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      RE: Seroprevalence of Zika virus among asymptomatic pregnant mothers and their newborns in the Najran region of southwest Saudi Arabia

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      Annals of Saudi Medicine
      King Faisal Specialist Hospital and Research Centre

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          Abstract

          To the Editor: We read the publication on “Seroprevalence of Zika virus among asymptomatic pregnant mothers and their newborns in the Najran region of southwest Saudi Arabia” with a great interest.1 Alayed et al found that “Twenty-four (5.85%) mothers tested positive for anti-ZIKV IgM and 52 (12.68%) tested positive for anti-ZIKV IgG, but all infant samples were negative.”1 In fact, in any area where the mosquito vector exists (Aedes aegypti), there is a risk for Zika virus disease. A high positive seroprevalence rate is reported from many areas around the world despite there being no overt clinical cases. A good example is a report from Cambodia where many local people have immunoreactivity to Zika virus despite there being no clinical disease.2 Indeed, most cases of Zika virus infection are asymptomatic3 and this is the difficulty in clinical surveillance of the emergence of the disease in any setting.

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          Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: Don't miss it!

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            Seroprevalence of Zika virus among asymptomatic pregnant mothers and their newborns in the Najran region of southwest Saudi Arabia

            BACKGROUND Zika virus (ZIKV) is a teratogenic flavivirus that can cause microcephaly. Its main vector, Aedes aegypti, has been previously identified in Saudi Arabia, but no ZIKV infection has yet been reported. Nevertheless, the country is at risk from ZIKV because it receives many travelers throughout the year, including pilgrims from ZIKV-endemic countries. OBJECTIVES Screen asymptomatic pregnant mothers and their newborns attending a major hospital in the Najran region for subclinical or past infections with ZIKV, using ELISA and RT-PCR. DESIGN Cross-sectional. SETTING Najran Maternity and Children Hospital (NMCH). SUBJECTS AND METHODS All pregnant women admitted to NMCH in labor between November 2016 and July 2017 were included in the study. Clinical and demographic data were collected by pre-validated physician-administered questionnaires. Paired umbilical and maternal serum samples were collected and frozen at −60°C, using ELISA to measure anti-ZIKA IgG and IgM antibodies and RT-PCR to further investigate positive samples. MAIN OUTCOME MEASURES Maternal and newborn serum anti-ZIKV IgM and IgG and ZIKV RT-PCR. SAMPLE SIZE 410 mother-newborn pairs. RESULTS The median gestational age was 38.5 weeks (range 33–42). Most (n=342, 83.41%) of the women were from Najran city. All of the newborns had normal growth parameters with no congenital malformations. None of the mothers had symptoms suggestive of ZIKV infection; 3 (0.7%) exhibited a low-grade fever (38°C), but did not test positive for anti-ZIKV antibodies. Thirty-five (8.53%) of mothers had travelled inside Saudi Arabia, but none outside the country. Twenty-four (5.85%) mothers tested positive for anti-ZIKV IgM and 52 (12.68%) tested positive for anti-ZIKV IgG, but all infant samples were negative. All seropositive ZIKV IgM were also ZIKV IgG positive, but RT-PCR testing of all seropositive samples was negative. CONCLUSION Although previous (resolved) ZIKV infection and cross-reactivity of the ELISA method with other flaviviruses cannot be excluded, the study found no confirmed cases of acute ZIKV infection. However, given the presence of the vector in Saudi Arabia, the presence of presumptive positive serology and the ongoing risk of ZIKV entry via a regular influx of travelers from endemic areas, we propose that continuous surveillance be conducted for ZIKV as well for other flaviviruses. Larger-scale nationwide studies are strongly recommended to gain a broader view of the potential threat from ZIKV in the country. LIMITATIONS Small sample size, unavailability of plaque reduction neutralization tests to confirm serology results, and RT-PCR was only conducted on ELISA-positive serum samples, due to resource constraints.
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              Seroprevalence of Zika virus in Cambodia: a preliminary report

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                Author and article information

                Journal
                Ann Saudi Med
                Ann Saudi Med
                Annals of Saudi Medicine
                King Faisal Specialist Hospital and Research Centre
                0256-4947
                0975-4466
                Mar-Apr 2019
                04 April 2019
                : 39
                : 2
                : 124
                Affiliations
                [a ]KMT Primary Care Center, Bangkok, Thailand
                [b ]Surindra Rajabhat University, Surin, Thailand
                Author notes
                Correspondence: Dr. Sora Yasri, KMT Primary Care Center, Bangkok 10150, Thailand, T: +6624767747, sorayasri@ 123456outlook.co.th , ORCID: https://orcid.org/0000-0001-8292-6656
                Article
                asm-2-124
                10.5144/0256-4947.2019.124
                6464673
                30955021
                c16af6b3-7b2d-47a8-a79f-7e2fa9c37f15
                Copyright © 2019, Annals of Saudi Medicine

                This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). The details of which can be accessed at http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                : 16 December 2018
                : 06 January 2019
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                Medicine
                Medicine

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