BACKGROUND: 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. METHODS: 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. FINDINGS: 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.
BACKGROUND: 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. METHODS: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 ZIKVinfection in pregnancy. FINDINGS: 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.
Authors: Marli T Cordeiro; Carlos A A Brito; Lindomar J Pena; Priscila M S Castanha; Laura H V G Gil; Kennya G S Lopes; Rafael Dhalia; Jucille A Meneses; Ana C Ishigami; Luisa M Mello; Liciana X E Alencar; Klarissa M Guarines; Laura C Rodrigues; Ernesto T A Marques Journal: J Infect Dis Date: 2016-10-05 Impact factor: 5.226
Authors: M L Nogueira; N R R Nery Júnior; C F Estofolete; A C Bernardes Terzian; G F Guimarães; N Zini; R Alves da Silva; G C Dutra Silva; L C Junqueira Franco; P Rahal; C Bittar; B Carneiro; P F C Vasconcelos; D Freitas Henriques; D M U Barbosa; P Lopes Rombola; L de Grande; A F Negri Reis; S A Palomares; M Wakai Catelan; L E A A Cruz; S H Necchi; R C V Mendonça; I N Penha Dos Santos; S B Alavarse Caron; F Costa; F A Bozza; A Soares de Souza; C C Brandão de Mattos; L C de Mattos; N Vasilakis; A H Oliani; D C M Vaz Oliani; A I Ko Journal: Clin Microbiol Infect Date: 2017-11-10 Impact factor: 8.067
Authors: Margaret A Honein; April L Dawson; Emily E Petersen; Abbey M Jones; Ellen H Lee; Mahsa M Yazdy; Nina Ahmad; Jennifer Macdonald; Nicole Evert; Andrea Bingham; Sascha R Ellington; Carrie K Shapiro-Mendoza; Titilope Oduyebo; Anne D Fine; Catherine M Brown; Jamie N Sommer; Jyoti Gupta; Philip Cavicchia; Sally Slavinski; Jennifer L White; S Michele Owen; Lyle R Petersen; Coleen Boyle; Dana Meaney-Delman; Denise J Jamieson Journal: JAMA Date: 2017-01-03 Impact factor: 56.272
Authors: Carrie K Shapiro-Mendoza; Marion E Rice; Romeo R Galang; Anna C Fulton; Kelley VanMaldeghem; Miguel Valencia Prado; Esther Ellis; Magele Scott Anesi; Regina M Simeone; Emily E Petersen; Sascha R Ellington; Abbey M Jones; Tonya Williams; Sarah Reagan-Steiner; Janice Perez-Padilla; Carmen C Deseda; Andrew Beron; Aifili John Tufa; Asher Rosinger; Nicole M Roth; Caitlin Green; Stacey Martin; Camille Delgado Lopez; Leah deWilde; Mary Goodwin; H Pamela Pagano; Cara T Mai; Carolyn Gould; Sherif Zaki; Leishla Nieves Ferrer; Michelle S Davis; Eva Lathrop; Kara Polen; Janet D Cragan; Megan Reynolds; Kimberly B Newsome; Mariam Marcano Huertas; Julu Bhatangar; Alma Martinez Quiñones; John F Nahabedian; Laura Adams; Tyler M Sharp; W Thane Hancock; Sonja A Rasmussen; Cynthia A Moore; Denise J Jamieson; Jorge L Munoz-Jordan; Helentina Garstang; Afeke Kambui; Carolee Masao; Margaret A Honein; Dana Meaney-Delman Journal: MMWR Morb Mortal Wkly Rep Date: 2017-06-16 Impact factor: 17.586
Authors: Mariana C Leal; Vanessa van der Linden; Thiago P Bezerra; Luciana de Valois; Adriana C G Borges; Margarida M C Antunes; Kátia G Brandt; Catharina X Moura; Laura C Rodrigues; Coeli R Ximenes Journal: Emerg Infect Dis Date: 2017-08-15 Impact factor: 6.883
Authors: Megan R Reynolds; Abbey M Jones; Emily E Petersen; Ellen H Lee; Marion E Rice; Andrea Bingham; Sascha R Ellington; Nicole Evert; Sarah Reagan-Steiner; Titilope Oduyebo; Catherine M Brown; Stacey Martin; Nina Ahmad; Julu Bhatnagar; Jennifer Macdonald; Carolyn Gould; Anne D Fine; Kara D Polen; Heather Lake-Burger; Christina L Hillard; Noemi Hall; Mahsa M Yazdy; Karnesha Slaughter; Jamie N Sommer; Alys Adamski; Meghan Raycraft; Shannon Fleck-Derderian; Jyoti Gupta; Kimberly Newsome; Madelyn Baez-Santiago; Sally Slavinski; Jennifer L White; Cynthia A Moore; Carrie K Shapiro-Mendoza; Lyle Petersen; Coleen Boyle; Denise J Jamieson; Dana Meaney-Delman; Margaret A Honein Journal: MMWR Morb Mortal Wkly Rep Date: 2017-04-07 Impact factor: 17.586
Authors: Demócrito de Barros Miranda-Filho; Elizabeth B Brickley; Anna Ramond; Celina Maria Turchi Martelli; Nuria Sanchez Clemente; Thália Velho Barreto de Araújo; Laura Cunha Rodrigues; Ulisses Ramos Montarroyos; Wayner Vieira de Souza; Maria de Fátima P M de Albuquerque; Liana O Ventura; Ernesto T A Marques; Mariana C Leal; Sophie H Eickmann; Maria Angela Wanderley Rocha; Paula Fabiana Sobral da Silva; Maria Durce Costa Gomes Carvalho; Regina Coeli F Ramos; Danielle Maria da Silva Oliveira; Morgana do Nascimento Xavier; Rômulo A L Vasconcelos; Andreia Veras Gonçalves; Alessandra Mertens Brainer; Marli Tenório Cordeiro; Ricardo Arraes de Alencar Ximenes Journal: Viruses Date: 2021-04-01 Impact factor: 5.048
Authors: Paula Fabiana Sobral da Silva; Sophie Helena Eickmann; Ricardo Arraes de Alencar Ximenes; Celina Maria Turchi Martelli; Elizabeth B Brickley; Marília C Lima; Ulisses R Montarroyos; Maria Durce Costa Gomes de Carvalho; Laura Cunha Rodrigues; Thalia Velho Barreto de Araújo; Liana O Ventura; Danielle Maria da Silva Oliveira; Regina Coeli Ferreira Ramos; Demócrito de Barros Miranda-Filho Journal: Viruses Date: 2021-07-22 Impact factor: 5.048
Authors: Ellie K Bohm; Jennifer T Vangorder-Braid; Anna S Jaeger; Ryan V Moriarty; John J Baczenas; Natalie C Bennett; Shelby L O'Connor; Michael K Fritsch; Nicole A Fuhler; Kevin K Noguchi; Matthew T Aliota Journal: J Virol Date: 2021-08-11 Impact factor: 5.103
Authors: Ludmila Lobkowicz; Grace M Power; Wayner Vieira De Souza; Ulisses Ramos Montarroyos; Celina Maria Turchi Martelli; Thalia Velho Barreto de Araùjo; Luciana Caroline Albuquerque Bezerra; Rafael Dhalia; Ernesto T A Marques; Demócrito de Barros Miranda-Filho; Elizabeth B Brickley; Ricardo Arraes de Alencar Ximenes Journal: BMJ Glob Health Date: 2021-12
Authors: Annelies Wilder-Smith; Elizabeth B Brickley; Ricardo Arraes de Alencar Ximenes; Demócrito de Barros Miranda-Filho; Celina Maria Turchi Martelli; Tom Solomon; Bart C Jacobs; Carlos A Pardo; Lyda Osorio; Beatriz Parra; Suzannah Lant; Hugh J Willison; Sonja Leonhard; Lance Turtle; Maria Lúcia Brito Ferreira; Rafael Freitas de Oliveira Franca; Louis Lambrechts; Johan Neyts; Suzanne Kaptein; Rosanna Peeling; Deborah Boeras; James Logan; Helen Dolk; Ieda M Orioli; Andreas Neumayr; Trudie Lang; Bonny Baker; Eduardo Massad; Raman Preet Journal: Glob Health Action Date: 2021-10-26 Impact factor: 2.640
Authors: Grace M Power; Aisling M Vaughan; Luxi Qiao; Nuria Sanchez Clemente; Julia M Pescarini; Enny S Paixão; Ludmila Lobkowicz; Amber I Raja; André Portela Souza; Mauricio Lima Barreto; Elizabeth B Brickley Journal: BMJ Glob Health Date: 2022-04
Authors: Luxi Qiao; Celina M Turchi Martelli; Amber I Raja; Nuria Sanchez Clemente; Thalia Velho Barreto de Araùjo; Ricardo Arraes de Alencar Ximenes; Demócrito de Barros Miranda-Filho; Anna Ramond; Elizabeth B Brickley Journal: BMJ Glob Health Date: 2021-06