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2.
Emerg Infect Dis ; 25(8): 1560-1562, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310228

RESUMO

To determine completeness of fatal congenital Zika syndrome reporting in Mexico, we examined data from the Mexican National Institute of Statistics and Geography. We found that an estimated 50% more infants died from microcephaly attributable to congenital Zika syndrome during 2016-2017 than were reported by the existing surveillance system.


Assuntos
Notificação de Doenças/estatística & dados numéricos , Infecção por Zika virus/epidemiologia , Infecção por Zika virus/virologia , Zika virus , Feminino , História do Século XXI , Humanos , Lactente , Mortalidade Infantil , México/epidemiologia , Microcefalia/epidemiologia , Microcefalia/etiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/história
3.
Eur J Pediatr ; 178(7): 1005-1011, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053953

RESUMO

Untreated phenylketonuria (PKU) in pregnancy causes a severe embryopathy called maternal PKU syndrome. Here, we aimed to assess management issues and pregnancy outcomes in the first published series of PKU pregnancies from the developing world. Data were collected retrospectively in a single center from 71 pregnancies and 45 live births of 32 women with PKU, 11 of whom were diagnosed in adulthood after having an affected child. Microcephaly, intellectual disability, and dysmorphic facies were more prevalent in offspring of untreated than treated pregnancies with classical PKU (100% vs. 0%, 91% vs. 0%, and 73% vs. 23% with p < 0.001, p < 0.001, and p = 0.037, respectively). In treated pregnancies, phenylalanine levels were higher during weeks 6-14 than other periods of gestation (4.38 vs. 3.93, 2.00 and 2.28 mg/dl; p < 0.05). Poor compliance correlated with higher phenylalanine levels (ρ = - 0.64, p = 0.019) and fluctuations (ρ = - 0.66, p = 0.014).Conclusion: More frequent phenylalanine measurements during late first trimester are crucial to improve outcomes in treated pregnancies. In order to prevent untreated pregnancies via detecting undiagnosed adults, countries where significantly many women of childbearing age were not screened as newborns may consider pre-pregnancy PKU screening. Microcephaly in the newborn should prompt screening for PKU in the mother. What Is Known •Untreated phenylketonuria during pregnancy causes maternal phenylketonuria syndrome in the newborn. •Effective treatment throughout pregnancy can prevent adverse fetal outcomes. What Is New: •Metabolic control is related to frequency of follow-up and worsens during late first trimester. Closer follow-up during this period may improve metabolic control. •In order to prevent untreated pregnancies, pre-pregnancy phenylketonuria screening may be considered if many women of childbearing age were not screened as newborns.


Assuntos
Fenilcetonúria Materna/epidemiologia , Resultado da Gravidez/epidemiologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/etiologia , Microcefalia/epidemiologia , Microcefalia/etiologia , Fenilcetonúria Materna/diagnóstico , Gravidez , Estudos Retrospectivos , Turquia/epidemiologia
4.
PLoS Med ; 16(3): e1002755, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30835728

RESUMO

BACKGROUND: In 2015, high rates of microcephaly were reported in Northeast Brazil following the first South American Zika virus (ZIKV) outbreak. Reported microcephaly rates in other Zika-affected areas were significantly lower, suggesting alternate causes or the involvement of arboviral cofactors in exacerbating microcephaly rates. METHODS AND FINDINGS: We merged data from multiple national reporting databases in Brazil to estimate exposure to 9 known or hypothesized causes of microcephaly for every pregnancy nationwide since the beginning of the ZIKV outbreak; this generated between 3.6 and 5.4 million cases (depending on analysis) over the time period 1 January 2015-23 May 2017. The association between ZIKV and microcephaly was statistically tested against models with alternative causes or with effect modifiers. We found no evidence for alternative non-ZIKV causes of the 2015-2017 microcephaly outbreak, nor that concurrent exposure to arbovirus infection or vaccination modified risk. We estimate an absolute risk of microcephaly of 40.8 (95% CI 34.2-49.3) per 10,000 births and a relative risk of 16.8 (95% CI 3.2-369.1) given ZIKV infection in the first or second trimester of pregnancy; however, because ZIKV infection rates were highly variable, most pregnant women in Brazil during the ZIKV outbreak will have been subject to lower risk levels. Statistically significant associations of ZIKV with other birth defects were also detected, but at lower relative risks than that of microcephaly (relative risk < 1.5). Our analysis was limited by missing data prior to the establishment of nationwide ZIKV surveillance, and its findings may be affected by unmeasured confounding causes of microcephaly not available in routinely collected surveillance data. CONCLUSIONS: This study strengthens the evidence that congenital ZIKV infection, particularly in the first 2 trimesters of pregnancy, is associated with microcephaly and less frequently with other birth defects. The finding of no alternative causes for geographic differences in microcephaly rate leads us to hypothesize that the Northeast region was disproportionately affected by this Zika outbreak, with 94% of an estimated 8.5 million total cases occurring in this region, suggesting a need for seroprevalence surveys to determine the underlying reason.


Assuntos
Surtos de Doenças , Microcefalia/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Microcefalia/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Fatores de Risco , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/transmissão
5.
PLoS Negl Trop Dis ; 13(3): e0007246, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30856223

RESUMO

Laboratory confirmation of Zika virus (ZIKV) infection during pregnancy is challenging due to cross-reactivity with dengue virus (DENV) and limited knowledge about the kinetics of anti-Zika antibody responses during pregnancy. We described ZIKV and DENV serological markers and the maternal-fetal transfer of antibodies among mothers and neonates after the ZIKV microcephaly outbreak in Northeast Brazil (2016). We included 89 microcephaly cases and 173 neonate controls at time of birth and their mothers. Microcephaly cases were defined as newborns with a particular head circumference (2 SD below the mean). Two controls without microcephaly were matched by the expected date of delivery and area of residence. We tested maternal serum for recent (ZIKV genome, IgM and IgG3 anti-NS1) and previous (ZIKV and DENV neutralizing antibodies [NAbs]) markers of infection. Multiple markers of recent or previous ZIKV and DENV infection in mothers were analyzed using principal component analysis (PCA). At delivery, 5.6% of microcephaly case mothers and 1.7% of control mothers were positive for ZIKV IgM. Positivity for ZIKV IgG3 anti-NS1 was 8.0% for case mothers and 3.5% for control mothers. ZIKV NAbs was slightly higher among mothers of cases (69.6%) than that of mothers of controls (57.2%; p = 0.054). DENV exposure was detected in 85.8% of all mothers. PCA discriminated two distinct components related to recent or previous ZIKV infection and DENV exposure. ZIKV NAbs were higher in newborns than in their corresponding mothers (p<0.001). We detected a high frequency of ZIKV exposure among mothers after the first wave of the ZIKV outbreak in Northeast Brazil. However, we found low sensitivity of the serological markers to recent infection (IgM and IgG3 anti-NS1) in perinatal samples of mothers of microcephaly cases. Since the neutralization test cannot precisely determine the time of infection, testing for ZIKV immune status should be performed as early as possible and throughout pregnancy to monitor acute Zika infection in endemic areas.


Assuntos
Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Dengue/diagnóstico , Microcefalia/epidemiologia , Microcefalia/etiologia , Complicações Infecciosas na Gravidez/diagnóstico , Infecção por Zika virus/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Dengue/epidemiologia , Vírus da Dengue/imunologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Adulto Jovem , Zika virus/imunologia , Infecção por Zika virus/complicações , Infecção por Zika virus/epidemiologia
6.
J Neonatal Perinatal Med ; 12(2): 127-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30741696

RESUMO

BACKGROUND: Perinatal asphyxia is a prominent cause of neonatal mortality in the developing world. Growth in head circumference is associated with improved neurodevelopment. Previous studies found a positive correlation between additional dietary supplementation and growth in head circumference among newborns with perinatal brain injury. This study aims to evaluate the association between anthropometric parameters and developmental outcomes in newborns with hypoxic ischemic encephalopathy (HIE). METHODS: Newborns at ≥36 weeks gestation with moderate to severe HIE were included in the study and growth parameters were monitored. Newborns with life-threatening anomalies were excluded. None of the study participants received therapeutic hypothermia (TH). Developmental Assessment Scale for Indian Infants (DASII) was used to evaluate neurodevelopmental outcomes at 1 year of age. RESULTS: Of 76 study participants, 46 were followed for 12 months, 28 died, and 2 were lost to follow-up. HIE stage III, Apgar score <5 at 5 minutes of age, pH ≤ 7.1 on first blood gas and base deficit > - 16 was associated with death or disability at 1 year of age. All anthropometric parameters were significantly lower in presence of death or disability. pH ≤ 7.1 at birth (odds ratio: 11.835, 95% CI 2.273-61.629, p = 0.003) and weight gain at one year (odds ratio 1.001, 95% CI 1.000-1.002, p = 0.03) were significantly associated with death and disability. CONCLUSION: pH > 7.1 at birth, and weight gain were associated with better neurodevelopmental outcomes at 1 year of age. Thus, in addition to TH, nutritional interventions may potentially improve outcomes among newborns with HIE.


Assuntos
Asfixia Neonatal/fisiopatologia , Peso Corporal , Cefalometria , Desenvolvimento Infantil , Cabeça/crescimento & desenvolvimento , Hipóxia-Isquemia Encefálica/fisiopatologia , Ganho de Peso , Antropometria , Anticonvulsivantes/uso terapêutico , Asfixia Neonatal/complicações , Gasometria , Paralisia Cerebral/epidemiologia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hipóxia-Isquemia Encefálica/complicações , Índia , Lactente , Recém-Nascido , Masculino , Microcefalia/epidemiologia , Convulsões/tratamento farmacológico , Convulsões/epidemiologia , Índice de Gravidade de Doença
7.
PLoS One ; 14(2): e0212507, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789944

RESUMO

Zika virus infection during pregnancy can cause microcephaly and other birth defects. We hypothesized that the Latin America Zika epidemic resulted in pregnant women and their partners adopting behavioral changes to limit risk, leading them to forego travel to Zika-affected locations. We evaluated this hypothesis by studying travelers' intent and behavior through Twitter data related to babymoon: a holiday taken by parents-to-be before their baby is born. We found the odds of mentioning representative Zika-affected locations in #babymoon tweets dropped significantly (Odds ratio: 0.29, 95% CI: 0.20-0.40) after the Zika-microcephaly association became well-known. This result was further corroborated through a content analysis of #babymoon tweets mentioning Zika-affected locations, which identified if the Twitter user was physically present in the Zika-affected locations. Conversely, we found a small but statistically insignificant increase in the odds of mentioning Zika-free locations from #babymoon tweets (Odds Ratio: 1.11, 95% CI: 0.97-1.27) after the Zika-microcephaly association became well-known.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Mídias Sociais , Viagem , Infecção por Zika virus/complicações , Infecção por Zika virus/epidemiologia , Feminino , Humanos , Recém-Nascido , América Latina/epidemiologia , Masculino , Microcefalia/epidemiologia , Microcefalia/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Comportamento de Redução do Risco , Viagem/estatística & dados numéricos , Infecção por Zika virus/prevenção & controle
8.
Artigo em Inglês | MEDLINE | ID: mdl-30678125

RESUMO

Zika virus (ZIKV) infection appeared in Brazil in 2015, causing an epidemic outbreak with increased rates of microcephaly and other serious birth disorders. We reviewed 102 cases of children who were diagnosed with microcephaly at birth and who had gestational exposure to ZIKV during the outbreak. We describe the clinical, neuroimaging, and neurophysiological findings. Most mothers (81%) reported symptoms of ZIKV infection, especially cutaneous rash, during the first trimester of pregnancy. The microcephaly was severe in 54.9% of the cases. All infants presented with brain malformations. The most frequent neuroimaging findings were cerebral atrophy (92.1%), ventriculomegaly (92.1%), malformation of cortical development (85.1%), and cortical⁻subcortical calcifications (80.2%). Abnormalities in neurological exams were found in 97.0% of the cases, epileptogenic activity in 56.3%, and arthrogryposis in 10.8% of the infants. The sensorineural screening suggested hearing loss in 17.3% and visual impairment in 14.1% of the infants. This group of infants who presented with microcephaly and whose mothers were exposed to ZIKV early during pregnancy showed clinical and radiological criteria for congenital ZIKV infection. A high frequency of brain abnormalities and signs of early neurological disorders were found, and epileptogenic activity and signs of sensorineural alterations were common. This suggests that microcephaly can be associated with a worst spectrum of neurological manifestations.


Assuntos
Microcefalia/patologia , Microcefalia/fisiopatologia , Infecção por Zika virus/congênito , Brasil/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Microcefalia/diagnóstico , Microcefalia/epidemiologia , Neuroimagem , Exame Neurológico , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia
10.
Am J Obstet Gynecol ; 220(1): 45-56, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30171843

RESUMO

Zika virus is a mosquito-transmitted flavivirus and was first linked to congenital microcephaly caused by a large outbreak in northeastern Brazil. Although the Zika virus epidemic is now in decline, pregnancies in large parts of the Americas remain at risk because of ongoing transmission and the potential for new outbreaks. This review presents why Zika virus is still a complex and worrisome public health problem with an expanding spectrum of birth defects and how Zika virus and related viruses evade the immune response to injure the fetus. Recent reports indicate that the spectrum of fetal brain and other anomalies associated with Zika virus exposure is broader and more complex than microcephaly alone and includes subtle fetal brain and ocular injuries; thus, the ability to prenatally diagnose fetal injury associated with Zika virus infection remains limited. New studies indicate that Zika virus imparts disproportionate effects on fetal growth with an unusual femur-sparing profile, potentially providing a new approach to identify viral injury to the fetus. Studies to determine the limitations of prenatal and postnatal testing for detection of Zika virus-associated birth defects and long-term neurocognitive deficits are needed to better guide women with a possible infectious exposure. It is also imperative that we investigate why the Zika virus is so adept at infecting the placenta and the fetal brain to better predict other viruses with similar capabilities that may give rise to new epidemics. The efficiency with which the Zika virus evades the early immune response to enable infection of the mother, placenta, and fetus is likely critical for understanding why the infection may either be fulminant or limited. Furthermore, studies suggest that several emerging and related viruses may also cause birth defects, including West Nile virus, which is endemic in many parts of the United States. With mosquito-borne diseases increasing worldwide, there remains an urgent need to better understand the pathogenesis of the Zika virus and related viruses to protect pregnancies and child health.


Assuntos
Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/virologia , Surtos de Doenças , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Anormalidades Congênitas/diagnóstico , Feminino , Saúde Global , Humanos , Recém-Nascido , Microcefalia/epidemiologia , Microcefalia/virologia , Gravidez , Prevalência , Medição de Risco , Estados Unidos/epidemiologia , Infecção por Zika virus/complicações , Infecção por Zika virus/prevenção & controle
11.
Birth Defects Res ; 111(2): 96-118, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30584689

RESUMO

BACKGROUND: The Zika epidemic has brought increased attention to congenital microcephaly as a birth outcome. However, little is known about risks for microcephaly unrelated to Zika. METHODS: Using data from the Slone Epidemiology Center Birth Defects Study from 1993 to 2015, we identified 57 cases of microcephaly alone ("isolated") and 109 cases of microcephaly that included other major birth defects ("non-isolated"), and considered a large number of potential risk factors including demographic characteristics, illnesses, and medications used during pregnancy. Where numbers permitted, we used logistic regression models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: Substantial differences in risk factors were observed for isolated versus non-isolated microcephaly. For isolated microcephaly, risk estimates were elevated for mothers of non-Hispanic, non-White race/ethnicity, and underweight pre-pregnancy body mass index (BMI). The risk for exposure anytime in pregnancy to acetaminophen was null; in contrast, the aOR for NSAIDs was 2.4 (95% CI: 1.3-4.2). This association was weakened (but not eliminated) after excluding those exposed to opioids or illicit drugs, and risk was not present among those reporting less frequent exposures. For non-isolated microcephaly, elevated risk estimates were found for urinary tract infection. CONCLUSIONS: Risk factors differed for isolated and non-isolated microcephaly. While some findings support previously reported associations, (e.g., smoking, alcohol, underweight BMI), we also identified risk factors not previously described, notably NSAID use for isolated microcephaly and urinary tract infection for non-isolated microcephaly; however, these results should be viewed as hypothesis generating.


Assuntos
Microcefalia/epidemiologia , Microcefalia/etiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Mães , Razão de Chances , Gravidez , Fatores de Risco , Adulto Jovem , Zika virus , Infecção por Zika virus/epidemiologia
12.
P R Health Sci J ; 37(Spec Issue): S66-S72, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30576580

RESUMO

The world has encountered a new and serious epidemic which has disproportionately affected fetuses and infants. What makes the Zika virus (ZIKV) epidemic such a threat in our times, is that a whole generation can be affected by birth defects caused by a seemingly innocuous maternal infection, which in most cases go unnoticed and undiagnosed. Spreading to over 80 countries and affecting millions, it is associated with severe birth defects known as congenital Zika syndrome (CZS), which include fetal brain development abnormalities (microcephaly and brain calcifications), retinal abnormalities, and contractures and hypertonia of the extremities. Testing strategies are challenging because of the lack of symptoms and cross reactivity with other viral infections. Obstetrical complications include fetal loss and the need for an emergency cesarean delivery. The rate of CZS has been described as ranging from 5 to 6% among cohorts in the US, reaching 11% for 1st trimester exposure. Prolonged viremia during pregnancy has been documented in a few cases, reaching 89 days after the onset of symptoms in one case and 109 days after such onset in another. If the ZIKV can infect, multiply in, and persist in diverse placental cells, then movement across the placenta, the fetal brain, and the maternal peripheral blood is possible. There is a sense of urgency, and we need safe and effective vaccines and treatments, particularly for pregnant women. If we do not expand testing and develop methods for early diagnosis and treatment, thousands of infants will be exposed to a neurotropic virus that causes severe birth defects and that could also affect the lives of those who form the next generation.


Assuntos
Anormalidades Congênitas/virologia , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/epidemiologia , Encéfalo/anormalidades , Encéfalo/virologia , Anormalidades Congênitas/epidemiologia , Epidemias , Feminino , Humanos , Recém-Nascido , Microcefalia/epidemiologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico
13.
P R Health Sci J ; 37(Spec Issue): S73-S76, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30576581

RESUMO

OBJECTIVE: Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants. METHODS: Retrospective medical record review of infants born to mothers with confirmed ZIKV infection during pregnancy was performed from January 2016-June 2017. We included patients admitted to UPH Neonatal Intensive Care Unit or referred for follow-up at UPH High Risk Clinics. The database was approved by the University of Puerto Rico, Medical Sciences Campus, IRB. RESULTS: 191 infants born to ZIKV positive mothers during pregnancy were identified. Normal head sonogram was found in 93% of the normo cephalic infants. Ocular findings were reported in 50% of the patients with microcephaly and 31% of the normo-cephalics. Fifteen newborns (7.8%) presented with microcephaly, of which 73% showed calcifications in head sonogram, and had severe anomalies on brain MRI. Auditory brainstem response test was performed on all newborns, 80% were within normal limits. CONCLUSION: Among the group of infants born to mothers with Zika positive test 4% had microcephaly. Of concern to us is the fact that 31% of normo cephalic infants had ocular manifestations and 7% of them had findings on head sonogram. While microcephaly is the severest form of Congenital Zika Syndrome, ocular manifestations might characterize the spectrum of disease. These findings reiterate the importance of detailed neonatal evaluations of exposed infants.


Assuntos
Encéfalo/anormalidades , Microcefalia/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/epidemiologia , Encéfalo/diagnóstico por imagem , Encéfalo/virologia , Bases de Dados Factuais , Anormalidades do Olho/epidemiologia , Anormalidades do Olho/virologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Imagem por Ressonância Magnética , Microcefalia/virologia , Gravidez , Porto Rico , Estudos Retrospectivos , Infecção por Zika virus/congênito
14.
P R Health Sci J ; 37(Spec Issue): S77-S80, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30576582

RESUMO

OBJECTIVE: After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in all newborns exposed to ZIKV prenatally has been emphasized because of a chorioretinal macular scar found in a number normocephalic patient exposed to ZIKV. METHODS: A retrospective review of the medical records of infants born to mothers found to be ZIKV-positive during their pregnancies (January 2016-July 2017) was performed. We included all newborns and infants admitted to the NICU and/or receiving ambulatory care at the high-risk clinics at the University Pediatric Hospital, San Juan, Puerto Rico. The creation of this database was approved by the IRB of the University of Puerto Rico, Medical Sciences Campus. RESULTS: Records from 234 newborns born to Zika-positive mothers were identified. The ophthalmic evaluations of 95 patients were available. Sixty-three of them had normal findings (66%). Twelve of the 95 patients had microcephaly (12.6% of the cohort). Of the microcephalic group, half had normal ophthalmological findings. Of the normocephalic group (83/95), almost 31% had ocular findings: a small optic nerve in 3%, a double-ring sign in 10%, macular stippling in 8%, mottling in 4%, an oval optic nerve in 2%, a tilted nerve in 1%, and blunted foveal reflex in 1%. CONCLUSION: We report herein ZIKV associated ophthalmologic findings, similar to those published, in 34% of the infants with suspected/confirmed ZIKV fetal exposure. These data underline the importance of ocular examination in patients with suspected congenital Zika but without other findings on physical exam.


Assuntos
Anormalidades do Olho/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/congênito , Brasil , Estudos de Coortes , Anormalidades do Olho/virologia , Feminino , Humanos , Recém-Nascido , Masculino , Microcefalia/epidemiologia , Microcefalia/virologia , Triagem Neonatal/métodos , Fenótipo , Gravidez , Porto Rico , Estudos Retrospectivos , Infecção por Zika virus/transmissão
15.
PLoS Negl Trop Dis ; 12(12): e0006991, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30532143

RESUMO

BACKGROUND: A significant increase in microcephaly incidence was reported in Northeast Brazil at the end of 2015, which has since been attributed to an epidemic of Zika virus (ZIKV) infections earlier that year. Further incidence of congenital Zika syndrome (CZS) was expected following waves of ZIKV infection throughout Latin America; however, only modest increases in microcephaly and CZS incidence have since been observed. The quantitative relationship between ZIKV infection, gestational age and congenital outcome remains poorly understood. METHODOLOGY/PRINCIPLE FINDINGS: We characterised the gestational-age-varying risk of microcephaly given ZIKV infection using publicly available incidence data from multiple locations in Brazil and Colombia. We found that the relative timings and shapes of ZIKV infection and microcephaly incidence curves suggested different gestational risk profiles for different locations, varying in both the duration and magnitude of gestational risk. Data from Northeast Brazil suggested a narrow window of risk during the first trimester, whereas data from Colombia suggested persistent risk throughout pregnancy. We then used the model to estimate which combination of behavioural and reporting changes would have been sufficient to explain the absence of a second microcephaly incidence wave in Bahia, Brazil; a population for which we had two years of data. We found that a 18.9-fold increase in ZIKV infection reporting rate was consistent with observed patterns. CONCLUSIONS: Our study illustrates how surveillance data may be used in principle to answer key questions in the absence of directed epidemiological studies. However, in this case, we suggest that currently available surveillance data are insufficient to accurately estimate the gestational-age-varying risk of microcephaly from ZIKV infection. The methods used here may be of use in future outbreaks and may help to inform improved surveillance and interpretation in countries yet to experience an outbreak of ZIKV infection.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Zika virus/fisiologia , Adulto , Brasil/epidemiologia , Colômbia/epidemiologia , Monitoramento Epidemiológico , Feminino , Humanos , Lactente , Masculino , Microcefalia/epidemiologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/virologia
17.
JCI Insight ; 3(21)2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30385728

RESUMO

BACKGROUND: An intricate fetal-maternal immune crosstalk during pregnancy is essential for a healthy birth. Hence, the infection-induced alterations of maternal immunity often lead to adverse outcomes for mother and/or child. The emergence of Zika virus (ZIKV) infection in pregnant women has been associated with more than 3,000 cases of microcephaly and nervous system malformations. METHODS: To explore the potential correlation of ZIKV-induced alteration of maternal immunity with fetal abnormalities, we performed extensive sera immunoprofiling of 74 pregnant women: 30 symptomatic ZIKV+ pregnant patients and 30 healthy pregnant controls in ZIKV-endemic Rio de Janeiro, along with 14 healthy pregnant controls in non-endemic Los Angeles. RESULTS: Extensive multiplexing analysis of 69 cytokines revealed that CXCL10, CCL2, and CCL8 chemokines were specifically associated with symptomatic ZIKV+ infection during pregnancy, and distinct immunoprofiles were detected at different trimesters in ZIKV-infected pregnant women. Intriguingly, the high CCL2 level and its inverse correlation with CD163, TNFRSF1A, and CCL22 levels was apparently associated with ZIKV-induced abnormal birth. CONCLUSION: Our findings provide insights into the alteration of ZIKV-elicited maternal immunity, serving as a potential clinical biomarker platform. FUNDING: NIH (CA200422, CA180779, DE023926, AI073099, AI116585, AI129496, AI140705, AI069120, AI056154, AI078389, AI28697, AI40718 and AI129534-01), Hastings Foundation, Fletcher Jones Foundation, Departamento de Ciência e Tecnologia (DECIT/25000.072811/2016-17) do Ministério da Saúde do Brasil, and Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior CAPES/88887.116627/2016-01.


Assuntos
Biomarcadores/metabolismo , Feto/anormalidades , Microcefalia/etiologia , Infecção por Zika virus/metabolismo , Zika virus/imunologia , Adolescente , Adulto , Biomarcadores/sangue , Brasil/epidemiologia , Citocinas/sangue , Citocinas/metabolismo , Feminino , Feto/metabolismo , Feto/virologia , Voluntários Saudáveis , Humanos , Imunidade Materno-Adquirida/fisiologia , Microcefalia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Trimestres da Gravidez , Estados Unidos/epidemiologia , Adulto Jovem , Infecção por Zika virus/complicações , Infecção por Zika virus/epidemiologia
18.
Rev Assoc Med Bras (1992) ; 64(7): 635-642, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30365666

RESUMO

AIM: the present study analysed the association between Zika-virus and microcephaly during the gestational period of women in Brazil. METHODOLOGY: Systematic reviews of intervention research, current publications of clinical investigations were used systematic search strategies in three electronic databases PubMed, SciELO and Google academic. The following keywords were used: Microcephaly, gestation, Zika-virus to perform the search, and 1020 articles were obtained after exclusion, 45 were left and 35 were eligible. The collection period was from 2004 to 2017. RESULTS: Epidemiological data suggest a temporal association between the quantitative increase and the Zika-virus epidemic, especially in Northeast Brazil. It is not consensual to measure the cephalic perimeter curve to be considered. CONCLUSION: Given this, the application of techniques to accurately diagnose the relationship between causes and effects in the pathogenesis of Zika virus infection in the central nervous system should be prioritized.


Assuntos
Microcefalia/epidemiologia , Microcefalia/virologia , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Infecção por Zika virus/complicações , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Surtos de Doenças , Feminino , Humanos , Microcefalia/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Zika virus/isolamento & purificação , Infecção por Zika virus/diagnóstico
19.
Epidemiol Serv Saude ; 27(3): e2018008, 2018 10 22.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30365695

RESUMO

OBJECTIVE: to describe congenital anomalies (CA) among live births of mothers resident in Tangará da Serra, MT, Brazil, during the period 2006-2016. METHODS: this was a descriptive study, using Brazilian Live Birth Information System (SINASC) data. RESULTS: out of 15,689 births, 77 were registered with CA (prevalence of 4.9/1,000); there was an 80.7% increase of recorded CA in 2016, accounting for 10.3/1,000 live births, including five cases of microcephaly; CA prevalence was higher among children born to women aged over 35 years (prevalence ratio [PR] =1.91; confidence interval [95%CI] 1.01;3.60), preterm (PR=2.22; 95%CI 1.26;3.92) and low birth weight infants (PR=3.21; 95%CI 1.86;5.54). CONCLUSION: low CA prevalence was found, possibly related to under-recording at birth; the increase observed in 2016 may be related to the Zika epidemic causing microcephaly, as well as greater attention by health professionals in relation to CA during this public health emergency.


Assuntos
Anormalidades Congênitas/epidemiologia , Microcefalia/epidemiologia , Resultado da Gravidez , Infecção por Zika virus/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Idade Materna , Microcefalia/virologia , Gravidez , Prevalência , Fatores de Risco , Infecção por Zika virus/complicações
20.
Epidemiol Serv Saude ; 27(3): e2017382, 2018 10 22.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30365699

RESUMO

OBJECTIVE: to characterize cases of congenital syndrome associated with Zika virus infection (CZS) and other infectious etiologies, resident in the state of São Paulo, Brazil, from October 30, 2015, to June 30, 2017. METHODS: this was a descriptive study of suspected cases of CZS and other infectious etiologies notified on the Public Health Events Registry. RESULTS: 960 cases were investigated up to epidemiological week 26/2017, and 146 were confirmed for congenital infection; of these, 59 (40.4%) were confirmed for congenital infection without etiological identification and 87 (59.6%) with laboratory confirmation, of which 55 were congenital syndrome associated with Zika virus and 32 were congenital syndrome associated with other infectious agents. CONCLUSION: this study enabled the detection of 23.9% CZS cases among suspected cases of infectious etiology.


Assuntos
Anormalidades Congênitas/epidemiologia , Microcefalia/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Anormalidades Congênitas/virologia , Feminino , Humanos , Recém-Nascido , Masculino , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Sistema de Registros , Síndrome , Infecção por Zika virus/complicações , Infecção por Zika virus/congênito
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