The severe congenital brain malformations of children exposed to Zika virus in pregnancy are a major focus of ZikaPLAN research and one of the main concerns about Zika infection. Indeed, it was this that led to the declaration of a Public Health Emergency of International Concern in February 2016.

“We are examining the social component and impact on families where a child is affected with microcephaly to understand how the quality of life is affected; the impact on divorce and unemployment but also on everyday loss of sleep, depression and difficulties with child care.”

Prof. Laura Rodrigues, London School of Hygiene & Tropical Medicine

Overall Objective

The group aims to:

  • determine the attack rate of Congenital Zika Syndrome by gestational week of infection,
  • describe the full spectrum of Congenital Zika Syndrome including neurodevelopmental milestones in the first three years of life.

Specific Objectives

Since the beginning of the project, MERG’s work has been divided along three research lines:

Congenital Zika implications for pregnant women to:

  • determine the absolute risk of miscarriage, stillbirth, microcephaly and other manifestations of the Zika congenital syndrome in neonates of pregnant women with Zika infection by gestational age,
  • define the full spectrum of the congenital Zika syndrome at birth,
  • develop an improved case definition of congenital Zika syndrome for surveillance purposes and birth defect registries (with partners Ulster and ECLAMC),

Congenital Zika implications for neonates to:

  • characterize the clinical spectrum of congenital Zika syndrome for neonates,
  • validate simple tools that can be used to assess deficiencies in other settings with low-resources,

 Evaluation of the social and economic impact to:

  • estimate the social impact and cost of having a child with congenital Zika infection syndrome on the lives of women and families (including: livelihood, occupation, mental health, health service needs) and the subsequent impact on public services.

Results and Achievements

Since the initiation of ZikaPLAN, MERG has established two multicentric cohorts: 

  • a cohort of pregnant women with an episode of rash during pregnancy,
  • a cohort of children with suspected prenatal exposure to Zika virus (ZIKV).

Out of the women who were identified with rash during pregnancy, a substantial proportion of them had detectable virus at the time of testing. Additional women were identified as ZIKV-positive by immunological testing. Analyses based on these data are underway to determine the attack rate of Congenital Zika Syndrome by gestational week of infection and the prevalence of adverse birth outcomes associated with Zika infection in pregnancy. 

Children with microcephaly and other clinical manifestations of Congenital Zika Syndrome are being monitored over the first three years of life. Based on these data, analyses to describe the full spectrum of Congenital Zika Syndrome including neurodevelopmental milestones in the first three years of life are being carried out. 

A further subset of maternal-child dyads is being evaluated to estimate the social impact and costs (e.g., on livelihood, occupation, mental health, and health service needs) of raising a child with congenital exposure to ZIKV. 

In addition to the results expected from this project, the cohort data collected by MERG will also contribute to:

  • joint statistical analysis with the ZIKAlliance and ZIKAction consortia,
  • an individual participant data meta-analysis of cohort data from across Brazil,
  • an individual participant data meta-analysis of cohort data from across the world, organized by the World Health Organization.
MERG and NEURO-ZIKA Networks

Where MERG and NEURO-ZIKA are active

Participating Organisations

Group leader: Dr. Elizabeth B. Brickley, London School of Hygiene & Tropical Medicine

  • Umeå University
  • Queen Mary University of London
  • Ulster University
  • Associação Técnica–Científica de Estudo Colaborativo Latino Americano de Malformações Congênitas
  • Fundação Oswaldo Fiocruz
  • Universidade de Pernambuco