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Re: Transplacental Transmission - Update on WNV in Pregnancy
Date:
Dec 20, 2002
Posted by:
Jeannie Griffiths (jtg4@cornell.edu)
This will help with the question that I posted last fall in regard to mares.
Thanks for passing on the information!
I did receive one phone call from The Horse (vet science related publications affiliated with AAEP).
Jeannie Griffiths Extension Horse Specialist Dept. of Animal Science Cornell University
At 10:39 AM 12/19/2002 -0500, Lois Levitan wrote:
An infant born in November to a woman who contracted WNV while pregnant is hospitalized in Syracuse, New York -- one of the only known cases of transplacental transmission (Onondaga Co Health Dept Commissioner Press Release, December 18, 2002). The following story is from the Syracuse morning newspaper. For background, see ERAP's WestNileVirus-l listserv postings from Oct 13, 15, and 17, 2002. -- LCL
The Syracuse Post-Standard SYRACUSE INFANT GETS WEST NILE FROM MOMCDC says it's the first case nationally where the virus was passed on to fetus.
December 19, 2002 By Mark Weiner Staff writerA Syracuse newborn has West Nile virus, surprising health officials who believed the disease could not be passed from pregnant mothers to their children.
The month-old girl, who was treated at Crouse Hospital, is the nation's first documented case of intrauterine transmission of West Nile, federal health officials plan to announce today.
Although the baby's life is not in danger, the viral infection may have caused health problems affecting the infant's central nervous system, according to a report from Onondaga County health officials. The 20-year-old mother, who was diagnosed with the virus in September, is recovering out of the hospital.
The U.S. Centers for Disease Control and Prevention previously told pregnant women there was no evidence that West Nile, a mosquito-borne disease, could be transmitted during pregnancy or birth.
Within the past few months, health officials also discovered the virus can be transmitted through a mother's breast milk and through blood transfusions.
Onondaga County Health Commissioner Dr. Lloyd Novick, whose department notified the CDC of the newborn case, said there is no evidence that pregnant women are more susceptible to the virus. The CDC has documented six cases of West Nile in pregnant women. None of the women or children died.
Novick said all pregnant women should continue to take the same precautions as the general public to avoid mosquito bites. He said mosquitoes are not a concern this time of year because most are dead or inactive in Central New York.
"We're talking about something that is of exceedingly low risk, so we would not advise taking any new precautions," Novick said Wednesday.
"We're not recommending screening of pregnant mothers," he said. "But since this is the first time this has happened, people have to be clinically aware of the possibility in the future."
Federal health officials declined to comment on the case Wednesday. Bernadette Burden, a spokeswoman at CDC headquarters in Atlanta, said West Nile would be the topic of a national media briefing with its doctors today.
New York state health officials are looking closely at the Syracuse case but don't plan any immediate change in strategy or advice regarding the virus.
"In terms of what this means, it's something we're going to have to consider further," said Kristine Smith, spokeswoman for the state health department in Albany. "Obviously, we will be looking closely at the possible ramifications. During the past year, we have learned much more about the possible modes of West Nile virus transmission."
The virus first appeared in North America with a 1999 outbreak in New York City. It has continued to spread across the nation, infecting people in 40 states this summer. The CDC reported 3,829 cases as of Dec. 11, with 225 deaths from the virus nationwide.
New York had 80 cases and five deaths. Illinois (778 cases), Michigan (546 cases), Ohio (431 cases) and Louisiana (323 cases) had the biggest outbreaks this year.
New York health officials, who were the first in the nation to detect transfusion-related cases of the virus this fall, will consider all of the new discoveries this winter while reassessing their strategy for dealing with the disease.
"These findings are very new, and we want to explore them with national experts," Smith said.
"As for recommendations for pregnant women, they would be the same for any other person trying to avoid West Nile virus," she said. "That's to try to avoid being bitten by a mosquito."
Those concerned about the virus should eliminate standing water on their property where mosquitoes can breed, wear long sleeves and pants, use repellent and avoid the outdoors at dawn and dusk, Smith said.
Novick said the risk to pregnant women is the same as the general population. West Nile virus is spread by the bite of an infected mosquito, and can infect people, horses, many types of birds, and some other animals.
Most people who are bitten by an infected mosquito will have no symptoms or only mild flu-like symptoms. On rare occasions, West Nile virus can result in severe or fatal illnesses, including encephalitis, an inflammation of the brain.
There is no evidence to suggest that West Nile virus can be spread from person to person or from animal to person. But now health officials will have to look closer at the mother-to-child link, Novick said.
Late this summer, the CDC and the Michigan Department of Community Health investigated the West Nile infection of a woman who received a blood transfusion and then became ill with the virus. She breast fed her healthy baby.
Although the infant has remained healthy, a blood sample from the infant showed antibodies to West Nile, indicating the baby had been infected.
"There has been very little experience with pregnancy and West Nile virus," Novick said. "Generally, newborns do well with this type of infection."
Other cases have been documented of pregnant women who have passed viruses similar to West Nile to their babies, Novick said.
Japanese encephalitis and dengue, both mosquito-borne viruses, have infected newborns in rare cases in Southeast Asia. Some of those children died.
The 20-year-old Syracuse woman lived on the city's Southwest Side when she was infected this summer. Health officials declined to identify her.
The woman was in her 27th week of pregnancy when she was admitted to Crouse Hospital on Aug. 29 with a two-day fever, severe headache, blurred vision, vomiting, and abdominal and back pain. The woman was released about a week later without her symptoms being attributed to West Nile.
When the woman later complained of muscle weakness, a symptom of the virus, she was re-admitted to the hospital Sept. 24 and diagnosed with West Nile virus. It was the first case in an expectant mother in New York state. The woman gave birth in mid-November, carrying the baby to full-term.
Tests on her daughter's spinal fluid and the umbilical cord blood "revealed there probably was a West Nile virus infection," Novick said.
Novick said the child has a number of health complications.
"It's not possible to say definitively whether these complications are a result of West Nile virus," he said. "But it's certainly a possibility. The child's progress will need to be followed."
The woman lived in the same Syracuse neighborhood as a 57-year-old man who became ill with the virus on Aug. 27. The man was Central New York's first West Nile case in history. Two other Onondaga County residents were diagnosed this year.
Health officials focused on the Syracuse neighborhood late in the summer, going door to door to eliminate old tires, debris and other potential mosquito breeding grounds.
© 2002 The Post-Standard. Used with permission.
-- Lois Levitan, PhD Program Leader Environmental Risk Analysis Program Center for the Environment 213 Rice Hall, Cornell University Ithaca, New York USA 14853-5601 Phone: (607) 255-4765 Fax: (607) 255-0238 Email: LCL3@cornell.edu Program Email: envrisk@cornell.edu Web:http://www.cfe.cornell.edu/ERAP
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