Chikungunya Virus during Pregnancy | CDC EID

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Volume 16, Number 3–March 2010
Research
Chikungunya Virus Infection during Pregnancy, Réunion, France, 2006
Xavier Fritel, Olivier Rollot, Patrick Gérardin, Bernard-Alex Gaüzère, Jacques Bideault, Louis Lagarde, Barbara Dhuime, Eric Orvain, Fabrice Cuillier, Duksha Ramful, Sylvain Sampériz, Marie-Christine Jaffar-Bandjee, Alain Michault, Liliane Cotte, Monique Kaminski, Alain Fourmaintraux, and the Chikungunya-Mère-Enfant Team
Author affiliations: Centre Hospitalier Régional de la Réunion, Saint-Denis, France (X. Fritel, P. Gérardin, B.-A. Gaüzère, E. Orvain, F. Cuillier, D. Ramful, S. Sampériz, M.-C. Jaffar-Bandjee, A. Michault, L. Cotte, A. Fourmaintraux); Centre d'Investigation Clinique–Epidémiologie Clinique de la Réunion, Saint-Denis (O. Rollot, P. Gérardin); Institut National de la Santé et de la Recherche Médicale, Villejuif, France (X. Fritel, P. Gérardin, M. Kaminski); Centre Hospitalier Intercommunal de Saint-Benoit-Saint-André, Saint-Benoit, France (J. Bideault); Centre Hospitalier Gabriel-Martin, Saint-Paul, France (L. Lagarde); Clinique Sainte-Clotilde, Saint-Denis (B. Dhuime); and Université Pierre et Marie Curie 6, Paris, France (X. Fritel, P. Gérardin, M. Kaminski)

Suggested citation for this article

Abstract
Mother-to-child transmission of chikungunya virus was reported during the 2005–2006 outbreak on Réunion Island, France. To determine the effects of this virus on pregnancy outcomes, we conducted a study of pregnant women in Réunion in 2006. The study population was composed of 1,400 pregnant women (628 uninfected, 658 infected during pregnancy, 27 infected before pregnancy, and 87 infected on unknown dates). We compared pregnancy outcomes for 655 (628 + 27) women not infected during pregnancy with 658 who were infected during pregnancy. Infection occurred during the first trimester for 15% of the infected women, the second for 59%, and the third for 26%. Only hospital admission during pregnancy differed between infected and uninfected women (40% vs. 29%). Other outcomes (cesarean deliveries, obstetric hemorrhaging, preterm births, stillbirths after 22 weeks, birthweight, congenital malformations, and newborn admissions) were similar. This virus had no observable effect on pregnancy outcomes.
Chikungunya virus infection is transmitted by mosquitoes of the genus Aedes. The virus was first isolated in 1952 and is found in eastern Africa, India, and Southeast Asia. Symptoms of infection are high fever and disabling muscle and joint pain, often associated with a rash and mild bleeding. Persons infected usually recover spontaneously in several days to a week (1). Fever and arthralgia may occur for several months or even years (2). Patients are treated only for their symptoms because there is no specific treatment for the underlying infection (3). Before the recent outbreak on the island of Réunion, the disease was not considered life-threatening.

Réunion, a French territory in the southwestern Indian Ocean, has a population of ≈785,000 inhabitants. Medical facilities in Réunion are similar to those in mainland France and other industrialized countries. A major chikungunya outbreak occurred in Réunion in 2005–2006. At the end of this outbreak, seroprevalence was estimated to be 38.2% (95% confidence interval [CI] 35.9%–40.6%); 300,000 (95% CI 283,000–320,000) persons were infected (4,5). Aedes albopictus mosquitoes were the primary vector in this outbreak.

The outbreak began in eastern Africa (6). It reached Réunion in March 2005 but was relatively inactive, with only several thousand cases until November 2005, when its incidence unexpectedly increased during summer in the Southern Hemisphere, peaking at 47,000 cases/week during week 5 of 2006. The most recent cases were reported in August 2006. Comparisons of 2006 with previous years showed that mortality rates increased during February, March, and April 2006 (7,8). Since 2006, the virus has caused several epidemics in the Indian Ocean region (Madagascar, India, Sri Lanka, Thailand, Malaysia, and Singapore). Three new cases of chikungunya were reported in August 2009 on Réunion Island (9).

The first cases of virus transmission from mother to child at birth were identified in February 2006; a total of 38 such cases were reported (10,11). The virus was also found in specimens from 3 early second trimester miscarriages (12). When this outbreak began, little information was available about the risk for chikungunya virus infection in pregnant women. In addition to virus transmission at birth, potential complications include transplacental transmission before birth, congenital malformations, stillbirths, growth restriction, and preterm delivery. Chikungunya virus belongs to the same family of viruses (Togaviridae) as rubella virus, for which some of these complications have been described (13). The high fever that characterizes chikungunya infection could cause uterine contractions or fetal heart rate abnormalities, which might promote spontaneous or induced preterm delivery (cesarean for fetal salvage). The hemorrhagic syndrome described at the onset of infection might be manifested by vaginal bleeding during pregnancy or third-stage hemorrhaging, as reported for infection with dengue virus (14,15). The proportion of symptomatic and asymptomatic infections was also unknown.

The purpose of our study (the Chikungunya-Mère-Enfant cohort study) was to determine the consequences of chikungunya infection on pregnancy outcomes. These results will be useful to public health officials and physicians who provide care for pregnant women or newborns because chikungunya can be imported by international travelers and the location of Ae. albopictus mosquitoes has extended beyond the tropics (16). These mosquitoes are found in 26 states in the United States and several countries in Europe, where outbreaks are possible (17,18).

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Suggested Citation for this Article
Fritel X, Rollot O, Gérardin P, Gaüzère B-A, Bideault J, Lagarde L, et al. Chikungunya virus infection during pregnancy, Réunion, France, 2006. Emerg Infect Dis [serial on the Internet]. 2010 Mar [date cited]. http://www.cdc.gov/EID/content/16/3/418.htm

DOI: 10.3201/eid1603.091403