ERRATA ISSUED SEE PAGES 14 & 15

DISCLAIMER
This paper was submitted to the Bulletin of the World Health Organization and was
posted to the Zika open site, according to the protocol for public health emergencies for
international concern as described in Christopher Dye et al.
(http://dx.doi.org/10.2471/BLT.16.170860)
The information herein is available for unrestricted use, distribution and reproduction in
any medium, provided that the original work is properly cited as indicated by the
Creative Commons Attribution 3.0 Intergovernmental Organizations licence (CC BY
IGO 3.0).
RECOMMENDED CITATION
Cunha AJLA, Magalhes-Barbosa MC, Lima-Setta F, Prata-Barbosa A. Evolution of
cases of microcephaly and neurological abnormalities suggestive of congenital infection
in Brazil: 2015-2016. [Submitted]. Bull World Health Organ E-pub: 16 Mar 2016. doi:
http://dx.doi.org/10.2471/BLT.16.173583

Evolution of cases of microcephaly and neurological

abnormalities suggestive of congenital infection in
Brazil: 2015-2016.
Antonio JLA Cunha,a Maria Clara Magalhes-Barbosa,b Fernanda
Lima-Settab & Arnaldo Prata-Barbosab
a

Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho,
373, Edifcio do Centro de Cincias da Sade, Bloco K, 2 andar, Cidade Universitria, Ilha do
Fundo, 21.941-902 Rio de Janeiro, Brazil

Instituto D'Or de Pesquisa e Ensino, Brazil

Correspondence to Antonio Cunha (email: antonioledo@yahoo.com.br).

(Submitted: 16 March 2016 Published online: 16 March 2016)

Abstract
Objective To describe the evolution of cases of microcephaly and neurological
abnormalities suggestive of congenital infection in Brazil in 2015-2016.
Methods Analysis of secondary epidemiological data, published by the Brazilian
Ministry of Health, to monitor the epidemic by Zika virus. Cases of microcephaly
classified as notified, confirmed, excluded, under investigation, and Zika virusassociated were studied, as well as their temporal evolution. The data are presented in
absolute numbers, percentages and prevalence rates. The excluded to confirmed ratio,
the increment rate and the percentage of confirmed cases were calculated.
Findings Until March 2016, the number of cases of microcephaly and/or abnormalities
of the central nervous system being investigated in Brazil (n=4231) was almost 6 times
the number of confirmed cases (n=745); these 745 were approximately one-third of
those who concluded the investigation (confirmed+excluded=1927). The number of
confirmed cases associated to Zika virus was small (n=88). Most of the notified and
confirmed cases occurred in the northeastern region, where the state of Pernambuco,
Paraba and Rio Grande do Norte showed the largest prevalence. A marked increase in
the notified cases (58.2%), confirmed cases (223.9%), and Zika virus associated cases
(> 14x) occurred in 2016.
Conclusions The epidemic of microcephaly and neurological abnormalities associated
with the Zika virus in Brazil is not declining and control measures should be intensified.
In the light of the vast potential for spread of this virus, the knowledge of what occurs in
Brazil may contribute to health actions in other places.
Key words microcephaly, congenital abnormalities, Zika virus

Introduction
In the beginning of 2015, an outbreak of the Zika virus, a flavivirus transmitted by the
Aedes Aegypti mosquito, was identified in northeastern Brazil. Then, a dramatic
increase in the number of cases of microcephaly was reported in areas affected by the
outbreak. Among the first reported cases, 74% of mothers reported a rash illness during
pregnancy, 71% of children had severe microcephaly (>3 standard deviation, SD, below
mean), about half had at least one neurological abnormality, and among 27 patients that
were submitted to neuroimaging studies, all were abnormal.1
In October 2015, the microcephaly notification became mandatory in Brazil. The
cases are monitored through the Information System of Live Births (SINASC). Recent
analyses show a large increase in the prevalence of microcephaly at birth in 2015,
especially in October and November.2 In November 2015, the Brazilian Ministry of
Health declared the Zika virus epidemic as a national health emergency3, and in
February 2016, the Emergency Committee of the World Health Organization announced
it as public health emergency of international concern.4 Since then, there is increasing
evidence in favor of the association of Zika virus infection in pregnancy with
microcephaly and/or other neurological abnormalities in newborns.5-9 The Ministry of
Health has been monitoring the situation of microcephaly in Brazil and periodic
newsletters are being published with the most recent information.10-17
The limited knowledge of the virus effects in the human body, as well as other
aspects of the epidemic, associated with its relatively fast evolution, emphasize the need
for updated and disseminated information. However, data on the relationship between
the Zika virus and microcephaly and/or other neurological abnormalities should be
examined critically. The information can assist in planning and implementing health
actions, as well as serve as experience to other regions of Brazil and even other
countries, since there is a possibility of increasing cases in the future.
This study aimed to describe the evolution of cases of microcephaly and other
central nervous system abnormalities suggestive of congenital infections in Brazil in
2015-2016. It also aims to describe the cases distribution and prevalence by geographic
regions and states in the same period.

Methodology

Secondary data analysis, extracted from the epidemiological reports from the Secretary
of Health Surveillance of the Brazilian Ministry of Health (SVS/MS) to monitor cases
of Zika virus infection.10-17
Microcephaly cases were classified as: notified, confirmed, excluded and still
under investigation in accordance with the definitions of "Protocol of surveillance and
response to the occurrence of microcephaly.18 The cases occurring in the country, from
October 22th, 2015 until March 5th, 2016 were described by geographic regions and by
the states with the largest number of cases. The prevalence in these states was
calculated. The temporal evolution of all the cases occurring in the country from
January 10th until March 5th was also described, including consolidated cases since
October 22th, 2015.
The following variables and definitions were used to refer to the microcephaly
cases:18
Notified case of microcephaly:
o Newborn with less than 37 weeks of gestational age, with head
circumference below the 3rd percentile at birth, according to Fenton
curve for sex.
o Newborn with 37 or more weeks of gestational age, with head
circumference of 32.0 cm or less at birth, according to the WHO
references.
Confirmed case of newborn with microcephaly related to congenital infection:
o By clinical and radiological criteria: notified case of microcephaly in
newborn AND neuroimaging studies abnormalities suggestive of
congenital infection AND/OR
o By clinical and laboratory criteria: notified case of microcephaly in
newborn AND laboratory diagnosis specific and conclusive to Zika virus
or Syphilis, Toxoplasmosis, Other infectious agent, Rubella,
Cytomegalovirus and Herpes virus (Z-STORCH), identified in samples
of the newborn and/or the mother.
Excluded case of microcephaly related to congenital infection:
o Case notified as microcephaly with normal results (no suggestive
alterations of congenital infection) by any neuroimaging study or by
clinical criteria after appropriate investigation.
For better understanding of the data presented in this study, we decided to use a
separate definition of the microcephaly cases associated to Zika virus, to which we refer
on several occasions.

Zika virus-associated case: Confirmed case of microcephaly in newborn with

specific and conclusive laboratory criteria positive to Zika virus infection in

samples from the newborn and/or the mother.
The data are presented in tables with absolute numbers, percentages and
prevalence rates per 100,000 inhabitants using population-based data provided by the
Brazilian Institute of Geography and Statistics (IBGE),19 and prevalence rates per
10,000 live births, using the mean of the last five years, available on the Department of
Informatics of the Brazilian Public Health System (DATASUS 2009-2013).20
Regarding the monitoring of microcephaly cases associated with congenital
infections, the use of the term "incidence" is not appropriate because it refers to new
cases of birth defects, including spontaneous abortions, which may not be counted
accurately. Thus, the term "prevalence" will be used for this purpose in this article.21
The ratio of excluded to confirmed cases was calculated by dividing the number of
excluded cases by the number of confirmed cases in the period. The increment rate of
cases was calculated using the percentage increase of cases that occurred from the
previous period to the next one. It was also calculated the percentage of confirmed cases
by dividing the total number of confirmed cases by the sum of the confirmed and
excluded cases.

Results
Until to March 5th, 2016 a total of 6,158 suspected cases of microcephaly and/or other
neurological abnormalities related to congenital infections were notified in Brazil by the
Ministry of Health. From this total, 745 cases have already been confirmed by clinical
and diagnostic criteria (image or laboratory), 1,182 were excluded due to normal
examinations or for presenting non-infectious causes of microcephaly and/or
neurological abnormalities, and 4,231 remain under investigation (Table 1). The
percentage of the total number of confirmed cases over the total number of confirmed
plus excluded cases was 38.7% (745/1927). Of these, the percentage of cases associated
with the Zika virus was 4.6% (88/1927). The majority of all the reported cases are in the
Northeast region of the country (Table 1). The 745 confirmed cases were registered in
282 municipalities of 18 states and, so far, autochthonous circulation of the Zika vrus
was encountered in 22 of the 26 states. The states of Pernambuco, Bahia, Paraba, Rio
Grande do Norte and Piau were those with the highest number of confirmed cases of
microcephaly and/or neurological abnormalities changes, until March 5th, 2016. In

those states, the percentage of confirmed cases varies, not necessarily as a function of
the absolute number of confirmed cases. Pernambuco has the highest prevalence of
confirmed cases per 100,000 inhabitants (2.57), followed by Rio Grande do Norte
(2.25) and Paraba (1.78). On the other hand, Rio Grande do Norte has the highest
prevalence of confirmed cases by 10,000 live births (41.32), followed by Pernambuco
(41.24) and Paraba (29.27). Paraba has the highest prevalence of total notified cases in
the studied period (20.71 per 100,000 inhabitants and 340.52 per 10,000 live births)
(Table 2).
In the period from January 20th to March 5th, a significant increase of
microcephaly and/or neurological abnormalities associated with congenital infection
notifications (58.2%) and confirmed cases (223.9%) was noted in Brazil. The numbers
of cases associated with the Zika virus has increased more than 14 times during that
period. The increment rate of excluded cases (319.2%) was much higher than the
increment rate of confirmed cases (223.9%). The absolute number of cases under
investigation showed mild increase in the period, while the excluded to confirmed cases
ratio remained relatively constant with a slight tendency to decline (Table 3).

Discussion
The data of the present study showed that by March 2016, the number of microcephaly
and/or neurological abnormalities cases being investigated in Brazil (n=4,231) was
almost 6 times the number of already confirmed cases (n=745); that the percentage of
cases effectively confirmed as microcephaly and/or neurological abnormalities (n=745)
was a little more than one third of those who have completed the investigation
(confirmed + excluded = 1,927); and that among these confirmed cases, the number
associated with the Zika virus was small (n=88). Most of the notified and confirmed
cases occurred in the northeastern region of Brazil, with variations in prevalence per
100,000 inhabitants and per 10,000 live births among the five states with the highest
number of confirmed cases.
A recent article based on the same data from Brazil reported a much lower
annual prevalence of microcephaly in 2015 (2.8/10,000 live births)7, than the prevalence
found in the present study (51/10,000 live births). However, the first study included the
months before the outbreak, when sub-notification was probably occurring, and only
severe cases of microcephaly (head circumference 3SD) were being notified. In 2016,
there was an outstanding increase in the notifications (58.2%), in the confirmed cases
6

(223.9%), and in the Zika virus-associated cases (> 14 times). In the same period, the
increment rate of excluded cases was almost 1.5 times the increment rate of confirmed
cases. However, the number of cases under investigation remained high, although the
increment rate was small in the period and the excluded/confirmed ratio had declined in
the last week studied.
The evidence that reinforce the association between Zika virus and the
occurrence of microcephaly in newborns are becoming more frequent.5-9 In this sense, it
is extremely relevant to study microcephaly since little is known about its frequency
alone or combined with other central nervous system abnormalities in children whose
mothers were affected by the Zika virus. The choice of a broad indicator made by the
Brazilian Ministry of Health, informing microcephaly along with other central nervous
system abnormalities suggestive of congenital infection, but excluding its noninfectious causes, has advantages and disadvantages. Advantages, to approach the
problem as a whole dimensioning all the deleterious effects of the virus on the central
nervous system, which in the future may need a more expanded definition as Zika
Virus Congenital Syndrome. Disadvantages, because it precludes the investigation of
the epidemiology of microcephaly alone and comparison with similar data from the
literature. On the other hand, it is not clear yet if the children whose mothers were
affected by the virus in pregnancy may present abnormalities of the nervous system,
without microcephaly.
The cases of microcephaly associated with Zika virus so far in Brazil are few
when compared with all the notifications. If we consider that most cases of Zika virus
infection are oligo or asymptomatic,11 the percentage of microcephaly and/or
neurological abnormalities associated to the virus seems to be too small. However,
many reported cases remain under investigation. It is possible that, increasing the
number of cases with laboratory investigation completed, the actual percentage of
nervous system abnormalities will be elucidated. This study data show that in Brazil, the
cases of microcephaly are increasing, whether they are classified as notified, confirmed
or Zika virus-associated. In early February, a decrease in the increment rate of notified,
confirmed, excluded and under investigation cases was observed, when compared with
the previous period. However, it must be considered that this period has coincided with
the Carnival holiday, during which a reduction of notifications may have occurred. Data
from the first week of February showed a resumption of notifications, with increase in
the increment rate of notified, confirmed, excluded and under investigation cases. On
7

the other hand, in the first week of March there was a deceleration trend, with a
decrease in the increment rate of notified, Zika virus-associated and under investigation
cases, despite the increase in the increment rate of confirmed and excluded cases. The
progressive decrease of the excluded to confirmed cases ratio can be explained by a
possible decrease in the measurement errors of the head circumference, which would be
expected with the growing experience during the outbreak, and/or by a real increase in
the number of Zika virus-associated cases. Further studies are needed to clarify this
issue. In this short period, the fact that the number of cases under investigation
remained relatively constant despite the increasing number of notifications, suggested
that the confirmation system implemented in Brazil is still not showing the ideal
effectiveness. The decreasing tendency of the excluded/confirmed cases ratio could
mean an effectiveness improvement over time. Only the monitoring of the evolution of
these indicators can clarify if this trend is real.
The data of the Brazilian Ministry of Health show that the epidemic is in
progress with autochthonous circulation of the Zika virus in 22 states, and spreading of
the 745 confirmed cases of microcephaly in 282 municipalities of 18 states. These data,
together with the observed trend of increased notifications and confirmations of
microcephaly and/or neurological abnormalities cases associated with congenital
infection, allied to the still limited knowledge about the Zika virus epidemic, make the
prevention and monitoring actions, attention to the affected cases, and research
development, topics of great priority.
In summary, the epidemiological surveillance data show that the microcephaly
outbreak associated with the Zika virus in Brazil is not declining. As microcephaly may
be caused by other infectious agents, the Brazilian Ministry of Health is investigating,
as expected, all cases of microcephaly and other neurological abnormalities, notified by
the states and its possible relationship with the Zika virus and other congenital
infections. In addition, strategies to attack the mosquito have been intensified, as well as
the attempt to provide the appropriate conditions to supply the required assistance to
Zika virus-associated microcephaly. Studies and analyses as the one presented in this
article can contribute to better understanding the impact of Zika infection on the general
population and on children in particular, as well as the need to maintain both the society
and health professionals informed about the evolution of the epidemic. In the light of
the vast potential for spread of this virus, the knowledge of what occurs in Brazil may
contribute to health actions in other places.
8

References
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A, et al. Possible Association Between Zika Virus Infection and Microcephaly Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:59-62. DOI:
http://dx.doi.org/10.15585/mmwr.mm6503e2
2. Brasil. Ministrio da Sade. Informe epidemiolgico n 01/2015 Semana
epidemiolgica 46 (in Portuguese). Available at:
http://portalsaude.saude.gov.br/images/pdf/2015/novembro/24/COES-Microcefalias--Informe-Epidemiol--gico---SE-46---24nov2015.pdf Acessed on 11/03/2016.
3. Brasil. Ministrio da Sade. Agncia Sade. MICROCEFALIA Ministrio da Sade
divulga boletim epidemiolgico. 2015.
http://portalsaude.saude.gov.br/index.php/cidadao/principal/agencia-saude/20805ministerio-da-saude-divulgaboletim-epidemiologico.
4. WHO Director-General summarizes the outcome of the Emergency Committee
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http://www.who.int/mediacentre/news/statements/2016/emergency-committeezikamicrocephaly/en/. Accessed on 14/02/2016.
5. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo
de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and
microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol. 2016; 47(1):6-7.
6. Mlakar J1, Korva M, Tul N, Popovi M, Poljak-Prijatelj M, Mraz J, et al. Zika
Virus Associated with Microcephaly. N Engl J Med. 2016; 374:951-8.
7. Oliveira WK, Escalante JC, Oliveira WTGH, Carmo GMI, Henriques CMP, Coelho
GE, et al. Increase in Reported Prevalence of Microcephaly in Infants born to
Women Living in Areas with Confirmed Zika Virus Transmission During the Fisrt
Trimester of Pregnancy - Brazil, 2015. MMWR Morb Mortal Wkly Rep March
2016; 65:1-6.
8. Meaney-Delman D, Rasmussen S, Staples JE, Oduyebo T, Ellington SR, Petersen
EE, et al. Zika virus and pregnancy: what obstetric health care providers need to
know. Obstetrics & Ginecology 2016; 0:1-7.
DOI:10.1097/AOG.0000000000001378.
9. Brasil P, Pereira JP, Gabaglia CR, Damasceno L, Wakimoto M, Nogueira MRM, et
al. Zika vrus infection in pregnant women in Rio de Janeiro Preliminary report. N
Engl J Med. 2016 March 04. [Epub ahead of print] DOI: 10.1056/NEJMoa1602412
10. Brasil. Ministrio da Sade. Centro de Operaes de Emergncias em Sade Pblica
sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe
epidemiolgico n 09 semana epidemiolgica (se) 02/2016 (10 a 16/01/2016).
Braslia: Ministrio da Sade, 2016 (in Portuguese).
11. Brasil. Ministrio da Sade. Centro de Operaes de Emergncias em Sade Pblica
sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe
epidemiolgico n 10 semana epidemiolgica (se) 03/2016 (17 a 23/01/2016).
Braslia: Ministrio da Sade, 2016 (in Portuguese).
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sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe

epidemiolgico n 11 semana epidemiolgica (se) 04/2016 (24 a 30/01/2016).

Braslia: Ministrio da Sade, 2016 (in Portuguese).
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sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe
epidemiolgico n 12. Semana epidemiolgica 05/2016 (31/01 a 06/02/2016).
Braslia: Ministrio da Sade, 2016 (in Portuguese).
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sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe
epidemiolgico n 13. Semana epidemiolgica 06/2016 (07/01 a 13/02/2016).
Braslia: Ministrio da Sade, 2016 (in Portuguese).
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sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe
epidemiolgico n 14. Semana epidemiolgica 07/2016 (14/01 a 20/02/2016).
Braslia: Ministrio da Sade, 2016 (in Portuguese).
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sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe
epidemiolgico n 15. Semana epidemiolgica 08/2016 (21/01 a 27/02/2016).
Braslia: Ministrio da Sade, 2016 (in Portuguese).
17. Brasil. Ministrio da Sade. Centro de Operaes de Emergncias em Sade Pblica
sobre Microcefalias. Monitoramento de Casos de Microcefalia no Brasil. Informe
epidemiolgico n 16. Semana epidemiolgica 09/2016 (28/01 a 05/02/2016).
Braslia: Ministrio da Sade, 2016 (in Portuguese).
18. Brasil. Ministrio da Sade. Secretaria de Vigilncia em Sade. Departamento de
Vigilncia das Doenas Transmissveis. Protocolo de vigilncia e resposta
ocorrncia de microcefalia relacionada infeco pelo vrus Zika / Ministrio da
Sade, Secretaria de Vigilncia em Sade, Departamento de Vigilncia das Doenas
Transmissveis. Braslia: Ministrio da Sade, Verso 1.3, 2016 (in Portuguese).
Available at: www.saude.gov.br/svs. Accessed on 11/03/2016.
19. IBGE. Projeo da populao do Brasil e das Unidades da Federao. Nota Tcnica
(in Portuguese). Available at: http://www.ibge.gov.br/apps/populacao/projecao/.
Accessed on 14/02/2016.
20. DATASUS. Available at:
http://www2.datasus.gov.br/DATASUS/index.php?area=0205
21. Organization WHO, (U.S.) C for DC and P, Systems IC for BDM. Birth defects
surveillance: a manual for programme managers [Internet]. World Health
Organization; 2014 [cited 2015 Dec 5]. Available from:
http://www.who.int/iris/handle/10665/110223

10

Table 1. Distribution of under investigation, confirmed, excluded, and notified cases of

microcephaly and/or neurological abnormalities suggestive of congenital infection in
Brazil by geographical regions, from November 8th, 2015 to 5th March, 2016. Brazil,
2016.
Region

Cases Under
Investigation

Northeast

3265

725

937

4927

Southeast

531

100

637

North

179

20

202

Midwest

227

10

91

328

29

34

64

4231

745

1182

6158

South
BRAZIL

Confirmed
Cases

Source: Brazilian Ministry of Health

11

Excluded
Cases

Total accumulated
notified cases

Table 2. Distribution and prevalence of the under investigation, confirmed and notified cases of microcephaly and/or neurological abnormalities suggestive
of congenital infection (per 100,000 inhabitants) in the five states in Brazil with the highest number of cases from October 22th, 2015 to February27th,
2016. Brazil, 2016.
Brazilian
states with
highest
number of
cases

Cases of microcephaly and/or neurological abnormalities, suggestive of congenital infection

Confirmed Excluded
Population Average
Under
2
cases
N
cases
N
(%)
Live
investigation
1
(%)
births
cases
20092013

Prevalence of
confirmed
cases per
100,000
inhabitants

Prevalence
of confirmed
cases per
10,000 live
births

Total
accumulated
cases notified
from 2015 to
2016

Prevalence of
total
accumulated
cases per
100,000
inhabitants

Prevalence of
total
accumulated
cases per 10,000
live births

Pernambuco

1,214

241 (47.44) 267 (52.56)

9,382,808

140,264

2.57

17.18

1,722

18.35

122.77

Bahia

609

156 (61.42) 98 (38.58)

15,248,593 211,660

1.02

7.37

863

5.66

40.77

Rio Grande
do Norte

278

78 (74.29)

27 (25.71)

3,463,049

47,698

2.25

16.35

383

11.06

80.30

Paraba

447

71 (18.73)

308 (81.27)

3,986,977

58,217

1.78

12.20

826

20.71

141.88

Piau

65

50 (67.57)

24 (32.43)

3,209,892

48,989

1.56

10.21

139

4.33

28.37

BRAZIL

4,231

745 (38.66) 1,182 (61.34) 205,488,496 2,893,285 0.36

2.57

6,158

3.00

21.28

Source: Brazilian Ministry of Health. 1 Number of confirmed cases divided by the sum of confirmed and excluded cases.

12

Table 3. Evolution of microcephaly and/or neurological abnormalities cases, suggestive of congenital infection in Brazil in 2016. Brazil, 2016.
Case Types
and Ratio

NOTIFIED
CASES
CONFIRMED
CASES
ZIKA VIRUSASSOCIATED
CASES
EXCLUDED
CASES
UNDER
INVESTIGAT
ION CASES
EXCLUDED/
CONFIRMED
CASES

DATA AND PERCENTUAL INCREMENT

Jan,
1016th

Jan,
1723th

3,893 4,180

Increment
(%)

Jan,
2430th

Increment
(%)

Jan
Feb
3106th

Increment
(%)

Feb
0713th

Increment
(%)

Feb
1420th

Increment
(%)

Feb
2127th

Increment
(%)

FebMar,
28-5th

7.37

4,783

14.43

5,079

6.19

5,280

3.96

5,640

6.82

5,909

4.77

6,158

4.21

58.18

230

270

17.39

404

49.63

462

14.36

508

9.96

583

14.76

641

9.95

745

16.22

223.91

17

183.33

41

141.18

67

63.41 (in
2 weeks)

82

22.39

88

7.32

1,366.67

282

462

63.83

709

53.46

765

7.90

837

9.41

950

13.50

1,046

10.11

1,182

13.00

319.15

1.98

3,670

6.44

3,852

4.96

3,935

2.15

4,107

4.37

4,222

2.80

4,231

0.21

25.14

1.75

1.66

1.65

1.63

1.63

1.59

3,381 3,448

1.23

1.71

Source: Brazilian Ministry of Health.

13

Increment TOTAL
(%)
Increment
(%)

ERRATA
Evolution of cases of microcephaly and neurological abnormalities suggestive of congenital
infection in Brazil: 2015-2016.
Cunha AJLA, Magalhes-Barbosa MC, Lima-Setta F, Prata-Barbosa A. Evolution of cases of
microcephaly and neurological abnormalities suggestive of congenital infection in Brazil: 20152016. [Submitted]. Bull World Health Organ E-pub: 16 Mar 2016.
doi: http://dx.doi.org/10.2471/BLT.16.173583

Location
Page 6, lines
4-6

Table 1, title
Table 2

14

Original text
On the other hand, Rio
Grande do Norte has the
highest prevalence of
confirmed cases by 10,000
live births (41.32), followed
by Pernambuco (41.24) and
Paraba (29.27).
from November 8th
Columns 8 and 11

Correction
The prevalence of confirmed cases per
10,000 live births was also higher in
Pernambuco (41.24), followed by Rio Grande
do Norte (39.25) and Paraba (29.27).

from October 22nd

Columns 8 and 11 of the new table (next
page)

Table 2. Distribution and prevalence of the under investigation, confirmed and notified cases of microcephaly and/or neurological abnormalities suggestive
of congenital infection (per 100,000 inhabitants and per 10.000 live births in five months) in the five states in Brazil with the highest number of cases from
October 22nd, 2015 to March 5th, 2016. Brazil, 2016.
Brazilian
states with
highest
number of
cases

Under
investigation
cases

Confirmed
cases
N (%)1

Pernambuco

1,214

241 (47.44)

Cases of microcephaly and/or neurological abnormalities, suggestive of congenital infection

Discarded
Population
Average
Prevalence
Prevalence
Total
Prevalence of
cases
Live
of
of
accumulated
total
N (%)2
births
confirmed
confirmed
cases notified
accumulated
2009-2013 cases per
cases per
from 2015 to
cases per
in five
100,000
10,000 live
2016
100,000
months
inhabitants
births
inhabitants
267 (52.56)
9,382,808
58,443
2.57
41.24
1,722
18.35

Bahia

609

156 (61.42)

98 (38.58)

15,248,593

88,192

1.02

17.69

863

5.66

97.85

Rio Grande
do Norte
Paraba

278

78 (74.29)

27 (25.71)

3,463,049

19,870

2.25

39.25

383

11.06

192.75

447

71 (18.73)

308 (81.27)

3,986,977

24,257

1.78

29.27

826

20.71

340.52

Piau

65

50 (67.57)

24 (32.43)

3,209,892

20,412

1.56

24.50

139

4.33

68.10

BRAZIL

4,231

745 (38.66)

1,182 (61.34)

205,488,496

1,205,535

0.36

6.18

6,158

3.00

51.08

Prevalence of total
accumulated cases
per 10,000

295.65

Source: Brazilian Ministry of Health.

Note: 1 Number of confirmed cases divided by the sum of confirmed and discarded cases; 2 Number of discarded cases divided by the sum of confirmed and discarded cases

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