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Auger N, Arbour L, Lewin A, Brousseau É, Healy-Profitós J, Luu TM. Congenital anomalies during Covid-19: artifact of surveillance or a real TORCH? Eur J Epidemiol 2024; 39:613-621. [PMID: 38589643 DOI: 10.1007/s10654-024-01122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
Infections in the first trimester of pregnancy can be teratogenic, but the possibility that Covid-19 could lead to birth defects is unclear. We examined whether SARS-CoV-2 infection during pregnancy or exposure to pandemic conditions were associated with the risk of congenital anomalies. We carried out a retrospective study of 420,222 neonates born in Quebec, Canada in two time periods: prepandemic (January 1, 2017 to March 12, 2020) vs. pandemic (March 13, 2020 to March 31, 2022). We classified pandemic births as early (first trimester completed before the pandemic) or late (first trimester during the pandemic), and identified patients with SARS-CoV-2 infections during pregnancy. We applied (1) adjusted log-binomial regression models to assess the association between SARS-CoV-2 infection and congenital anomalies, and (2) autoregressive interrupted time series regression to analyze temporal trends in the monthly number of defects in all patients regardless of infection. In total, 29,263 newborns (7.0%) had a congenital anomaly. First trimester SARS-CoV-2 infections were not associated with a greater risk of birth defects compared with no infection (RR 1.07, 95% CI 0.59-1.95). However, births during the late pandemic period were more likely to be diagnosed with congenital microcephaly compared with prepandemic births (RR 1.44, 95% CI 1.21-1.71). Interrupted time series analysis confirmed that the frequency of microcephaly increased during the late pandemic period, whereas other anomalies did not. We conclude that Covid-19 is likely not teratogenic, but enhanced surveillance of anomalies among late pandemic births may have heightened the detection of infants with microcephaly.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Institut national de santé publique du Québec, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Hema-Quebec, Montreal, QC, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, QC, Canada
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2
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Buekens P, Alger J, Berrueta M. Preparing for the next emerging perinatal infectious disease. Pediatr Res 2024; 95:414-415. [PMID: 38253874 PMCID: PMC10837072 DOI: 10.1038/s41390-023-02987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Pierre Buekens
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Jackeline Alger
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
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3
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Roth NM, Woodworth KR, Godfred-Cato S, Delaney AM, Olson SM, Nahabedian JF, Reynolds MR, Jones AM, Neelam V, Valencia-Prado M, Delgado-López C, Lee EH, Ellis EM, Lake-Burger H, Tonzel JL, Higgins CA, Chan RL, Tong VT, Gilboa SM, Cragan JD, Honein MA, Moore CA. Identifying possible inaccuracy in reported birth head circumference measurements among infants in the US Zika Pregnancy and Infant Registry. Birth Defects Res 2022; 114:314-318. [PMID: 35332688 PMCID: PMC10391875 DOI: 10.1002/bdr2.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The US Zika Pregnancy and Infant Registry (USZPIR) monitors infants born to mothers with confirmed or possible Zika virus infection during pregnancy. The surveillance case definition for Zika-associated birth defects includes microcephaly based on head circumference (HC). METHODS We assessed birth and follow-up data from infants with birth HC measurements <3rd percentile and birthweight ≥10th percentile to determine possible misclassification of microcephaly. We developed a schema informed by literature review and expert opinion to identify possible HC measurement inaccuracy using HC growth velocity and longitudinal HC measurements between 2 and 12 months of age. Two or more HC measurements were required for assessment. Inaccuracy in birth HC measurement was suspected if growth velocity was >3 cm/month in the first 3 months or HC was consistently >25th percentile during follow-up. RESULTS Of 6,799 liveborn infants in USZPIR, 351 (5.2%) had Zika-associated birth defects, of which 111 had birth HC measurements <3rd percentile and birthweight ≥10th percentile. Of 84/111 infants with sufficient follow-up, 38/84 (45%) were classified as having possible inaccuracy of birth HC measurement, 19/84 (23%) had HC ≥3rd percentile on follow-up without meeting criteria for possible inaccuracy, and 27/84 (32%) had continued HC <3rd percentile. After excluding possible inaccuracies, the proportion of infants with Zika-associated birth defects including microcephaly decreased from 5.2% to 4.6%. CONCLUSIONS About one-third of infants in USZPIR with Zika-associated birth defects had only microcephaly, but indications of possible measurement inaccuracy were common. Implementation of this schema in longitudinal studies can reduce misclassification of microcephaly.
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Affiliation(s)
- Nicole M Roth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Augustina M Delaney
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Eagle Global Scientific, LLC, Alpharetta, Georgia, USA
| | - Samantha M Olson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- G2S Corporation, San Antonio, Texas, USA
| | | | - Megan R Reynolds
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Abbey M Jones
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Ellen H Lee
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Esther M Ellis
- US Virgin Islands Department of Health, Christiansted, US Virgin Islands, USA
| | | | | | | | - Ronna L Chan
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet D Cragan
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cynthia A Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Mercado-Reyes M, Gilboa SM, Valencia D, Daza M, Tong VT, Galang RR, Winfield CM, Godfred-Cato S, Benavides M, Villanueva JM, Thomas JD, Daniels J, Zaki S, Reagan-Steiner S, Bhatnagar J, Schiffer J, Steward-Clark E, Ricaldi JN, Osorio J, Sancken CL, Pardo L, Tinker SC, Anderson KN, Rico A, Burkel VK, Hojnacki J, Delahoy MJ, González M, Osorio MB, Moore CA, Honein MA, Ospina Martinez ML. Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016-2018. Trop Med Infect Dis 2021; 6:183. [PMID: 34698287 PMCID: PMC8544689 DOI: 10.3390/tropicalmed6040183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/18/2021] [Accepted: 10/07/2021] [Indexed: 01/16/2023] Open
Abstract
Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May-November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia's existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.
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Affiliation(s)
- Marcela Mercado-Reyes
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Marcela Daza
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Van T. Tong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Romeo R. Galang
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Christina M. Winfield
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Mónica Benavides
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Julie M. Villanueva
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jennifer D. Thomas
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jonathan Daniels
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sherif Zaki
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Sarah Reagan-Steiner
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Julu Bhatnagar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.M.V.); (J.D.T.); (J.D.); (S.Z.); (S.R.-S.); (J.B.)
| | - Jarad Schiffer
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Evelene Steward-Clark
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.S.); (E.S.-C.)
| | - Jessica N. Ricaldi
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Johana Osorio
- Research Division, Vysnova Partners, Landover, MD 20785, USA;
| | - Christina L. Sancken
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Lissethe Pardo
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Kayla N. Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Angelica Rico
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | | | - Jacob Hojnacki
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA;
| | | | - Maritza González
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - May B. Osorio
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
| | - Cynthia A. Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Margaret A. Honein
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (D.V.); (V.T.T.); (C.M.W.); (S.G.-C.); (C.L.S.); (S.C.T.); (K.N.A.); (C.A.M.); (M.A.H.)
| | - Martha Lucia Ospina Martinez
- Instituto Nacional de Salud, Bogotá 111321, Colombia; (M.M.-R.); (M.D.); (M.B.); (L.P.); (A.R.); (M.G.); (M.B.O.); (M.L.O.M.)
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5
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Alger J, Buekens P, Cafferata ML, Alvarez Z, Berrueta M, Bock H, Bustillo C, Calderón A, Callejas A, Castillo M, Ciganda A, Fúnes J, García J, García K, Gibbons L, Gilboa SM, Harville EW, Hernández G, López R, López W, Lorenzana I, Tulio Luque M, Maldonado C, Moore CA, Ochoa C, Parham L, Pastrana K, Rico F, Rodríguez H, Stella C, Valencia D, Varela D, Wesson DM, Zúniga C, Tong VT. Microcephaly Outcomes among Zika Virus-Infected Pregnant Women in Honduras. Am J Trop Med Hyg 2021; 104:1737-1740. [PMID: 33724927 PMCID: PMC8103474 DOI: 10.4269/ajtmh.20-1483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/19/2021] [Indexed: 11/07/2022] Open
Abstract
The impact of Zika virus (ZIKV) infection on pregnancies shows regional variation emphasizing the importance of studies in different geographical areas. We conducted a prospective study in Tegucigalpa, Honduras, recruiting 668 pregnant women between July 20, 2016, and December 31, 2016. We performed Trioplex real-time reverse transcriptase-PCR (rRT-PCR) in 357 serum samples taken at the first prenatal visit. The presence of ZIKV was confirmed in seven pregnancies (7/357, 2.0%). Nine babies (1.6%) had microcephaly (head circumference more than two SDs below the mean), including two (0.3%) with severe microcephaly (head circumference [HC] more than three SDs below the mean). The mothers of both babies with severe microcephaly had evidence of ZIKV infection. A positive ZIKV Trioplex rRT-PCR was associated with a 33.3% (95% CI: 4.3-77.7%) risk of HC more than three SDs below the mean.
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Affiliation(s)
- Jackeline Alger
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras;,Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras;,Unidad de Investigación Científica, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | - Pierre Buekens
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana;,Address correspondence to Pierre Buekens, W. H. Watkins Professor of Epidemiology School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2001, New Orleans, LA 70112. E-mail:
| | - Maria Luisa Cafferata
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina;,Unidad de Investigación Clínica y Epidemiológica, Montevideo, Uruguay
| | - Zulma Alvarez
- Unidad de Vigilancia de la Salud, Región Sanitaria Metropolitana del Distrito Central (RSMDC), Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Harry Bock
- Dirección General, RSMDC, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Carolina Bustillo
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras;,Departamento de Ginecología y Obstetricia, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Alejandra Calderón
- Centro de Salud Alonso Suazo, RSMDC, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Allison Callejas
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Mario Castillo
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Alvaro Ciganda
- Unidad de Investigación Clínica y Epidemiológica, Montevideo, Uruguay
| | - Jenny Fúnes
- Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras;,Departamento de Pediatría, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Jorge García
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras;,Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Kimberly García
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily W. Harville
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Gustavo Hernández
- Departamento de Pediatría, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Raquel López
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Wendy López
- Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa, Honduras;,Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras
| | - Marco Tulio Luque
- Servicio de Infectología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Carlos Maldonado
- Servicio de Oftalmología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Cynthia A. Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carlos Ochoa
- Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa, Honduras
| | - Leda Parham
- Centro de Investigaciones Genéticas, Instituto de Investigaciones en Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras;,Escuela de Microbiología, Facultad de Ciencias, UNAH, Tegucigalpa, Honduras
| | - Karla Pastrana
- Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa, Honduras;,Departamento de Ginecología y Obstetricia, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras
| | - Fátima Rico
- Departamento de Pediatría, Facultad de Ciencias Médicas, UNAH, Tegucigalpa, Honduras;,Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | | | - Candela Stella
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Diana Valencia
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Douglas Varela
- Servicio de Neurología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa, Honduras
| | - Dawn M. Wesson
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Concepción Zúniga
- Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras;,Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa, Honduras
| | - Van T. Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas. Trop Med Infect Dis 2020; 6:tropicalmed6010005. [PMID: 33383742 PMCID: PMC7838815 DOI: 10.3390/tropicalmed6010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022] Open
Abstract
Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as “severe microcephaly”) and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Informático Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71–2.93) had HC < 2SD, including two (0.35%, 95% CI 0.04–1.24) with HC < 3SD, and 11 (1.9%, 95% CI, 0.79–3.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution.
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