Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil

Supported by the São Paulo Research Foundation (FAPESP) via grants 2013/21719-3 and 2016/15021-1 to MLN, grant 2015/12295-0 to ACBT and grant 2016/05115-9 to LCM. The opinions, assumptions and conclusions or recommendations expressed in this material are the responsibility of the authors and do not necessarily reflect the views of FAPESP. PFCV was supported by the Zika Virus Fast Track program provided by the Coordination for the Improvement of Higher Level Education Personnel and the Brazilian National Council for Scientific and Technological Development (CNPq) by grants 303999/2016-0, 440405/2016-5 and 457664/2013-4. MLM is a CNPq research fellowSão José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, BrazilHealth Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Federal University of Bahia. Salvador, BA, Brazil / Yale School of Public Health. New Haven, Connecticut, USA.Fundacao Oswaldo Cruz. Rio de Janeiro, RJ, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.University of Texas Medical Branch. Galveston, Texas, USA.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.Yale School of Public Health. New Haven, Connecticut, USA.Objectives: We aimed to report the first 54 cases of pregnant women infected by Zika virus (ZIKV) and their virologic and clinical outcomes, as well as their newborns' outcomes, in 2016, after the emergence of ZIKV in dengue-endemic areas of São Paulo, Brazil. Methods: This descriptive study was performed from February to October 2016 on 54 quantitative realtime PCR ZIKV-positive pregnant women identified by the public health authority of Sao José do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiologic data collected before and after birth. Adverse outcomes in newborns were analysed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by reverse transcription PCR (RT-PCR). Results: A total of 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis confirmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited adverse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though a broad clinical spectrum of outcomes, including lenticulostriate vasculopathy, subependymal cysts, and auditory and ophthalmologic disorders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes. Conclusions: Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or nonexistent in this study. The clinical presentation the newborns we studied was mild compared to other reports, suggesting that there is significant heterogeneity in congenital Zika infection