Date of Award

1-1-2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Albert Ko

Abstract

ZIKA-ASSOCIATED MICROCEPHALY AMONG PUBLIC AND PRIVATE HOSPITALS IN SALVADOR, BRAZIL

Adeolu Aromolaran, B.Sc., Joseph Lim, Ph.D., Federico Costa, Ph.D., Albert Ko, M.D. Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT.

In 2015, Brazil experienced an outbreak of Zika-associated microcephaly that disproportionately affected the states in the northeast. These states have very low socioeconomic status (SES) when compared to other regions in Brazil. Multiple hypotheses have been proposed to explain this geographic cluster (site of introduction of Zika virus (ZIKV), environmental factors, interaction with other viruses and lower socioeconomic status). However, there is a paucity of data regarding the link between SES and Zika-associated microcephaly. Therefore, we aim to describe and compare the burden of microcephaly at a public hospital (hospital 1) which serves patients of low SES and a private hospital (hospital 2) with a patient population of high SES. We implemented active surveillance at both hospitals to investigate microcephaly cases from October 1, 2015 – January 31, 2016. Clinical evaluation and diagnostic tests were performed for 85 infants with microcephaly and serological screening was performed on their mothers. We also conducted a serosurvey of 362 mothers of non-microcephaly controls. We found that maternal (ZIKV) seroprevalence varied widely between the hospitals in this period. Hospital 1 had a high sample adjusted prevalence of 63.9% (95%CI-60.3-67.5) when compared to hospital 2, 18.7% (95%CI-15.9-21.5) (p

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