• Thalia Velho Barreto de Araújo, Laura Cunha Rodrigues, Ricardo Arraes de Alencar Ximenes, de Barros Miranda-Filho Demócrito D University of Pernambuco, Recife, Brazil., Ulisses Ramos Montarroyos, Ana Paula Lopes de Melo, Sandra Valongueiro, de Albuquerque Maria de Fátima Pessoa Militão MFPM The Research Center Aggeu Magalhães (CPqAM) and Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil., Wayner Vieira Souza, Cynthia Braga, Sinval Pinto Brandão Filho, Marli Tenório Cordeiro, Enrique Vazquez, Di Cavalcanti Souza Cruz Danielle D Instituto Materno Infantil Fernando Figueira, Recife, Brazil., Henriques Cláudio Maierovitch Pessanha CMP Fiocruz Brasília, Brasília, Brazil., Luciana Caroline Albuquerque Bezerra, Priscila Mayrelle da Silva Castanha, Rafael Dhalia, Ernesto Torres Azevedo Marques-Júnior, Martelli Celina Maria Turchi CMT The Research Center Aggeu Magalhães (CPqAM) and Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil; Department of Community Health, Federa, investigators from the Microcephaly Epidemic Research Group, Brazilian Ministry of Health, Pan American Health Organization, Instituto de Medicina Integral Professor Fernando Figueira, and State Health Department of Pernambuco.
• Department of Social Medicine, Federal University of Pernambuco, Recife, Brazil. Electronic address: thalia@ufpe.br.
• Lancet Infect Dis. 2016 Dec 1; 16 (12): 1356-1363.

BackgroundThe microcephaly epidemic, which started in Brazil in 2015, was declared a Public Health Emergency of International Concern by WHO in 2016. We report the preliminary results of a case-control study investigating the association between microcephaly and Zika virus infection during pregnancy.MethodsWe did this case-control study in eight public hospitals in Recife, Brazil. Cases were neonates with microcephaly. Two controls (neonates without microcephaly), matched by expected date of delivery and area of residence, were selected for each case. Serum samples of cases and controls and cerebrospinal fluid samples of cases were tested for Zika virus-specific IgM and by quantitative RT-PCR. Laboratory-confirmed Zika virus infection during pregnancy was defined as detection of Zika virus-specific IgM or a positive RT-PCR result in neonates. Maternal serum samples were tested by plaque reduction neutralisation assay for Zika virus and dengue virus. We estimated crude odds ratios (ORs) and 95% CIs using a median unbiased estimator for binary data in an unconditional logistic regression model. We estimated ORs separately for cases with and without radiological evidence of brain abnormalities.FindingsBetween Jan 15, 2016, and May 2, 2016, we prospectively recruited 32 cases and 62 controls. 24 (80%) of 30 mothers of cases had Zika virus infection compared with 39 (64%) of 61 mothers of controls (p=0·12). 13 (41%) of 32 cases and none of 62 controls had laboratory-confirmed Zika virus infection; crude overall OR 55·5 (95% CI 8·6-∞); OR 113·3 (95% CI 14·5-∞) for seven cases with brain abnormalities; and OR 24·7 (95% CI 2·9-∞) for four cases without brain abnormalities.InterpretationOur data suggest that the microcephaly epidemic is a result of congenital Zika virus infection. We await further data from this ongoing study to assess other potential risk factors and to confirm the strength of association in a larger sample size.FundingBrazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.Copyright This is an Open Access article published under the CC BY 3.0 IGO license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

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