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

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-Ju...

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Published in:PLoS neglected tropical diseases 2021-03, Vol.15 (3), p.e0009216
Main Authors: Ximenes, Ricardo Arraes de Alencar, Miranda-Filho, Demócrito de Barros, Montarroyos, Ulisses Ramos, Martelli, Celina Maria Turchi, Araújo, Thalia Velho Barreto de, Brickley, Elizabeth, Albuquerque, Maria de Fátima Pessoa Militão de, Souza, Wayner Vieira, Ventura, Liana O, Ventura, Camila V, Gois, Adriana L, Leal, Mariana C, Oliveira, Danielle Maria da Silva, Eickmann, Sophie Helena, Carvalho, Maria Durce C G, Silva, Paula F S da, Rocha, Maria Angela Wanderley, Ramos, Regina Coeli Ferreira, Brandão-Filho, Sinval Pinto, Cordeiro, Marli Tenorio, Bezerra, Luciana Caroline Albuquerque, Dimech, George, Valongueiro, Sandra, Pires, Pedro, Castanha, Priscila Mayrelle da Silva, Dhalia, Rafael, Marques-Júnior, Ernesto Torres Azevedo, Rodrigues, Laura C
Format: Article
Language:English
Subjects:
Aquatic reptiles
Biology and Life Sciences
Birth defects
Cohorts
Data collection
Dysphagia
Epidemics
Exanthema
Health surveillance
Identification
Infections
Medical research
Medicine and Health Sciences
Methods
Microcephaly
Microencephaly
Neurological diseases
Pregnancy
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
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Description
Summary: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.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0009216