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Paixao ES, Cardim LL, Costa MCN, Brickley EB, de Carvalho-Sauer RCO, Carmo EH, Andrade RFS, Rodrigues MS, Veiga RV, Costa LC, Moore CA, França GVA, Smeeth L, Rodrigues LC, Barreto ML, Teixeira MG. Mortality from Congenital Zika Syndrome - Nationwide Cohort Study in Brazil. N Engl J Med 2022; 386:757-767. [PMID: 35196428 PMCID: PMC7612437 DOI: 10.1056/nejmoa2101195] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prenatal exposure to Zika virus has potential teratogenic effects, with a wide spectrum of clinical presentation referred to as congenital Zika syndrome. Data on survival among children with congenital Zika syndrome are limited. METHODS In this population-based cohort study, we used linked, routinely collected data in Brazil, from January 2015 through December 2018, to estimate mortality among live-born children with congenital Zika syndrome as compared with those without the syndrome. Kaplan-Meier curves and survival models were assessed with adjustment for confounding and with stratification according to gestational age, birth weight, and status of being small for gestational age. RESULTS A total of 11,481,215 live-born children were followed to 36 months of age. The mortality rate was 52.6 deaths (95% confidence interval [CI], 47.6 to 58.0) per 1000 person-years among live-born children with congenital Zika syndrome, as compared with 5.6 deaths (95% CI, 5.6 to 5.7) per 1000 person-years among those without the syndrome. The mortality rate ratio among live-born children with congenital Zika syndrome, as compared with those without the syndrome, was 11.3 (95% CI, 10.2 to 12.4). Among infants born before 32 weeks of gestation or with a birth weight of less than 1500 g, the risks of death were similar regardless of congenital Zika syndrome status. Among infants born at term, those with congenital Zika syndrome were 14.3 times (95% CI, 12.4 to 16.4) as likely to die as those without the syndrome (mortality rate, 38.4 vs. 2.7 deaths per 1000 person-years). Among infants with a birth weight of 2500 g or greater, those with congenital Zika syndrome were 12.9 times (95% CI, 10.9 to 15.3) as likely to die as those without the syndrome (mortality rate, 32.6 vs. 2.5 deaths per 1000 person-years). The burden of congenital anomalies, diseases of the nervous system, and infectious diseases as recorded causes of deaths was higher among live-born children with congenital Zika syndrome than among those without the syndrome. CONCLUSIONS The risk of death was higher among live-born children with congenital Zika syndrome than among those without the syndrome and persisted throughout the first 3 years of life. (Funded by the Ministry of Health of Brazil and others.).
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Affiliation(s)
- Enny S Paixao
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Luciana L Cardim
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Maria C N Costa
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Elizabeth B Brickley
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Rita C O de Carvalho-Sauer
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Eduardo H Carmo
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Roberto F S Andrade
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Moreno S Rodrigues
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Rafael V Veiga
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Larissa C Costa
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Cynthia A Moore
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Giovanny V A França
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Liam Smeeth
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Laura C Rodrigues
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Mauricio L Barreto
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
| | - Maria G Teixeira
- From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.)
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N. Costa MC, Cardim LL, Teixeira MG, Barreto ML, de Carvalho-Sauer RDCO, R. Barreto F, Itaparica Carvalho MS, Oliveira WK, França GVA, Carmo EH, Andrade RFS, Rodrigues MS, Veiga RV, Oliveira JF, Fernandes QHRF, Costa LC, Coelho GE, Paixao ES. Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †. Viruses 2020; 12:v12111228. [PMID: 33138282 PMCID: PMC7692842 DOI: 10.3390/v12111228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child's health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child-maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015-2017. METHODS Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. RESULTS The microcephaly/CZS case fatality rate was 10% (95% CI 9.2-10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63-2.83), and very low birth weight (OR = 3.77; 95% CI 2.20-6.46); late preterm births (OR = 1.65; 95% CI 1.21-2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46-8.02) and 5th minutes (OR = 4.13; 95% CI 2.78-6.13), among others. CONCLUSIONS A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.
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Affiliation(s)
- Maria Conceição N. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Luciana Lobato Cardim
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Maria Gloria Teixeira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Mauricio L. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
| | - Rita de Cassia Oliveira de Carvalho-Sauer
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia ZC 40110-040, Brazil;
- East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus, Bahia ZC 44570-550, Brazil
| | - Florisneide R. Barreto
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Martha Suely Itaparica Carvalho
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Municipal Health Secretariat of Salvador, Bahia ZC 40010-010, Brazil
| | - Wanderson K. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Technical Directorate of Education and Research, Ministry of Defense Hospital das Armed Forces, Brasília ZC 70675-731, Brazil
| | - Giovanny V. A. França
- Secretariat of Health Surveillance, Ministry of Health, Brasilia ZC 70070-040, Brazil;
| | - Eduardo Hage Carmo
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Roberto F. S. Andrade
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- Physics Institute, Federal University of Bahia, Salvador, Bahia ZC 40210-340, Brazil
| | - Moreno S. Rodrigues
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Rafael V. Veiga
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Juliane F. Oliveira
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | | | - Larissa C. Costa
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
| | - Giovanini E. Coelho
- Department of Communicable Diseases and Environmental Determinants of Health, Neglected, Tropical and Vector-Borne Diseases, Pan-American Health Organization/World Health Organization, Washington, WA 20037, USA;
| | - Enny S. Paixao
- Oswaldo Cruz Foundation, Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Salvador, Bahia ZC 41745-715, Brazil; (M.C.N.C.); (L.L.C.); (M.G.T.); (M.L.B.); (F.R.B.); (M.S.I.C.); (W.K.O.); (E.H.C.); (R.F.S.A.); (M.S.R.); (R.V.V.); (J.F.O.); (L.C.C.)
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Correspondence:
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8
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Ferreira AC, Zaverucha-do-Valle C, Reis PA, Barbosa-Lima G, Vieira YR, Mattos M, Silva PDP, Sacramento C, de Castro Faria Neto HC, Campanati L, Tanuri A, Brüning K, Bozza FA, Bozza PT, Souza TML. Sofosbuvir protects Zika virus-infected mice from mortality, preventing short- and long-term sequelae. Sci Rep 2017; 7:9409. [PMID: 28842610 PMCID: PMC5573375 DOI: 10.1038/s41598-017-09797-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/28/2017] [Indexed: 01/04/2023] Open
Abstract
Zika virus (ZIKV) causes significant public health concerns because of its association with congenital malformations, neurological disorders in adults, and, more recently, death. Considering the necessity to mitigate ZIKV-associated diseases, antiviral interventions are an urgent necessity. Sofosbuvir, a drug in clinical use against hepatitis C virus (HCV), is among the FDA-approved substances endowed with anti-ZIKV activity. In this work, we further investigated the in vivo activity of sofosbuvir against ZIKV. Neonatal Swiss mice were infected with ZIKV (2 × 107 PFU) and treated with sofosbuvir at 20 mg/kg/day, a concentration compatible with pre-clinical development of this drug. We found that sofosbuvir reduced acute levels of ZIKV from 60 to 90% in different anatomical compartments, such as the blood plasma, spleen, kidney, and brain. Early treatment with sofosbuvir doubled the percentage and time of survival of ZIKV-infected animals. Sofosbuvir also prevented the acute neuromotor impairment triggered by ZIKV. In the long-term behavioural analysis of ZIKV-associated sequelae, sofosbuvir prevented loss of hippocampal- and amygdala-dependent memory. Our results indicate that sofosbuvir inhibits ZIKV replication in vivo, which is consistent with the prospective necessity of antiviral drugs to treat ZIKV-infected individuals.
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Affiliation(s)
- André C Ferreira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Camila Zaverucha-do-Valle
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- Instituto Nacional de Infectologia (INI), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Patrícia A Reis
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | | | - Mayara Mattos
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Priscila de Paiva Silva
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Carolina Sacramento
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Hugo C de Castro Faria Neto
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Loraine Campanati
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Amilcar Tanuri
- Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Karin Brüning
- BMK Consortium: Blanver Farmoquímica Ltda; Microbiológica Química e Farmacêutica Ltda, Karin Bruning & Cia. Ltda, Taboão da Serra, SP, Brazil
| | - Fernando A Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- Instituto Nacional de Infectologia (INI), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Patrícia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago Moreno L Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.
- Instituto Nacional de Infectologia (INI), Fiocruz, Rio de Janeiro, RJ, Brazil.
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil.
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Sarno M, Sacramento GA, Khouri R, do Rosário MS, Costa F, Archanjo G, Santos LA, Nery N, Vasilakis N, Ko AI, de Almeida ARP. Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise. PLoS Negl Trop Dis 2016; 10:e0004517. [PMID: 26914330 PMCID: PMC4767410 DOI: 10.1371/journal.pntd.0004517] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The rapid spread of Zika virus in the Americas and current outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses. METHODOLOGY/PRINCIPAL FINDINGS We report a case of a 20-year-old pregnant woman who was referred to our service after a large Zika virus outbreak in the city of Salvador, Brazil with an ultrasound examination that showed intrauterine growth retardation of the fetus at the 18th gestational week. Ultrasound examinations in the 2nd and 3rd trimesters demonstrated severe microcephaly, hydranencephaly, intracranial calcifications and destructive lesions of posterior fossa, in addition to hydrothorax, ascites and subcutaneous edema. An induced labor was performed at the 32nd gestational week due to fetal demise and delivered a female fetus. ZIKV-specific real-time polymerase chain reaction amplification products were obtained from extracts of cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid, while extracts of heart, lung, liver, vitreous body of the eye and placenta did not yield detectable products. CONCLUSIONS/SIGNIFICANCE This case report provides evidence that in addition to microcephaly, there may be a link between Zika virus infection and hydrops fetalis and fetal demise. Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes.
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Affiliation(s)
- Manoel Sarno
- Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Gielson A Sacramento
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil
| | - Ricardo Khouri
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil
| | - Mateus S do Rosário
- Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil
| | - Federico Costa
- Faculdade de Medicina da Bahia and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Gracinda Archanjo
- Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil
| | - Luciane A Santos
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil
| | - Nivison Nery
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil
| | - Nikos Vasilakis
- Department of Pathology and Center of Biodefense and Emerging Infectious Diseases, Institute for Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Albert I Ko
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Antonio R P de Almeida
- Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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