Abstract
Since an outbreak in Brazil, which started in 2015, Zika has been recognized as an important cause of microcephaly. The highest burden of this outbreak was in northeast Brazil, including the state of Pernambuco. The prevalence of congenital microcephaly in Pernambuco state was estimated from the RESP (Registro de Eventos em Saúde Pública) surveillance system, from August 2015 to August 2016 inclusive. The denominators were estimated at the municipality level from official demographic data. Microcephaly was defined as a neonatal head circumference below the 3rd percentile of the Intergrowth standards. Smoothed maps of the prevalence of microcephaly were obtained from a Bayesian model which was conditional autoregressive (CAR) in space, and first order autoregressive in time. A total of 742 cases were identified. Additionally, high and early occurrences were identified in the Recife Metropolitan Region, on the coast, and in a north–south band about 300 km inland. Over a substantial part of the state, the overall prevalence, aggregating over the study period, was above 0.5%. The reasons for the high occurrence in the inland area remain unclear.
Highlights
In November 2015, an epidemic of congenital microcephaly, associated with the Zika virus, was declared a Public Health Emergency of National Importance by the Brazilian Ministry of Health [1]
On the basis of the Bradford Hill criteria, a causal link has been inferred [3], and the Centers for Disease Control and Prevention of the USA has concluded that ‘There is scientific consensus that Zika virus infection during pregnancy is a cause of microcephaly’ [4]
The main transmission route of Zika is by mosquitoes of the genus Aedes [5]
Summary
In November 2015, an epidemic of congenital microcephaly, associated with the Zika virus, was declared a Public Health Emergency of National Importance by the Brazilian Ministry of Health [1]. The World Health Organization declared a Public Health Emergency of International Concern [2]. On the basis of the Bradford Hill criteria, a causal link has been inferred [3], and the Centers for Disease Control and Prevention of the USA has concluded that ‘There is scientific consensus that Zika virus infection during pregnancy is a cause of microcephaly’ [4]. Causes of congenital microcephaly include chromosomal abnormalities (e.g., trisomy 21), monogenic disorders (e.g., Cornelia de Lange syndrome), in utero exposure to teratogens (e.g., alcohol, heavy metals), as well as maternal infections (e.g., toxoplasmosis, rubella, cytomegalovirus) [6].
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