Mortality from Congenital Zika Syndrome — Nationwide Cohort Study in Brazil

Paixão, Enny S.; Cardim, Luciana Lobato; Costa, M. C.; Brickley, Elizabeth B; Carvalho-Sauer, Rita de Cássia Oliveira de; Carmo, Eduardo Hage; Andrade, Roberto F. S.; Rodrigues, Moreno S.; Veiga, Rafael Valente; Costa, Larissa C.; Moore, Cynthia A.; França, Giovanny Vinícius Araújo de; Smeeth, Liam; Rodrigues, Laura C.; Barreto, Maurício Lima; Teixeira, Maria Glória

doi:10.1056/nejmoa2101195

Cited by 45 publications

(35 citation statements)

References 26 publications

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“…The literature reports that children with CZS may develop symptoms similar to those found in other children with cerebral palsy, such as ineffective cough and respiratory disorders due to muscle tone and strength changes [ 27 ]. The evaluation of this domain is important since respiratory impairments can increase the degree of morbidity, even causing the need for hospitalization and ventilatory support [ 27 ] and/or mortality [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model

Souza

Ribeiro²,

Hamanaka³

et al. 2022

Viruses

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Understanding functioning and disabilities in children with Congenital Zika Syndrome (CZS) is essential for health planning. We describe disabilities present in children with CZS followed in a reference hospital in Rio de Janeiro, Brazil, based on the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). This was a cohort study of children >3 years of age with CZS. Disability was characterized through outcomes related to ICF components assessed via clinical and motor development evaluations. Among 50 children, with a median age of 40 months, 47 (94%) presented with severe impairment and 46 (92%) had microcephaly. Damage to the head and neck was found in most children, with abnormal central nervous system imaging universally present. Most children had cognitive impairment (92%), muscle tone problems (90%), and speech deficits (94%). We found movement limitations in all categories but more pervasively (80–94%), in postural transfers and displacements. The main environmental factors identified in the ICF model were the use of products or substances for personal consumption and access to health services. Children with CZS have extremely high rates of disability beyond aged 3 years, particularly regarding motor activity. ICF-based models can contribute to the assessment of health domains.

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Section: Discussionmentioning

confidence: 99%

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model

Souza

Ribeiro²,

Hamanaka³

et al. 2022

Viruses

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“…The World Health Organization (WHO) described ZIKV infection as similar to dengue fever and chikungunya by manifesting fever, skin rash, headache, arthralgia, and myalgia [1,2]. The virus can be passed through the placenta with teratogenic effects in the fetus, including central nervous system (CNS) pathologies [4]. Congenital Zika infection (CZS) can be normal or severe; early infection during the first trimester increases the risk for intrauterine growth restriction (IUGR), while late complications have different manifestations [4].…”

Section: Introduction and Background Introductionmentioning

confidence: 99%

“…The virus can be passed through the placenta with teratogenic effects in the fetus, including central nervous system (CNS) pathologies [4]. Congenital Zika infection (CZS) can be normal or severe; early infection during the first trimester increases the risk for intrauterine growth restriction (IUGR), while late complications have different manifestations [4]. The first and second trimesters have an elevated risk of affecting the development of CNS in the fetus [5].…”

Section: Introduction and Background Introductionmentioning

confidence: 99%

Zika Virus: A Systematic Review of Teratogenesis, Congenital Anomalies, and Child Mortality

Saldivia¹,

Unnikrishnan²,

Chavarria³

et al. 2023

Cureus

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Zika virus infection (ZIKV) was one of the most catastrophic epidemics. ZIKV in nonpregnant women is mild and sometimes asymptomatic. However, infection during pregnancy leads to congenital malformations in the fetus, while maternal signs of infection are preceded by a rash. The maternal-fetal infection begins with a rash that occurs early during pregnancy. The most severe pathologies were related to the first trimester of gestation, including microcephaly, musculoskeletal, genitourinary, craniofacial, ocular, and pulmonary manifestations. The prognosis may not be encouraging. Herd immunity increases CD8 + (cytotoxic Tlymphocytes) earlier and decreases in the resolution phase. However, CD4 + (T-helper cells) remains higher after infection. Recent ongoing vaccine development shows good immunity, control of the vector (Aedes mosquitoes), and treatment. ZIKV, anomalies, mortality, herd immunity, and vaccine were our main keywords. This systematic review demonstrates the teratogenesis of ZIKV in children, congenital anomalies, mortality, and a view of the future and behavior of ZIKV.

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“…Offspring with congenital Zika syndrome (CZS) can present with a broad spectrum of clinical manifestations that can be detected during pregnancy or after birth 4 5. Emerging evidence suggests that children with CZS have lifelong health sequelae that can increase mortality risk6 and require costly interventions with widespread social and economic impacts on the affected individual and their family 7. While it is well known that social risk markers at the community (eg, sanitation), household (eg, crowding, housing materials) and individual (eg, education) levels are associated with a higher risk of infectious diseases4 8–13 including arboviruses,14 research on the relationship between socioeconomic factors and CZS remains limited.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

et al. 2022

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While it is well known that socioeconomic markers are associated with a higher risk of arbovirus infections, research on the relationship between socioeconomic factors and congenital Zika syndrome (CZS) remains limited. This study investigates the relationship between socioeconomic risk markers and live births with CZS in Brazil. We conducted a population-based study using data from all registered live births in Brazil (Live Births Information System) linked with the Public Health Event Record from 1 January 2015 to 31 December 2018. We used logistic regression models to estimate the OR and 95% CIs of CZS based on a three-level framework. In an analysis of 11 366 686 live births, of which 3353 had CZS, we observed that live births of self-identified black or mixed race/brown mothers (1.72 (95% CI 1.47 to 2.01) and 1.37 (95% CI 1.24 to 1.51)) were associated with a higher odds of CZS. Live births from single women compared with married women and those from women with less than 12 years of education compared with those with more than 12 years of education also had higher odds of CZS. In addition, live births following fewer prenatal care appointments had increased odds of CZS in the nationwide data. However, in the analyses conducted in the Northeast region (where the microcephaly epidemic started before the link with Zika virus was established and before preventive measures were known or disseminated), no statistical association was found between the number of prenatal care appointments and the odds of CZS. This study shows that live births of the most socially vulnerable women in Brazil had the greatest odds of CZS. This disproportionate distribution of risk places an even greater burden on already socioeconomically disadvantaged groups, and the lifelong disabilities caused by this syndrome may reinforce existing social and health inequalities.

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Mortality from Congenital Zika Syndrome — Nationwide Cohort Study in Brazil

Cited by 45 publications

References 26 publications

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model

Zika Virus: A Systematic Review of Teratogenesis, Congenital Anomalies, and Child Mortality

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

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