Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation
Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation
复制标题
DOI：
10.1016/s0140-6736(16)30902-3
复制
发表时间：
2016-08-27
期刊：
影响因子：
168.9
通讯作者：
Victora, Cesar G.
中科院分区：
文献类型：
--
作者：
Franca, Giovanny V. A.;Schuler-Faccini, Lavinia;Victora, Cesar G.
背景2015年11月，巴西报告了小头畸形症流行，后来被归因于先天性寨卡病毒感染。截至2016年6月4日，巴西卫生部已收到7830例疑似病例报告，但对其特征知之甚少。我们的目的是描述这些新生儿的临床表现，人体测量学，和survival.Methods我们回顾了所有1501活产婴儿的调查，在国家一级的医疗队已经完成了截至2016年2月27日，并根据神经影像学和实验室结果寨卡病毒和其他相关感染的疑似病例分为五类。明确病例有寨卡病毒感染的实验室证据;高度可能病例有特定的神经影像学检查结果，其他先天性感染的实验室结果为阴性;中度可能病例有特定的影像学检查结果，但不能排除其他感染;有些可能病例有影像学检查结果，但当地团队没有详细报告;所有其他新生儿都被归类为丢弃病例。根据胎龄对头围进行评估，采用InterGrowth标准。调查结果2015年11月19日至2015年2月27日期间，巴西卫生部共收到1501例疑似病例报告，其中899例被排除。在其余602例病例中，76例确诊为先天性寨卡病毒综合征，54例高度可能，181例中度可能，291例有点可能。四组之间的临床、人体测量和生存率差异很小。与这四组相比，899例丢弃病例的头围较大（平均Z评分-1.54 vs-3.13，差异1.58 [95% CI 1.45-1.72]）;第一周死亡率较低（14/1000 vs 51/1000;率比0.28 [95% CI 0.14-0.56]）;妊娠期皮疹史的可能性较小（20.7% vs 61.4%，率比0.34 [95% CI 0.27-0.42]）。妊娠晚期的皮疹与大脑异常有关，尽管头部大小正常。五分之一的明确或很可能病例的头围在正常范围内（高于-2 SD，低于InterGrowth标准的中位数），三分之一的明确和很可能病例在妊娠期间没有皮疹病史。疫情高峰期发生在2015年11月下旬。解读寨卡病毒先天性综合症是一种新型的致畸性疾病。由于许多明确或可能的病例呈现正常的头围值，并且他们的母亲没有报告有皮疹，因此必须修改筛查标准，以检测所有受影响的新生儿。版权所有（C）作者。由Elsevier Ltd.发布。这是CC BY许可下的开放获取文章。
Background In November, 2015, an epidemic of microcephaly was reported in Brazil, which was later attributed to congenital Zika virus infection. 7830 suspected cases had been reported to the Brazilian Ministry of Health by June 4, 2016, but little is known about their characteristics. We aimed to describe these newborn babies in terms of clinical findings, anthropometry, and survival.Methods We reviewed all 1501 liveborn infants for whom investigation by medical teams at State level had been completed as of Feb 27, 2016, and classified suspected cases into five categories based on neuroimaging and laboratory results for Zika virus and other relevant infections. Definite cases had laboratory evidence of Zika virus infection; highly probable cases presented specific neuroimaging findings, and negative laboratory results for other congenital infections; moderately probable cases had specific imaging findings but other infections could not be ruled out; somewhat probable cases had imaging findings, but these were not reported in detail by the local teams; all other newborn babies were classified as discarded cases. Head circumference by gestational age was assessed with InterGrowth standards. First week mortality and history of rash were provided by the State medical teams.Findings Between Nov 19, 2015, and Feb 27, 2015, investigations were completed for 1501 suspected cases reported to the Brazilian Ministry of Health, of whom 899 were discarded. Of the remainder 602 cases, 76 were definite, 54 highly probable, 181 moderately probable, and 291 somewhat probable of congenital Zika virus syndrome. Clinical, anthropometric, and survival differences were small among the four groups. Compared with these four groups, the 899 discarded cases had larger head circumferences (mean Z scores -1.54 vs -3.13, difference 1.58 [95% CI 1.45-1.72]); lower first-week mortality (14 per 1000 vs 51 per 1000; rate ratio 0.28 [95% CI 0.14-0.56]); and were less likely to have a history of rash during pregnancy (20.7% vs 61.4%, ratio 0.34 [95% CI 0.27-0.42]). Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads. One in five definite or probable cases presented head circumferences in the normal range (above -2 SD below the median of the InterGrowth standard) and for one third of definite and probable cases there was no history of a rash during pregnancy. The peak of the epidemic occurred in late November, 2015.Interpretation Zika virus congenital syndrome is a new teratogenic disease. Because many definite or probable cases present normal head circumference values and their mothers do not report having a rash, screening criteria must be revised in order to detect all affected newborn babies. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.