C'est une première en France métropolitaine : deux cas autochtones de Zika ont été signalés à Hyères dans le Var.Les deux personnes qui résident dans le même quartier et qui ont présenté leurs premiers symptômes en août n'avaient pas voyagé et ont été piquées en France métropolitaine. Brasil P, Pereira JP Jr, Moreira ME, et al. * Plus–minus values are means ±SD. When the mother is symptomatic, the infection is confirmed by a positive reverse transcription polymerase chain reaction (RT‐PCR) test of the blood or urine 15 and/or by detection of anti‐ZIKV antibodies. De la mère au fœtus, elle est possible tout au long de la grossesse et les conséquences fœtales seront d’autant plus grave que l’infection survient tôt durant la grossesse. Among these 9 women, the last available ultrasonographic data were from the third trimester for 5 women and from the second trimester for 4 women; these fetal ultrasonographic examinations were normal. Virus Zika : toute l'actualité en direct, soyez informé de toute l'info en continu, en images et en vidéos. Characteristics of Infection in the Women with Symptomatic, PCR-Confirmed ZIKV Infection. Reynolds MR, Jones AM, Petersen EE, et al. It provides employers, employees and physicians with information to better prevent occupational diseases. Although the rate of complications would be expected to be higher among women with symptomatic infection than among those who were asymptomatic, an observational study involving U.S. women did not show any significant difference in the rate of birth defects between the offspring of women who had symptomatic ZIKV infection and the offspring of women who had asymptomatic ZIKV infection during pregnancy.5 A recent study also showed no significant association between disease severity or viral load and adverse outcomes.16 Second, we were not able to fully assess the presence of birth defects possibly associated with ZIKV infection in the case of the 11 miscarriages, 2 of the 6 stillbirths, and the 1 voluntary abortion, as well as in the 96 live-born infants (18.2% of the 527 live-born infants) who did not undergo prenatal ultrasonography after ZIKV infection. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Shapiro-Mendoza CK, Rice ME, Galang RR, et al. Honein MA, Dawson AL, Petersen EE, et al. Le virus zika est transmis à l’homme par la piqûre d’un moustique du genre Aedes (A.aegypti et A.albopictus) largement réparti dans le monde et dont la période d’activité est surtout diurne. N Engl J Med 2017;377:1399-1400. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Characteristics of the Women with Symptomatic, PCR-Confirmed ZIKV Infection. It is complementary to the first arm (ZIKA-DFA-FE) consisting in the follow-up of women in the French Overseas Departments who are pregnant during the Zika epidemic period. Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. In 3 of the 527 live births (0.6%), clinical abnormalities other than microcephaly were detected at birth. Partagez et commentez en temps réel, à tout moment de la journée. The study was performed in the French territories of Martinique, Guadeloupe, and French Guiana. virus Zika au cours de la grossesse Bruno Hoen, Anna L Funk, Benoit Tressières, Ingrid Vingadassalom, Eustase Janky, Philippe Kadhel, Catherine Ryan, Kinda Schepers, Stanie Gaete, Arnaud Fontanet These percentages did not differ by trimester of infection. 20 janvier 2016 (https://www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=hcspa20160105_zikaactualisationmodpec.pdf). No abnormalities were detected in any of the live-born infants from twin pregnancies. Clin Infect Dis 2017;65:877-883. The date of ZIKV infection was considered to be the date of the first ZIKV-related symptom onset. 14. von der Hagen M, Pivarcsi M, Liebe J, et al. ), and Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne (S.Y. No other potential conflict of interest relevant to this article was reported. We believe that this aspect of the study design had a limited effect on the rate of birth defects that could have been identified if all neonates had undergone brain imaging soon after birth. Although missing ultrasonographic data may have led to underdiagnosis of ZIKV-related birth defects, it should be noted that in our cohort, only 1 live-born baby had an isolated brain abnormality (ventriculomegaly), detected by MRI, in the absence of clinical abnormalities, after infection during the second trimester of pregnancy. From INSERM Centre d’Investigation Clinique 1424 (B.H., C.C., B.T. We acknowledge that our study has limitations. Le dépistage échographique pendant la grossesse peut retrouver : calcifications, ventriculomégalies, anomalies de développement du cortex, du corps calleux ou du cervelet, anomalies ophtalmiques, l’infection peut être évolutive après la naissance. Implications of chikungunya virus in pregnancy are mostly related to intrapartum transmission that may be associated with … ), INSERM Centre d’Investigation Clinique 1424 (M.D., M.N. Also, the majority of missing ultrasonographic data involved pregnancies in which infection occurred during the third trimester, and the consequences of infection during the third trimester were found to be limited in the other infants of the same cohort. 10. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT02916732. Indeed, it has been reported that when ZIKV infection occurs during the first trimester or early second trimester, all brain abnormalities can be detected with ultrasonography before 28 weeks of gestation.10 Another study showed that none of 103 infants with normal prenatal ultrasonographic findings and normal clinical examinations at birth had anomalies attributable to ZIKV when MRI of the head was performed after birth.17 Still, the absence of microcephaly at birth does not exclude the possibility of delayed development of microcephaly or other ZIKV-related brain and other abnormalities.18 This information is now being collected as part of a cohort study of the infants (ClinicalTrials.gov number, NCT02810210); the study includes regular clinical examinations with specialized hearing and ophthalmologic testing. † Among the 527 live births, 96 infants (18.2%) did not undergo prenatal ultrasonography after the mother had been infected with ZIKV (7.9% when ZIKV infection occurred in the first trimester, 11.3% when infection occurred in the second trimester, and 48.3% when infection occurred in the third trimester). Zika virus was first discovered in 1947 and is named after the Zika Forest in Uganda. Neurologic and ocular abnormalities were more common when ZIKV infection had occurred during the first trimester (24 of 189 fetuses and infants [12.7%]) than when it had occurred during the second trimester (9 of 252 [3.6%]) or third trimester (6 of 114 [5.3%]) (P=0.001). Among the 527 live births, 69 infants (13.1%) were small for gestational age, and 75 infants (14.2%) were delivered through emergency cesarean section. The risk of birth defects possibly associated with ZIKV infection was similar in Guadeloupe and Martinique (7.2% and 7.5%, respectively). Alerte au virus Zika en France : 2 cas signalés dans le Var. First, we found a 7.0% overall risk of neurologic and ocular defects possibly associated with ZIKV infection that were evident at birth in the offspring of women in French territories in the Americas who had acute, symptomatic, PCR-confirmed ZIKV infection during pregnancy. Chez les patients infectés, le virus est retrouvé dans les urines, les larmes, les sécrétions vaginales, le lait maternel. If a fetal abnormality was identified during a follow-up ultrasonographic examination, magnetic resonance imaging (MRI) of the fetus was performed, and the woman was followed up monthly with laboratory testing and ultrasonography, as reported elsewhere.9-11 The end point for each woman enrolled in the study was the pregnancy outcome: delivery of a live-born infant with or without birth defects, miscarriage, termination of pregnancy for medical reasons, or stillbirth. ), Pôle Mère-Enfant, Centre Hospitalier de l’Ouest Guyanais (G.C. Microcephaly was considered moderate when the head circumference was between 3 SD and 2 SD below the mean and severe when the head circumference was more than 3 SD below the mean. » Que faire pendant la grossesse ? Likewise, to allow for comparison with other studies, we summarized our data in two mutually exclusive categories: birth defects possibly associated with ZIKV infection5 (brain abnormalities with or without microcephaly regardless of the presence of additional birth defects); and neural-tube defects and other early brain malformations (e.g., anencephaly, acrania, encephalocele, holoprosencephaly, or arhinencephaly), eye abnormalities, and other consequences of central nervous system dysfunction among fetuses and infants who had neither evident brain abnormalities nor microcephaly. ZIKA-DFA-FE was a cohort study that used four different recruitment methods in an attempt to capture all women whose pregnancies overlapped with the period of the ZIKV epidemic in French territories in the Americas (details are provided in the Supplementary Appendix, available with the full text of this article at NEJM.org). It spreads through bites from an infected Aedes species mosquito, which are the same ones that spread dengue and chikunyunya viruses. ‡ These results are possibly associated with ZIKV infection. A total of 31 women underwent amniocentesis during the course of their pregnancy, with 27 instances of karyotyping and 20 ZIKV RT-PCR assays. Ultrasound Obstet Gynecol 2016;47:6-7. L’évolution est le plus souvent rapidement favorable avec une guérison spontanée en 2 à 7 jours. Ultrasound imaging for identification of cerebral damage in congenital Zika virus syndrome: a case series. These data included age, ethnic group, residence, level of education, professional activity, and lifestyle factors. Surveillance des grossesses en cas d’épidémie : mise en place de mesures drastiques contre les moustiques, Lutte anti-vectorielle collective et individuelle, Protection individuelle : vêtements longs, répulsifs, moustiquaires. 16. The case had reported symptom onset on 29 July 2019. In the twin pregnancy that resulted in 1 live birth and 1 miscarried fetus, the mother had been infected with ZIKV during the sixth week of pregnancy; the loss of 1 fetus occurred at 10 weeks of gestation, and the other fetus was carried to 41 weeks of gestation and was born healthy, without any abnormalities. Description of 13 infants born during October 2015–January 2016 with congenital Zika virus infection without microcephaly at birth — Brazil. All other live-born babies with ZIKV-related defects had at least one abnormality that would have been detected during the clinical examination at birth (e.g., microcephaly, clubfoot, or a neural-tube defect such as spina bifida). It is spread by daytime-active Aedes mosquitoes, such as A. aegypti and A. albopictus. In French Guiana, where the number of participants (24) was small, no birth defects possibly associated with ZIKV infection were observed. Baud D, Gubler DJ, Schaub B, Lanteri MC, Musso D. An update on Zika virus infection. Women were included in this analysis if they met all of the following criteria: ongoing pregnancy at any gestational stage; clinical symptoms consistent with acute ZIKV infection, with at least one symptom of pruritic rash, fever, conjunctival hyperemia, arthralgia, or myalgia; and laboratory confirmation of recent ZIKV infection, on the basis of a positive result on a reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay performed on a specimen of blood, urine, or both. Une infection par le virus Zika chez une femme enceinte peut poser des risques importants pour le bébé à naître, même si la femme ne présente pas de symptômes d'infection. Diagnostic approach to microcephaly in childhood: a two-center study and review of the literature. Vital signs: update on Zika virus–associated birth defects and evaluation of all U.S. infants with congenital Zika virus exposure — U.S. Zika Pregnancy Registry, 2016. ), INSERM Centre d’Investigation Clinique (M.B., A.C.), Centre de Ressources Biologiques (R.C. Diagnostic clinique différentiel : dengue, chikungunya, paludisme…, Complications chez l’adulte : syndrome de Guillain et Barré, encéphalites, Diagnostic direct : détection du génome viral par RT-PCR, sang : dans les 5 premiers jours des symptômes, urines : dans les 10 jours suivant l’apparition des symptômes, Diagnostic sérologique : apparition des IgM au 5ème jour et des IgG au 8ème jour, Possibilité de réaction croisée avec la dengue. 1. Neurologic and ocular abnormalities possibly associated with ZIKV infection were observed in 39 fetuses and infants (7.0%; 95% confidence interval [CI], 5.0 to 9.5): 28 live-born infants, 10 fetuses that were not carried to term because of termination of pregnancy for medical reasons, and 1 stillborn baby. We present here the pregnancy outcomes in a cohort of women living in French territories in the Americas (French Guiana, Guadeloupe, and Martinique) who had symptomatic, laboratory-confirmed ZIKV infection during pregnancy. pendant la grossesse par tous moyens (vêtements longs, répulsifs, moustiquaires) et éviter de voyager en zones d’endémie. Women were included in this analysis if they met all of the following criteria: ongoing pregnancy at any gestational stage; clinical symptoms consistent with acute ZIKV infection, with at least one symptom of pruritic rash, fever, conjunctival hyperemia, arthralgia, or myalgia; and laboratory confirmation of recent ZIKV infection, on the basis of a positive result on a reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay performed on a specimen of blood, urine, or both. No fetal abnormality or birth defect was observed in any of the women who had coinfection with syphilis (4 women), human immunodeficiency virus (2), toxoplasmosis (3), or cytomegalovirus (1). Lancet 2017;390:2099-2109. The virus was first isolated in 1947 from rhesus monkeys of the Zika forests of Uganda. 6. Of the 546 women with known outcomes, 185 (33.9%) were infected with ZIKV in the first trimester of pregnancy, 249 (45.6%) in the second trimester, and 112 (20.5%) in the third trimester. During the enrollment visit, sociodemographic data were collected for each woman. 12. Schaub B, Gueneret Ml, Jolivet En, et al. Issues de grossesse et anomalies congénitales dans une cohorte de 546 femmes ayant présenté une infection symptomatique à virus Zika (ZIKV) au cours de l'épidémie de Zika dans les TFA B. Hoen, A. Cabié, A. Funk, C. Herrmann-Storck, F. Najioullah, K. Schepers, M. Douine, S. Stegmann-Planchard, D. Rousset, A. Fontanet le 23 octobre 2019 à 16h17 Rechercher. Moore CA, Staples JE, Dobyns WB, et al. In the case of live birth, microcephaly was defined as moderate when the head circumference was between 3 SD and 2 SD below the mean and severe when the head circumference was more than 3 SD below the mean, on the basis of INTERGROWTH-21st standards (http://intergrowth21.ndog.ox.ac.uk/) for sex and gestational age. Il se trouve à de fortes concentrations dans le sperme et la transmission par voie sexuelle, surtout dans le sens homme-femme, est une voie non négligeable de contamination. The study protocol was prepared with the help of the INSERM Research and Action Targeting Emerging Infectious Disease (REACTing) network. Treatment involves taking pain killers to relieve the painful symptoms. Only the longer-term follow-up of the children born to the women in the current study will help identify the full spectrum of ZIKV-related complications. Thus, 561 women with symptomatic, PCR-confirmed, ZIKV infection were included in the analysis in this study. In addition, the extensive use of MRI in the Brazilian cohort may have resulted in isolated abnormal imaging findings that have not been observed in other studies in which the use of MRI has been less frequent. During these follow-up visits, a clinician also inquired about events that may have occurred (e.g., pregnancy complications or treatments received) since the previous visit. MMWR Morb Mortal Wkly Rep 2017;66:615-621. JAMA 2017;317:59-68. However, aspirin should be avoided until infection by the dengue virus has been ruled out because, in this case, the anticoagulant effect of the drug could cause bleeding. In the case of pregnancy loss or termination of pregnancy for medical reasons, autopsy measurements when available and findings from the last ultrasonographic examination were used to assess for microcephaly. Il en va sans doute de même pour Zika. For live-born infants, maternal and cord-blood specimens were obtained on the day of delivery, and serum specimens were frozen. Arbovirus à ARN du genre Flavivirus, il … MMWR Morb Mortal Wkly Rep 2017;66:366-373. The rapid spread of the Zika virus (ZIKV) in the Americas and its potential association with thousands of suspected cases of microcephaly in Brazil and higher rates of Guillain-Barré syndrome meet the conditions for a Public Health Emergency of International Concern, as stated by the World Health Organization in February 2016. Les études en cours vont préciser les conséquences fœtales réelles, l’évolutivité possible après la naissance et les facteurs de risques. Valuable tools for building a rewarding career in health care. Address reprint requests to Dr. Hoen at the Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, BP 465, 97159 Pointe-à-Pitre, CEDEX, France, or at [email protected]. L’OMS a ainsi décrit le syndrome congénital associé à l’infection ZIKV : disproportion crânio-faciale, spasticité, convulsions, irritabilité, troubles de l’alimentation, anomalies oculaires, malformations à l’imagerie. Mes favoris. Méta analyse sur 2941 cas : 2,3% de microcéphalies soit 10 fois plus que dans la population générale. On 9 October 2019, the French authorities reported an autochthonous Zika virus (ZIKV) case in Hyeres, Var department, France. The diagnosis of ZIKV infection was made on the basis of PCR testing of specimens of blood or urine or both, and the date of infection could be ascertained because the date of symptom onset was close to the date of ZIKV PCR testing. Zika outbreaks have probably occurred in many locations. ), Paris; CIRE de Guyane, Santé Publique France (V.A. ZIKA ET GROSSESSE. 8. Zika virus (ZIKV) is a flavivirus that is mainly transmitted by the Aedes aegypti mosquito, although it is also transmitted sexually, perinatally, via blood transfusion, and probably by breastfeeding. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure, Bupropion and Naltrexone in Methamphetamine Use Disorder, https://www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=hcspa20160105_zikaactualisationmodpec.pdf, http://www.cnpgo.org/1/upload/1_virus_zika_et_grossesse_cnpgo_version_1.3_recos.pdf. Les publications ultérieures ont montré : un taux de transmission materno-fœtale autour de 10%, des conséquences malformatives fœtales surtout cérébrales d’autant plus fréquentes que la contamination a eu lieu aux deux 1ers trimestres de la grossesse, la microcéphalie est la forme la plus avancée de la maladie. Risques de virus Zika pendant la grossesse. Zika virus is a disease that is found in warm, tropical climates, particularly tropical Africa, Southeast Asia, and the Pacific Islands. Passing the “TORCH.” Infect Dis Clin Pract 2008;16:4-5.