title: Microcephaly and Zika virus: a clinical and epidemiological analysis of the current outbreak in Brazil.
abstract: OBJECTIVE
  This study aimed to critically review the literature available regarding the Zika virus outbreak in Brazil and its possible association with microcephaly cases.
  
  
  METHODS
  Experts from Instituto do Cérebro do Rio Grande do Sul performed a critical (nonsystematic) literature review regarding different aspects of the Zika virus outbreak in Brazil, such as transmission, epidemiology, diagnostic criteria, and its possible association with the increase of microcephaly reports. The PubMed search using the key word "Zika virus" in February 2016 yielded 151 articles. The manuscripts were reviewed, as well as all publications/guidelines from the Brazilian Ministry of Health, World Health Organization and Centers for Disease Control and Prevention (CDC - United States).
  
  
  RESULTS
  Epidemiological data suggest a temporal association between the increased number of microcephaly notifications in Brazil and outbreak of Zika virus, primarily in the Brazil's Northeast. It has been previously documented that many different viruses might cause congenital acquired microcephaly. Still there is no consensus on the best curve to measure cephalic circumference, specifically in preterm neonates. Conflicting opinions regarding the diagnosis of microcephaly (below 2 or 3 standard deviations) that should be used for the notifications were also found in the literature.
  
  
  CONCLUSIONS
  The development of diagnostic techniques that confirm a cause-effect association and studies regarding the physiopathology of the central nervous system impairment should be prioritized. It is also necessary to strictly define the criteria for the diagnosis of microcephaly to identify cases that should undergo an etiological investigation.
authors.affiliation: School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil. Electronic address: nunes@pucrs.br.
authors.forename: Magda Lahorgue
authors.initials: ML
authors.lastname: Nunes
authors.affiliation: Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil; Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil.
authors.forename: Celia Regina
authors.initials: CR
authors.lastname: Carlini
authors.affiliation: Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil; Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Marinowic
authors.affiliation: Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil; Post-Graduate Program in Pediatrics and Child Health, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Felipe Kalil
authors.initials: FK
authors.lastname: Neto
authors.affiliation: School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil.
authors.forename: Humberto Holmer
authors.initials: HH
authors.lastname: Fiori
authors.affiliation: Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil; Department of Pediatrics, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Marcelo Comerlato
authors.initials: MC
authors.lastname: Scotta
authors.affiliation: School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil.
authors.forename: Pedro Luis Ávila
authors.initials: PL
authors.lastname: Zanella
authors.affiliation: Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil; Department of Diagnostic Methods, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Ricardo Bernardi
authors.initials: RB
authors.lastname: Soder
authors.affiliation: School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Zika-Team, Instituto do Cérebro do Rio Grande do Sul (Inscer), Porto Alegre, RS, Brazil.
authors.forename: Jaderson Costa
authors.initials: JC
authors.lastname: da Costa
mesh_terms: D000330:Aedes; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007303:Insect Vectors; D008831:Microcephaly / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D000071244:Zika Virus / Q000302:isolation & purification; D000071243:Zika Virus Infection / Q000175:diagnosis / Q000453:epidemiology*
keywords: Cortical development; Desenvolvimento cortical; Gestação; Microcefalia; Microcephaly; Neuroimagem; Neuroimaging; Pregnancy; Vírus Zika; Zika virus