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Euro Surveill. 2018 Nov;23(45). doi: 10.2807/1560-7917.ES.2018.23.45.1700757.

Congenital brain abnormalities during a Zika virus epidemic in Salvador, Brazil, April 2015 to July 2016.

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Universidade Federal da Bahia, Salvador, Brazil.
Fundação Oswaldo Cruz, Salvador, Brazil.
Secretaria Municipal de Saúde de Salvador, Salvador, Brazil.
Emory University, Atlanta, United States.
Harvard Medical School, Boston, United States.
Massachusetts General Hospital, Boston, United States.
Boston Children's Hospital, Boston, United States.


BackgroundNorth-eastern Brazil was the region most affected by the outbreak of congenital Zika syndrome that followed the 2015 Zika virus (ZIKV) epidemics, with thousands of suspected microcephaly cases reported to the health authorities, mostly between late 2015 and early 2016. Aim: To describe clinical and epidemiological aspects of the outbreak of congenital brain abnormalities (CBAs) and to evaluate the accuracy of different head circumference screening criteria in predicting CBAs.MethodBetween April 2015 and July 2016, the Centers for Information and Epidemiologic Surveillance of Salvador, Brazil investigated the reported cases suspected of microcephaly and, based on intracranial imaging studies, confirmed or excluded a diagnosis of CBA. Sensitivity, specificity and positive and negative predictive values of different head circumference screening criteria in predicting CBAs were calculated.ResultsOf the 365 investigated cases, 166 (45.5%) had confirmed CBAs. The most common findings were intracranial calcifications and ventriculomegaly in 143 (86.1%) and 111 (66.9%) of the 166 CBA cases, respectively. Prevalence of CBAs peaked in December 2015 (2.24 cases/100 live births). Cases of CBAs were significantly more likely to have been born preterm and to mothers who had clinical manifestations of arboviral infection during pregnancy. None of the head circumference screening criteria performed optimally in predicting CBAs.ConclusionThis study highlights the magnitude of neurological consequences of the ZIKV epidemic and the limitations of head circumference in accurately identifying children with CBA. Gestational symptoms compatible with ZIKV infection should be combined with imaging studies for efficient detection of suspect CBAs during ZIKV epidemics.


Zika virus; brain abnormalities; microcephaly; nervous system malformation; prevalence; sensitivity and specificity

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