Serologic surveillance of maternal Zika infection in a prospective cohort in Leon, Nicaragua during the peak of the Zika epidemic

• Published in: PloS one Vol. 15; no. 4; p. e0230692
• Main Authors: Collins, Matthew H., Zepeda, Omar, Blette, Bryan, Jadi, Ramesh, Morales, Marlen, Pérez, Rigoberto, Liou, Guei-Jiun Alice, Montoya-Cruz, Magelda, Harris, Eva, Becker-Dreps, Sylvia, de Silva, Aravinda M., Stringer, Jeffrey, Bucardo, Filemon, Stringer, Elizabeth
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.04.2020; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Algorithms; Anencephaly; Antibodies; Antigens; Biology and life sciences; Birth; Cohort Studies; Complications; Congenital anomalies; Congenital defects; Congenital diseases; Dengue; Dengue fever; Epidemics; Epidemiological Monitoring; Female; Fetuses; Genetic disorders; Gynecology; Health aspects; Health surveillance; Humans; Immunology; Infection; Infections; Infectious diseases; Medical laboratories; Medical research; Medicine; Medicine and Health Sciences; Microcephaly; Mothers; Neutralization; Nicaragua - epidemiology; Obstetrics; Patient care; People and Places; Polymerase chain reaction; Pregnancy; Pregnancy complications; Pregnant women; Prenatal care; Prospective Studies; Public health; Serologic Tests; Serology; Standard deviation; Time Factors; Vector-borne diseases; Viruses; Women; Womens health; Young Adult; Zika virus; Zika Virus Infection - epidemiology; Zika Virus Infection - immunology; Nicaragua; Brazil; United States > US; California
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0230692

Zika virus caused thousands of congenital anomalies during a recent epidemic. Because Zika emerged in areas endemic for dengue and these related flaviviruses elicit cross-reactive antibodies, it is challenging to serologically monitor pregnant women for Zika infection. A prospective cohort of 253 pregnant women was established in León, Nicaragua. Women were followed during prenatal care through delivery. Serologic specimens were obtained at each visit, and birth outcome was recorded. Established flavivirus serologic methods were adapted to determine Zika seroprevalence, and a stepwise testing algorithm estimated timing of Zika infection in relation to pregnancy. Zika seroprevalence was approximately 59% among women tested. Neutralization testing was highly concordant with Zika NS1 BOB results. Per study algorithm, 21% (40/187) of women were classified as experiencing Incident ZIKV infection during pregnancy. Importantly, the Incident ZIKV group included mostly women pregnant during the 2016 Zika epidemic peak and the only 3 subjects in the cohort with RT-PCR-confirmed infections. Approximately 17% of births had complications; 1.5% (3/194) manifesting clinical criteria of congenital Zika syndrome, one was RT-PCR-confirmed as a case of congenital Zika syndrome. Adverse birth outcome did not correlate with timing of Zika infection. By leveraging prenatal care systems, we developed a simple algorithm for identifying women who were likely infected by Zika during pregnancy.