High Background Congenital Microcephaly in Rural Guatemala: Implications for Neonatal Congenital Zika Virus Infection Screening

Rick, Anne-Marie; Domek, Gretchen J.; Cunningham, Maureen; Olson, Daniel; Lamb, Molly M.; Jimenez-Zambrano, Andrea; Heinrichs, Gretchen; Berman, Stephen; Asturias, Edwin J.

doi:10.9745/ghsp-d-17-00116

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…The Sistema Informatico Perinatal (SIP; Perinatal Information System) is a high-quality clinical database used in 20 countries in Latin America and the Caribbean 9. Begun in 1983, SIP is the product of a technical consensus among professionals in the region, and data are collected under the auspices of PAHO’s Latin American Center of Perinatology, Women’s Health and Reproductive Health (Centro Latinoamericano de Perinatologia, Salud de la Mujer y Reproductiva (CLAP/SMR)10).…”

Section: Methodsmentioning

confidence: 99%

Measurement error, microcephaly prevalence and implications for Zika: an analysis of Uruguay perinatal data

Harville

Buekens

Cafferata³

et al. 2019

Arch Dis Child

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Background and objectiveThe Zika virus outbreak has drawn attention to microcephaly, whose definition is based on head circumference measuring below a percentile or number of SDs below the mean. The objective of this analysis was to assess how differences in measurement precision might affect prevalence and trends of microcephaly.MethodsData from all births in Uruguay during 2010–2015 were obtained from the Perinatal Information System. The prevalence of births with microcephaly was calculated based on head circumference measurement at birth applying the INTERGROWTH-21st standards for sex and gestational age, and compared by method of ascertaining gestational age.ResultsRounding and digit preference was observed: 74% of head circumference measurements were reported as a whole centimetre value. The prevalence of births varied substantially by the criterion used to define microcephaly (<3 SD, <2 SD, <3rd percentile for gestational age) and could be halved or doubled based on adding or subtracting a half-centimetre from all reported head circumference measurements. If 4 days were added to gestational age calculations, rather than using completed gestational weeks (without days) for gestational age reporting, the prevalence was 1.7–2 times higher.DiscussionRounding in measurement of head circumference and reporting preferences of gestational age may have contributed to a lower prevalence of microcephaly than expected in this population. Differences in head circumference measurement protocols and gestational age dating have the potential to affect the prevalence of babies reported with microcephaly, and this limitation should be acknowledged when interpreting head circumference data collected for surveillance.

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Section: Methodsmentioning

confidence: 99%

Measurement error, microcephaly prevalence and implications for Zika: an analysis of Uruguay perinatal data

Harville

Buekens

Cafferata³

et al. 2019

Arch Dis Child

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“…A previous study conducted in the state of Bahia showed a 37.2 % prevalence of low birth weight in newborns with congenital ZIKV syndrome, including microcephaly [23]. In a study carried out in Guatemala, a birth weight of < −1 standard deviation and small for gestational age were associated with microcephaly [24].…”

Section: Variable Adjusted Odds Ratiomentioning

confidence: 81%

Zika Virus and Pregnancy: Association between Acute Infection and Microcephaly in Newborns in the State of Rio de Janeiro, Brazil

Pereira

Júnior

Werner

et al. 2020

Geburtshilfe Frauenheilkd

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Introduction Aim of the study was to evaluate the association between microcephaly and acute infection with Zika virus (ZIKV) in pregnant women in the state of Rio de Janeiro, Brazil. Infection was confirmed by laboratory testing. Materials and Methods A cross-sectional retrospective study of pregnant women with symptoms occurring between 2015 and 2016 suggestive of acute ZIKV infection was carried out, with confirmation of infection done by blood or urine RT-PCR. The relative proportions of categorical variables were calculated for two distinct groups: pregnant women whose newborns had microcephaly and pregnant women who gave birth to infants without microcephaly. Confidence intervals with a 95% level of agreement were estimated for the relative ratios. Results A total of 1609 pregnant women with a mean age of 26.4 ± 6.5 years were evaluated. As regards the time of acute infection, 19.6% (316) of cases occurred in the first trimester of pregnancy. Nineteen (76%) of the 25 cases with microcephaly (1.5%) were associated with an infection contracted in the first trimester of pregnancy (p < 0.001, OR = 13.7, 95% CI: 5.6 – 37.7). 48% (12/25) of the newborns with microcephaly had a birth weight of < 2500 grams, while only 7% (116/1597) of the group of newborns without microcephaly had a similarly low birth weight (p < 0.001, OR = 11.7, 95% CI: 5.2 – 26.2). Logistic regression showed that a birth weight of < 2500 g (OR = 12.54) and ZIKV infection in the first trimester of pregnancy (OR = 14.05) were associated with microcephaly (area under ROC curve = 0.86). Conclusion Acute ZIKV infection in the first trimester of pregnancy and low birth weight are associated with microcephaly.

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“…For example, this study can provide information on the incidence of microcephaly and neurodevelopmental outcomes, which are increasingly being documented in low-resource settings. 10,27 In addition, our results will help untangle the possible associations and interactions between microcephaly and neurodevelopmental outcomes and health determinants like poverty, malnutrition, and recurrent illnesses and infections. In parallel to our study, two other studies were launched in the region: the Centers for Disease Control and Prevention conducted a facility-based observational study on the clinical and virological manifestations of postnatal ZIVK (PMID: 29813148) 28 , and the prospective pregnancy cohort study of Zika in Infants and Pregnancy (ZIP) in six endemic countries (Brazil, Colombia, Guatemala, Nicaragua, Puerto Rico and Peru), which included follow up of thee infants up to one year of age (PMID: 31391005).…”

Section: Discussionmentioning

confidence: 92%

“…5 In 2013, as a response to the needs assessment, CHD, an academic-private global health partnership (CU and AgroAmerica), began implementing clinical services and community maternal-child programs to register and follow pregnant women and their children under 3 years of age to improve child growth and development. 9,10…”

Section: Methodsmentioning

confidence: 99%

Challenges and lessons learned from the rapid operationalization of a prospective cohort to study the natural history and neurodevelopmental outcomes of postnatal Zika virus infection among infants and children in rural Guatemala

Paniagua-Ávila

Olson

Connery

et al. 2022

Preprint

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During the course of the 2015-2017 outbreak of Zika virus (ZIKV) infection in the Americas, the emerging virus was recognized as a congenital infection that could damage the developing brain. As the Latin American ZIKV outbreak advanced, the scientific and public health community questioned if this newly recognized neurotropic flavivirus could affect the developing brain of infants and young children infected after birth. We report here the design, methods and rapid operationalization of a prospective natural history cohort study aimed at evaluating the potential neurological and neurodevelopmental effects of postnatal Zika virus infection in infants and young children, which had become epidemic in Central America. This study enrolled a cohort of 500 mothers and their infants, along with nearly 400 children 1.5-3.5 years of age who were born during the initial phase of the ZIKV epidemic in a rural area of Guatemala. Our solutions and lessons learned while tackling real-life challenges may serve as a guide to other researchers carrying out studies of emerging infectious diseases of public health priority in resource-constrained settings.

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High Background Congenital Microcephaly in Rural Guatemala: Implications for Neonatal Congenital Zika Virus Infection Screening

Cited by 11 publications

References 8 publications

Measurement error, microcephaly prevalence and implications for Zika: an analysis of Uruguay perinatal data

Measurement error, microcephaly prevalence and implications for Zika: an analysis of Uruguay perinatal data

Zika Virus and Pregnancy: Association between Acute Infection and Microcephaly in Newborns in the State of Rio de Janeiro, Brazil

Challenges and lessons learned from the rapid operationalization of a prospective cohort to study the natural history and neurodevelopmental outcomes of postnatal Zika virus infection among infants and children in rural Guatemala

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