mosquito vectors of Zika virus.
RESULTS: We identified 49 confirmed and 59 probable cases of Zika virus disease. The patients resided in 9 of the 10 municipalities on Yap. Rash, fever, arthralgia, and conjunctivitis were common symptoms. No hospitalizations, hemorrhagic manifestations, or deaths due to Zika virus were reported. We estimated that 73% (95% confidence interval, 68 to 77) of Yap residents 3 years of age or older had been recently infected with Zika virus. Aedes hensilli was the predominant mosquito species identified.
CONCLUSIONS: This outbreak of Zika virus illness in Micronesia represents transmission of Zika virus outside Africa and Asia. Although most patients had mild illness, clinicians and public health officials should be aware of the risk of further expansion of Zika virus transmission.

2009 Massachusetts Medical Society
PMID 19516034  N Engl J Med. 2009 Jun 11;360(24):2536-43. doi: 10.1056・・・
著者: Usama Ashraf, Jing Ye, Xindi Ruan, Shengfeng Wan, Bibo Zhu, Shengbo Cao
雑誌名: Viruses. 2015 Jan 19;7(1):219-38. doi: 10.3390/v7010219. Epub 2015 Jan 19.
Abstract/Text Usutu virus (USUV) is an African mosquito-borne flavivirus belonging to the Japanese encephalitis virus serocomplex. USUV is closely related to Murray Valley encephalitis virus, Japanese encephalitis virus, and West Nile virus. USUV was discovered in South Africa in 1959. In Europe, the first true demonstration of circulation of USUV was reported in Austria in 2001 with a significant die-off of Eurasian blackbirds. In the subsequent years, USUV expanded to neighboring countries, including Italy, Germany, Spain, Hungary, Switzerland, Poland, England, Czech Republic, Greece, and Belgium, where it caused unusual mortality in birds. In 2009, the first two human cases of USUV infection in Europe have been reported in Italy, causing meningoencephalitis in immunocompromised patients. This review describes USUV in terms of its life cycle, USUV surveillance from Africa to Europe, human cases, its cellular tropism and pathogenesis, its genetic relationship with other flaviviruses, genetic diversity among USUV strains, its diagnosis, and a discussion of the potential future threat to Asian countries.

PMID 25606971  Viruses. 2015 Jan 19;7(1):219-38. doi: 10.3390/v7010219・・・
著者: Giulietta Venturi, Lorenzo Zammarchi, Claudia Fortuna, Maria Elena Remoli, Eleonora Benedetti, Cristiano Fiorentini, Michele Trotta, Caterina Rizzo, Antonia Mantella, Giovanni Rezza, Alessandro Bartoloni
雑誌名: Euro Surveill. 2016;21(8):30148. doi: 10.2807/1560-7917.ES.2016.21.8.30148.
Abstract/Text We report a case of Zika virus infection imported in Florence, Italy ex-Thailand, leading to a secondary autochthonous case, probably through sexual transmission. The two cases occurred in May 2014 but were retrospectively diagnosed in 2016 on the basis of serological tests (plaque reduction neutralisation) performed on stored serum samples. Our report provides further evidence that sexual transmission of Zika virus is possible.

PMID 26939607  Euro Surveill. 2016;21(8):30148. doi: 10.2807/1560-7917・・・
著者: Alexander Davidson, Sally Slavinski, Kendra Komoto, Jennifer Rakeman, Don Weiss
雑誌名: MMWR Morb Mortal Wkly Rep. 2016 Jul 22;65(28):716-7. doi: 10.15585/mmwr.mm6528e2. Epub 2016 Jul 22.
Abstract/Text A routine investigation by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) identified a nonpregnant woman in her twenties who reported she had engaged in a single event of condomless vaginal intercourse with a male partner the day she returned to NYC (day 0) from travel to an area with ongoing Zika virus transmission. She had headache and abdominal cramping while in the airport awaiting return to NYC. The following day (day 1) she developed fever, fatigue, a maculopapular rash, myalgia, arthralgia, back pain, swelling of the extremities, and numbness and tingling in her hands and feet. In addition, on day 1, the woman began menses that she described as heavier than usual. On day 3 she visited her primary care provider who obtained blood and urine specimens. Zika virus RNA was detected in both serum and urine by real-time reverse transcription-polymerase chain reaction (rRT-PCR) performed at the DOHMH Public Health Laboratory using a test based on an assay developed at CDC (1). The results of serum testing for anti-Zika virus immunoglobulin M (IgM) antibody performed by the New York State Department of Health Wadsworth Center laboratory was negative using the CDC Zika IgM antibody capture enzyme-linked immunosorbent assay (Zika MAC-ELISA) (2).

PMID 27442327  MMWR Morb Mortal Wkly Rep. 2016 Jul 22;65(28):716-7. do・・・
著者: D Trew Deckard, Wendy M Chung, John T Brooks, Jessica C Smith, Senait Woldai, Morgan Hennessey, Natalie Kwit, Paul Mead
雑誌名: MMWR Morb Mortal Wkly Rep. 2016 Apr 15;65(14):372-4. doi: 10.15585/mmwr.mm6514a3. Epub 2016 Apr 15.
Abstract/Text Zika virus infection has been linked to increased risk for Guillain-Barré syndrome and adverse fetal outcomes, including congenital microcephaly. In January 2016, after notification from a local health care provider, an investigation by Dallas County Health and Human Services (DCHHS) identified a case of sexual transmission of Zika virus between a man with recent travel to an area of active Zika virus transmission (patient A) and his nontraveling male partner (patient B). At this time, there had been one prior case report of sexual transmission of Zika virus. The present case report indicates Zika virus can be transmitted through anal sex, as well as vaginal sex. Identification and investigation of cases of sexual transmission of Zika virus in nonendemic areas present valuable opportunities to inform recommendations to prevent sexual transmission of Zika virus.

PMID 27078057  MMWR Morb Mortal Wkly Rep. 2016 Apr 15;65(14):372-4. do・・・
著者: Edward B Hayes
雑誌名: Emerg Infect Dis. 2009 Sep;15(9):1347-50. doi: 10.3201/eid1509.090442.
Abstract/Text Zika virus (ZIKV) is a flavivirus related to yellow fever, dengue, West Nile, and Japanese encephalitis viruses. In 2007 ZIKV caused an outbreak of relatively mild disease characterized by rash, arthralgia, and conjunctivitis on Yap Island in the southwestern Pacific Ocean. This was the first time that ZIKV was detected outside of Africa and Asia. The history, transmission dynamics, virology, and clinical manifestations of ZIKV disease are discussed, along with the possibility for diagnostic confusion between ZIKV illness and dengue.The emergence of ZIKV outside of its previously known geographic range should prompt awareness of the potential for ZIKV to spread to other Pacific islands and the Americas.

PMID 19788800  Emerg Infect Dis. 2009 Sep;15(9):1347-50. doi: 10.3201/・・・
著者: Paul S Mead, Nisha K Duggal, Sarah A Hook, Mark Delorey, Marc Fischer, Dana Olzenak McGuire, Heidi Becksted, Ryan J Max, Michael Anishchenko, Amy M Schwartz, Wen-Pin Tzeng, Christina A Nelson, Erin M McDonald, John T Brooks, Aaron C Brault, Alison F Hinckley
雑誌名: N Engl J Med. 2018 Apr 12;378(15):1377-1385. doi: 10.1056/NEJMoa1711038.
Abstract/Text BACKGROUND: Zika virus (ZIKV) is an emerging mosquito-borne flavivirus that has been linked to adverse birth outcomes. Previous reports have shown that person-to-person transmission can occur by means of sexual contact.
METHODS: We conducted a prospective study involving men with symptomatic ZIKV infection to determine the frequency and duration of ZIKV shedding in semen and urine and to identify risk factors for prolonged shedding in these fluids. Specimens were obtained twice per month for 6 months after illness onset and were tested by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay for ZIKV RNA and by Vero cell culture and plaque assay for infectious ZIKV.
RESULTS: A total of 1327 semen samples from 184 men and 1038 urine samples from 183 men were obtained 14 to 304 days after illness onset. ZIKV RNA was detected in the urine of 7 men (4%) and in the semen of 60 (33%), including in semen samples from 22 of 36 men (61%) who were tested within 30 days after illness onset. ZIKV RNA shedding in semen decreased substantially during the 3 months after illness onset but continued for 281 days in 1 man (1%). Factors that were independently associated with prolonged RNA shedding included older age, less frequent ejaculation, and the presence of certain symptoms at the time of initial illness. Infectious ZIKV was isolated from 3 of 78 semen samples with detectable ZIKV RNA, all obtained within 30 days after illness onset and all with at least 7.0 log10 ZIKV RNA copies per milliliter of semen.
CONCLUSIONS: ZIKV RNA was commonly present in the semen of men with symptomatic ZIKV infection and persisted in some men for more than 6 months. In contrast, shedding of infectious ZIKV appeared to be much less common and was limited to the first few weeks after illness onset. (Funded by the Centers for Disease Control and Prevention.).

PMID 29641964  N Engl J Med. 2018 Apr 12;378(15):1377-1385. doi: 10.10・・・
著者: A Roth, A Mercier, C Lepers, D Hoy, S Duituturaga, E Benyon, L Guillaumot, Y Souares
雑誌名: Euro Surveill. 2014 Oct 16;19(41). Epub 2014 Oct 16.
Abstract/Text
PMID 25345518  Euro Surveill. 2014 Oct 16;19(41). Epub 2014 Oct 16.
著者: Derek Gatherer, Alain Kohl
雑誌名: J Gen Virol. 2016 Feb;97(2):269-73. doi: 10.1099/jgv.0.000381. Epub 2015 Dec 18.
Abstract/Text Zika virus (family Flaviviridae) is an emerging arbovirus. Spread by Aedes mosquitoes, it was first discovered in Uganda in 1947, and later in humans elsewhere in sub-Saharan Africa, arriving in south-east Asia at latest by the mid-twentieth century. In the twenty-first century, it spread across the Pacific islands reaching South America around 2014. Since then it has spread rapidly northwards reaching Mexico in November 2015. Its clinical profile is that of a dengue-like febrile illness, but associations with Guillain-Barré syndrome and microcephaly have appeared recently. The final geographical range and ultimate clinical impact of Zika virus are still a matter for speculation.

PMID 26684466  J Gen Virol. 2016 Feb;97(2):269-73. doi: 10.1099/jgv.0.・・・
著者: S Kutsuna, Y Kato, T Takasaki, Ml Moi, A Kotaki, H Uemura, T Matono, Y Fujiya, M Mawatari, N Takeshita, K Hayakawa, S Kanagawa, N Ohmagari
雑誌名: Euro Surveill. 2014 Jan 30;19(4). Epub 2014 Jan 30.
Abstract/Text
PMID 24507466  Euro Surveill. 2014 Jan 30;19(4). Epub 2014 Jan 30.
著者: Koh Shinohara, Satoshi Kutsuna, Tomohiko Takasaki, Meng Ling Moi, Makiko Ikeda, Akira Kotaki, Kei Yamamoto, Yoshihiro Fujiya, Momoko Mawatari, Nozomi Takeshita, Kayoko Hayakawa, Shuzo Kanagawa, Yasuyuki Kato, Norio Ohmagari
雑誌名: J Travel Med. 2016 Jan;23(1). doi: 10.1093/jtm/tav011. Epub 2016 Jan 18.
Abstract/Text In July 2014, a Japanese traveller returning from Thailand was investigated for fever, headache, rash and conjunctivitis. Zika virus RNA was detected in his urine sample by real-time reverse transcription polymerase chain reaction. Serological tests showed cross reactivity of IgM against the dengue virus. Zika fever could be misdiagnosed or missed and should be considered in febrile patients with a rash, especially those returning from Thailand.

© The Author 2016. Published by Oxford University Press on behalf of International society of travel medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PMID 26782128  J Travel Med. 2016 Jan;23(1). doi: 10.1093/jtm/tav011. ・・・
著者: E Oehler, L Watrin, P Larre, I Leparc-Goffart, S Lastere, F Valour, L Baudouin, Hp Mallet, D Musso, F Ghawche
雑誌名: Euro Surveill. 2014 Mar 6;19(9). Epub 2014 Mar 6.
Abstract/Text Zika fever, considered as an emerging disease of arboviral origin, because of its expanding geographic area, is known as a benign infection usually presenting as an influenza-like illness with cutaneous rash. So far, Zika virus infection has never led to hospitalisation. We describe the first case of Guillain-Barré syndrome (GBS) occurring immediately after a Zika virus infection, during the current Zika and type 1 and 3 dengue fever co-epidemics in French Polynesia.

PMID 24626205  Euro Surveill. 2014 Mar 6;19(9). Epub 2014 Mar 6.
著者: Sylvie Mécharles, Cécile Herrmann, Pascale Poullain, Tuan-Huy Tran, Nathalie Deschamps, Grégory Mathon, Anne Landais, Sébastien Breurec, Annie Lannuzel
雑誌名: Lancet. 2016 Apr 2;387(10026):1481. doi: 10.1016/S0140-6736(16)00644-9. Epub 2016 Mar 4.
Abstract/Text
PMID 26946926  Lancet. 2016 Apr 2;387(10026):1481. doi: 10.1016/S0140-・・・
著者: Guillaume Carteaux, Marianne Maquart, Alexandre Bedet, Damien Contou, Pierre Brugières, Slim Fourati, Laurent Cleret de Langavant, Thomas de Broucker, Christian Brun-Buisson, Isabelle Leparc-Goffart, Armand Mekontso Dessap
雑誌名: N Engl J Med. 2016 Apr 21;374(16):1595-6. doi: 10.1056/NEJMc1602964. Epub 2016 Mar 9.
Abstract/Text
PMID 26958738  N Engl J Med. 2016 Apr 21;374(16):1595-6. doi: 10.1056/・・・
著者: Rafael Mello Galliez, Mariana Spitz, Patricia Piazza Rafful, Marcelo Cagy, Claudia Escosteguy, Caroline Spósito Brito Germano, Elisa Sasse, Alessandro Luis Gonçalves, Paola Paz Silveira, Paula Pezzuto, Alice Maria de Magalhães Ornelas, Amilcar Tanuri, Renato Santana Aguiar, Fernanda Tovar Moll
雑誌名: Open Forum Infect Dis. 2016 Oct;3(4):ofw203. doi: 10.1093/ofid/ofw203. Epub 2016 Oct 3.
Abstract/Text Brazil has experienced a Zika virus (ZIKV) outbreak with increased incidence of congenital malformations and neurological manifestations. We describe a case of a 26-year-old Brazilian Caucasian man infected with ZIKV and diagnosed with encephalomyelitis. Brain and spinal cord images showed hyperintense lesions on T2 and fluid-attenuated inversion recovery (FLAIR), and levels of proinflammatory cytokines in the cerebrospinal fluid showed a remarkable increase of interleukin (IL)-6 and IL-8. The observed pattern suggests immune activation during the acute phase, along with the neurological impairment, with normalization in the recovery phase. This is the first longitudinal report of ZIKV infection causing encephalomyelitis with documented immune activation.

PMID 28053996  Open Forum Infect Dis. 2016 Oct;3(4):ofw203. doi: 10.10・・・
著者: Luisa Barzon, Monia Pacenti, Elisa Franchin, Enrico Lavezzo, Marta Trevisan, Dino Sgarabotto, Giorgio Palù
雑誌名: Euro Surveill. 2016 Aug 11;21(32). doi: 10.2807/1560-7917.ES.2016.21.32.30316.
Abstract/Text We describe the dynamics of Zika virus (ZIKV) infection in a man in his early 40s who developed fever and rash after returning from Haiti to Italy, in January 2016. Follow-up laboratory testing demonstrated detectable ZIKV RNA in plasma up to day 9 after symptom onset and in urine and saliva up to days 15 and 47, respectively. Notably, persistent shedding of ZIKV RNA was demonstrated in semen, still detectable at 181 days after onset.

This article is copyright of The Authors, 2016.
PMID 27542178  Euro Surveill. 2016 Aug 11;21(32). doi: 10.2807/1560-79・・・
著者: Emanuele Nicastri, Concetta Castilletti, Giuseppina Liuzzi, Marco Iannetta, Maria R Capobianchi, Giuseppe Ippolito
雑誌名: Euro Surveill. 2016 Aug 11;21(32). doi: 10.2807/1560-7917.ES.2016.21.32.30314.
Abstract/Text A man in his early 30s reported in January 2016 a history of fever, asthenia and erythematous rash during a stay in Haiti. On his return to Italy, ZIKV RNA was detected in his urine and saliva 91 days after symptom onset, and in his semen on day 188, six months after symptom onset. Our findings support the possibility of sexual transmission of ZIKV and highlight the importance of continuing to investigate non-vector-borne ZIKV infection.

This article is copyright of The Authors, 2016.
PMID 27541989  Euro Surveill. 2016 Aug 11;21(32). doi: 10.2807/1560-79・・・
著者: Yaoska Reyes, Natalie M Bowman, Sylvia Becker-Dreps, Edwing Centeno, Matthew H Collins, Guei-Jiun Alice Liou, Filemón Bucardo
雑誌名: Emerg Infect Dis. 2019 Apr;25(4):808-810. doi: 10.3201/eid2504.180977.
Abstract/Text Zika virus, an arthropod-borne flavivirus pathogen in humans, is unusual because it can be sexually transmitted and can be shed for prolonged periods in semen. We report viral shedding in vaginal secretions for up to 6 months, indicating the potential for sexual and vertical transmission by infected women.

PMID 30882329  Emerg Infect Dis. 2019 Apr;25(4):808-810. doi: 10.3201/・・・
著者: Kara D Polen, Suzanne M Gilboa, Susan Hills, Titilope Oduyebo, Katrin S Kohl, John T Brooks, Alys Adamski, Regina M Simeone, Allison T Walker, Dmitry M Kissin, Lyle R Petersen, Margaret A Honein, Dana Meaney-Delman
雑誌名: MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):868-871. doi: 10.15585/mmwr.mm6731e2. Epub 2018 Aug 10.
Abstract/Text Zika virus infection can occur as a result of mosquitoborne or sexual transmission of the virus. Infection during pregnancy is a cause of fetal brain abnormalities and other serious birth defects (1,2). CDC has updated the interim guidance for men with possible Zika virus exposure who 1) are planning to conceive with their partner, or 2) want to prevent sexual transmission of Zika virus at any time (3). CDC now recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) before engaging in unprotected sex. CDC now also recommends that for couples who are not trying to conceive, men can consider using condoms or abstaining from sex for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) to minimize their risk for sexual transmission of Zika virus. All other guidance for Zika virus remains unchanged. The definition of possible Zika virus exposure remains unchanged and includes travel to or residence in an area with risk for Zika virus transmission (https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika) or sex without a condom with a partner who traveled to or lives in an area with risk for Zika virus transmission. CDC will continue to update recommendations as new information becomes available.

PMID 30091965  MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):868-871. ・・・
著者: Jernej Mlakar, Misa Korva, Nataša Tul, Mara Popović, Mateja Poljšak-Prijatelj, Jerica Mraz, Marko Kolenc, Katarina Resman Rus, Tina Vesnaver Vipotnik, Vesna Fabjan Vodušek, Alenka Vizjak, Jože Pižem, Miroslav Petrovec, Tatjana Avšič Županc
雑誌名: N Engl J Med. 2016 Mar 10;374(10):951-8. doi: 10.1056/NEJMoa1600651. Epub 2016 Feb 10.
Abstract/Text A widespread epidemic of Zika virus (ZIKV) infection was reported in 2015 in South and Central America and the Caribbean. A major concern associated with this infection is the apparent increased incidence of microcephaly in fetuses born to mothers infected with ZIKV. In this report, we describe the case of an expectant mother who had a febrile illness with rash at the end of the first trimester of pregnancy while she was living in Brazil. Ultrasonography performed at 29 weeks of gestation revealed microcephaly with calcifications in the fetal brain and placenta. After the mother requested termination of the pregnancy, a fetal autopsy was performed. Micrencephaly (an abnormally small brain) was observed, with almost complete agyria, hydrocephalus, and multifocal dystrophic calcifications in the cortex and subcortical white matter, with associated cortical displacement and mild focal inflammation. ZIKV was found in the fetal brain tissue on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay, with consistent findings on electron microscopy. The complete genome of ZIKV was recovered from the fetal brain.

PMID 26862926  N Engl J Med. 2016 Mar 10;374(10):951-8. doi: 10.1056/N・・・
著者: Rita W Driggers, Cheng-Ying Ho, Essi M Korhonen, Suvi Kuivanen, Anne J Jääskeläinen, Teemu Smura, Avi Rosenberg, D Ashley Hill, Roberta L DeBiasi, Gilbert Vezina, Julia Timofeev, Fausto J Rodriguez, Lev Levanov, Jennifer Razak, Preetha Iyengar, Andrew Hennenfent, Richard Kennedy, Robert Lanciotti, Adre du Plessis, Olli Vapalahti
雑誌名: N Engl J Med. 2016 Jun 2;374(22):2142-51. doi: 10.1056/NEJMoa1601824. Epub 2016 Mar 30.
Abstract/Text The current outbreak of Zika virus (ZIKV) infection has been associated with an apparent increased risk of congenital microcephaly. We describe a case of a pregnant woman and her fetus infected with ZIKV during the 11th gestational week. The fetal head circumference decreased from the 47th percentile to the 24th percentile between 16 and 20 weeks of gestation. ZIKV RNA was identified in maternal serum at 16 and 21 weeks of gestation. At 19 and 20 weeks of gestation, substantial brain abnormalities were detected on ultrasonography and magnetic resonance imaging (MRI) without the presence of microcephaly or intracranial calcifications. On postmortem analysis of the fetal brain, diffuse cerebral cortical thinning, high ZIKV RNA loads, and viral particles were detected, and ZIKV was subsequently isolated.

PMID 27028667  N Engl J Med. 2016 Jun 2;374(22):2142-51. doi: 10.1056/・・・
著者: Simon Cauchemez, Marianne Besnard, Priscillia Bompard, Timothée Dub, Prisca Guillemette-Artur, Dominique Eyrolle-Guignot, Henrik Salje, Maria D Van Kerkhove, Véronique Abadie, Catherine Garel, Arnaud Fontanet, Henri-Pierre Mallet
雑誌名: Lancet. 2016 May 21;387(10033):2125-2132. doi: 10.1016/S0140-6736(16)00651-6. Epub 2016 Mar 16.
Abstract/Text BACKGROUND: The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified.
METHODS: We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk.
FINDINGS: The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62-70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0-8) per 10,000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34-191) per 10,000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data.
INTERPRETATION: Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus.
FUNDING: Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.

Copyright © 2016 Elsevier Ltd. All rights reserved.
PMID 26993883  Lancet. 2016 May 21;387(10033):2125-2132. doi: 10.1016/・・・
著者:
雑誌名: N Engl J Med. 2016 Aug 4;375(5):498. doi: 10.1056/NEJMx160025.
Abstract/Text
PMID 27518688  N Engl J Med. 2016 Aug 4;375(5):498. doi: 10.1056/NEJMx・・・
著者: Lavinia Schuler-Faccini, Erlane M Ribeiro, Ian M L Feitosa, Dafne D G Horovitz, Denise P Cavalcanti, André Pessoa, Maria Juliana R Doriqui, Joao Ivanildo Neri, Joao Monteiro de Pina Neto, Hector Y C Wanderley, Mirlene Cernach, Antonette S El-Husny, Marcos V S Pone, Cassio L C Serao, Maria Teresa V Sanseverino, Brazilian Medical Genetics Society–Zika Embryopathy Task Force
雑誌名: MMWR Morb Mortal Wkly Rep. 2016 Jan 29;65(3):59-62. doi: 10.15585/mmwr.mm6503e2. Epub 2016 Jan 29.
Abstract/Text In early 2015, an outbreak of Zika virus, a flavivirus transmitted by Aedes mosquitoes, was identified in northeast Brazil, an area where dengue virus was also circulating. By September, reports of an increase in the number of infants born with microcephaly in Zika virus-affected areas began to emerge, and Zika virus RNA was identified in the amniotic fluid of two women whose fetuses had been found to have microcephaly by prenatal ultrasound. The Brazil Ministry of Health (MoH) established a task force to investigate the possible association of microcephaly with Zika virus infection during pregnancy and a registry for incident microcephaly cases (head circumference ≥2 standard deviations [SD] below the mean for sex and gestational age at birth) and pregnancy outcomes among women suspected to have had Zika virus infection during pregnancy. Among a cohort of 35 infants with microcephaly born during August-October 2015 in eight of Brazil's 26 states and reported to the registry, the mothers of all 35 had lived in or visited Zika virus-affected areas during pregnancy, 25 (71%) infants had severe microcephaly (head circumference >3 SD below the mean for sex and gestational age), 17 (49%) had at least one neurologic abnormality, and among 27 infants who had neuroimaging studies, all had abnormalities. Tests for other congenital infections were negative. All infants had a lumbar puncture as part of the evaluation and cerebrospinal fluid (CSF) samples were sent to a reference laboratory in Brazil for Zika virus testing; results are not yet available. Further studies are needed to confirm the association of microcephaly with Zika virus infection during pregnancy and to understand any other adverse pregnancy outcomes associated with Zika virus infection. Pregnant women in Zika virus-affected areas should protect themselves from mosquito bites by using air conditioning, screens, or nets when indoors, wearing long sleeves and pants, using permethrin-treated clothing and gear, and using insect repellents when outdoors. Pregnant and lactating women can use all U.S. Environmental Protection Agency (EPA)-registered insect repellents according to the product label.

PMID 26820244  MMWR Morb Mortal Wkly Rep. 2016 Jan 29;65(3):59-62. doi・・・
著者: Bruno de Paula Freitas, João Rafael de Oliveira Dias, Juliana Prazeres, Gielson Almeida Sacramento, Albert Icksang Ko, Maurício Maia, Rubens Belfort
雑誌名: JAMA Ophthalmol. 2016 May 1;134(5):529-535. doi: 10.1001/jamaophthalmol.2016.0267.
Abstract/Text Importance: The Zika virus (ZIKV) has rapidly reached epidemic proportions, especially in northeastern Brazil, and has rapidly spread to other parts of the Americas. A recent increase in the prevalence of microcephaly in newborn infants and vision-threatening findings in these infants is likely associated with the rapid spread of ZIKV.
Objective: To evaluate the ocular findings in infants with microcephaly associated with presumed intrauterine ZIKV infection in Salvador, Bahia, Brazil.
Design, Setting, and Participants: Case series at a tertiary hospital. Twenty-nine infants with microcephaly (defined by a cephalic circumference of ≤32 cm) with a presumed diagnosis of congenital ZIKV were recruited through an active search and referrals from other hospitals and health unities. The study was conducted between December 1 and December 21, 2015.
Interventions: All infants and mothers underwent systemic and ophthalmic examinations from December 1 through December 21, 2015, in the Roberto Santos General Hospital, Salvador, Brazil. Anterior segment and retinal, choroidal, and optic nerve abnormalities were documented using a wide-field digital imaging system. The differential diagnosis included toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, syphilis, and human immunodeficiency virus, which were ruled out through serologic and clinical examinations.
Main Outcomes and Measures: Ocular abnormalities associated with ZIKV.
Results: Twenty-three of 29 mothers (79.3%) reported suspected ZIKV infection signs and symptoms during pregnancy, 18 in the first trimester, 4 in the second trimester, and 1 in the third trimester. Of the 29 infants (58 eyes) examined (18 [62.1%] female), ocular abnormalities were present in 17 eyes (29.3%) of 10 children (34.5%). Bilateral findings were found in 7 of 10 patients presenting with ocular lesions, the most common of which were focal pigment mottling of the retina and chorioretinal atrophy in 11 of the 17 eyes with abnormalities (64.7%), followed by optic nerve abnormalities in 8 eyes (47.1%), bilateral iris coloboma in 1 patient (2 eyes [11.8%]), and lens subluxation in 1 eye (5.9%).
Conclusions and Relevance: Congenital infection due to presumed ZIKV exposure is associated with vision-threatening findings, which include bilateral macular and perimacular lesions as well as optic nerve abnormalities in most cases.

PMID 26865554  JAMA Ophthalmol. 2016 May 1;134(5):529-535. doi: 10.100・・・
著者: Mariana C Leal, Lilian F Muniz, Tamires S A Ferreira, Cristiane M Santos, Luciana C Almeida, Vanessa Van Der Linden, Regina C F Ramos, Laura C Rodrigues, Silvio S Caldas Neto
雑誌名: MMWR Morb Mortal Wkly Rep. 2016 Sep 2;65(34):917-9. doi: 10.15585/mmwr.mm6534e3. Epub 2016 Sep 2.
Abstract/Text Congenital infection with Zika virus causes microcephaly and other brain abnormalities (1). Hearing loss associated with other congenital viral infections is well described; however, little is known about hearing loss in infants with congenital Zika virus infection. A retrospective assessment of a series of 70 infants aged 0-10 months with microcephaly and laboratory evidence of Zika virus infection was conducted by the Hospital Agamenon Magalhães in Brazil and partners. The infants were enrolled during November 2015-May 2016 and had screening and diagnostic hearing tests. Five (7%) infants had sensorineural hearing loss, all of whom had severe microcephaly; however, one child was tested after receiving treatment with an ototoxic antibiotic. If this child is excluded, the prevalence of sensorineural hearing loss was 5.8% (four of 69), which is similar to that seen in association with other congenital viral infections. Additional information is needed to understand the prevalence and spectrum of hearing loss in children with congenital Zika virus infection; all infants born to women with evidence of Zika virus infection during pregnancy should have their hearing tested, including infants who appear normal at birth.

PMID 27585248  MMWR Morb Mortal Wkly Rep. 2016 Sep 2;65(34):917-9. doi・・・
著者: Vanessa van der Linden, André Pessoa, William Dobyns, A James Barkovich, Hélio van der Linden Júnior, Epitacio Leite Rolim Filho, Erlane Marques Ribeiro, Mariana de Carvalho Leal, Pablo Picasso de Araújo Coimbra, Maria de Fátima Viana Vasco Aragão, Islane Verçosa, Camila Ventura, Regina Coeli Ramos, Danielle Di Cavalcanti Sousa Cruz, Marli Tenório Cordeiro, Vivian Maria Ribeiro Mota, Mary Dott, Christina Hillard, Cynthia A Moore
雑誌名: MMWR Morb Mortal Wkly Rep. 2016 Dec 2;65(47):1343-1348. doi: 10.15585/mmwr.mm6547e2. Epub 2016 Dec 2.
Abstract/Text Congenital Zika virus infection can cause microcephaly and severe brain abnormalities (1). Congenital Zika syndrome comprises a spectrum of clinical features (2); however, as is the case with most newly recognized teratogens, the earliest documented clinical presentation is expected to be the most severe. Initial descriptions of the effects of in utero Zika virus infection centered prominently on the finding of congenital microcephaly (3). To assess the possibility of clinical presentations that do not include congenital microcephaly, a retrospective assessment of 13 infants from the Brazilian states of Pernambuco and Ceará with normal head size at birth and laboratory evidence of congenital Zika virus infection was conducted. All infants had brain abnormalities on neuroimaging consistent with congenital Zika syndrome, including decreased brain volume, ventriculomegaly, subcortical calcifications, and cortical malformations. The earliest evaluation occurred on the second day of life. Among all infants, head growth was documented to have decelerated as early as 5 months of age, and 11 infants had microcephaly. These findings provide evidence that among infants with prenatal exposure to Zika virus, the absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities. These findings support the recommendation for comprehensive medical and developmental follow-up of infants exposed to Zika virus prenatally. Early neuroimaging might identify brain abnormalities related to congenital Zika infection even among infants with a normal head circumference (4).

PMID 27906905  MMWR Morb Mortal Wkly Rep. 2016 Dec 2;65(47):1343-1348.・・・
著者: Patrícia Brasil, José P Pereira, M Elisabeth Moreira, Rita M Ribeiro Nogueira, Luana Damasceno, Mayumi Wakimoto, Renata S Rabello, Stephanie G Valderramos, Umme-Aiman Halai, Tania S Salles, Andrea A Zin, Dafne Horovitz, Pedro Daltro, Marcia Boechat, Claudia Raja Gabaglia, Patrícia Carvalho de Sequeira, José H Pilotto, Raquel Medialdea-Carrera, Denise Cotrim da Cunha, Liege M Abreu de Carvalho, Marcos Pone, André Machado Siqueira, Guilherme A Calvet, Ana E Rodrigues Baião, Elizabeth S Neves, Paulo R Nassar de Carvalho, Renata H Hasue, Peter B Marschik, Christa Einspieler, Carla Janzen, James D Cherry, Ana M Bispo de Filippis, Karin Nielsen-Saines
雑誌名: N Engl J Med. 2016 Dec 15;375(24):2321-2334. doi: 10.1056/NEJMoa1602412. Epub 2016 Mar 4.
Abstract/Text BACKGROUND: Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants.
METHODS: We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes.
RESULTS: A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester).
CONCLUSIONS: Despite mild clinical symptoms in the mother, ZIKV infection during pregnancy is deleterious to the fetus and is associated with fetal death, fetal growth restriction, and a spectrum of central nervous system abnormalities. (Funded by Ministério da Saúde do Brasil and others.).

PMID 26943629  N Engl J Med. 2016 Dec 15;375(24):2321-2334. doi: 10.10・・・
著者: Margaret A Honein, April L Dawson, Emily E Petersen, Abbey M Jones, Ellen H Lee, Mahsa M Yazdy, Nina Ahmad, Jennifer Macdonald, Nicole Evert, Andrea Bingham, Sascha R Ellington, Carrie K Shapiro-Mendoza, Titilope Oduyebo, Anne D Fine, Catherine M Brown, Jamie N Sommer, Jyoti Gupta, Philip Cavicchia, Sally Slavinski, Jennifer L White, S Michele Owen, Lyle R Petersen, Coleen Boyle, Dana Meaney-Delman, Denise J Jamieson, US Zika Pregnancy Registry Collaboration
雑誌名: JAMA. 2017 Jan 3;317(1):59-68. doi: 10.1001/jama.2016.19006.
Abstract/Text Importance: Understanding the risk of birth defects associated with Zika virus infection during pregnancy may help guide communication, prevention, and planning efforts. In the absence of Zika virus, microcephaly occurs in approximately 7 per 10 000 live births.
Objective: To estimate the preliminary proportion of fetuses or infants with birth defects after maternal Zika virus infection by trimester of infection and maternal symptoms.
Design, Setting, and Participants: Completed pregnancies with maternal, fetal, or infant laboratory evidence of possible recent Zika virus infection and outcomes reported in the continental United States and Hawaii from January 15 to September 22, 2016, in the US Zika Pregnancy Registry, a collaboration between the CDC and state and local health departments.
Exposures: Laboratory evidence of possible recent Zika virus infection in a maternal, placental, fetal, or infant sample.
Main Outcomes and Measures: Birth defects potentially Zika associated: brain abnormalities with or without microcephaly, neural tube defects and other early brain malformations, eye abnormalities, and other central nervous system consequences.
Results: Among 442 completed pregnancies in women (median age, 28 years; range, 15-50 years) with laboratory evidence of possible recent Zika virus infection, birth defects potentially related to Zika virus were identified in 26 (6%; 95% CI, 4%-8%) fetuses or infants. There were 21 infants with birth defects among 395 live births and 5 fetuses with birth defects among 47 pregnancy losses. Birth defects were reported for 16 of 271 (6%; 95% CI, 4%-9%) pregnant asymptomatic women and 10 of 167 (6%; 95% CI, 3%-11%) symptomatic pregnant women. Of the 26 affected fetuses or infants, 4 had microcephaly and no reported neuroimaging, 14 had microcephaly and brain abnormalities, and 4 had brain abnormalities without microcephaly; reported brain abnormalities included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities. Infants with microcephaly (18/442) represent 4% of completed pregnancies. Birth defects were reported in 9 of 85 (11%; 95% CI, 6%-19%) completed pregnancies with maternal symptoms or exposure exclusively in the first trimester (or first trimester and periconceptional period), with no reports of birth defects among fetuses or infants with prenatal exposure to Zika virus infection only in the second or third trimesters.
Conclusions and Relevance: Among pregnant women in the United States with completed pregnancies and laboratory evidence of possible recent Zika infection, 6% of fetuses or infants had evidence of Zika-associated birth defects, primarily brain abnormalities and microcephaly, whereas among women with first-trimester Zika infection, 11% of fetuses or infants had evidence of Zika-associated birth defects. These findings support the importance of screening pregnant women for Zika virus exposure.

PMID 27960197  JAMA. 2017 Jan 3;317(1):59-68. doi: 10.1001/jama.2016.1・・・
著者: Bruno Hoen, Bruno Schaub, Anna L Funk, Vanessa Ardillon, Manon Boullard, André Cabié, Caroline Callier, Gabriel Carles, Sylvie Cassadou, Raymond Césaire, Maylis Douine, Cécile Herrmann-Storck, Philippe Kadhel, Cédric Laouénan, Yoann Madec, Alice Monthieux, Mathieu Nacher, Fatiha Najioullah, Dominique Rousset, Catherine Ryan, Kinda Schepers, Sofia Stegmann-Planchard, Benoît Tressières, Jean-Luc Voluménie, Samson Yassinguezo, Eustase Janky, Arnaud Fontanet
雑誌名: N Engl J Med. 2018 Mar 15;378(11):985-994. doi: 10.1056/NEJMoa1709481.
Abstract/Text BACKGROUND: The risk of congenital neurologic defects related to Zika virus (ZIKV) infection has ranged from 6 to 42% in various reports. The aim of this study was to estimate this risk among pregnant women with symptomatic ZIKV infection in French territories in the Americas.
METHODS: From March 2016 through November 2016, we enrolled in this prospective cohort study pregnant women with symptomatic ZIKV infection that was confirmed by polymerase-chain-reaction (PCR) assay. The analysis included all data collected up to April 27, 2017, the date of the last delivery in the cohort.
RESULTS: Among the 555 fetuses and infants in the 546 pregnancies included in the analysis, 28 (5.0%) were not carried to term or were stillborn, and 527 were born alive. Neurologic and ocular defects possibly associated with ZIKV infection were seen in 39 fetuses and infants (7.0%; 95% confidence interval, 5.0 to 9.5); of these, 10 were not carried to term because of termination of pregnancy for medical reasons, 1 was stillborn, and 28 were live-born. Microcephaly (defined as head circumference more than 2 SD below the mean for sex and gestational age) was detected in 32 fetuses and infants (5.8%), of whom 9 (1.6%) had severe microcephaly (more than 3 SD below the mean). Neurologic and ocular defects were more common when ZIKV infection occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001).
CONCLUSIONS: Among pregnant women with symptomatic, PCR-confirmed ZIKV infection, birth defects possibly associated with ZIKV infection were present in 7% of fetuses and infants. Defects occurred more frequently in fetuses and infants whose mothers had been infected early in pregnancy. Longer-term follow-up of infants is required to assess any manifestations not detected at birth. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT02916732 .).

PMID 29539287  N Engl J Med. 2018 Mar 15;378(11):985-994. doi: 10.1056・・・
著者: Tolulope Adebanjo, Shana Godfred-Cato, Laura Viens, Marc Fischer, J Erin Staples, Wendi Kuhnert-Tallman, Henry Walke, Titilope Oduyebo, Kara Polen, Georgina Peacock, Dana Meaney-Delman, Margaret A Honein, Sonja A Rasmussen, Cynthia A Moore, Contributors
雑誌名: MMWR Morb Mortal Wkly Rep. 2017 Oct 20;66(41):1089-1099. doi: 10.15585/mmwr.mm6641a1. Epub 2017 Oct 20.
Abstract/Text CDC has updated its interim guidance for U.S. health care providers caring for infants with possible congenital Zika virus infection (1) in response to recently published updated guidance for health care providers caring for pregnant women with possible Zika virus exposure (2), unknown sensitivity and specificity of currently available diagnostic tests for congenital Zika virus infection, and recognition of additional clinical findings associated with congenital Zika virus infection. All infants born to mothers with possible Zika virus exposure* during pregnancy should receive a standard evaluation at birth and at each subsequent well-child visit including a comprehensive physical examination, age-appropriate vision screening and developmental monitoring and screening using validated tools (3-5), and newborn hearing screen at birth, preferably using auditory brainstem response (ABR) methodology (6). Specific guidance for laboratory testing and clinical evaluation are provided for three clinical scenarios in the setting of possible maternal Zika virus exposure: 1) infants with clinical findings consistent with congenital Zika syndrome regardless of maternal testing results, 2) infants without clinical findings consistent with congenital Zika syndrome who were born to mothers with laboratory evidence of possible Zika virus infection,† and 3) infants without clinical findings consistent with congenital Zika syndrome who were born to mothers without laboratory evidence of possible Zika virus infection. Infants in the first two scenarios should receive further testing and evaluation for Zika virus, whereas for the third group, further testing and clinical evaluation for Zika virus are not recommended. Health care providers should remain alert for abnormal findings (e.g., postnatal-onset microcephaly and eye abnormalities without microcephaly) in infants with possible congenital Zika virus exposure without apparent abnormalities at birth.

PMID 29049277  MMWR Morb Mortal Wkly Rep. 2017 Oct 20;66(41):1089-1099・・・

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