Perinatal and Neonatal Chikungunya Virus Transmission: A Case Series

Abstract

Background: Large-scale epidemics in countries with high birth rates can create a concerning scenario where pregnant people are more likely to transmit the virus. In addition, increased international mobility has made arboviruses a growing problem for travelers. The increased risk of vertical transmission has been related to maternal viremia near delivery. Such transmission leads to severe infection of newborns and may be associated with subsequent neurological impairment including cerebral palsy. This case series provides an overview of clinical and laboratory findings in pregnant individuals with confirmed chikungunya virus (CHIKV) infection as well as the clinical effects on their newborn emphasizing the severity of neonatal chikungunya.

Methods: An ambispective case series enrolled newborns with confirmed exposure to CHIKV in utero or in the neonatal period.

Results: During the delivery period, the transmission rate among viremic individuals was approximately 62% (18/29). Fever, irritability, rash, and poor feeding in the first week of life were critical signs of neonatal chikungunya, highlighting its severity.

Conclusion: Close monitoring of healthy newborns during the first week of life is essential in areas affected by CHIKV epidemics, and in offspring of pregnant travelers who visited the outbreaks zones. This case series is intended to increase neonatologists' awareness of the possibility of mother-to-child transmission of CHIKV among newborns with a sepsis-like presentation. Prioritizing CHIKV vaccination for women of childbearing age should also be considered.

Keywords: chikungunya; mother-to-child; neonatal encephalophaty; neonatal sepsis; newborn; vertical transmission.

Figure 1.

Study population: 58 pregnant people positive for CHIKV: RT-PCR positive and/or IgM positive; infants symptomatic confirmed: RT-PCR and/or IgM positive (n = 17); infants symptomatic not confirmed: RT-PCR and/or IgM negative (n = 9); and infants asymptomatic: RT-PCR and/or IgM negative (n = 29) and RT-PCR and/or IgM positive (n = 1).

Figure 2.

Flowchart of newborns exposed to CHIKV.

Figure 3.

Clinical manifestations of CHIKV infection in neonates. (A) Post chikungunya pigmentary disorder, (B) chik sign, (C) scaled skin syndrome like presentation, (D) irritability and crusty perioral lesions, (E) roseoliform rash and respiratory distress, and (F) vesicolobullous lesions.

Figure 4.

Brain magnetic resonance imaging (MRI) showing restricted diffusion in the corpus callosum (arrows in (A)), associated with subcortical vasogenic edema (arrows in (B)), and cavitations in the frontal and parietal lobes, suggesting a perivascular distribution (arrows in (C)). Follow-up brain MRI, in the third month of life demonstrated thinning of the corpus callosum (arrow in (D)), without restricted diffusion (E) and that the cavitation had shrunk and the subcortical lesions had improved (arrows in (F)) [1, 13].