Abstract
Zika virus infection emerged as a public health emergency after increasing evidence for its association with neurologic disorders and congenital malformations. In Salvador, Brazil, outbreaks of acute exanthematous illness (AEI) attributed to Zika virus, Guillain-Barré syndrome (GBS), and microcephaly occurred in 2015. We investigated temporal correlations and time lags between these outbreaks to identify a common link between them by using epidemic curves and time series cross-correlations. Number of GBS cases peaked after a lag of 5-9 weeks from the AEI peak. Number of suspected cases of microcephaly peaked after a lag of 30-33 weeks from the AEI peak, which corresponded to time of potential infections of pregnant mothers during the first trimester. These findings support the association of GBS and microcephaly with Zika virus infection and provide evidence for a temporal relationship between timing of arboviral infection of pregnant women during the first trimester and birth outcome.
Highlights
Zika virus infection emerged as a public health emergency after increasing evidence for its association with neurologic disorders and congenital malformations
Using raw and smoothed temporal data collected during these outbreaks, we investigated the temporal associations and determined the time lags between epidemiologic curves of the suspected Zika virus infection outbreak, reported cases of Guillain-Barré syndrome (GBS), and reported suspected cases of microcephaly
After neurologic syndrome cases in adults potentially associated with a previous Zika virus infection were first reported in Salvador in late May, CIES initiated surveillance for hospitalizations caused by neurologic manifestations that might be linked to Zika
Summary
Zika virus infection emerged as a public health emergency after increasing evidence for its association with neurologic disorders and congenital malformations. In Salvador, Brazil, outbreaks of acute exanthematous illness (AEI) attributed to Zika virus, Guillain-Barré syndrome (GBS), and microcephaly occurred in 2015. Number of suspected cases of microcephaly peaked after a lag of 30–33 weeks from the AEI peak, which corresponded to time of potential infections of pregnant mothers during the first trimester. These findings support the association of GBS and microcephaly with Zika virus infection and provide evidence for a temporal relationship between timing of arboviral infection of pregnant women during the first trimester and birth outcome. Clinical evidence increasingly supports an association of prenatal Zika virus infection with birth of babies with microcephaly, and other neurologic and ophthalmologic complications, as well as miscarriages and stillbirths [12,13,14,15,16,17]
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