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We detected an unusual increase in congenital cerebral malformations and dysfunction in fetuses and newborns in French Polynesia, following an epidemic of Zika virus (ZIKV), from October 2013 to March 2014. A retrospective review identified 19 cases, including eight with major brain lesions and severe microcephaly, six with severe cerebral lesions without microcephaly and five with brainstem dysfunction without visible malformations. Imaging revealed profound neurological lesions (septal and callosal disruption, ventriculomegaly, abnormal neuronal migration, cerebellar hypoplasia, occipital pseudocysts, brain calcifications). Amniotic fluid was drawn from seven cases at gestation weeks 20 to 29. ZIKV RNA was detected by RT-PCR and infectious ZIKV isolates were obtained in four of five microcephalic, but not in two non-microcephalic cases with severe brain lesions. Medical termination of pregnancy was performed in eleven cases; two cases with brainstem dysfunction died in the first months of life; six cases are alive, with severe neurological impairment. The results show that four of seven tested fetuses with major neurological injuries were infected with ZIKV in utero. For other non-microcephalic, congenital abnormalities we were not able to prove or exclude ZIKV infection retrospectively. The unusual occurrence of brain malformations or dysfunction without microcephaly following a ZIKV outbreak needs further studies.


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  1. Ioos S, Mallet HP, Leparc Goffart I, Gauthier V, Cardoso T, Herida M. Current Zika virus epidemiology and recent epidemics. Med Mal Infect. 2014;44(7):302-7.  https://doi.org/10.1016/j.medmal.2014.04.008  PMID: 25001879 
  2. Kucharski AJ, Eggo RM, Mallet HP, Edmunds J, Nilles EJ. Transmission dynamics of Zika virus in island populations: a modelling analysis of the 2013-2014 French Polynesia outbreak. bioRxiv. 2016;7.  https://doi.org/10.1101/038588 
  3. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Microcephaly in Brazil potentially linked to the ZIKV epidemic. Nov 2015. Available from: http://ecdc.europa.eu/en/publications/Publications/zika- microcephaly-Brazil-rapid-risk-assessment-Nov-2015.pdf
  4. Pan American Health Organization (PAHO) / World Health Organization (WHO). Epidemiological alert. Increase in microcephaly in the northeast of Brazil. Washington DC: PAHO / WHO; 17 Nov 2015. Available from: http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=32636&lang=en
  5. Besnard M, Mallet HP. Increase of cerebral congenital malformations among newborns and foetus in French Polynesia, 2014-2015, following a ZIKV outbreak. [Accessed 31 Mar 2016]. Available from: https://app.box.com/s/ptvqdargwr10m3ag849rv59c5iditco7
  6. Haute Autorité de Santé (HAS). Suivi et orientation des femmes enceintes en fonction des situations à risque identifiées. [Monitoring and guidance of pregnant women based on identified risk situations]. May 2007. Saint-Denis: HAS. French. Available from: http://www.has-sante.fr/portail/jcms/c_547976/fr/suivi-et-orientation-des-femmes-enceintes-en-fonction-des-situations-a-risque-identifiees
  7. World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems 10th Revision. ICD-10 Version: 2016. Geneva: WHO. Available from: http://apps.who.int/classifications/icd10/browse/2016/en
  8. Association des Utilisateurs de Dossiers Informatisés en Pédiatrie. Obstétrique et Gynécologie (AUDIPOG). Head circumference charts. [Accessed 31 Mar 2016]. Available from: http://www.audipog.net/pdf/courbes_pc.pdf
  9. Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DD, Cavalcanti DP, Pessoa A, et al. Brazilian Medical Genetics Society–Zika Embryopathy Task Force. Possible association between zikavirus infection and microcephaly, Brazil 2015. MMWR Morb Mortal Wkly Rep. 2016;65(3):59-62.  https://doi.org/10.15585/mmwr.mm6503e2  PMID: 26820244 
  10. Martines RB, Bhatnagar J, Keating MK, Silva-Flannery L, Muehlenbachs A, Gary J, et al. Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses - Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(6):159-60.  https://doi.org/10.15585/mmwr.mm6506e1  PMID: 26890059 
  11. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol. 2016;47(1):6-7.  https://doi.org/10.1002/uog.15831  PMID: 26731034 
  12. Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, et al. ZIKV associated with microcephaly. N Engl J Med. 2016;374(10):951-8.  https://doi.org/10.1056/NEJMoa1600651  PMID: 26862926 
  13. Sarno M, Sacramento GA, Khouri R, do Rosário MS, Costa F, Archanjo G, et al. Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise. PLoS Negl Trop Dis. 2016;10(2):e0004517.  https://doi.org/10.1371/journal.pntd.0004517  PMID: 26914330 
  14. Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015;73(3):199-213.  https://doi.org/10.1111/aji.12355  PMID: 25582523 
  15. Tarrant A, Garel C, Germanaud D, de Villemeur TB, Mignot C, Lenoir M, et al. Microcephaly: a radiological review. Pediatr Radiol. 2009;39(8):772-80, quiz 888-9.  https://doi.org/10.1007/s00247-009-1266-x  PMID: 19437006 
  16. Esteban H, Blondiaux E, Audureau E, Sileo C, Moutard ML, Gelot A, et al. Prenatal features of isolated subependymal pseudocysts associated with adverse pregnancy outcome. Ultrasound Obstet Gynecol. 2015;46(6):678-87.  https://doi.org/10.1002/uog.14820  PMID: 25684100 
  17. Abadie V, Morisseau-Durand MP, Beyler C, Manach Y, Couly G. Brainstem dysfunction: a possible neuroembryological pathogenesis of isolated Pierre Robin sequence. Eur J Pediatr. 2002;161(5):275-80.  https://doi.org/10.1007/s00431-002-0936-6  PMID: 12012224 
  18. Abadie V, Couly G. Congenital feeding and swallowing disorders. Handb Clin Neurol. 2013;113:1539-49.  https://doi.org/10.1016/B978-0-444-59565-2.00024-1  PMID: 23622377 
  19. Holder-Espinasse M, Abadie V, Cormier-Daire V, Beyler C, Manach Y, Munnich A, et al. Pierre Robin sequence: a series of 117 consecutive cases. J Pediatr. 2001;139(4):588-90.  https://doi.org/10.1067/mpd.2001.117784  PMID: 11598609 

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