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Lancet Infect Dis. 2016 Dec;16(12):1356-1363. doi: 10.1016/S1473-3099(16)30318-8. Epub 2016 Sep 16.

Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: preliminary report of a case-control study.

Author information

1
Department of Social Medicine, Federal University of Pernambuco, Recife, Brazil. Electronic address: thalia@ufpe.br.
2
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
3
Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil; University of Pernambuco, Recife, Brazil.
4
University of Pernambuco, Recife, Brazil.
5
Department of Community Health, Federal University of Pernambuco, Vitória de Santo Antão, Brazil.
6
Department of Social Medicine, Federal University of Pernambuco, Recife, Brazil.
7
The Research Center Aggeu Magalhães (CPqAM) and Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil.
8
Pan American Health Organization, Brasília, Brazil.
9
Instituto Materno Infantil Fernando Figueira, Recife, Brazil.
10
Fiocruz Brasília, Brasília, Brazil.
11
Pernambuco State Health Department, Recife, Brazil.
12
The Research Center Aggeu Magalhães (CPqAM) and Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil; Department of Community Health, Federal University of Goiás, Goiânia, Brazil.

Abstract

BACKGROUND:

The microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy.

METHODS:

We did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities.

FINDINGS:

Between Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6-∞); OR 113·3 (95% CI 14·5-∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9-∞) for four cases without brain abnormalities.

INTERPRETATION:

Our data suggest that the microcephaly epidemic is a result of congenital Zika virus infection. We await further data from this ongoing study to assess other potential risk factors and to confirm the strength of association in a larger sample size.

FUNDING:

Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

PMID:
27641777
DOI:
10.1016/S1473-3099(16)30318-8
[Indexed for MEDLINE]
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