Infectious diseases can result in devastating morbidities and mortality on the developing fetus and neonate, highlighting the importance of prevention, screening, early recognition, and treatment. A subset of the Centers for Disease Control and Prevention (CDC), the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) works to reduce the incidence, morbidity, mortality, and health disparities related to human immunodeficiency virus (HIV), viral hepatitis, sexually transmitted diseases, and tuberculosis (TB) for individuals of every age. The NCHHSTP performs public health surveillance, funds prevention research, and supports programs to prevent and control infectious diseases.1 One of the strategic aims of the NCHHSTP is to prevent infectious disease through healthcare.2 In addition, the importance of healthy development of the child is one of the basic principles in the constitution of the World Health Organization.3 Aligned with the goals set forth by the NCHHSTP and the World Health Organization, this special 2-part series focuses on the definitions, incidence, pathophysiology, prevention, and management of various congenital infectious diseases.
Many infectious diseases are routinely screened for during pregnancy, while others are not.
Hepatitis B, rubella, Chlamydia trachomatis, and Neisseria gonorrhoeae are some of the common infectious diseases screened for during pregnancy and are the focus of a review article on maternal titers and serologies. Two additional infectious diseases that are commonly screened for, HIV and congenital syphilis (CS), will be explored in depth in additional, separate articles.
Prenatal screening provides important information to both obstetric and neonatal healthcare providers to improve neonatal outcomes associated with congenital infectious diseases; however, not all infectious diseases are screened for during pregnancy. In addition, not all pregnant women receive prenatal care, and, therefore, prenatal screening for infectious disease. This makes familiarity with various infectious disease symptomatologies important for all neonatal providers. TB and Zika virus are not routinely screened for during pregnancy, and therefore, deserve our special attention to raise awareness, as many neonatal providers will not be familiar with the symptomology associated with these diseases. TB and Zika virus will be presented in separate articles in this special 2-part series on congenital infectious disease.
According to the CDC, 1 in 7 people living with HIV are unaware of their positive status.4 Globally, HIV and acquired immune deficiency syndrome (AIDS) killed 1 million people in 2016.5 Neonates born to nontreated, HIV-positive mothers have a 25% chance of contracting HIV themselves.6,7 In comparison, a much lower rate of transmission occurs (0.2%-2.2%) when antiretroviral treatment begins before or during pregnancy.8,9 These facts highlight the importance of HIV screening prior to and during pregnancy. A review on congenital HIV is offered in this series.
Congenital syphilis commands our attention as well, due to the recent overall increase in syphilis in the United States by 38% during the years of 2012-2014.2 In 2014, there were 11.6 cases of CS per 100,000 live births.2 Lack of prenatal care has been implicated in this spike. Syphilis remains a global problem as well, with nearly 1 million pregnant women infected each year.10 CS may result in fetal loss, stillbirth, neonatal death, low birth weight, and infections.10 Screening and treatment with penicillin during pregnancy can alleviate the morbidity and mortality associated with CS. A review of CS with a corresponding case study is presented.
I recently gave a talk at a state neonatal conference regarding congenital TB. I was met with black stares when I asked the audience if they had ever worked up or treated a neonate for congenital TB. Although the overall rate of TB is decreasing in the United States and worldwide, pregnant cases in the United States are actually increasing.11 TB remains in the top 10 list for causes of death globally.5 These statistics, along with recent immigration patterns, make congenital TB a diagnosis that should be considered in certain scenarios in the neonatal intensive care unit. Congenital TB can have devastating effects, including mortality, on the neonate, especially when not promptly diagnosed. An overview of congenital TB is presented to raise awareness of this potential new threat to the neonatal intensive care unit.
The Zika virus is a relatively new threat to neonates in this country and has received much press of late. The virus is more common in Africa, the Americas, Asia, and the Pacific; as such, pregnant women are not advised to travel to Zika-endemic areas.13 Congenital Zika syndrome is linked to severe microcephaly, decreased brain tissue, scarring and pigment changes to the back of the eye, limited range of motion, and hypertonicity.14 There is currently no vaccine or treatment for Zika.13 A review article of Zika is offered in addition to a patient education supplement for the clinician.
This special 2-part series on congenital infectious disease offers a comprehensive review on maternal titers and serologies offered during routine prenatal screening and focuses on congenital syndromes associated with HIV, syphilis, TB, and Zika virus. As neonatal providers we have a responsibility to collaborate with obstetric providers and infectious disease specialists to provide the best quality care and outcomes for our tiny patients through education, prevention, screening, early recognition, and treatment (when available).
7. Nesheim S, Taylor A, Lampe MA, et al A framework for elimination of perinatal transmission of HIV in the United States. Pediatrics. 2012;130(4):738–744. doi:10.1542/peds.2012-0194
8. Bernstein HB, Wegman AD. HIV infection: antepartum treatment and management. Clin Obstet Gynecol. 2018;61(1):122–136.
9. Mandelbrot L, Tubiana R, Le Chanadec J, et al No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception. Clin Infect Dis. 2015;61(11):1715–1725.