Zika Virus Disease in Pregnancy: A Case Series from the Kerala Outbreak

Zika virus (ZIKV), a mosquito-borne flavivirus, has emerged as a significant global health concern due to its potential adverse effects on maternal and fetal health. Severe fetal abnormalities, such as microcephaly, were notably linked to previous ZIKV outbreaks, particularly in Brazil. However, the correlation between ZIKV and congenital anomalies in India remains inconclusive.

This case series retrospectively analysed pregnant women diagnosed with Zika virus disease (ZVD) at KIMSHEALTH, Thiruvananthapuram, from 2021 to 2024. ZIKV infection was confirmed via ZIKV RT-PCR testing on patient samples.The study identified ten confirmed cases of ZVD in pregnant women. Clinical presentations included maculopapular rash (in all patients), fever, joint pain, non-purulent conjunctivitis, and myalgia. Among these, two infections near term resulted in normal fetal outcomes, one mid-trimester infection led to a normal delivery, six women opted for medical termination of pregnancy (MTP), and one woman experienced a miscarriage.

The clinical features of ZVD during pregnancy observed in this cohort were similar to those in the general population. The absence of congenital anomalies suggests a potentially less pathogenic strain of ZIKV in India. However, further studies involving larger populations are required to conclusively determine the risk of congenital Zika syndrome in this region. This study underscores the need for ongoing surveillance and research to fully understand the impact of ZIKV on pregnancy in India.