title: Time Lags between Exanthematous Illness Attributed to Zika Virus, Guillain-Barré Syndrome, and Microcephaly, Salvador, Brazil.
abstract: Zika virus infection emerged as a public health emergency after increasing evidence for its association with neurologic disorders and congenital malformations. In Salvador, Brazil, outbreaks of acute exanthematous illness (AEI) attributed to Zika virus, Guillain-Barré syndrome (GBS), and microcephaly occurred in 2015. We investigated temporal correlations and time lags between these outbreaks to identify a common link between them by using epidemic curves and time series cross-correlations. Number of GBS cases peaked after a lag of 5-9 weeks from the AEI peak. Number of suspected cases of microcephaly peaked after a lag of 30-33 weeks from the AEI peak, which corresponded to time of potential infections of pregnant mothers during the first trimester. These findings support the association of GBS and microcephaly with Zika virus infection and provide evidence for a temporal relationship between timing of arboviral infection of pregnant women during the first trimester and birth outcome.
authors.forename: Igor A D
authors.initials: IA
authors.lastname: Paploski
authors.forename: Ana Paula P B
authors.initials: AP
authors.lastname: Prates
authors.forename: Cristiane W
authors.initials: CW
authors.lastname: Cardoso
authors.forename: Mariana
authors.initials: M
authors.lastname: Kikuti
authors.forename: Monaise M O
authors.initials: MM
authors.lastname: Silva
authors.forename: Lance A
authors.initials: LA
authors.lastname: Waller
authors.forename: Mitermayer G
authors.initials: MG
authors.lastname: Reis
authors.forename: Uriel
authors.initials: U
authors.lastname: Kitron
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Ribeiro
mesh_terms: D001938:Brazil / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005076:Exanthema / Q000150:complications / Q000453:epidemiology / Q000821:virology*; D005260:Female; D020275:Guillain-Barre Syndrome / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D008831:Microcephaly / Q000453:epidemiology / Q000821:virology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D013997:Time Factors; D000071243:Zika Virus Infection / Q000150:complications* / Q000453:epidemiology*
keywords: Brazil; Guillain-Barré syndrome; Salvador; Zika virus; epidemiology; exanthematous illness; microcephaly; outbreaks; pregnant women; time lags; viruses