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Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas

Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth...

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Autores principales: Harville, Emily W., Tong, Van T., Gilboa, Suzanne M., Moore, Cynthia A., Cafferata, Maria Luisa, Alger, Jackeline, Gibbons, Luz, Bustillo, Carolina, Callejas, Allison, Castillo, Mario, Fúnes, Jenny, García, Jorge, Hernández, Gustavo, López, Wendy, Ochoa, Carlos, Rico, Fátima, Rodríguez, Heriberto, Zúniga, Concepción, Ciganda, Alvaro, Stella, Candela, Tomasso, Giselle, Buekens, Pierre
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838815/
https://www.ncbi.nlm.nih.gov/pubmed/33383742
http://dx.doi.org/10.3390/tropicalmed6010005
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author Harville, Emily W.
Tong, Van T.
Gilboa, Suzanne M.
Moore, Cynthia A.
Cafferata, Maria Luisa
Alger, Jackeline
Gibbons, Luz
Bustillo, Carolina
Callejas, Allison
Castillo, Mario
Fúnes, Jenny
García, Jorge
Hernández, Gustavo
López, Wendy
Ochoa, Carlos
Rico, Fátima
Rodríguez, Heriberto
Zúniga, Concepción
Ciganda, Alvaro
Stella, Candela
Tomasso, Giselle
Buekens, Pierre
author_facet Harville, Emily W.
Tong, Van T.
Gilboa, Suzanne M.
Moore, Cynthia A.
Cafferata, Maria Luisa
Alger, Jackeline
Gibbons, Luz
Bustillo, Carolina
Callejas, Allison
Castillo, Mario
Fúnes, Jenny
García, Jorge
Hernández, Gustavo
López, Wendy
Ochoa, Carlos
Rico, Fátima
Rodríguez, Heriberto
Zúniga, Concepción
Ciganda, Alvaro
Stella, Candela
Tomasso, Giselle
Buekens, Pierre
author_sort Harville, Emily W.
collection PubMed
description Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as “severe microcephaly”) and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Informático Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71–2.93) had HC < 2SD, including two (0.35%, 95% CI 0.04–1.24) with HC < 3SD, and 11 (1.9%, 95% CI, 0.79–3.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution.
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spelling pubmed-78388152021-01-28 Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas Harville, Emily W. Tong, Van T. Gilboa, Suzanne M. Moore, Cynthia A. Cafferata, Maria Luisa Alger, Jackeline Gibbons, Luz Bustillo, Carolina Callejas, Allison Castillo, Mario Fúnes, Jenny García, Jorge Hernández, Gustavo López, Wendy Ochoa, Carlos Rico, Fátima Rodríguez, Heriberto Zúniga, Concepción Ciganda, Alvaro Stella, Candela Tomasso, Giselle Buekens, Pierre Trop Med Infect Dis Article Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as “severe microcephaly”) and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Informático Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71–2.93) had HC < 2SD, including two (0.35%, 95% CI 0.04–1.24) with HC < 3SD, and 11 (1.9%, 95% CI, 0.79–3.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution. MDPI 2020-12-29 /pmc/articles/PMC7838815/ /pubmed/33383742 http://dx.doi.org/10.3390/tropicalmed6010005 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Harville, Emily W.
Tong, Van T.
Gilboa, Suzanne M.
Moore, Cynthia A.
Cafferata, Maria Luisa
Alger, Jackeline
Gibbons, Luz
Bustillo, Carolina
Callejas, Allison
Castillo, Mario
Fúnes, Jenny
García, Jorge
Hernández, Gustavo
López, Wendy
Ochoa, Carlos
Rico, Fátima
Rodríguez, Heriberto
Zúniga, Concepción
Ciganda, Alvaro
Stella, Candela
Tomasso, Giselle
Buekens, Pierre
Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas
title Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas
title_full Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas
title_fullStr Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas
title_full_unstemmed Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas
title_short Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas
title_sort measurement of head circumference: implications for microcephaly surveillance in zika-affected areas
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838815/
https://www.ncbi.nlm.nih.gov/pubmed/33383742
http://dx.doi.org/10.3390/tropicalmed6010005
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