title: Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases.
abstract: The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition.
authors.affiliation: Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil.
authors.forename: Wayner Vieira de
authors.initials: WV
authors.lastname: Souza
authors.affiliation: Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Thalia Velho Barreto de
authors.initials: TV
authors.lastname: Araújo
authors.affiliation: Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil.
authors.forename: Maria de Fátima P Militão
authors.initials: Mde F
authors.lastname: Albuquerque
authors.affiliation: Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil.
authors.forename: Maria Cynthia
authors.initials: MC
authors.lastname: Braga
authors.affiliation: Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Ricardo Arraes de Alencar
authors.initials: RA
authors.lastname: Ximenes
authors.affiliation: Universidade de Pernambuco, Recife, Brazil.
authors.forename: Demócrito de Barros
authors.initials: Dde B
authors.lastname: Miranda-Filho
authors.affiliation: Secretaria Executiva de Vigilância em Saúde, Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil.
authors.forename: Luciana Caroline Albuquerque
authors.initials: LC
authors.lastname: Bezerra
authors.affiliation: Secretaria Executiva de Vigilância em Saúde, Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil.
authors.forename: George Santiago
authors.initials: GS
authors.lastname: Dimech
authors.affiliation: Secretaria Executiva de Vigilância em Saúde, Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil.
authors.forename: Patrícia Ismael de
authors.initials: PI
authors.lastname: Carvalho
authors.affiliation: Secretaria Executiva de Vigilância em Saúde, Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil.
authors.forename: Romildo Siqueira de
authors.initials: RS
authors.lastname: Assunção
authors.affiliation: Secretaria Executiva de Vigilância em Saúde, Secretaria Estadual de Saúde de Pernambuco, Recife, Brasil.
authors.forename: Roselene Hans
authors.initials: RH
authors.lastname: Santos
authors.affiliation: Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.
authors.forename: Wanderson Kleber de
authors.initials: WK
authors.lastname: Oliveira
authors.affiliation: London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.
authors.forename: Laura Cunha
authors.initials: LC
authors.lastname: Rodrigues
authors.affiliation: Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brazil.
authors.forename: Celina Maria Turchi
authors.initials: CM
authors.lastname: Martelli
mesh_terms: D001938:Brazil / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008831:Microcephaly / Q000175:diagnosis / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000071244:Zika Virus / Q000302:isolation & purification; D000071243:Zika Virus Infection / Q000175:diagnosis / Q000453:epidemiology*