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Mother-to-child transmission of Chikungunya virus: A systematic review and meta-analysis

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  • Despina Contopoulos-Ioannidis
  • Shoshana Newman-Lindsay
  • Camille Chow
  • A Desiree LaBeaud

Abstract

Background: Chikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and may cause fetal and neonatal infections after maternal CHIKV-infections during gestation. Methodology: We performed a systematic review to evaluate the risk for: a) mother-to-child transmission (MTCT), b) antepartum fetal deaths (APFD), c) symptomatic neonatal disease, and d) neonatal deaths from maternal CHIKV-infections during gestation. We also recorded the neonatal clinical manifestations after such maternal infections (qualitative data synthesis). We searched PubMed (last search 3/2017) for articles, of any study design, with any of the above outcomes. We calculated the overall risk of MTCT, APFDs and risk of symptomatic neonatal disease by simple pooling. For endpoints with ≥5 events in more than one study, we also synthesized the data by random-effect-model (REM) meta-analysis. Principal findings: Among 563 identified articles, 13 articles from 8 cohorts were included in the quantitative data synthesis and 33 articles in the qualitative data synthesis. Most cohorts reported data only on symptomatic rather than on all neonatal infections. By extrapolation also of these data, the overall pooled-MTCT-risk across cohorts was at least 15.5% (206/1331), (12.6% by REMs). The pooled APFD-risk was 1.7% (20/1203); while the risk of CHIKV-confirmed-APFDs was 0.3% (3/1203). Overall, the pooled-risk of symptomatic neonatal disease was 15.3% (203/1331), (11.9% by REMs). The pooled risk of symptomatic disease was 50.0% (23/46) among intrapartum vs 0% (0/712) among antepartum/peripartum maternal infections. Infected newborns, from maternal infections during gestation were either asymptomatic or presented within their first week of life, but not at birth, with fever, irritability, hyperalgesia, diffuse limb edema, rashes and occasionally sepsis-like illness and meningoencephalitis. The pooled-risk of neonatal death was 0.6% (5/832) among maternal infections and 2.8% (5/182) among neonatal infections; long-term neurodevelopmental delays occurred in 50% of symptomatic neonatal infections. Conclusions/Significance: Published cohorts with data on the risk to the fetus and/or newborn from maternal CHIKV-infections during gestation were sparse compared to the number of recently reported CHIKV-infection outbreaks worldwide; however perinatal infections do occur, at high rates during intrapartum period, and can be related to neonatal death and long-term disabilities. Author summary: Chikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and can cause infections of the fetus and newborn after maternal CHIKV-infections during gestation. In this systematic review, we evaluated the risk for mother-to-child transmission (MTCT), antepartum fetal deaths (APFD) and symptomatic neonatal disease from maternal CHIKV-infections during gestation. Whenever meaningful, we also synthesized the data by random-effect-model (REM) meta-analysis. We also recorded the list of clinical manifestations of neonatal infections after maternal infections during gestation. Overall, published cohorts with pertinent data to estimate the impact to the fetuses and newborns of maternal CHIKV-infections were sparse compared to the number of recently reported CHIKV-infection outbreaks worldwide. Most cohorts reported data only on symptomatic neonatal infections rather than on all (symptomatic and asymptomatic) neonatal infections. By extrapolation also of these data, the pooled MTCT-risk was at least 15.5% (206/1331), (12.6% by REMs). Symptomatic disease occurred almost exclusively with maternal infections around the time of delivery. Overall, the pooled risk of symptomatic disease was 15.3% (203/1331), (11.9% by REMs); however, the risk of symptomatic disease from intrapartum maternal infections was 50.0% (23/46) vs 0% (0/712) from antepartum/peripartum maternal infections. The pooled APFDs-risk was low (1.7%); however, APFDs occurred with maternal infections in all trimesters. Infected newborns were either asymptomatic or presented during their first week of life, but not at the time of birth, with manifestations such as fever, irritability, rashes, hyperalgesia syndrome, diffuse limb edema, bullous dermatitis and occasionally also meningoencephalitis. Long-term neurodevelopmental delays occurred in 50% of symptomatic neonatal infections.

Suggested Citation

  • Despina Contopoulos-Ioannidis & Shoshana Newman-Lindsay & Camille Chow & A Desiree LaBeaud, 2018. "Mother-to-child transmission of Chikungunya virus: A systematic review and meta-analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 12(6), pages 1-20, June.
    • Handle: RePEc:plo:pntd00:0006510
    DOI: 10.1371/journal.pntd.0006510
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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Walter Leal Filho & Svenja Scheday & Juliane Boenecke & Abhijit Gogoi & Anish Maharaj & Samuela Korovou, 2019. "Climate Change, Health and Mosquito-Borne Diseases: Trends and Implications to the Pacific Region," IJERPH, MDPI, vol. 16(24), pages 1-12, December.

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