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Author Notes:

Guilherme S. Ribeiro: guilherme.ribeiro@bahia.fiocruz.br

We thank health professionals in Salvador, Brazil, especially those working in surveillance activities, those providing healthcare for children born with congenital malformations and those providing support for affected children’s families.

We also thank the children reported as suspected cases of Zika congenital syndrome and their parents.

Conflict of interest: None declared.


Research Funding:

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.


  • Zika virus
  • brain abnormalities
  • microcephaly
  • nervous system malformation
  • prevalence
  • sensitivity and specificity

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


Journal Title:



Volume 23, Number 45


Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2018, European Centre for Disease Prevention and Control (ECDC). All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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