Seizures as a Complication of Congenital Zika Syndrome in Early Infancy

Jamary Oliveira-Filho Postgraduate Program in Health Sciences, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil;

Search for other papers by Jamary Oliveira-Filho in
Current site
Google Scholar
PubMed
Close
,
Ridalva Felzemburgh Escola de Enfermagem, Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil;

Search for other papers by Ridalva Felzemburgh in
Current site
Google Scholar
PubMed
Close
,
Federico Costa Escola de Enfermagem, Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil;

Search for other papers by Federico Costa in
Current site
Google Scholar
PubMed
Close
,
Nivison Nery Jr., Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Brazil;

Search for other papers by Nivison Nery Jr., in
Current site
Google Scholar
PubMed
Close
,
Adriana Mattos Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Brazil;

Search for other papers by Adriana Mattos in
Current site
Google Scholar
PubMed
Close
,
Daniele F. Henriques Instituto Evandro Chagas, Belem, Brazil;

Search for other papers by Daniele F. Henriques in
Current site
Google Scholar
PubMed
Close
,
Albert I. Ko Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Brazil;
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut

Search for other papers by Albert I. Ko in
Current site
Google Scholar
PubMed
Close
, and
for the Salvador Zika Response Team‡ Postgraduate Program in Health Sciences, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil;
Escola de Enfermagem, Instituto da Saúde Coletiva and Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil;
Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Brazil;
Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Brazil;
Instituto Evandro Chagas, Belem, Brazil;
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut

Search for other papers by for the Salvador Zika Response Team‡ in
Current site
Google Scholar
PubMed
Close
Restricted access

Zika virus transmission in Brazil was linked to a large outbreak of microcephaly but less is known about longer term anthropometric and neurological outcomes. We studied a cohort of infants born between October 31, 2015, and January 9, 2016, in a state maternity hospital, followed up for 101 ± 28 days by home visits. Microcephaly (< 2 standard deviations, Intergrowth standard) occurred in 62 of 412 (15%) births. Congenital Zika syndrome (CZS) was diagnosed in 29 patients. Among CZS patients, we observed a significant gain in anthropometric measures (P < 0.001) but no significant gain in percentile for these measures. The main neurological outcome was epilepsy, occurring in 48% of infants at a rate of 15.6 cases per 100 patient-months, frequently requiring multiple anti-seizure medications. The cumulative fatality rate was 7.4% (95% confidence interval: 2.1–23.4%). Health-care professionals should be alerted on the high risk of epilepsy and death associated with CZS in early infancy and the need to actively screen for seizures and initiate timely treatment.

Author Notes

Address correspondence to Jamary Oliveira-Filho, Rua Reitor Miguel Calmon, Sem Numero, Bairro Canela, Instituto de Ciencias da Saude, sala 415, Salvador, Bahia 40110-100, Brazil. E-mail: jamary@mail.harvard.edu

Financial support: This study was supported by NIH Grants RO1 NS064905, NIH R01 AI052473, U01 AI088752, and R25 TW009338, and the Oswaldo Cruz Foundation.

Authors’ addresses: Jamary Oliveira-Filho, Department of Biomorphology, Instituto de Ciencias da Saude, Universidade Federal da Bahia, Salvador, Brazil, E-mail: jamary@mail.harvard.edu. Ridalva Felzemburgh, Escola de Enfermagem, Universidade Federal da Bahia, Salvador, Brazil, E-mail: ridalva@gmail.com. Federico Costa, Laboratory of Pathology and Molecular Biology, Oswaldo Cruz Foundation, Salvador, Brazil, and Yale School of Public Health, Yale University, New Haven, CT, E-mail: fcosta2001@gmail.com. Nivison Nery Jr., Laboratory of Pathology and Molecular Biology, Oswaldo Cruz Foundation, Salvador, Brazil, E-mail: nivisonjr@hotmail.com. Adriana Mattos, Post-Graduate Program in Health Sciences, Universidade Federal da Bahia, Salvador, Brazil, E-mail: dricamattos@gmail.com. Daniele F. Henriques, Instituto Evandro Chagas, Rio de Janeiro, Brazil, E-mail: danielehenriques@iec.gov.br. Albert I. Ko, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil, E-mail: albert.ko@yale.edu.

These authors contributed equally to this work.

Salvador Zika Response Team: Jamile S. Fukuda, MD (Universidade do Estado da Bahia, Site Investigador); Ricardo Khouri, PhD (Core Laboratory PI); Lívia P. Pereira, RN (Universidade Federal da Bahia, Site Investigador); Josely B. Santos, RN (Universidade Federal da Bahia, Site Investigador); Aglaya O. L. C. Almeida, RN (Universidade Federal da Bahia, Site Investigador); Carla C. C. O. J. Lima, RN (Universidade Federal da Bahia, Site Investigador), Humberto Castro-Lima, MD (Escola Baiana de Medicina e Saude Publica, Core EEG PI); Hugo C. Ribeiro, MD (Universidade Federal da Bahia, Site Investigator); Mitermayer G. Reis, MD, PhD (FIOCRUZ, Site Investigator); Antonio R. Almeida, MD, PhD (Universidade Federal da Bahia, Site Investigator); Pedro F. C. Vasconcelos (Instituto Evandro Chagas).

  • 1.

    Franca GV et al. 2016. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. Lancet 388: 891897.

  • 2.

    Costa F et al. 2016. Emergence of congenital Zika syndrome: viewpoint from the front lines. Ann Intern Med 164: 689691.

  • 3.

    Rasmussen SA, Jamieson DJ, Honein MA, Petersen LR, 2016. Zika virus and birth defects–reviewing the evidence for causality. N Engl J Med 374: 19811987.

  • 4.

    Hazin AN et al. 2016. Computed tomographic findings in microcephaly associated with Zika virus. N Engl J Med 374: 21932195.

  • 5.

    de Paula Freitas B, de Oliveira Dias JR, Prazeres J, Sacramento GA, Ko AI, Maia M, Belfort R Jr., 2016. Ocular findings in infants with microcephaly associated with presumed Zika virus congenital infection in Salvador, Brazil. JAMA Ophthalmol 134: 529535.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Satterfield-Nash A et al. 2017. Health and development at age 19–24 months of 19 children who were born with microcephaly and laboratory evidence of congenital Zika virus infection during the 2015 Zika virus outbreak—Brazil, 2017. MMWR Morb Mortal Wkly Rep 15: 13471351.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Ito Y et al. Japanese Society for Pediatric Infectious Diseases, 2013. Risk factors for poor outcome in congenital cytomegalovirus infection and neonatal herpes on the basis of a nationwide survey in Japan. Pediatr Int 55: 566571.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Carvalho MD, Miranda-Filho DB, van der Linden V, Sobral PF, Ramos RC, Rocha MA, Cordeiro MT, de Alencar SP, Nunes ML, 2017. Sleep EEG patterns in infants with congenital Zika virus syndrome. Clin Neurophysiol 128: 204214.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 376 349 34
Full Text Views 876 17 2
PDF Downloads 138 8 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save