Relative and attributable risks of neurological and perinatal adverse outcomes among children with and without prenatal Zika virus exposure in Northeast Brazil: A prospective cohort study (2015-2018).

Background: Although there has been substantial progress in the characterization of Congenital Zika Syndrome, the lack of a control group in the majority of published studies on Zika virus (ZIKV) infections during pregnancy limits our understanding of, first, the magnitude by which prenatal ZIKV exposure may increase risks of adverse outcomes for offspring and, second, the fraction of abnormalities that are attributable to this exposure.

Methods: To overcome this limitation, this study harmonized and integrated data collected prospectively in Recife, Pernambuco, Brazil, from offspring of ZIKV-exposed women in the Microcephaly Epidemic Research Group (MERG) Pregnant Women Cohort and from offspring of ZIKV-unexposed women in the Zika in Infants and Pregnancy (ZIP) Study. We compared the data to estimate the relative risk (RR) and attributable risk percent (AR%) of: (i) adverse birth outcomes including low birth weight (LBW), prematurity and small for gestational age (SGA) and (ii) developmental abnormalities including microcephaly and neurological, ophthalmological, audiological, and neuroimaging alterations.

Mapping the risk of Zika virus infections in pregnant persons and microcephaly in newborns in relation to socioeconomic indicators in Recife, Pernambuco, Brazil: A spatial analysis (2015 to 2021).

Objective: Using spatial analysis techniques, this study investigates the associations between socioeconomic indicators measured at the census tract level and the incidence of Zika virus (ZIKV) infection in pregnant persons and microcephaly in newborns in Recife, Pernambuco, Brazil, from 2015 to 2021.

Methods: In this ecological study, data on cases of ZIKV infections among pregnant persons registered in the Brazilian Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificaçao, SINAN-Zika) and cases of microcephaly among live births registered in the Public Health Event Registration System (Registro de Eventos em Saúde Pública, RESP-Microcefalia) and the Live Birth Information System (Sistema de Informações Sobre Nascidos Vivos, SINASC) were georeferenced based on residential address and aggregated within census tracts. Spatial autocorrelation was performed using the bivariate global and local Moran's I indices, which considered the incidence rates of maternal ZIKV infections and microcephaly during the epidemic (2015-2017) and post-epidemic (2018-2021) time periods in relation to each other as well as social, economic, sanitation, and urban infrastructure covariates derived from the 2010 census.

Late-onset hearing loss was not observed among preschool- aged children with prenatal Zika virus exposure: An analysis of the Microcephaly Epidemic Research Group Pediatric Cohort (2015-2019).

Zika virus (ZIKV) infection during pregnancy can lead to Congenital Zika Syndrome (CZS), with significant impacts on early childhood development. This study aimed to analyze the natural history of hearing loss in children with CZS during their first four years of life. Data were collected from the Microcephaly Epidemic Research Group Pediatric Cohort in Pernambuco, Brazil.

Clinical spectrum of congenital Zika virus infection in Brazil: Update and issues for research development.

This review aimed to provide an update on the morphological and/or functional abnormalities related to congenital Zika virus (ZIKV) infection, based on primary data from studies conducted in Brazil since 2015. During the epidemic years (2015-2016), case series and pediatric cohort studies described several birth defects, including severe and/or disproportionate microcephaly, cranial bone overlap, skull collapse, congenital contractures (arthrogryposis and/or clubfoot), and visual and hearing abnormalities, as part of the spectrum of Congenital Zika Syndrome (CZS). Brain imaging abnormalities, mainly cortical atrophy, ventriculomegaly, and calcifications, serve as structural markers of CZS severity.

Feeding characteristics and growth among children with prenatal exposure to Zika virus with and without microcephaly in the microcephaly epidemic research group pediatric cohort.

Objective: To describe the feeding characteristics and growth of children with prenatal exposure to Zika virus (ZIKV) from birth to 48 months.

Design: Using data from the prospective Microcephaly Epidemic Research Group Pediatric Cohort (MERG-PC), children without microcephaly born to mothers with evidence of ZIKV infection during pregnancy (ZIKV-exposed children without microcephaly) and children with Zika-related microcephaly were compared using repeated cross-sectional analyses within the following age strata: birth; 1 to 12; 13 to 24; 25 to 36; and 37 to 48 months. The groups were compared in relation to prematurity, birth weight, breastfeeding, alternative feeding routes, dysphagia and anthropometric profiles based on the World Health Organization Anthro z-scores (weight-length/height, weight-age, length/height-age and BMI-age).

Delays in obtaining hospital care and abortion-related complications within a context of illegality.

Abortion, particularly when illegal, highlights inequities in different populations. Although abortion-related mortality is lower compared to other obstetric causes, abortion complications tend to be more lethal. Delays in seeking and obtaining care are determinants of negative outcomes.

Congenital zika syndrome and family impacts: an integrative review.

In 2015, a range of congenital anomalies resulting from mother-to-child transmission of the zika virus emerged. Later called congenital zika syndrome (CZS), the condition includes microcephaly. Since then, around 4,000 children have been affected in 27 countries, with Brazil accounting for the largest proportion of cases.

Access to childbirth care services in the interior of Pernambuco, Northeast region of Brazil.

Objective: To analyze the access of women to the public health system network to childbirth care, highlighting the barriers related to the "availability and accommodation" dimension in a health macroregion of Pernambuco.

Methods: Ecological study, conducted based on hospital birth records from the Hospital Information System of the Brazilian Unified Health System (SUS), and information from the state's Hospital Beds Regulation Center, about women residing in health macroregion II, in 2018. Displacements were reviewed considering the geographic distance between the municipality of residence and that of the childbirth; estimated time of displacement of pregnant women; ratio of shifts blocked for admission of pregnant women for delivery; and the reason for unavailability.

Risk of adverse outcomes in offspring with RT-PCR confirmed prenatal Zika virus exposure: An individual participant data meta-analysis of 13 cohorts in the Zika Brazilian Cohorts Consortium.

Background: Knowledge regarding the risks associated with Zika virus (ZIKV) infections in pregnancy has relied on individual studies with relatively small sample sizes and variable risk estimates of adverse outcomes, or on surveillance or routinely collected data. Using data from the Zika Brazilian Cohorts Consortium, this study aims, to estimate the risk of adverse outcomes among offspring of women with RT-PCR-confirmed ZIKV infection during pregnancy and to explore heterogeneity between studies.

Methods: We performed an individual participant data meta-analysis of the offspring of 1548 pregnant women from 13 studies, using one and two-stage meta-analyses to estimate the absolute risks.

Characteristics of children of the Microcephaly Epidemic Research Group Pediatric Cohort who developed postnatal microcephaly.

The number of studies published on postnatal microcephaly in children with Congenital Zika Syndrome is small, clinical presentations vary and aspects of the evolution of these children remain unclarified. The present case series examined clinical characteristics and assessed the growth velocity of the head circumference, weight and height Z-scores in 23 children who developed postnatal microcephaly during follow-up in the Microcephaly Epidemic Research Group Pediatric Cohort. To estimate the change in the head circumference, weight and height Z-scores over time and compare the mean difference between sexes, we used multilevel mixed-effects linear regressions with child-specific random effects.

Zika-Related Microcephaly and Its Repercussions for the Urinary Tract: Clinical, Urodynamic, Scintigraphic and Radiological Aspects.

Aims: Describing the urodynamic parameters of children aged 3 to 5 years with microcephaly related to congenital Zika syndrome and verifying the association with clinical, imaging and neurological characteristics.

Methods: From October 2018 to March 2020, children with Zika-related microcephaly underwent urological, ultrasonographic and urodynamic evaluation. In selected cases, complementary exams such as urethrocystography and scintigraphy were performed.

The economic burden of congenital Zika Syndrome in Brazil: an overview at 5 years and 10 years.

Background: The aim of this paper is to estimate the economic burden of children with congenital Zika Syndrome (CZS) in Brazil over 5-10 years.

Methods: We conducted a modelling study based on data collected in a case-control study in Brazil, including children with CZS (cases) and typically developing children (controls), born in 2015 and 2016. In total, 484 participants were recruited in two sites, Recife and Rio de Janeiro.

Risk of SARS-CoV-2 infection among front-line healthcare workers in Northeast Brazil: a respondent-driven sampling approach.

Objectives: We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW).

Design, Setting And Participants: Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil.

Outcome Measures: The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test.

Co-circulation of Chikungunya Virus during the 2015-2017 Zika Virus Outbreak in Pernambuco, Brazil: An Analysis of the Microcephaly Epidemic Research Group Pregnancy Cohort.

Co-circulation of arthropod-borne viruses, particularly those with shared mosquito vectors like Zika (ZIKV) and Chikungunya (CHIKV), is increasingly reported. An accurate differential diagnosis between ZIKV and CHIKV is of high clinical importance, especially in the context of pregnancy, but remains challenging due to limitations in the availability of specialized laboratory testing facilities. Using data collected from the prospective pregnancy cohort study of the Microcephaly Epidemic Research Group, which followed up pregnant persons with rash during the peak and decline of the 2015-2017 ZIKV epidemic in Recife, Pernambuco, Brazil, this study aims to describe the geographic and temporal distribution of ZIKV and CHIKV infections and to investigate the extent to which ZIKV and CHIKV infections may be clinically differentiable.

Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017.

Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil-the epicentre of the Brazilian microcephaly epidemic-has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads.

Neurodevelopment in Children Exposed to Zika Virus: What Are the Consequences for Children Who Do Not Present with Microcephaly at Birth?

The relation of Zika virus (ZIKV) with microcephaly is well established. However, knowledge is lacking on later developmental outcomes in children with evidence of maternal ZIKV infection during pregnancy born without microcephaly. The objective of this analysis is to investigate the impact of prenatal exposure to ZIKV on neuropsychomotor development in children without microcephaly.

Epidemic preparedness: Prenatal Zika virus screening during the next epidemic.

Zika virus (ZIKV) is a vectorborne infectious agent of global public health significance due to its potential to cause severe teratogenic outcomes. The question of whether health systems should consider adopting screening programmes for ZIKV infections during pregnancy warrants consideration. In this analysis, we apply the Wilson-Jungner framework to appraise the potential utility of a prenatal ZIKV screening programme, outline potential screening strategies within the case-finding pathway, and consider other epidemiological factors that may influence the planning of such a screening programme.

Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy.

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika.

The Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC): A Cohort Profile.

This cohort profile aims to describe the ongoing follow-up of children in the Microcephaly Epidemic Research Group Paediatric Cohort (MERG-PC). The profile details the context and aims of the study, study population, methodology including assessments, and key results and publications to date. The children that make up MERG-PC were born in Recife or within 120 km of the city, in Pernambuco/Brazil, the epicentre of the microcephaly epidemic.

[Covid-19 in the Northeast of Brazil: from lockdown to the relaxation of social distancing measures].

Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast.

Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil.

Background: While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood.

Methods: Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV.

Barriers in Accessing Care for Consequence of Unsafe Abortion by Black Women: Evidence of Institutional Racism in Brazil.

Women face difficulties in accessing post-abortion care, as hierarchical care operates under discrimination mechanisms that condemn women in abortion. In addition, it is the Black and Brown women who are more subject to unsafe abortions and need hospitalization to complete the termination of pregnancy or treat associated complications. This study aimed at identifying factors associated with the institutional barriers in access to health services for women who underwent abortion by race/color.

The first hundred days of COVID-19 in Pernambuco State, Brazil: epidemiology in historical context.

The timeline of the COVID-19 pandemic began on December 31, 2019, in China, with SARS-CoV-2 identified as the etiological agent. This article aims to describe the COVID-19 epidemic's spatial and temporal dynamics in the first hundred days in the State of Pernambuco, Brazil. We present the evolution in cases and deaths according to epidemiological weeks.

Zika virus infection in pregnancy: a protocol for the joint analysis of the prospective cohort studies of the ZIKAlliance, ZikaPLAN and ZIKAction consortia.

Introduction: Zika virus (ZIKV) infection in pregnancy has been associated with microcephaly and severe neurological damage to the fetus. Our aim is to document the risks of adverse pregnancy and birth outcomes and the prevalence of laboratory markers of congenital infection in deliveries to women experiencing ZIKV infection during pregnancy, using data from European Commission-funded prospective cohort studies in 20 centres in 11 countries across Latin America and the Caribbean.

Methods And Analysis: We will carry out a centre-by-centre analysis of the risks of adverse pregnancy and birth outcomes, comparing women with confirmed and suspected ZIKV infection in pregnancy to those with no evidence of infection in pregnancy.

"Life Is Taking Me Where I Need to Go": Biographical Disruption and New Arrangements in the Lives of Female Family Carers of Children with Congenital Zika Syndrome in Pernambuco, Brazil.

The congenital Zika syndrome (CZS) epidemic in Brazil turned the spotlight on many other factors beyond illness, such as poverty, gender, and inequalities in health care. Women were the emblematic subjects in this study, not only because Zika virus is a vertical transmission disease, but also because women-in Brazil and elsewhere-typically represent the primary carers of children. This is a qualitative analytic study using semi-structured interviews with 23 female family carers of children with CZS in Brazil.