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https://www.arca.fiocruz.br/handle/icict/50277
DEVELOPMENTAL OUTCOMES IN CHILDREN EXPOSED TO ZIKA VIRUS IN UTERO FROM A BRAZILIAN URBAN SLUM COHORT STUDY
Author
Ticona, Juan P. Aguilar
Nery Junior, Nivison
Ladines-Lim, Joseph B.
Gambrah, Claudia
Sacramento, Gielson
Freitas, Bruno de Paula
Bouzon, Joseane
Oliveira Filho, Jamary
Borja, Ana
Adhikarla, Haritha
Montoya, Magelda
Chin, Athena
WunderJunior, Elsio A.
Ballalai, Verena
Vieira, Carina
Belfort, Rubens
AlmeidaI, Antonio R. P.
Reis, Mitermayer Galvão dos
HarrisID, Eva
Ko, Albert Icksang
Costa, Federico
Nery Junior, Nivison
Ladines-Lim, Joseph B.
Gambrah, Claudia
Sacramento, Gielson
Freitas, Bruno de Paula
Bouzon, Joseane
Oliveira Filho, Jamary
Borja, Ana
Adhikarla, Haritha
Montoya, Magelda
Chin, Athena
WunderJunior, Elsio A.
Ballalai, Verena
Vieira, Carina
Belfort, Rubens
AlmeidaI, Antonio R. P.
Reis, Mitermayer Galvão dos
HarrisID, Eva
Ko, Albert Icksang
Costa, Federico
Affilliation
"Múltipla ver em Notas"
Abstract
The prevalence of developmental alterations associated with in-utero Zika virus (ZIKV)
exposure in children is not well understood. Furthermore, estimation of the Population Attributable
Fraction (PAF) of developmental alterations attributed to ZIKV has not been performed
due to lack of population-based cohorts with data on symptomatic and
asymptomatic ZIKV exposures and an appropriate control group. The aim of this study was
to characterize neurodevelopmental outcomes of children at 11 to 32 months of age with
intrauterine ZIKV exposure and estimate the PAF of alterations secondary to ZIKV
exposure.
Methodology/Principal findings
We performed a cohort of biannual community-based prospective serosurveys in a slum
community in Salvador, Brazil. We recruited women participating in our cohort, with a documented
pregnancy from January 2015 to December 2016 and children born to those mothers.
Children were classified as ZIKV exposed in utero (born from women with ZIKV
seroconversion during pregnancy) or unexposed (born from women without ZIKV seroconversion
or that seroconverted before/after pregnancy) by using an IgG monoclonal antibody
blockade-of-binding (BoB). We interviewed mothers and performed anthropometric, audiometric,
ophthalmological, neurologic, and neurodevelopmental evaluations of their children at 11 to 32 months of age. Among the 655 women participating in the cohort, 66 (10%) were
pregnant during the study period. 46 (70%) of them completed follow-up, of whom ZIKV
seroconversion occurred before, during, and after pregnancy in 25 (54%), 13 (28%), and 1
(2%), respectively. The rest of women, 7 (21.2%), did not present ZIKV seroconversion. At
11 to 32 months of life, the 13 ZIKV-exposed children had increased risk of mild cognitive
delay (RR 5.1; 95%CI 1.1–24.4) compared with the 33 children unexposed, with a PAF of
53.5%. Exposed children also had increased risk of altered auditory behavior (RR 6.0; 95%
CI 1.3–26.9), with a PAF of 59.5%.
Conclusions
A significant proportion of children exposed in utero to ZIKV developed mild cognitive delay
and auditory behavioral abnormalities even in the absence of gross birth defects such as
microcephaly and other neurodevelopmental domains. Furthermore, our findings suggest
that over half of these abnormalities could be attributed to intrauterine ZIKV exposure.
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