Journal Article

Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil

Eickmann, Sophie Helena, Pires, Pedro, Dimech, George, Miranda-Filho, Demócrito de Barros, Valongueiro, Sandra, Silva, Paula F. S. da, Brickley, Elizabeth, Oliveira, Danielle Maria da Silva, Albuquerque, Maria de Fátima Pessoa Militão de, Ramos, Regina Coeli Ferreira, Carvalho, Maria Durce C. G., Brandão-Filho, Sinval Pinto, Martelli, Celina Maria Turchi, Rocha, Maria Angela Wanderley, Dhalia, Rafael, Montarroyos, Ulisses Ramos, Gois, Adriana L., Ventura, Liana O., Castanha, Priscila Mayrelle da Silva, Souza, Wayner Vieira, Ventura, Camila V., Cordeiro, Marli Tenorio, Bezerra, Luciana Caroline Albuquerque, Marques-Júnior, Ernesto Torres Azevedo, Rodrigues, Laura C., Araújo, Thalia Velho Barreto de, Leal, Mariana C., Ximenes, Ricardo Arraes de Alencar

2021

Overview

While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood. Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy. 376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aquatic reptiles / Biology and Life Sciences / Birth defects / Brazil - epidemiology / Central Nervous System Diseases - congenital / Central Nervous System Diseases - virology / Cohorts / Data collection / Dysphagia / Epidemics / Exanthema / Female / Health surveillance / Humans / Identification / Infections / Medical research / Medicine and Health Sciences / Methods / Microcephaly / Microencephaly / Neurological diseases / Pregnancy / Pregnancy Complications, Infectious - epidemiology / Pregnancy Complications, Infectious - virology / Pregnancy Outcome / Pregnancy, Complications of / Programmes / Public health / Research and Analysis Methods / Risk assessment / Risk factors / Sentinel health events / Tropical diseases / Vector-borne diseases / Women / Womens health / Zika Virus / Zika Virus Infection - congenital / Zika Virus Infection - pathology