Simon Cauchemez1, Marianne Besnard2, Priscillia Bompard3, Timothée Dub4, Prisca Guillemette-Artur5, Dominique Eyrolle-Guignot6, Henrik Salje7, Maria D Van Kerkhove8, Véronique Abadie9, Catherine Garel10, Arnaud Fontanet11, Henri-Pierre Mallet3. 1. Mathematical Modelling of Infectious Diseases, Institut Pasteur, Paris, France. Electronic address: simon.cauchemez@pasteur.fr. 2. Neonatal Care Department, French Polynesia Hospital Centre, Pirae, Tahiti, French Polynesia. 3. Bureau de Veille Sanitaire, Direction de la Santé, Papeete, Tahiti, French Polynesia. 4. Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France. 5. Medical Imaging Department, French Polynesia Hospital Centre, Pirae, Tahiti, French Polynesia. 6. Gynecology-Obstetrics Department, French Polynesia Hospital Centre, Pirae, Tahiti, French Polynesia. 7. Mathematical Modelling of Infectious Diseases, Institut Pasteur, Paris, France; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA. 8. Centre for Global Health, Institut Pasteur, Paris, France. 9. General Paediatrics Department, Necker Hospital, Paris, France. 10. Department of Paediatric Radiology, Hôpital d'Enfants Armand-Trousseau, Paris, France. 11. Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France; Centre for Global Health, Institut Pasteur, Paris, France; Conservatoire National des Arts et Métiers, Paris, France.
Abstract
BACKGROUND: The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified. METHODS: We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk. FINDINGS: The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62-70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0-8) per 10,000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34-191) per 10,000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data. INTERPRETATION: Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus. FUNDING: Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.
BACKGROUND: The emergence of Zika virus in the Americas has coincided with increased reports of babies born with microcephaly. On Feb 1, 2016, WHO declared the suspected link between Zika virus and microcephaly to be a Public Health Emergency of International Concern. This association, however, has not been precisely quantified. METHODS: We retrospectively analysed data from a Zika virus outbreak in French Polynesia, which was the largest documented outbreak before that in the Americas. We used serological and surveillance data to estimate the probability of infection with Zika virus for each week of the epidemic and searched medical records to identify all cases of microcephaly from September, 2013, to July, 2015. Simple models were used to assess periods of risk in pregnancy when Zika virus might increase the risk of microcephaly and estimate the associated risk. FINDINGS: The Zika virus outbreak began in October, 2013, and ended in April, 2014, and 66% (95% CI 62-70) of the general population were infected. Of the eight microcephaly cases identified during the 23-month study period, seven (88%) occurred in the 4-month period March 1 to July 10, 2014. The timing of these cases was best explained by a period of risk in the first trimester of pregnancy. In this model, the baseline prevalence of microcephaly was two cases (95% CI 0-8) per 10,000 neonates, and the risk of microcephaly associated with Zika virus infection was 95 cases (34-191) per 10,000 women infected in the first trimester. We could not rule out an increased risk of microcephaly from infection in other trimesters, but models that excluded the first trimester were not supported by the data. INTERPRETATION: Our findings provide a quantitative estimate of the risk of microcephaly in fetuses and neonates whose mothers are infected with Zika virus. FUNDING: Labex-IBEID, NIH-MIDAS, AXA Research fund, EU-PREDEMICS.
Authors: Andrew J O Whitehouse; Stephen R Zubrick; Eve Blair; John P Newnham; Martha Hickey Journal: Arch Dis Child Date: 2010-10-04 Impact factor: 3.791
Authors: Michelle Silasi; Ingrid Cardenas; Ja-Young Kwon; Karen Racicot; Paula Aldo; Gil Mor Journal: Am J Reprod Immunol Date: 2015-01-13 Impact factor: 3.886
Authors: David L Heymann; Abraham Hodgson; Amadou Alpha Sall; David O Freedman; J Erin Staples; Fernando Althabe; Kalpana Baruah; Ghazala Mahmud; Nyoman Kandun; Pedro F C Vasconcelos; Silvia Bino; K U Menon Journal: Lancet Date: 2016-02-11 Impact factor: 79.321
Authors: Mathilde Guerbois; Ildefonso Fernandez-Salas; Sasha R Azar; Rogelio Danis-Lozano; Celia M Alpuche-Aranda; Grace Leal; Iliana R Garcia-Malo; Esteban E Diaz-Gonzalez; Mauricio Casas-Martinez; Shannan L Rossi; Samanta L Del Río-Galván; Rosa M Sanchez-Casas; Christopher M Roundy; Thomas G Wood; Steven G Widen; Nikos Vasilakis; Scott C Weaver Journal: J Infect Dis Date: 2016-07-19 Impact factor: 5.226
Authors: T Alex Perkins; Amir S Siraj; Corrine W Ruktanonchai; Moritz U G Kraemer; Andrew J Tatem Journal: Nat Microbiol Date: 2016-07-25 Impact factor: 17.745
Authors: Marko Culjat; Stephen E Darling; Vivek R Nerurkar; Natascha Ching; Mukesh Kumar; Sarah K Min; Rupa Wong; Leon Grant; Marian E Melish Journal: Clin Infect Dis Date: 2016-05-18 Impact factor: 9.079