In-utero exposure to chikungunya and child morbimortality: a population-based study using linked routine data

Area of Science:

• Infectious Diseases
• Epidemiology
• Public Health

Background:

• Chikungunya virus (CHIKV) infection during pregnancy poses risks to newborns.
• In-utero CHIKV exposure is associated with neonatal morbidity and potential neurodevelopmental issues.
• Long-term health outcomes following prenatal CHIKV exposure require further investigation.

Purpose of the Study:

• To evaluate the long-term morbidity associated with in-utero Chikungunya virus exposure.
• To quantify the risk of hospitalization and death in infants exposed to CHIKV during gestation.
• To assess the impact of the timing of CHIKV exposure (trimester, intrapartum) on infant health outcomes.

Main Methods:

• Registry-based cohort study in Brazil (2015-2018).
• Linked infant records to track all-cause first hospitalization and death until age three.
• Utilized adjusted stratified Cox models to estimate hazard ratios (HR) and confidence intervals (CIs).

Main Results:

• 1,821 CHIKV-exposed and 18,210 unexposed infants were analyzed.
• In-utero CHIKV exposure showed an elevated hospitalization risk (HR: 1.21, 95% CI: 1.11-1.36).
• Intrapartum exposure carried a twofold increased risk (HR: 2.08, 95% CI: 1.33-3.44); first and second-trimester exposures also elevated risk. Evidence for increased mortality risk was limited.

Conclusions:

• In-utero Chikungunya virus exposure is associated with significantly elevated infant hospitalization rates.
• The timing of exposure, especially intrapartum, influences the severity of health risks.
• Findings underscore the importance of monitoring and managing CHIKV in pregnant populations to mitigate adverse infant outcomes.