Prevalence and Risk Factors for Microcephaly at Birth in Brazil in 2010

Silva, Antônio Augusto Moura da; Barbieri, Marco Antônio; Alves, Maria Teresa Seabra Soares de Britto; Carvalho, Carolina Abreu de; Batista, Rosângela Fernandes Lucena; Ribeiro, Marizélia Rodrigues Costa; Lamy-Filho, Fernando; Lamy, Zeni Carvalho; Cardoso, Viviane C.; Cavalli, Ricardo Carvalho; Simões, Vanda Maria Ferreira; Bettiol, Heloísa

doi:10.1542/peds.2017-0589

Cited by 36 publications

(44 citation statements)

References 23 publications

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“…In this area, the involvement among researchers and clinicians that led to the early discovery of the causal link between Zika and microcephaly may have generated a hyper-awareness of the problem. The more strict head circumference measurements counterbalanced the usual under-reporting 11,50 . It should be noted that the main surveillance system for neonatal congenital malformation (Latin American Collaborative Study of Congenital Malformations -ECLAMC) did not detect the microcephaly epidemic in the early stages 14 , possibly due to the geographical constraints of the sentinel hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…So far, microcephaly ratios as high as in the Brazilian NE region have not been described in any other region in the world that had undergone a Zika epidemic [7][8][9] . Several reasons for this discrepancy were suggested -poor data quality [10][11][12] , the unreliability of secondary data sources 13,14 , virus genetic variation 15 , socioeconomic factors 16 , dengue immunity profile of the population 17 , and women postponing pregnancy or having abortions [18][19][20] .…”

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confidence: 99%

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Association of past dengue fever epidemics with the risk of Zika microcephaly at the population level in Brazil

Carvalho

Freitas

Cruz

et al. 2020

Sci Rep

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Despite all the research done on the first Zika virus (ZIKV) epidemics, it was only after the Brazilian epidemic that the congenital Zika Syndrome was described. this was made possible due to the large number of babies born with microcephaly in the Northeast region (NE) in a narrow time. We hypothesize that the fivefold difference in the rate of microcephalic neonates between the NE and other regions is partially an effect of the population prior immunity against Dengue viruses (DENV), that cross-react with ZIKV. In this ecological study, we analysed the interaction between dengue fever epidemics from 2001 to 2014 and the 2015/2016 microcephaly epidemic in 400 microregions in Brazil using random-effects models under a Bayesian approach. The estimated effect of the time lag between the most recent large dengue epidemic (>400/100,000 inhabitants) and the microcephaly epidemic ranged from protection (up to 6 years prior) to an increased risk (from 7 to 12 years). This sustained window of protection, larger than described in previous longitudinal studies, is possibly an effect of herd immunity and of multiple exposures to DENV that could boost immunity.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Association of past dengue fever epidemics with the risk of Zika microcephaly at the population level in Brazil

Carvalho

Freitas

Cruz

et al. 2020

Sci Rep

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“…Intrauterine growth restriction (IUGR) is a hallmark feature ZIKV infection in rodent models and human pregnancy. (42, 52–55) Two large Brazilian case series of pregnant women with ZIKV infections have reported a profile of “disproportionate” fetal growth, which described a small head in relation to a longer body. (42, 55) Other case series in Brazil(56) and the Caribbean(36) have also reported abnormal growth of the fetal head in the context of a normally growing femur.…”

Section: Intrauterine Growth Restriction and Stillbirthmentioning

confidence: 99%

“…(42, 52–55) Two large Brazilian case series of pregnant women with ZIKV infections have reported a profile of “disproportionate” fetal growth, which described a small head in relation to a longer body. (42, 55) Other case series in Brazil(56) and the Caribbean(36) have also reported abnormal growth of the fetal head in the context of a normally growing femur. A similar pattern of growth in early childhood among infants exposed to ZIKV during fetal life revealed a disproportionately small head (65% with HC ≤-3 SD) compared to growth of the skeleton (14% with birth length ≤-3 SD).…”

Section: Intrauterine Growth Restriction and Stillbirthmentioning

confidence: 99%

Zika virus and the nonmicrocephalic fetus: why we should still worry

Walker

Little²,

Roby

et al. 2019

American Journal of Obstetrics and Gynecology

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Zika virus (ZIKV) is a mosquito-transmitted flavivirus and was first linked to congenital microcephaly due to a large outbreak in Northeastern Brazil. Although the ZIKV epidemic is now in decline, pregnancies in large parts of the Americas remain at risk due to ongoing transmission and the potential for new outbreaks. This review presents why Zika virus is still a complex and worrisome public health problem with an expanding spectrum of birth defects and why ZIKV and related viruses may evade the immune response to injure the fetus. Recent reports indicate that the spectrum of fetal brain and other anomalies associated with ZIKV exposure is broader and more complex than microcephaly alone and includes subtle fetal brain and ocular injuries; thus, the ability to prenatally diagnose fetal injury associated with ZIKV infection remains limited. New studies indicate that ZIKV imparts disproportionate effects on fetal growth with an unusual femur-sparing profile, potentially providing a new approach to identify viral injury to the fetus. Studies to determine the limitations of prenatal and postnatal testing for detection of ZIKV-associated birth defects and long-term neurocognitive deficits are needed to better guide counseling for women with a possible infectious exposure. It is also imperative that we investigate why ZIKV is so adept at infecting the placenta and the fetal brain to better predict other viruses with similar capabilities that may give rise to new epidemics. The efficiency with which ZIKV evades the early immune response to enable infection of the mother, placenta and fetus is likely critical for understanding why the infection may either be fulminant or limited. Furthermore, studies suggest that several emerging and related viruses may also cause birth defects, including West Nile virus, which is endemic in many parts of the United States. With mosquito-borne diseases increasing worldwide, there remains an urgent need to better understand the pathogenesis of ZIKV and related viruses to protect pregnancies and child health.

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“…A few points need to be considered to better understand the lower microcephaly rates observed following the 2016 outbreak. First, given the nonspecific nature of ZIKV clinical presentation and cocirculation of other infections with similar signs and symptoms, it is likely that misclassification of disease exposure occurred frequently . Moreover, notification of any medical condition is vulnerable to disease awareness among health care providers.…”

Section: Recent Trends: Lower Microcephaly Rates In the 2016 Outbreakmentioning

confidence: 99%

Untold stories of the Zika virus epidemic in Brazil

Avelino‐Silva

Kallas

2018

Reviews in Medical Virology

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The Zika virus infection outbreak in Brazil in 2014 to 2015 resulted in the identification of previously unknown consequences of the disease, including the notorious microcephaly among many defects in fetuses born to women infected during pregnancy. A number of individuals were involved in this remarkable discovery, from the detection of viral circulation in the country to the studies on the causal link with congenital abnormalities and the provision of awareness and social support to families affected by the disease. In this article, we review the background to this experience, describing aspects of the epidemiology, medical research, and scientific response to the Zika virus outbreak in Brazil.

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Prevalence and Risk Factors for Microcephaly at Birth in Brazil in 2010

Abstract: The prevalence of severe microcephaly was much higher than expected in both cities. Our findings suggest that microcephaly was endemic in both municipalities before the circulation of the Zika virus.

Cited by 36 publications

References 23 publications

Association of past dengue fever epidemics with the risk of Zika microcephaly at the population level in Brazil

Association of past dengue fever epidemics with the risk of Zika microcephaly at the population level in Brazil

Zika virus and the nonmicrocephalic fetus: why we should still worry

Untold stories of the Zika virus epidemic in Brazil

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