Zika Virus Infection and Microcephaly: A Case-Control Study in Brazil

Sabrina Gabriele Maia Oliveira Rocha; Luciano Lima Correia; Antônio José Lêdo Alves da Cunha; Hermano Alexandre Lima Rocha; Álvaro Jorge Madeiro Leite; Jocileide Sales Campos; Tereza de Jesus Pinheiro Gomes Bandeira; Lucas Silveira do Nascimento; Anamaria Cavalcante e Silva

doi:10.5334/aogh.2394

Zika Virus Infection and Microcephaly: A Case-Control Study in Brazil

Volume 85 (2019): Issue 1

By: Sabrina Gabriele Maia Oliveira Rocha, Luciano Lima Correia, Antônio José Lêdo Alves da Cunha, Hermano Alexandre Lima Rocha , Álvaro Jorge Madeiro Leite, Jocileide Sales Campos, Tereza de Jesus Pinheiro Gomes Bandeira, Lucas Silveira do Nascimento and Anamaria Cavalcante e Silva

Open Access

|Aug 2019

Figures & Tables

Table 1

Baseline and birth characteristics of the sample.

		Condition						p value
		Case		Control		Total
		n or median	% or interquartile	n or median	% or interquartile	n or median	% or interquartile
Sex	Male	29	50.9%	69	60.0%	98	57.0%	0.194
Female	28	49.1%	46	40.0%	74	43.0%
Age in months		6.50	4.0–21.0	11.00	4.0–20.0	9	4.0–20.0	0.474
Birth weight		2.67	2.3–3.0	3.22	2.8–3.7	3.010	2.6–3.4	<0.001
Cephalic perimeter		31.00	29.5–32.0	35.00	34.0–35.5	33.0	31.0–35.0	<0.001
Timing of birth	Normal	45	77.6%	94	81.7%	139	80.3%	0.025
Timing of birth	Preterm	12	20.7%	9	7.8%	21	12.1%
Post term	1	1.7%	9	7.8%	10	5.8%
Not specified	0	0.0%	3	2.6%	3	1.7%

Table 2

Ratios of diseases presented by the mother during pregnancy in cases and controls.

		Condition				p value
		Case		Control
		n or median	% or interquartile	n or median	% or interquartile
Fever	Yes, once	16	28.1%	16	13.9%	0.022
Fever	Yes, more than once	9	15.8%	11	9.6%
No fever	32	56.1%	88	76.5%
Gestation month of fever		3	2.0–6.0	5	4.0–7.0	0.032
Days of fever		2	1.0–3.0	3	3.0–5.0	0.057
Fever intensity	Low	11	50.0%	6	26.1%	0.151
Fever intensity	Moderate	8	36.4%	9	39.1%
High	3	13.6%	8	34.8%
Any appointment with a physician	Yes	18	58.1%	26	66.7%	0.449
Any appointment with a physician	No	12	38.7%	13	33.3%
Do not remember	1	3.2%	0	0.0%
Diseases during pregnancy	Other	8	47.0%	12	46.1%	0.040
Diseases during pregnancy	Urinary infection	1	5.2%	12	46.1%
Zika	8	47.0%	2	7.6%
Headache intensity	Low	8	15.1%	16	17.4%	0.865
Headache intensity	Moderate	10	18.9%	20	21.7%
High	14	26.4%	19	20.7%
None	21	39.6%	37	40,2%
Stiff neck	Yes	5	9.6%	14	14.4%	0.599
Stiff neck	No	47	90.4%	81	83.5%
Do not remember	0	0.0%	1	1.0%
Eye pain	Yes	12	22.2%	14	15.2%	0.227
Eye pain	No	41	75.9%	78	84.8%
Do not remember	1	1.9%	0	0.0%
Photophobia	Yes	10	18.5%	13	13.5%	0.417
No	44	81.5%	83	86.5%
Seizures	Generalized	2	3.7%	1	1.0%	0.527
Seizures	Focal	2	3.7%	4	4.1%
No	50	92.6%	92	94.8%
Disorientations	Yes	0	0.0%	5	5.2%	0.172
Disorientations	No	54	100.0%	90	93.8%
Do not remember	0	0.0%	1	1.0%
Amnesia	Yes	2	3.8%	5	5.4%	0.678
Amnesia	No	51	96.2%	87	93.5%
Do not remember	0	0.0%	1	1.1%
Behavioral changes	Yes	13	24.1%	29	30.2%	0.422
No	41	75.9%	67	69.8%
Dyspnea	Yes	16	30.2%	27	28.7%	0.851
No	37	69.8%	67	71.3%
Precordialgia	Yes	4	7.4%	14	14.4%	0.202
No	50	92.6%	83	85.6%
Dysarthria	Yes	0	0.0%	6	6.3%	0.062
No	53	100.0%	89	93.7%
Epigastralgia	Yes	10	18.5%	17	17.5%	0.879
No	44	81.5%	80	82.5%
Diarrhea	Yes	5	9.4%	10	10.3%	0.864
No	48	90.6%	87	89.7%
Nausea	Yes	33	61.1%	58	60.4%	0.933
No	21	38.9%	38	39.6%
Sore throat	Yes	6	11.1%	21	21.6%	0.105
No	48	88.9%	76	78.4%
Cough	Yes	13	24.1%	23	24.0%	0.987
No	41	75.9%	73	76.0%
Back pain	Yes	27	50.0%	58	59.8%	0.245
No	27	50.0%	39	40.2%
Muscle pain	Yes	14	26.9%	12	12.5%	0.028
No	38	73.1%	84	87.5%
Joint pain	Yes	23	42.6%	19	19.6%	0.002
No	31	57.4%	78	80.4%
Difficulty moving	Yes	12	22.6%	14	14.9%	0.237
No	41	77.4%	80	85.1%
Joint edema	Yes	17	31.5%	25	26.0%	0.600
Joint edema	No	37	68.5%	70	72.9%
Do not remember	0	0.0%	1	1.0%
Paralysis	Ascending	1	1.9%	3	3.2%	0.629
No	53	98.1%	91	96.8%
Weakness	Generalized	13	24.1%	9	9.6%	0.041
Weakness	Focal	4	7.4%	13	13.8%
No	37	68.5%	72	76.6%
Conjunctivitis	Yes	0	0.0%	2	2.1%	0.290
No	52	100.0%	92	97.9%
Bleeding	Yes	10	19.6%	16	17.2%	0.720
No	41	80.4%	77	82.8%
Skin changes	Yes	25	48.1%	14	14.7%	<0.001
No	27	51.9%	81	85.3%
Thick skin	Yes	11	42.3%	5	27.8%	0.325
No	15	57.7%	13	72.2%
Spot with a border	Yes	3	12.0%	0	0.0%	0.128
No	22	88.0%	18	100.0%
Erythema	Yes	17	68.0%	7	38.9%	0.058
No	8	32.0%	11	61.1%
Vesicles	Yes	1	4.0%	0	0.0%	0.391
No	24	96.0%	18	100.0%
Itchy spots	Yes	11	44.0%	6	33.3%	0.480
No	14	56.0%	12	66.7%
Petechiae	Yes	16	64.0%	7	38.9%	0.103
No	9	36.0%	11	61.1%
Bruises	Yes	3	12.0%	0	0.0%	0.128
No	22	88.0%	18	100.0%
Stings during pregnancy	Yes	17	30.9%	18	16.4%	0.031
No	38	69.1%	92	83.6%
Zika infection	Yes	27	46.6%	9	7.8%	<0.001
No	31	53.4%	107	92.2%
Diagnosis of zika by a health professional	Yes	18	81.8%	6	66.7%	0.360
No	4	18.2%	3	33.3%
Gestation month of zika diagnosis		3	2.0–4.0	5	3.0–6.0	0.246
What was the severity of zika?	Low	14	63.6%	7	87.5%	0.360
What was the severity of zika?	Moderate	4	18.2%	1	12.5%
High	4	18.2%	0	0.0%
Internment due to zika	Yes	0	0.0%	1	11.1%	0.120
No	21	100.0%	8	88.9%
Had dengue fever	Yes	1	1.8%	1	0.9%	0.606
No	56	98.2%	115	99.1%
Had chikungunya	Yes	1	1.8%	0	0.0%	0.153
No	56	98.2%	116	100.0%
Had rubella	No	57	100.0%	116	100.0%	–
Had toxoplasmosis infection	Yes	2	3.5%	3	2.6%	0.734
No	55	96.5%	113	97.4%
Had cytomegalovirus infection	Yes	2	3.5%	0	0.0%	0.042
No	55	96.5%	116	100.0%
Had herpes	Yes	2	3.5%	1	0,9%	0.210
No	55	96.5%	115	99.1%
Had syphilis	Yes	1	1.8%	1	0.9%	0.606
No	56	98.2%	115	99.1%
Had AIDS	No	56	100.0%	116	100.0%	–
Had hypertension	Yes	3	5.5%	18	15.8%	0.056
No	52	94.5%	96	84.2%
Had eclampsia	Yes	1	3.3%	2	3.3%	1.000
No	29	96.7%	58	96.7%
Had preeclampsia	Yes	0	0.0%	6	10.0%	0.078
No	29	100.0%	54	90.0%
Had diabetes	Yes	1	1.8%	6	5.3%	0.292
No	54	98.2%	108	94.7%
Had kidney disease	Yes	1	3.3%	5	8.3%	0.370
No	29	96.7%	55	91.7%
Had anemia	Yes	12	21.1%	23	20.2%	0.534
No	45	78.9%	91	79.8%
Had the flu	Yes	18	31.6%	44	38.3%	0.390
No	39	68.4%	71	61.7%
Had diarrhea	Yes	8	14.0%	7	6.1%	0.082
No	49	86.0%	108	93.9%
Had an allergy	Yes	5	8.9%	5	4.3%	0.225
No	51	91.1%	111	95.7%
Had asthma	Yes	1	3.3%	1	1.7%	0.613
No	29	96.7%	59	98.3%

Table 3

Ratios of exposures of the mother during pregnancy in cases and controls.

		Condition				p value
		Case		Control
		n or median	% or interquartile	n or median	% or interquartile
Worked during pregnancy	Yes, outside home	20	35.1%	31	27.2%	0.235
Worked during pregnancy	Yes, at home	8	14.0%	10	8.8%
No	29	50.9%	73	64.0%
Contact with ink	Yes, during pregnancy	16	27.6%	35	30.7%	0.822
Contact with ink	Yes, before	1	1.7%	1	0.9%
No	41	70.7%	78	68.4%
Contact with varnishes	Yes, during pregnancy	8	13.8%	9	7.9%	0.168
Contact with varnishes	Yes, before	1	1.7%	0	0.0%
No	49	84.5%	105	92.1%
Contact with solvents	Yes, during pregnancy	8	13.8%	12	10.4%	0.291
Contact with solvents	Yes, before	1	1.7%	0	0.0%
No	49	84.5%	103	89.6%
Contact with tails	Yes, during pregnancy	9	15.8%	14	12.2%	0.637
Contact with tails	Yes, before	0	0.0%	1	0.9%
No	48	84.2%	100	87.0%
Contact with repellents	Yes, during pregnancy	20	34.5%	55	47.8%	0.095
No	38	65.5%	60	52.2%
Contact with pesticides	Yes, during pregnancy	4	7.0%	7	6.1%	0.814
No	53	93.0%	108	93.9%
Contact with poisons	Yes, during pregnancy	7	12.3%	19	16.8%	0.438
No	50	87.7%	94	83.2%
Contact with pesticides	Yes, during pregnancy	0	0.0%	2	1.8%	0.314
No	57	100.0%	112	98.2%
Contact with hair dye	Yes, during pregnancy	8	13.8%	21	18.4%	0.443
No	50	86.2%	93	81.6%
Contact with enamels	Yes, during pregnancy	33	56.9%	67	59.3%	0.953
Contact with enamels	Yes, before	1	1.7%	2	1.8%
No	24	41.4%	44	38.9%
Contact with capillary smoothing with ammonia	Yes, during pregnancy	2	3.4%	6	5.3%	0.667
Contact with capillary smoothing with ammonia	Yes, before	0	0.0%	1	0.9%
No	56	96.6%	107	93.9%
Contact with capillary straighteners without ammonia	Yes, during pregnancy	2	3.4%	6	5.2%	0.672
Contact with capillary straighteners without ammonia	Yes, before	0	0.0%	1	0.9%
No	56	96.6%	108	93.9%
Performed radiographs	Yes, during pregnancy	6	10.5%	2	1.8%	0.010
No	51	89.5%	112	98.2%
Performed CT scans	Yes, during pregnancy	0	0.0%	1	0.9%	0.036
Performed CT scans	Yes, before	3	5.4%	0	0.0%
No	53	94.6%	113	99.1%
Performed Magnetic	Yes, during pregnancy	2	4.8%	0	0.0%	0.074
Resonance	Yes, before	1	2.4%	1	1.0%
Imaging	No	39	92.9%	98	99.0%
Smoked during pregnancy	Yes, all the days	1	17%	5	4.3%	0.272
Smoked during pregnancy	Yes, some days	2	3.4%	1	0.9%
No, stopped smoking	3	5.2%	2	1.7%
No, never smoked	52	89.7%	108	93.1%
Number of cigarettes per day		15	10.0–20.0	7	4.0–10.0	0.333
Alcohol consumption during pregnancy	Yes, a little	5	8.8%	11	9.5%	0.999
Alcohol consumption during pregnancy	Yes, moderate	1	1.8%	2	1.7%
Yes, a lot	1	1.8%	2	1.7%
No	50	87.7%	101	87.1%

Table 4

Multivariate analysis of the determinants of microcephaly.

	B	S.E.	Adjusted OR	Adjusted OR CI 95%		p-value
	B	S.E.	Adjusted OR	Inferior	Superior	p-value
Zika virus	2.686	1.131	14.680	1.598	134.833	0.018
Muscle pain	0.480	0.711	1.617	0.401	6.517	0.499
Joint pain	0.731	0.602	2.078	0.638	6.768	0.225
Skin changes	–0.321	0.905	0.725	0.123	4.277	0.723
Sting during pregnancy	0.115	0.796	1.122	0.236	5.345	0.885
Radiography	0.261	0.908	1.298	0.219	7.692	0.774
CT Scan	–0.434	0.899	0.648	0.111	3.777	0.630

[i] Block 1: Zika virus, muscle pain, joint pain, skin changes, stings during pregnancy.

Block 2: Radiography, CT scan.

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DOI: https://doi.org/10.5334/aogh.2394 | Journal eISSN: 2214-9996

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Language: English

Published on: Aug 28, 2019

Published by: Ubiquity Press

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© 2019 Sabrina Gabriele Maia Oliveira Rocha, Luciano Lima Correia, Antônio José Lêdo Alves da Cunha, Hermano Alexandre Lima Rocha, Álvaro Jorge Madeiro Leite, Jocileide Sales Campos, Tereza de Jesus Pinheiro Gomes Bandeira, Lucas Silveira do Nascimento, Anamaria Cavalcante e Silva, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 85 (2019): Issue 1