Congenital cerebral malformations and dysfunction in fetuses and newborns following the 2013 to 2014 Zika virus epidemic in French Polynesia
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A Zika virus (ZIKV) outbreak in French Polynesia from October 2013 to March 2014 resulted in 8,750 suspected cases reported through the general practitioners-based (25 to 45 sentinel practitioners) sentinel surveillance system for infectious diseases. The system exists since 2009 and syndromic cases definitions are basis for weekly reporting. An estimated 32,000 suspected cases sought medical care and more than half of the population might have been infected [1,2]. ZIKV is an emerging arbovirus that before 2013 was considered to cause only mild disease, characterised by fever, rash, joint pain, and conjunctivitis. From 2014 to 2015, following the ZIKV epidemic, we observed an unusual increase in annual congenital cerebral malformations (two-fold), brainstem dysfunction (31-fold), and severe microcephaly (14-fold) among fetuses and newborns (data not shown). Following the announcement by the Brazilian Government in November 2015 of a dramatic increase in the incidence of microcephaly possibly associated with an ongoing ZIKV outbreak [3,4], we notified the World Health Organization (WHO) of this unusual cluster of congenital neurological abnormalities in our islands . French Polynesia consists of five archipelagos in the South Pacific Ocean, with 118 islands, of which 76 are inhabited. The total population was 271,800 in 2014 and 70% reside on Tahiti. Approximately 4,200 births are recorded per year (2014: 4,161 births), mainly in Tahiti, with 60% at the Centre Hospitalier de Polynésie Française (CHPF), 30% in two private clinics in Tahiti, and 10% in two distant district hospitals. We report here a retrospective case series of 19 fetal and newborn cases with congenital cerebral malformations and dysfunction and detail the neurological lesions identified and the corresponding virological results.