title: Vertical Transmission of Dengue Virus in the Peripartum Period and Viral Kinetics in Newborns and Breast Milk: New Data.
abstract: CONCLUSIONS
  We investigated 10 mother-newborn pairs and found a 90% rate of dengue virus (DENV) transmission during the perinatal period. Here, we describe DENV kinetics in the sera of newborns before the onset of disease. Of the breast-milk samples analyzed, 75% tested positive for DENV.
  
  
  BACKGROUND
  Dengue is the most common mosquito-borne viral disease in humans. With this study, we aimed to investigate the risk of vertical (DENV) transmission during the peripartum period and to describe its viral kinetics in serum and breast milk.
  
  
  METHODS
  We carried out a prospective study during the 2012-2013 dengue epidemic in New Caledonia, its most severe on record. All mothers hospitalized at the Centre Hospitalier Territorial in Nouméa, New Caledonia, with symptoms of dengue infection between 7 days before and 2 days after delivery and/or whose infant was infected during breastfeeding were investigated. DENV was detected and quantified by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) in sera and breast milk (mothers), sera and gastric fluid (newborns), cord blood, and placentas. DENV kinetics and sequences in sera and breast milk were studied. Clinical presentation and biological evolution in mother-newborn pairs were analyzed.
  
  
  RESULTS
  Ten mother-newborn pairs were investigated over an 11-month period. One premature birth, 3 hemorrhagic complications, and 1 maternal death occurred. Nine newborns were infected and symptomatic. One case of deep thrombocytopenia and 1 case of anoxic encephalopathy occurred. DENV was detected in breast milk samples from 9 (75%) of 12 infected breastfeeding mothers. Original DENV kinetics in sera and breast milk were described.
  
  
  CONCLUSIONS
  The occurrence of vertical DENV transmission was high (90%) in viremic mothers at delivery, and these mothers and their infants were at major risk for obstetric and neonatal complications. The modes of viral transmission are difficult to clarify. The risk of DENV transmission through breast milk seems plausible. Close follow-up of mothers and prolonged surveillance of their newborns are required for minimizing complications. Complementary studies are needed to elaborate preventive recommendations.
authors.affiliation: Department of Pediatrics, Centre Hospitalier Territorial.
authors.forename: Lucille
authors.initials: L
authors.lastname: Arragain
authors.affiliation: Department of Dengue and Arboviruses Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network.
authors.forename: Myrielle
authors.initials: M
authors.lastname: Dupont-Rouzeyrol
authors.affiliation: Department of Dengue and Arboviruses Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network.
authors.forename: Olivia
authors.initials: O
authors.lastname: O'Connor
authors.affiliation: Department of Neonatology, Centre Hospitalier Territorial.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sigur
authors.affiliation: Health Department, Direction of Health and Social Affairs of New Caledonia.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Grangeon
authors.affiliation: Department of Pediatrics, Centre Hospitalier Territorial.
authors.forename: Emilie
authors.initials: E
authors.lastname: Huguon
authors.affiliation: Obstetrics and Gynecology.
authors.forename: Clothilde
authors.initials: C
authors.lastname: Dechanet
authors.affiliation: Internal Medicine and Infectious Diseases, Centre Hospitalier Territorial.
authors.forename: Cécile
authors.initials: C
authors.lastname: Cazorla
authors.affiliation: Immuno-Serology and Molecular Biology Lab, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa.
authors.forename: Ann-Claire
authors.initials: AC
authors.lastname: Gourinat
authors.affiliation: Internal Medicine and Infectious Diseases, Centre Hospitalier Territorial.
authors.forename: Elodie
authors.initials: E
authors.lastname: Descloux
mesh_terms: D003715:Dengue / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission*; D003716:Dengue Virus / Q000235:genetics / Q000378:metabolism; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000821:virology*; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D007700:Kinetics; D008297:Male; D008895:Milk, Human / Q000821:virology*; D009510:New Caledonia / Q000453:epidemiology; D058725:Peripartum Period; D010802:Phylogeny; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D014766:Viremia / Q000821:virology
keywords: breast milk; dengue; kinetics; transmission; vertical