Congenital malformations in sub-Saharan Africa—warnings of a silent epidemic?

Abstract

SARS-CoV-2 has tragically shown the cost of a global pandemic. Only a few years earlier, the outbreak of Zika virus in Brazil and elsewhere in South America caught the international community by surprise. There was no epidemiological surveillance for Zika virus established at the time, since the African-origin virus was previously endemic in Africa and Asia only; clinicians either failed to notify authorities of suspected cases, or reported Zika, dengue, and chikungunya infections in parallel, with limited diagnostic facilities available to differentiate between them. 1 Fischer C Drosten C Drexler JF The difficulties in obtaining reliable Zika virus diagnostics. Lancet Infect Dis. 2019; 19: 240-241 Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar A lack of common understanding about diagnosis and symptoms produced different case definitions and a wide range of case estimates; 2 Victora CG Schuler-Faccini L Matijasevich A Ribeiro E Pessoa A Barros FC Microcephaly in Brazil: how to interpret reported numbers?. Lancet. 2016; 387: 621-624 Summary Full Text Full Text PDF PubMed Scopus (165) Google Scholar early estimates of the risk of microcephaly varied across Brazil. 3 Jaenisch T Rosenberger KD Brito C Brady O Brasil P Marques ET Risk of microcephaly after Zika virus infection in Brazil, 2015 to 2016. Bull World Health Organ. 2017; 95: 191-198 Crossref PubMed Scopus (60) Google Scholar These challenges delayed meaningful epidemiological interpretations and probably contributed to an increase in unsafe abortions 4 Aiken AR Scott JG Gomperts R Trussell J Worrell M Aiken CE Requests for abortion in Latin America related to concern about Zika Virus exposure. N Engl J Med. 2016; 375: 396-398 Crossref PubMed Scopus (1) Google Scholar and pregnancy delays 5 Castro MC Han QC Carvalho LR Victora CG França GVA Implications of Zika virus and congenital Zika syndrome for the number of live births in Brazil. Proc Natl Acad Sci USA. 2018; 115: 6177-6182 Crossref PubMed Scopus (49) Google Scholar throughout Latin America for fear of the Zika-associated complications.