Analysis of the follow-up and diagnosis of pregnant women and newborns with suspected Zika virus infection in Espírito Santo, Brazil: strengths and areas for improvement in future epidemics

https://doi.org/10.63923/smhs.2026.142

Abstract

Zika virus (ZIKV) infection gained prominence in 2015 following a marked increase in cases of microcephaly and other congenital abnormalities among newborns of women infected during pregnancy, ultimately leading to the recognition of Congenital Zika Syndrome (CZS). This longitudinal descriptive study aimed to analyze changes in epidemiological surveillance, diagnostic methods, and the classification of suspected CZS cases in the state of Espírito Santo, Brazil, using data from the unified RESP-Microcephaly/DATASUS database from 2015 to 2024. Case incidence and temporal trends were analyzed, as well as associations between maternal infection, vertical transmission, clinical manifestations, diagnostic methods, and neonatal outcomes, using chi-square tests, odds ratios (OR), and binomial logistic regression. A total of 851 suspected cases of ZIKV infection during pregnancy were analyzed, according to data availability for each variable. The number of investigated cases peaked in 2016, followed by a progressive decline in notifications in subsequent years. Newborns of mothers with confirmed ZIKV infection had higher odds of CZS confirmation (OR = 5.1; 95% CI: 2.28–11.4; *p* < 0.001), supporting the occurrence of vertical transmission. Maternal clinical manifestations were significantly associated with confirmed infection, whereas the clinical characteristics evaluated in newborns were not. Among newborns, only IgM serology and PCR were significantly associated with diagnosis, although these were the least frequently used tests, whereas imaging examinations, which were more commonly performed, showed no significant association with case confirmation. In addition, maternal signs and symptoms showed greater diagnostic discrimination than the clinical characteristics assessed in newborns. These findings suggest limitations in the diagnostic strategy adopted for newborns and a possible underestimation of infection incidence, highlighting the need to strengthen prenatal follow-up, expand access to more informative laboratory diagnostic methods, and improve epidemiological investigation, thereby contributing to more effective responses to future epidemics.

References

1. ADEBANJO, Titilope et al. Update: Interim Guidance for the Diagnosis, Evaluation, and Management of Infants with Possible Congenital Zika Virus Infection — United States, October 2017. Morbidity and Mortality Weekly Report (MMWR), Atlanta, v. 66, n. 41, p. 1089-1099, 2017. DOI: 10.15585/mmwr.mm6641a1.
2. ARAÚJO, J. M. D., & FERREIRA, M. A. M. (2024). State capacity impact on COVID-19 mortality in Brazil. Cadernos de Saúde Pública, 40, e00171523.
3. ARAÚJO, Tania Maria Varejão Barbosa de et al. Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study. The Lancet Infectious Diseases, Londres, v. 18, n. 3, p. 328-336, 2018. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S1473309917307272.
4. Associação Médica Brasileira (AMB) / Conselho Federal de Medicina (CFM). Zika Vírus e Gravidez. Disponível em: https://amb.org.br/wp-content/uploads/2021/08/ZIKA-VIRUS-GRAVIDEZ-FINAL-2016.pdf
5. Pereira, A. C. N., de Castro, P. H. M., Romeiro, R. V., de Aquino, A. C. O., Silveira, F. A., & Seixas, J. A. (2025). Avaliação da correlação entre casos de infecção pelo Zika vírus em gestantes e a síndrome congênita associada à infecção pelo vírus Zika no Brasil. Revista Saber Digital, 18(3), e20251809-e20251809.
6. BRASIL. Ministério da Saúde. **Manual de Gestação de Alto Risco**. Brasília: Ministério da Saúde, 2022. (Série A. Normas e Manuais Técnicos).
7. BRASIL. Ministério da Saúde. **Protocolo de vigilância e resposta à ocorrência de microcefalia relacionada à infecção pelo vírus Zika**. Brasília: Ministério da Saúde, 2016.
8. CDC (Centers for Disease Control and Prevention). Pediatric Evaluation & Follow-up Tool for Infants with Possible Congenital Zika Virus Exposure. Atlanta: CDC, 2024.
9. Fleury Medicina e Saúde. Diagnóstico de infecções na gestação. Disponível em: https://www.fleury.com.br/medico/artigos-cientificos/diagnostico-de-infeccoes-na-gestacao
10. FORTIN O, MULKEY SB. Neurodevelopmental outcomes in congenital and perinatal infections. Curr Opin Infect Dis. 2023 Oct 1;36(5):405-413. doi: 10.1097/QCO.0000000000000946. Epub 2023 Jul 19. PMID: 37466092; PMCID: PMC10530333.
11. FRANÇA, Giovanny Vinícius Araújo et al. Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation. The Lancet, Londres, v. 388, n. 10047, p. 891-897, 2016. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30902-3/fulltext.
12. MARINHO, Fatima et al. Microcephaly in Brazil: prevalence and characterization of cases from the Information System on Live Births (Sinasc), 2000-2015. Epidemiologia e Serviços de Saúde, Brasília, v. 25, n. 4, p. 701-712, 2016. Disponível em: https://www.scielo.br/j/ress/a/nwGLZsdg3K5Ff7Zxn4cwkYh/?format=html&lang=en
13. MARTELLI, Celina Maria Turchi et al. Clinical spectrum of congenital Zika virus infection in Brazil. Revista da Sociedade Brasileira de Medicina Tropical, Uberaba, v. 57, e00931-2024, 2024. Disponível em: https://www.scielo.br/j/rsbmt/a/t7gzpRVmMb5h88f3DDHqfNK/?lang=en
14. MARTINES, Rodrigo Barbosa et al. Pathology of congenital Zika syndrome in Brazil: a case series. The Lancet, Londres, v. 388, n. 10047, p. 898-904, 2016. Disponível em: https://pubmed.ncbi.nlm.nih.gov/27372395/
15. MOORE, Cynthia A. et al. Characterizing the Pattern of Anomalies in Congenital Zika Syndrome for Pediatric Clinicians. JAMA Pediatrics, Chicago, v. 171, n. 3, p. 288-295, 2017. DOI: 10.1001/jamapediatrics.2016.3982.
16. MULKEY, S. B. et al. Complexities of Zika Diagnosis and Evaluation in a U.S. Congenital Zika Program. Journal of the Pediatric Infectious Diseases Society, 2023.
17. MUSSO, Didier; KO, Albert I.; BAUD, David. Zika Virus Infection — After the Pandemic. The New England Journal of Medicine, Boston, v. 381, n. 15, p. 1444-1457, 2019. DOI: 10.1056/NEJMra1808246.
18. NORONHA L, ZANLUCA C, AZEVEDO MLV, LUZ KG, DUARTE DOS SANTOS CN. Zika virus damages the human placental barrier and presents marked fetal neurotropism. Memórias do Instituto Oswaldo Cruz, 2016. DOI: 10.1590/0074-02760160085. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878297/
19. OLIVEIRA CS, MATOS HJ, RAMOS FLP, PINTO AYN, ALMEIDA MPS, GUIMARÃES VPR, et al. Acompanhamento de gestantes com confirmação laboratorial de infecção pelo vírus Zika na região metropolitana de Belém, Estado do Pará, Brasil: dados preliminares. Revista Pan-Amazônica de Saúde, 2016;7(Esp). Disponível em: http://scielo.iec.gov.br/scielo.php?script=sci_arttext&pid=S2176-62232016000500209
20. PACHECO, Oscar et al. Zika virus disease in Colombia: preliminary report. The New England Journal of Medicine, Boston, 2016. DOI: 10.1056/NEJMoa1604037.
21. PAIXÃO ES, RODRIGUES LC, COSTA MCN, et al. Population-based surveillance for congenital zika virus syndrome: a latent class analysis of recorded cases from 2015–2018. BMC Pregnancy and Childbirth, 2022. Disponível em: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04860-3
22. PAIXÃO, B., BARONI, L., PEDROSO, M., SALLES, R., ESCOBAR, L., DE SOUSA, C., ... & OGASAWARA, E. (2021). Estimation of COVID-19 under-reporting in the Brazilian states through SARI. New Generation Computing, 39(3), 623-645.
23. RANÇA et al. Síndrome congênita associada à infecção pelo vírus Zika em nascidos vivos no Brasil: descrição da distribuição dos casos notificados e confirmados em 2015-2016. Epidemiologia e Serviços de Saúde, Brasília, v. 27, n. 2, e2017473, 2018. Disponível em: https://www.scielo.br/j/ress/a/nvpwC7jVqpBg6Y5Z4zRJwzd/?lang=pt. Acesso em: 19 mai. 2026.
24. RODRIGUES, Fernanda Mariano Garcia de Souza. Diversidade genética do Zika virus no Estado do Espírito Santo. 2018. 73 f. Dissertação (Mestrado em Biotecnologia) – Centro de Ciências da Saúde, Universidade Federal do Espírito Santo, Vitória, 2018. Disponível em: https://repositorio.ufes.br/items/1203dda1-699d-49ae-ac17-32cc44dba873. Acesso em: 19 mai. 2026.
25. SINGH T, LOPEZ CA, GIUBERTI C, DENNIS ML, ITELL HL, HEIMSATH HJ, et al. Efficient transplacental IgG transfer in women infected with Zika virus during pregnancy. PLoS Neglected Tropical Diseases, 2019;13(8):e0007648. DOI: 10.1371/journal.pntd.0007648. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6730934/
26. TEIXEIRA GA, DANTAS DNA, CARVALHO GAF, SILVA AN, LIRA ALB, ENDERS BC. Análise do conceito síndrome congênita pelo Zika vírus. Ciência & Saúde Coletiva, 2020;25(2):567-574. DOI: 10.1590/1413-81232020252.30002017. Disponível em: https://www.scielo.br/j/csc/a/Hw7b8hsPTbJncZkwWCmj8Cq/
27. TEIXEIRA, MARIA GLÓRIA et al. Evidências da vigilância epidemiológica para o avanço do conhecimento sobre a epidemia pelo vírus Zika no Brasil. Epidemiologia e Serviços de Saúde, Brasília, v. 27, n. 4, e2018230, 2018. Disponível em: https://www.scielo.br/j/ress/a/G3vDx8ZdX7VrzmFctRxG58p/?lang=pt. Acesso em: 19 mai. 2026.
28. TEIXEIRA, MARIA GLÓRIA et al. Vigilância em Saúde no SUS: construção, efeitos e perspectivas. Ciência & Saúde Coletiva, Rio de Janeiro, v. 23, n. 6, p. 1811-1818, jun. 2018. Disponível em: https://www.scielo.br/j/csc/a/FxcSJBQq8G7CNSxhTyT7Qbn/?lang=pt. Acesso em: 19 mai. 2026.