From the London School of Hygiene and Tropical Medicine, London (E.S.P., E.B.B., L.S., L.C.R.); the Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (E.S.P., L.L.C., M.C.N.C., E.H.C., R.F.S.A., M.S.R., R.V.V., L.C.C., L.C.R., M.L.B., M.G.T.), and Instituto de Saude Coletiva, Federal University of Bahia (M.C.N.C., M.L.B., M.G.T.), Salvador, the East Regional Health Center of the State Health Secretariat of Bahia, Santo Antonio de Jesus (R.C.O.C.-S.), and the Secretariat of Health Surveillance, Ministry of Health, Brasilia (G.V.A.F.) - all in Brazil; and the Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (C.A.M.).
N Engl J Med. 2022 Feb 24;386(8):757-767. doi: 10.1056/NEJMoa2101195.
Prenatal exposure to Zika virus has potential teratogenic effects, with a wide spectrum of clinical presentation referred to as congenital Zika syndrome. Data on survival among children with congenital Zika syndrome are limited.
In this population-based cohort study, we used linked, routinely collected data in Brazil, from January 2015 through December 2018, to estimate mortality among live-born children with congenital Zika syndrome as compared with those without the syndrome. Kaplan-Meier curves and survival models were assessed with adjustment for confounding and with stratification according to gestational age, birth weight, and status of being small for gestational age.
A total of 11,481,215 live-born children were followed to 36 months of age. The mortality rate was 52.6 deaths (95% confidence interval [CI], 47.6 to 58.0) per 1000 person-years among live-born children with congenital Zika syndrome, as compared with 5.6 deaths (95% CI, 5.6 to 5.7) per 1000 person-years among those without the syndrome. The mortality rate ratio among live-born children with congenital Zika syndrome, as compared with those without the syndrome, was 11.3 (95% CI, 10.2 to 12.4). Among infants born before 32 weeks of gestation or with a birth weight of less than 1500 g, the risks of death were similar regardless of congenital Zika syndrome status. Among infants born at term, those with congenital Zika syndrome were 14.3 times (95% CI, 12.4 to 16.4) as likely to die as those without the syndrome (mortality rate, 38.4 vs. 2.7 deaths per 1000 person-years). Among infants with a birth weight of 2500 g or greater, those with congenital Zika syndrome were 12.9 times (95% CI, 10.9 to 15.3) as likely to die as those without the syndrome (mortality rate, 32.6 vs. 2.5 deaths per 1000 person-years). The burden of congenital anomalies, diseases of the nervous system, and infectious diseases as recorded causes of deaths was higher among live-born children with congenital Zika syndrome than among those without the syndrome.
The risk of death was higher among live-born children with congenital Zika syndrome than among those without the syndrome and persisted throughout the first 3 years of life. (Funded by the Ministry of Health of Brazil and others.).
Zika 病毒的产前暴露具有潜在的致畸作用，其临床表现广泛，被称为先天性 Zika 综合征。先天性 Zika 综合征患儿的生存数据有限。
在这项基于人群的队列研究中，我们使用了巴西 2015 年 1 月至 2018 年 12 月期间的相关、常规收集的数据，以比较患有先天性 Zika 综合征的活产儿与未患有该病的活产儿的死亡率。Kaplan-Meier 曲线和生存模型的评估经过了混杂因素的调整，并根据胎龄、出生体重和小于胎龄儿的状态进行了分层。
共随访了 11481215 名活产儿至 36 个月龄。患有先天性 Zika 综合征的活产儿的死亡率为每 1000 人年 52.6 例死亡（95%置信区间[CI]，47.6 至 58.0），而未患有该病的活产儿的死亡率为每 1000 人年 5.6 例死亡（95%CI，5.6 至 5.7）。与未患有该病的活产儿相比，患有先天性 Zika 综合征的活产儿的死亡率比为 11.3（95%CI，10.2 至 12.4）。在胎龄小于 32 周或出生体重小于 1500 克的婴儿中，无论是否患有先天性 Zika 综合征，死亡风险均相似。在足月出生的婴儿中，患有先天性 Zika 综合征的婴儿死亡的可能性是未患有该病的婴儿的 14.3 倍（95%CI，12.4 至 16.4；死亡率为 38.4 例死亡/每 1000 人年，而后者为 2.7 例死亡/每 1000 人年）。在出生体重为 2500 克或以上的婴儿中，患有先天性 Zika 综合征的婴儿死亡的可能性是未患有该病的婴儿的 12.9 倍（95%CI，10.9 至 15.3；死亡率为 32.6 例死亡/每 1000 人年，而后者为 2.5 例死亡/每 1000 人年）。患有先天性 Zika 综合征的活产儿记录的死亡原因中，先天性异常、神经系统疾病和传染病的负担高于未患有该病的活产儿。
与未患有该病的活产儿相比，患有先天性 Zika 综合征的活产儿的死亡风险更高，且这种风险在出生后的头 3 年持续存在。（由巴西卫生部和其他机构资助）。
