1887
  1. Home
  2. Eurosurveillance
  3. Volume 23, Issue 45, 08/Nov/2018
  4. Article
Research article Open Access
Like 0
Download

Abstract

Background

North-eastern Brazil was the region most affected by the outbreak of congenital Zika syndrome that followed the 2015 Zika virus (ZIKV) epidemics, with thousands of suspected microcephaly cases reported to the health authorities, mostly between late 2015 and early 2016. To describe clinical and epidemiological aspects of the outbreak of congenital brain abnormalities (CBAs) and to evaluate the accuracy of different head circumference screening criteria in predicting CBAs.

Method

Between April 2015 and July 2016, the Centers for Information and Epidemiologic Surveillance of Salvador, Brazil investigated the reported cases suspected of microcephaly and, based on intracranial imaging studies, confirmed or excluded a diagnosis of CBA. Sensitivity, specificity and positive and negative predictive values of different head circumference screening criteria in predicting CBAs were calculated.

Results

Of the 365 investigated cases, 166 (45.5%) had confirmed CBAs. The most common findings were intracranial calcifications and ventriculomegaly in 143 (86.1%) and 111 (66.9%) of the 166 CBA cases, respectively. Prevalence of CBAs peaked in December 2015 (2.24 cases/100 live births). Cases of CBAs were significantly more likely to have been born preterm and to mothers who had clinical manifestations of arboviral infection during pregnancy. None of the head circumference screening criteria performed optimally in predicting CBAs.

Conclusion

This study highlights the magnitude of neurological consequences of the ZIKV epidemic and the limitations of head circumference in accurately identifying children with CBA. Gestational symptoms compatible with ZIKV infection should be combined with imaging studies for efficient detection of suspect CBAs during ZIKV epidemics.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2018.23.45.1700757
2018-11-08
2024-12-26
/content/10.2807/1560-7917.ES.2018.23.45.1700757
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/23/45/eurosurv-23-45-5.html?itemId=/content/10.2807/1560-7917.ES.2018.23.45.1700757&mimeType=html&fmt=ahah

References

  1. Campos GS, Bandeira AC, Sardi SI. Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis. 2015;21(10):1885-6.  https://doi.org/10.3201/eid2110.150847  PMID: 26401719 
  2. Zanluca C, Melo VC, Mosimann ALP, Santos GI, Santos CN, Luz K. First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz. 2015;110(4):569-72.  https://doi.org/10.1590/0074-02760150192  PMID: 26061233 
  3. Paploski IAD, Prates APPB, Cardoso CW, Kikuti M, Silva MMO, Waller LA, et al. Time Lags between Exanthematous Illness Attributed to Zika Virus, Guillain-Barré Syndrome, and Microcephaly, Salvador, Brazil. Emerg Infect Dis. 2016;22(8):1438-44.  https://doi.org/10.3201/eid2208.160496  PMID: 27144515 
  4. Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR. Zika Virus and Birth Defects--Reviewing the Evidence for Causality. N Engl J Med. 2016;374(20):1981-7.  https://doi.org/10.1056/NEJMsr1604338  PMID: 27074377 
  5. de Araújo TVB, Rodrigues LC, de Alencar Ximenes RA, de Barros Miranda-Filho D, Montarroyos UR, de Melo APL, et al. Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study. Lancet Infect Dis. 2016;16(12):1356-63.  https://doi.org/10.1016/S1473-3099(16)30318-8  PMID: 27641777 
  6. Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro. N Engl J Med. 2016;375(24):2321-34.  https://doi.org/10.1056/NEJMoa1602412  PMID: 26943629 
  7. Miranda-Filho DB, Martelli CMT, Ximenes RA, Araújo TVB, Rocha MAW, Ramos RCF, et al. Initial Description of the Presumed Congenital Zika Syndrome. Am J Public Health. 2016;106(4):598-600.  https://doi.org/10.2105/AJPH.2016.303115  PMID: 26959258 
  8. Secretaria de Vigilância em Saúde. Procedimentos preliminares a serem adotados para a vigilância dos casos de microcefalia no Brasil. [Preliminary procedures to be adopted for surveillance of microcephaly cases in Brazil]. Brasília – DF : Minisrério da Saúde ; 2015. Portuguese.
  9. Secretaria de Vigilância em Saúde. Protocolo de vigilância e resposta à ocorrência de microcefalia relacionada à infecção pelo vírus zika [Protocol for surveillance and response to occurence of microcephaly related to Zika virus infection]. Brasília - DF: Ministério da Saúde; 2015. Portuguese. Available from: http://portalsaude.saude.gov.br/images/pdf/2015/dezembro/09/Microcefalia---Protocolo-de-vigil--ncia-e-resposta---vers--o-1----09dez2015-8h.pdf
  10. Secretaria de Vigilância em Saúde. Protocolo de vigilância e resposta à ocorrência de microcefalia relacionada à infecção pelo vírus zika [Protocol for surveillance and response to occurence of microcephaly related to Zika virus infection]. Brasília - DF: Ministério da Saúde; 2016. Portuguese. Available from: http://combateaedes.saude.gov.br/images/sala-de-situacao/Microcefalia-Protocolo-de-vigilancia-e-resposta-10mar2016-18h.pdf
  11. van der Linden V, Pessoa A, Dobyns W, Barkovich AJ, Júnior HV, Filho ELR, et al. Description of 13 Infants Born During October 2015-January 2016 With Congenital Zika Virus Infection Without Microcephaly at Birth - Brazil. MMWR Morb Mortal Wkly Rep. 2016;65(47):1343-8.  https://doi.org/10.15585/mmwr.mm6547e2  PMID: 27906905 
  12. DATASUS. Sistema Nacional de Nascidos Vivos [Live Birth Information System]. Brasília - DF: Ministério da Saúde; 2016. Portuguese. [Accessed 11 Jun 2016]. Available from: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sinasc/cnv/nvuf.def
  13. Pan American Health Organization (PAHO). Lineamientos preliminares de vigilancia de microcefalia en recién nacidos en entornos con riesgo de circulación de virus Zika. [Preliminary guidelines for surveillance of microcephaly in newborns in environments with risk of Zika virus circulation]. Washington-DC: PAHO; 2016.Portuguese.
  14. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13(1):59.  https://doi.org/10.1186/1471-2431-13-59  PMID: 23601190 
  15. Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384(9946):857-68.  https://doi.org/10.1016/S0140-6736(14)60932-6  PMID: 25209487 
  16. World Health Organization (WHO). The WHO child growth standards. Geneva: WHO; 2016. [Accessed 31 Mar 2016]. Available from: http://www.who.int/childgrowth/en/
  17. StataCorp. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP; 2015.
  18. Marinho F, de Araújo VEM, Porto DL, Ferreira HL, Coelho MRS, Lecca RCR, et al. Microcefalia no Brasil: prevalência e caracterização dos casos a partir do Sistema de Informações sobre Nascidos Vivos (Sinasc), 2000-2015. [Microcephaly in Brazil: prevalence and characterization of cases from the Live Birth Information System (Sinasc), 2000-2015]. Epidemiol e Serviços Saúde. 2016 Oct;25(4):701-12. Portuguese. Available from: http://www.iec.pa.gov.br/template_doi_ess.php?doi=10.5123/S1679-49742016000400701&scielo=S2237-96222016000400701
  19. Kleber de Oliveira W, Cortez-Escalante J, De Oliveira WT, do Carmo GMI, Henriques CMP, Coelho GE, et al. Increase in Reported Prevalence of Microcephaly in Infants Born to Women Living in Areas with Confirmed Zika Virus Transmission During the First Trimester of Pregnancy - Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(9):242-7.  https://doi.org/10.15585/mmwr.mm6509e2  PMID: 26963593 
  20. Cauchemez S, Besnard M, Bompard P, Dub T, Guillemette-Artur P, Eyrolle-Guignot D, et al. Association between Zika virus and microcephaly in French Polynesia, 2013-15: a retrospective study. Lancet. 2016;387(10033):2125-32.  https://doi.org/10.1016/S0140-6736(16)00651-6  PMID: 26993883 
  21. de Oliveira WK, de França GVA, Carmo EH, Duncan BB, de Souza Kuchenbecker R, Schmidt MI. Infection-related microcephaly after the 2015 and 2016 Zika virus outbreaks in Brazil: a surveillance-based analysis. Lancet. 2017;390(10097):861-70.  https://doi.org/10.1016/S0140-6736(17)31368-5  PMID: 28647172 
  22. Cuevas EL, Tong VT, Rozo N, Valencia D, Pacheco O, Gilboa SM, et al. Preliminary Report of Microcephaly Potentially Associated with Zika Virus Infection During Pregnancy - Colombia, January-November 2016. MMWR Morb Mortal Wkly Rep. 2016;65(49):1409-13.  https://doi.org/10.15585/mmwr.mm6549e1  PMID: 27977645 
  23. Butler D. Brazil asks whether Zika acts alone to cause birth defects. Nature. 2016;535(7613):475-6.  https://doi.org/10.1038/nature.2016.20309  PMID: 27466104 
  24. Barbier A, Boivin A, Yoon W, Vallerand D, Platt RW, Audibert F, et al. New reference curves for head circumference at birth, by gestational age. Pediatrics. 2013;131(4):e1158-67.  https://doi.org/10.1542/peds.2011-3846  PMID: 23509164 
  25. de Fatima Vasco Aragao M, van der Linden V, Brainer-Lima AM, Coeli RR, Rocha MA, Sobral da Silva P, et al. Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study. BMJ. 2016;353:i1901.  https://doi.org/10.1136/bmj.i1901  PMID: 27075009 
  26. Hazin AN, Poretti A, Di Cavalcanti Souza Cruz D, Tenorio M, van der Linden A, Pena LJ, et al. Computed Tomographic Findings in Microcephaly Associated with Zika Virus. N Engl J Med. 2016;374(22):2193-5.  https://doi.org/10.1056/NEJMc1603617  PMID: 27050112 
  27. Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, et al. Zika Virus Infection in Pregnant Women in Rio de Janeiro. N Engl J Med. 2016;375(24):2321-34.  https://doi.org/10.1056/NEJMoa1602412  PMID: 26943629 
  28. Melo AS, Aguiar RS, Amorim MM, Arruda MB, Melo FO, Ribeiro ST, et al. Congenital zika virus infection: Beyond neonatal microcephaly. JAMA Neurol. 2016;73(12):1407-16.  https://doi.org/10.1001/jamaneurol.2016.3720  PMID: 27695855 
  29. Leal MC, Muniz LF, Ferreira TSA, Santos CM, Almeida LC, Van Der Linden V, et al. Hearing Loss in Infants with Microcephaly and Evidence of Congenital Zika Virus Infection - Brazil, November 2015-May 2016. MMWR Morb Mortal Wkly Rep. 2016;65(34):917-9.  https://doi.org/10.15585/mmwr.mm6534e3  PMID: 27585248 
  30. de Paula Freitas B, de Oliveira Dias JR, Prazeres J, Sacramento GA, Ko AI, Maia M, et al. Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol. 2016;1-19. PMID: 26865554 
  31. Duffy MR, Chen T-H, Hancock WT, Powers AM, Kool JL, Lanciotti RS, et al. Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med. 2009;360(24):2536-43.  https://doi.org/10.1056/NEJMoa0805715  PMID: 19516034 
  32. França GVA, Schuler-Faccini L, Oliveira WK, Henriques CMP, Carmo EH, Pedi VD, et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet. 2016;388(10047):891-7.  https://doi.org/10.1016/S0140-6736(16)30902-3  PMID: 27372398 
  33. Ventura CV, Maia M, Travassos SB, Martins TT, Patriota F, Nunes ME, et al. Risk Factors Associated With the Ophthalmoscopic Findings Identified in Infants With Presumed Zika Virus Congenital Infection. JAMA Ophthalmol. 2016;134(8):912-8.  https://doi.org/10.1001/jamaophthalmol.2016.1784  PMID: 27228275 
  34. Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, et al. Birth Defects Among Fetuses and Infants of US Women With Evidence of Possible Zika Virus Infection During Pregnancy. JAMA. 2017;317(1):59-68.  https://doi.org/10.1001/jama.2016.19006  PMID: 27960197 
  35. Dolk H. The predictive value of microcephaly during the first year of life for mental retardation at seven years. Dev Med Child Neurol. 1991;33(11):974-83.  https://doi.org/10.1111/j.1469-8749.1991.tb14813.x  PMID: 1743426 
  36. van der Linden V, Pessoa A, Dobyns W, Barkovich AJ, Júnior HV, Filho ELR, et al. Description of 13 Infants Born During October 2015-January 2016 With Congenital Zika Virus Infection Without Microcephaly at Birth - Brazil. MMWR Morb Mortal Wkly Rep. 2016;65(47):1343-8.  https://doi.org/10.15585/mmwr.mm6547e2  PMID: 27906905 
  37. Alarcon A, Martinez-Biarge M, Cabañas F, Quero J, García-Alix A. A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection. Neonatology. 2016;110(4):277-85.  https://doi.org/10.1159/000446690  PMID: 27344149 
  38. Kwak M, Yum M-S, Yeh H-R, Kim H-J, Ko T-S. Brain Magnetic Resonance Imaging Findings of Congenital Cytomegalovirus Infection as a Prognostic Factor for Neurological Outcome. Pediatr Neurol. 2018;83:14-8.  https://doi.org/10.1016/j.pediatrneurol.2018.03.008  PMID: 29681488 
  39. Victora CG, Schuler-Faccini L, Matijasevich A, Ribeiro E, Pessoa A, Barros FC. Microcephaly in Brazil: how to interpret reported numbers? Lancet. 2016;387(10019):621-4.  https://doi.org/10.1016/S0140-6736(16)00273-7  PMID: 26864961 
  40. Sanz Cortes M, Rivera AM, Yepez M, Guimaraes CV, Diaz Yunes I, Zarutskie A, et al. Clinical assessment and brain findings in a cohort of mothers, fetuses and infants infected with ZIKA virus. Am J Obstet Gynecol. 2018;218(4):440.e1-36.  https://doi.org/10.1016/j.ajog.2018.01.012  PMID: 29353032 
  41. Levine D, Jani JC, Castro-Aragon I, Cannie M. How Does Imaging of Congenital Zika Compare with Imaging of Other TORCH Infections? Radiology. 2017;285(3):744-61.  https://doi.org/10.1148/radiol.2017171238  PMID: 29155634 
Congenital brain abnormalities during a Zika virus epidemic in Salvador, Brazil, April 2015 to July 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Mariana+Kikuti&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kikuti Mariana</a>, <a href="/search?value1=Cristiane+W.+Cardoso&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cardoso Cristiane W.</a>, <a href="/search?value1=Ana+P.B.+Prates&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Prates Ana P.B.</a>, <a href="/search?value1=Igor+A.D.+Paploski&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Paploski Igor A.D.</a>, <a href="/search?value1=Uriel+Kitron&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kitron Uriel</a>, <a href="/search?value1=Mitermayer+G.+Reis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Reis Mitermayer G.</a>, <a href="/search?value1=Ganeshwaran+H.+Mochida&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mochida Ganeshwaran H.</a>, <a href="/search?value1=Guilherme+S.+Ribeiro&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ribeiro Guilherme S.</a></span>. Congenital brain abnormalities during a Zika virus epidemic in Salvador, Brazil, April 2015 to July 2016. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(45):pii=1700757. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.45.1700757" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.45.1700757</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 01 Nov 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 27 Jun 2018 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.45.1700757
/content/10.2807/1560-7917.ES.2018.23.45.1700757
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error