Síndrome congênita associada à infecção pelo vírus Zika em nascidos vivos no Brasil: descrição da distribuição dos casos notificados e confirmados em 2015-2016

França, Giovanny Vinícius Araújo de; Pedi, Vaneide Daciane; Garcia, Márcio Henrique de Oliveira; Carmo, Greice Madeleine Ikeda do; Leal, Mariana Bertol; García, Leila Posenato

doi:10.5123/s1679-49742018000200014

Cited by 38 publications

(29 citation statements)

References 15 publications

(15 reference statements)

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“…From 13 March 2016 onwards [20,21], MM was diagnosed if the infant’s head circumference at birth was less than or equal to 31.9 cm for male or 31.5 cm for female babies. MWSD was diagnosed if subsequent imaging techniques (primarily CT and MRI scanning; S1 Text, section 1.2) revealed brain or CNS developmental abnormalities.…”

Section: Methodsmentioning

confidence: 99%

The association between Zika virus infection and microcephaly in Brazil 2015–2017: An observational analysis of over 4 million births

et al. 2019

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Background In 2015, high rates of microcephaly were reported in Northeast Brazil following the first South American Zika virus (ZIKV) outbreak. Reported microcephaly rates in other Zika-affected areas were significantly lower, suggesting alternate causes or the involvement of arboviral cofactors in exacerbating microcephaly rates. Methods and findings We merged data from multiple national reporting databases in Brazil to estimate exposure to 9 known or hypothesized causes of microcephaly for every pregnancy nationwide since the beginning of the ZIKV outbreak; this generated between 3.6 and 5.4 million cases (depending on analysis) over the time period 1 January 2015–23 May 2017. The association between ZIKV and microcephaly was statistically tested against models with alternative causes or with effect modifiers. We found no evidence for alternative non-ZIKV causes of the 2015–2017 microcephaly outbreak, nor that concurrent exposure to arbovirus infection or vaccination modified risk. We estimate an absolute risk of microcephaly of 40.8 (95% CI 34.2–49.3) per 10,000 births and a relative risk of 16.8 (95% CI 3.2–369.1) given ZIKV infection in the first or second trimester of pregnancy; however, because ZIKV infection rates were highly variable, most pregnant women in Brazil during the ZIKV outbreak will have been subject to lower risk levels. Statistically significant associations of ZIKV with other birth defects were also detected, but at lower relative risks than that of microcephaly (relative risk < 1.5). Our analysis was limited by missing data prior to the establishment of nationwide ZIKV surveillance, and its findings may be affected by unmeasured confounding causes of microcephaly not available in routinely collected surveillance data. Conclusions This study strengthens the evidence that congenital ZIKV infection, particularly in the first 2 trimesters of pregnancy, is associated with microcephaly and less frequently with other birth defects. The finding of no alternative causes for geographic differences in microcephaly rate leads us to hypothesize that the Northeast region was disproportionately affected by this Zika outbreak, with 94% of an estimated 8.5 million total cases occurring in this region, suggesting a need for seroprevalence surveys to determine the underlying reason.

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Section: Methodsmentioning

confidence: 99%

The association between Zika virus infection and microcephaly in Brazil 2015–2017: An observational analysis of over 4 million births

et al. 2019

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“…More recent evidence suggests that not all children with developmental issues relating to Zika have CZS or present with microcephaly at birth. Some are born with a normal head circumference and go on to develop microcephaly later, and others show evidence of the other features without microcephaly 7 . Microcephaly, therefore may be the tip of the iceberg with regards the wider array of clinical and developmental features 8 .…”

Section: Introductionmentioning

confidence: 99%

Development and assessment of the feasibility of a Zika family support programme: a study protocol

Duttine

Smythe

Sá³

et al. 2019

Wellcome Open Res

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The Zika virus outbreak in Brazil in 2015 affected thousands of people. Zika is now known to cause congenital malformations leading to impairments and developmental delays in affected children, including Congenital Zika Syndrome (CZS). Children with CZS have complex care needs. Caregivers require significant levels of support to meet these needs, and there are large gaps in healthcare services. This study aims to develop, pilot and assess the feasibility and scalability of a community-based Family Support Programme for caregivers of children with CZS. The programme is adapted from the Getting to Know Cerebral Palsy (GTKCP) programme for the context of CZS in Brazil. GTKCP is a 10-session programme held with 6-10 caregivers in the local community. It includes practical, educational, peer-support and psychosocial aspects, which aim to improve confidence and capacity to care for a child with CP, and quality of life and empowerment of caregivers. The research project contains four components: Ascertaining need for the caregiver programme: a mixed-methods approach that included two literature reviews, interviews with key stakeholders in country, and incorporation of findings from the Social and Economic Impact of Zika study.Adapting GTKCP for the context of CZS and Brazil: undertaken with guidance from technical experts.Pilot testing the intervention: deliver the 10-session programme to one group of caregivers of children with CZS in Rio de Janeiro and another in Greater Salvador.Update the manual through fast-track learning from participant and facilitator feedback. Assessing the feasibility of the intervention for scale up: deliver the updated programme to two groups each in Rio de Janeiro and Greater Salvador, and evaluate the acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited efficacy, through questionnaires, direct observation, semi-structured interviews and cost calculation. The project has ethics approval in both the UK and Brazil.

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“…In Brazil, dengue is an important cause of epidemics since the 1980s, chikungunya virus (CHIKV) emerged in 2014 3 , and Zika virus (ZIKV) in 2015. Zika virus emergence and spread in Brazil -the congenital Zika syndrome and its consequences in neonate 4,5,6,7,8 -have raised major concerns.…”

Section: Introductionmentioning

confidence: 99%

A populational-based birth cohort study in a low-income urban area in Rio de Janeiro, Brazil: implementation and description of the characteristics of the study

et al. 2019

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A comprehensive cohort study including an entomological surveillance component can contribute to our knowledge of clinical aspects and transmission patterns of arbovirosis. This article describes the implementation of a populational-based birth cohort study that included an entomological surveillance component, and its associated challenges in a low-income community of Rio de Janeiro, Brazil. The participants were recruited in two periods: from 2012 to 2014, and from 2015 to 2017. The children had scheduled pediatric consultations and in case of fever. Epidemiological, clinical data and biological samples were collected at pediatric visits. Active febrile surveillance was performed by telephone calls, social networking, message apps, and household visits. A total of 387 newborns and 332 new children were included during the first and second recruitment periods, respectively. By July 2017, there were 451 children on follow-up. During the study, 2,759 pediatric visits were performed: 1,783 asymptomatic and 976 febrile/rash consultations. The number of febrile or rash consultations increased 3.5-fold after the use of media tools for surveillance. No temporal pattern, seasonality or peak of febrile cases was observed during the study period. A total of 10,105 adult mosquitoes (including 3,523 Aedes spp. and 6,582 Culex quinquefasciatus) and 46,047 Aedes eggs were collected from households, schools, and key sites. Although challenging, this structured sentinel populational-based birth cohort is relevant to the knowledge of risks and awareness of emerging pathogens.

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Síndrome congênita associada à infecção pelo vírus Zika em nascidos vivos no Brasil: descrição da distribuição dos casos notificados e confirmados em 2015-2016

Abstract: one fifth of the cases reported in 2015-16 were confirmed the CZS, reinforcing their relevance as a public health problem; efforts aimed at the diagnostic confirmation of the syndrome should be prioritized.

Cited by 38 publications

References 15 publications

The association between Zika virus infection and microcephaly in Brazil 2015–2017: An observational analysis of over 4 million births

The association between Zika virus infection and microcephaly in Brazil 2015–2017: An observational analysis of over 4 million births

Development and assessment of the feasibility of a Zika family support programme: a study protocol

A populational-based birth cohort study in a low-income urban area in Rio de Janeiro, Brazil: implementation and description of the characteristics of the study

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