Possible Vertical Transmission of SARS-CoV-2 From an Infecte
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly infectious, with multiple possible routes of transmission. Controversy exists regarding whether SARS-CoV-2 can be transmitted in utero from an infected mother to her infant before birth. A series of 9 pregnant women found no mother-child transmission.

Incidence 1: On January 28, 2020, a 29-year-old primiparous woman, suspected of being exposed to SARS-CoV-2 developed a temperature of 37.9° C and nasal congestion, which progressed to respiratory difficulties. On January 31, a chest CT showed patchy ground-glass opacities in the periphery of both lungs. The RT-PCR on a nasopharyngeal swab was positive (Table 1). On February 2, the patient was admitted to Renmin Hospital and received antiviral, antibiotic, corticosteroid, and oxygen therapies. Results from 4 repeat RT-PCR tests were positive. On February 21, IgG and IgM antibody levels to SARS-CoV-2 were 107.89 AU/mL and 279.72 AU/mL, respectively. The results of an RT-PCR test of the patient’s vaginal secretions were negative.

Incidence 2: On February 22, an infant girl was delivered by cesarean in a negative-pressure isolation room. The mother wore an N95 mask and did not hold the infant. Her birth weight was 3120 g and Apgar scores were 9 at 1 minute and 10 at 5 minutes. The neonate had no symptoms and was immediately quarantined in the neonatal intensive care unit. At 2 hours of age, the SARS-CoV-2 IgG level was 140.32 AU/mL and the IgM level was 45.83 AU/mL. Cytokines were elevated, as well as a white blood cell count of 18.08 × 109/L. Chest CT was normal. The neonate was transferred to a children’s hospital as per protocol. Results from 5 RT-PCR tests on nasopharyngeal swabs taken from 2 hours to 16 days of age were negative. Her IgM and IgG levels were still elevated on March 7(Table 2) , and she was discharged on March 18.

A neonate born to a mother with COVID-19 had elevated antibody levels and abnormal cytokine test results 2 hours after birth. The elevated IgM antibody level suggests that the neonate was infected in utero. IgM antibodies are not transferred to the fetus via the placenta. The infant potentially could have been exposed for 23 days from the time of the mother’s diagnosis of COVID-19 to delivery. The laboratory results displaying inflammation and liver injury indirectly support the possibility of vertical transmission. Although infection at delivery cannot be ruled out, IgM antibodies usually do not appear until 3 to 7 days after infection, and the elevated IgM in the neonate was evident in a blood sample drawn 2 hours after birth. Also, the mother’s vaginal secretions were negative for SARS-CoV-2. The infant’s repeatedly negative RT-PCR test results on nasopharyngeal swabs are difficult to explain, although these tests are not always positive with infection. IgG antibodies can be transmitted to the fetus through the placenta and appear later than IgM. Therefore, the elevated IgG level may reflect maternal or infant infection.

Source: https://jamanetwork.com/journals/jama/fullarticle/2763853
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