Congenital brain abnormalities during a zika virus epidemic in Salvador, Brazil, april 2015 to july 2016

• Type of Material: Article
• Authors: Mariana Kikuti, Fundacao Oswaldo Cruz; Cristiane W. Cardoso, Secretaria Municipal de Saúde de Salvador; Ana P.B. Prates, Secretaria Municipal de Saúde de Salvador; Igor A.D. Paploski, Fundacao Oswaldo Cruz; Uriel Kitron, Emory University; Mitermayer G. Reis, Fundacao Oswaldo Cruz; Ganeshwaran H. Mochida, Boston Children's Hospital; Guilherme S. Ribeiro, Fundacao Oswaldo Cruz
• Language: English
• Date: 2018-11-08
• Publisher: European Centre for Disease Prevention and Control
• Publication Version: Final Published Version
• Copyright Statement: © 2018, European Centre for Disease Prevention and Control (ECDC). All rights reserved.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2807/1560-7917.ES.2018.23.45.1700757
• Title of Journal or Parent Work: Eurosurveillance
• Volume: 23
• Issue: 45
• Grant/Funding Information: The Brazilian National Council of Technological and Scientific Development, the Brazilian Coordination for the Improvement of Higher Education, the Bahia Foundation for Research Support, the National Institute of Neurological Disease and Stroke, the Manton Center for Orphan Disease Research, Boston Children’s Hospital Faculty Career Development Award and the David Rockefeller Center for Latin American Studies at Harvard University provided funding for the study, but they played no role in data analyses.
• Keywords: Zika virus; microcephaly; brain abnormalities; prevalence; sensitivity and specificity; nervous system malformation
• Research Categories: Health Sciences, Epidemiology; Biology, Neuroscience; Environmental Sciences

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. Aim: 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.