Title:	Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases
Other Titles:	Microcefalia no Estado de Pernambuco, Brasil: características epidemiológicas e avaliação da acurácia diagnóstica dos pontos de corte adotados para notificação de caso Microcefalia en el estado de Pernambuco, Brasil: características epidemiológicas y evaluación de la precisión diagnóstica de los puntos de corte adoptados para la notificación de casos
Authors:	Souza, Wayner Vieira de Araújo, Thalia Velho Barreto de Albuquerque, Maria de Fátima Pessoa Militão de Braga, Maria Cynthia Ximenes, Ricardo Arraes de Alencar Miranda-Filho, Demócrito de Barros Bezerra, Luciana Caroline Albuquerque Dimech, George Santiago Carvalho, Patrícia Ismael de Assunção, Romildo Siqueira de Santos, Roselene Hans Oliveira, Wanderson Kleber de Rodrigues, Laura Cunha Martelli, Celina Maria Turchi
Affilliation:	Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil
Abstract:	The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition.
Keywords:	Brazil Female Gestational Age Humans Infant Newborn Male Microcephaly Pregnancy Pregnancy Complications, Infectious ROC Curve Sensitivity and Specificity Zika virus Zika Virus Infection Epidemiology
keywords:	Microcefalia Brasil Zika virus Epidemiologia
DeCS:	Zika virus Sensibilidade e Especificidade Infecção pelo Zika virus Humanos Masculino Gravidez Complicações Infecciosas na Gravidez Curva ROC Microcefalia Recém-Nascido Feminino Idade Gestacional Epidemiologia Diagnóstico
Issue Date:	2016
Citation:	SOUZA, Wayner Vieira de et al. Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases. Cadernos de Saúde Pública, v. 32, n. 4, p. 1-7, 2016.
DOI:	10.1590/0102-311X00017216
ISSN:	1678-4464
Copyright:	open access
Appears in Collections:	PE - IAM - Artigos de Periódicos

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