Divé et al.
Tick-borne encephalitis virus (TBEV) infection in pregnancy. Absence of virus transmission to the fetuses despite severe maternal disease – A case study
Ticks Tick Borne Dis. 2020, article 101491
Congenital malformations have been attributed to some flavivirus infections of the mother (Zika-, West Nile- Dengue virus). The course of acute TBE virus infections during pregnancy has not yet been investigated systematically. So far, two TBE virus infections during pregnancy have been reported from Sweden and Germany.
Patient 1
A 30-year old German woman at 19 weeks of gestation severely suffered from TBE. She had a history of multiple sclerosis, but prior to hospitalization, no pregnancy complications had been observed. The pregnant woman had to be transferred to the intensive care unit due to extensive cervical myelitis. Some weeks after admission to the hospital, the patient’s mobility gradually improved and after 70 days, she was able to walk without support. She was discharged to a neurological rehabilitation center after a total of 119 days of hospitalization. She gave birth to a child (child 1) by caesarean section without complication.
Patient 2
A previously healthy 40-year old Swedish woman at 30 weeks of gestation with dizygotic twins (children 2 and 3) required intensive care due to a TBE virus infection; she was seated and intubated. After recovery, she gave vaginal birth to her twins after 37 weeks of gestation. In both mothers, TBE specific IgM and IgG antibodies were found in the serum at time of admission to the hospital and the titers increased; they also had intrathecal IgM and IgG antibodies. A detailed assessment of health was carried out for the three fetuses. All neonates delivered at term and within a 15-month follow-up period, no alterations in the neurological development of the children were found. PCR tests for TBE virus was negative in the umbilical cord blood of the children. TBE IgM antibodies were not detected in any of the children. TBE IgG antibodies were found in the umbilical cord blood, and the serum titers declined over time. These results indicate the absence of perinatal viremia of the children. A literature search revealed only three cases of maternal TBE virus infections during pregnancy and these publications are extensively discussed. The authors encourage TBE vaccination for all women prior to pregnancy when living in or traveling to endemic countries.