Congenital and perinatal complications of chikungunya fever: a Latin American experience

Highlights

• The effects of chikungunya fever (CHIKF) on pregnancy outcomes and its consequences for 169 symptomatic infants born to infected mothers at the peak of the epidemic wave in Latin America were analyzed.

• Newborns with CHIKF seen at four large regional maternity hospitals in three different Central and South American countries were evaluated prospectively.

• This study presents the largest series of symptomatic neonates with CHIKF analyzed so far in any region and the first involving infection by the Asian genotype of chikungunya virus. With few exceptions, the frequency of clinical findings seen in suspected cases was similar to that of confirmed patients in this series. Rash, hyperalgesia syndrome, and meningoencephalitis were significantly less common in the suspected cases in comparison to confirmed patients. Although clinical manifestations were similar to those reported previously, the percentage of neurological complications was lower. The case fatality rate was comparatively higher.

Summary

Background

During the years 2014 and 2015, the Region of the Americas underwent a devastating epidemic of chikungunya virus (CHIKV) of the Asian genotype, resulting in millions of affected individuals. However, epidemiological and clinical information on this experience is scarce. Prior knowledge of congenital and neonatal illness caused by CHIKV is limited and almost exclusively based on data obtained from a single outbreak of the East/Central/South African (ECSA) genotype. The effect of chikungunya fever (CHIKF) on pregnancy outcomes and its consequences for infants born to infected mothers at the peak of the epidemic wave in Latin America are reviewed herein. Epidemiological and clinical data on maternal and neonatal infections were collected prospectively and analyzed.

Methods

One hundred sixty-nine symptomatic newborns with CHIKF seen at four large regional maternity hospitals in three different Central and South American countries were evaluated prospectively. The outcomes of pregnancies in symptomatic infected mothers at two of these clinical centers were also analyzed.

Results

The observed vertical transmission rate ranged between 27.7% and 48.29%. The incidence of congenital disease was unrelated to the use of cesarean section or natural delivery. The case fatality rate (CFR) at the only center that reported deaths was 5.3%. The most common clinical manifestations included fever, irritability, rash, hyperalgesia syndrome, diffuse limb edema, meningoencephalitis, and bullous dermatitis. Severe complications included meningoencephalitis, myocarditis, seizures, and acute respiratory failure. Leukocytosis with neutrophilia and normal or increased platelets was a common finding, and in those with signs of meningeal involvement, moderate lymphocytic pleocytosis with normal glucose and protein levels was typical.

Conclusions

This study presents the largest number of symptomatic neonates with CHIKF analyzed so far in any region and is the first involving infection with the Asian genotype of CHIKV. Although the clinical manifestations found were similar to those reported previously, the percentage of neurological complications was lower. The CFR was comparatively high. Chikungunya represented a substantial risk for neonates born to symptomatic parturients during the chikungunya outbreak in the Americas Region, with important clinical and public health implications.