Possible Association Between Zika Virus Infection and Microcephaly

Centers for Disease Control & Prevention (CDC)

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Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015

Author(s): Lavinia Schuler-Faccini, Erlane M. Ribeiro, Ian M.L. Feitosa, Dafne D.G. Horovitz, Denise P. Cavalcanti, André Pessoa, Maria Juliana R. Doriqui, Joao Ivanildo Neri, Joao Monteiro de Pina Neto, Hector Y.C. Wanderley, Mirlene Cernach, Antonette S. El-Husny, Marcos V.S. Pone, Cassio L.C. Serao, Maria Teresa V. Sanseverino and Brazilian Medical Genetics Society–Zika Embryopathy Task Force

Source: Morbidity and Mortality Weekly Report , Vol. 65, No. 3 (January 29, 2016), pp. 59-62

Published by: Centers for Disease Control & Prevention (CDC)

Stable URL: https://www.jstor.org/stable/10.2307/24856988

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Morbidity and Mortality Weekly Report

Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015

Lavinia Schuler-Faccini, PhD1; Erlane M. Ribeiro, PhD2; Ian M.L. Feitosa, MD3; Dafne D.G. Horovitz, PhD4; Denise P. Cavalcanti, PhD, MD5; André Pessoa2; Maria Juliana R. Doriqui, MD6; Joao Ivanildo Neri, MD7; Joao Monteiro de Pina Neto, PhD8; Hector Y.C. Wanderley, MD9; Mirlene Cernach, PhD10; Antonette S. El-Husny, PhD11; Marcos V.S. Pone, PhD4; Cassio L.C. Serao, MD12; Maria Teresa V. Sanseverino, PhD13; Brazilian Medical Genetics Society–Zika Embryopathy Task Force14

On January 22, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).

In early 2015, an outbreak of Zika virus, a flavivirus trans­ mitted by Aedes mosquitoes, was identified in northeast Brazil, an area where dengue virus was also circulating. By September, reports of an increase in the number of infants born with microcephaly in Zika virus-affected areas began to emerge, and Zika virus RNA was identified in the amniotic fluid of two women whose fetuses had been found to have microcephaly by prenatal ultrasound. The Brazil Ministry of Health (MoH) established a task force to investigate the possible association of microcephaly with Zika virus infection during pregnancy and a registry for incident microcephaly cases (head circumference ≥2 standard deviations [SD] below the mean for sex and ges­ tational age at birth) and pregnancy outcomes among women suspected to have had Zika virus infection during pregnancy. Among a cohort of 35 infants with microcephaly born dur­ ing August–October 2015 in eight of Brazil’s 26 states and reported to the registry, the mothers of all 35 had lived in or visited Zika virus-affected areas during pregnancy, 25 (71%) infants had severe microcephaly (head circumference >3 SD below the mean for sex and gestational age), 17 (49%) had at least one neurologic abnormality, and among 27 infants who had neuroimaging studies, all had abnormalities. Tests for other congenital infections were negative. All infants had a lumbar puncture as part of the evaluation and cerebrospinal fluid (CSF) samples were sent to a reference laboratory in Brazil for Zika virus testing; results are not yet available. Further studies are needed to confirm the association of microcephaly with Zika virus infection during pregnancy and to understand any other adverse pregnancy outcomes associated with Zika virus infec­ tion. Pregnant women in Zika virus-affected areas should pro­ tect themselves from mosquito bites by using air conditioning, screens, or nets when indoors, wearing long sleeves and pants, using permethrin-treated clothing and gear, and using insect repellents when outdoors. Pregnant and lactating women can use all U.S. Environmental Protection Agency (EPA)-registered insect repellents according to the product label.

An outbreak of Zika virus infection was recognized in northeast Brazil in early 2015 (1). In September 2015, health authorities began to receive reports from physicians in this region of an

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increase in the number of infants born with microcephaly. In October, the MoH confirmed an increase in birth prevalence of microcephaly in northeast Brazil, compared with previously reported estimates (approximately 0.5/10,000 live births), which are based on review of birth certificates and include descriptions of major congenital anomalies. The MoH rapidly established a microcephaly registry in Brazil. On November 17, 2015, the MoH reported the increase in microcephaly cases, and possible associa­ tion of microcephaly with Zika virus infection during pregnancy on its website;* and the Pan American Health Organization (PAHO) published an alert regarding the increase in occurrence of microcephaly in Brazil (2). In December, PAHO reported the identification of Zika virus RNA by reverse transcription-polymerase chain reaction (RT-PCR) in amniotic fluid samples from two pregnant women whose fetuses were found to have microcephaly by prenatal ultrasound, and the identification of Zika virus RNA from multiple body tissues, including the brain, of an infant with microcephaly who died in the immediate neonatal period (3). These events prompted new alerts from the MoH, the European Centre for Disease Prevention and Control (4), and CDC (5) concerning the possible association of microcephaly with the recent outbreak of Zika virus infection.