Produção Nacional
Revisado por pares
Association and birth prevalence of microcephaly attributable to Zika virus infection among infants in Paraíba, Brazil, in 2015–16: a case-control study
2018; Elsevier BV; Volume: 2; Issue: 3 Linguagem: Inglês
10.1016/s2352-4642(18)30020-8
ISSN2352-4650
AutoresElisabeth Krow‐Lucal, Marcia Regina de Andrade, Juliana Nunes Abath Cananéa, Cynthia A. Moore, Priscila Leal e Leite, Brad J. Biggerstaff, Cibelle Mendes Cabral, Megumi Itoh, Jadher Pércio, Marcelo Yoshito Wada, Ann M. Powers, Aristides Barbosa, Roberta Batista Abath, J. Erin Staples, Giovanini Evelim Coelho, Emerson Luiz Lima Araújo, Eva Lídia Arcoverde Medeiros, Jonas Lotufo Brant de Carvalho, Matheus de Paula Cerroni, Henrique de Barros Moreira Beltrão, Francieli Fontana Sutile Tardetti Fantinato, Michael Laurence Zini Lise, Patrícia Miyuki Ohara, Elionardo Resende, Eduardo Saad, Annabelle de St. Maurice, Ada Dieke, Alexia Harrist, Natalie Kwit, Mariel Marlow, Gnakub N. Soke, Roseanne de Arruda Pessoa, Renata Candido da Silva, Rogéria Chelly Diniz, Micheline César de Araújo Ariette, Clarice França Lira, Sandra Regina Matos, Taciana Mendonça Maia Wanderley, Vanessa Oliveira Costa Silva, Hélio Soares da Silva, Eduardo Hage Carmo, Myrian Kathleen Toscano de Carvalho, Nena Lentini, Raquel Miranda, Erin Boland, Paul Burns, Marc Fischer, Jeremy P. Ledermann, Fátima Coronado, Julio Dicent-Taillepierre, Brendan Flannery, Alexandre Macedo de Oliveira, J. Fernando Arena,
Tópico(s)Virology and Viral Diseases
ResumoBackgroundIn 2015, the number of infants born with microcephaly increased in Paraíba, Brazil, after a suspected Zika virus outbreak. We did a retrospective case-control investigation to assess the association of microcephaly and Zika virus.MethodsWe enrolled cases reported to the national database for microcephaly and born between Aug 1, 2015, and Feb 1, 2016, on the basis of their birth head circumference and total body length. We identified controls from the national birth registry and matched them to cases by location, aiming to enrol a minimum of two controls per case. Mothers of both cases and controls were asked about demographics, exposures, and illnesses and infants were measured at a follow-up visit 1–7 months after birth. We took blood samples from mothers and infants and classified those containing Zika virus IgM and neutralising antibodies as evidence of recent infection. We calculated prevalence of microcephaly and odds ratios (ORs) using a conditional logistic regression model with maximum penalised conditional likelihood, and combined these ORs with exposure probability estimates to determine the attributable risk.FindingsWe enrolled 164 of 706 infants with complete information reported with microcephaly at birth, of whom we classified 91 (55%) as having microcephaly on the basis of their birth measurements, 36 (22%) as small, 21 (13%) as disproportionate, and 16 (10%) as not having microcephaly. 43 (26%) of the 164 infants had microcephaly at follow-up for an estimated prevalence of 5·9 per 1000 livebirths. We enrolled 114 control infants matched to the 43 infants classified as having microcephaly at follow-up. Infants with microcephaly at follow-up were more likely than control infants to be younger (OR 0·5, 95% CI 0·4–0·7), have recent Zika virus infection (21·9, 7·0–109·3), or a mother with Zika-like symptoms in the first trimester (6·2, 2·8–15·4). Once Zika virus infection and infant age were controlled for, we found no significant association between microcephaly and maternal demographics, medications, toxins, or other infections. Based on the presence of Zika virus antibodies in infants, we concluded that 35–87% of microcephaly occurring during the time of our investigation in northeast Brazil was attributable to Zika virus. We estimate 2–5 infants per 1000 livebirths in Paraíba had microcephaly attributable to Zika virus.InterpretationTime of exposure to Zika virus and evidence of infection in the infants were the only risk factors associated with microcephaly. This investigation has improved understanding of the outbreak of microcephaly in northeast Brazil and highlights the need to obtain multiple measurements after birth to establish if an infant has microcephaly and the need for further research to optimise testing criteria for congenital Zika virus infection.FundingCenters for Disease Control and Prevention.
Referência(s)