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Young kids with congenital Zika syndrome have 13-fold higher death rate, study finds
Stephanie Soucheray, MA
Today at 4:25 p.m.
Zika A new study of mortality rates among children younger than 5 years old in Brazil shows that children with congenital Zika syndrome (CZS) had a 13-fold higher risk of death compared with those without CZS.
The population-based study, published today in JAMA Network Open, was based on routine data collected on all children born from January 2015 to December 2018 in Brazil, with follow-up occurring until December 2020, or death.
14% death rate before age 5
While CZS is tied to significant developmental and neurologic delays in the first years of life, the increased risk of death has not yet been fully defined. Risk of death has been associated with several symptoms of CZS, including microcephaly (small brain and head) and poorly controlled seizures, dysphagia (difficulty swallowing) leading to aspiration pneumonia, and hydrocephalus, which is cerebrospinal fluid buildup in the brain, also known as "water on the brain."
The authors of the study looked at all-cause and cause-specific deaths from respiratory, infectious and parasitic, and nervous system diseases among children with or without CZS. Among the 11,387,431 live births included in the study, 3,080 children had CZS, acquired during the Zika outbreak of 2015-2016.
Compared to children without CZS, those with the congenital syndrome were more likely to be preterm and have low birth weight. Among the children with CZS, 444 (14.4%) died before the age of 5, including 154 (34.7%) from respiratory diseases, 152 (34.2%) from infectious and parasitic diseases, and 82 (18.5%) from nervous system diseases.
Risk of death even higher at age 2
Children with CZS were 13.10 times more likely to die in the first 5 years of life (95% confidence interval [CI], 11.86 to 14.46 times) compared with those without the syndrome.
The cause-specific mortality hazard ratios were 30.28 (95% CI, 25.59 to 35.83) for respiratory diseases, 28.26 (95% CI, 23.85 to 33.48) for infectious and parasitic diseases, and 57.11 (95% CI, 45.23 to 72.11) for nervous system diseases.
The risk of death was highest at the age of 2 years for all causes of death for children with CZS.
Children with CZS at 2 years of age had approximately 45 times greater risk of death from all causes.
"Children with CZS at 2 years of age had approximately 45 times greater risk of death from all causes, approximately 70 times greater risk of death from infectious and parasitic diseases, and more than 100 times greater risk of death from nervous system diseases, compared with children without CZS at the same age in adjusted models," the authors note.
"The results underscore the importance of active surveillance for ZIKV transmission, the need for vaccine and antiviral development to reduce vertical transmission, and adequate care for these children, especially during and after infectious disease epidemics," they add.
Young kids with congenital Zika syndrome have 13-fold higher death rate, study finds
Stephanie Soucheray, MA
Today at 4:25 p.m.
Zika A new study of mortality rates among children younger than 5 years old in Brazil shows that children with congenital Zika syndrome (CZS) had a 13-fold higher risk of death compared with those without CZS.
The population-based study, published today in JAMA Network Open, was based on routine data collected on all children born from January 2015 to December 2018 in Brazil, with follow-up occurring until December 2020, or death.
14% death rate before age 5
While CZS is tied to significant developmental and neurologic delays in the first years of life, the increased risk of death has not yet been fully defined. Risk of death has been associated with several symptoms of CZS, including microcephaly (small brain and head) and poorly controlled seizures, dysphagia (difficulty swallowing) leading to aspiration pneumonia, and hydrocephalus, which is cerebrospinal fluid buildup in the brain, also known as "water on the brain."
The authors of the study looked at all-cause and cause-specific deaths from respiratory, infectious and parasitic, and nervous system diseases among children with or without CZS. Among the 11,387,431 live births included in the study, 3,080 children had CZS, acquired during the Zika outbreak of 2015-2016.
Compared to children without CZS, those with the congenital syndrome were more likely to be preterm and have low birth weight. Among the children with CZS, 444 (14.4%) died before the age of 5, including 154 (34.7%) from respiratory diseases, 152 (34.2%) from infectious and parasitic diseases, and 82 (18.5%) from nervous system diseases.
Risk of death even higher at age 2
Children with CZS were 13.10 times more likely to die in the first 5 years of life (95% confidence interval [CI], 11.86 to 14.46 times) compared with those without the syndrome.
The cause-specific mortality hazard ratios were 30.28 (95% CI, 25.59 to 35.83) for respiratory diseases, 28.26 (95% CI, 23.85 to 33.48) for infectious and parasitic diseases, and 57.11 (95% CI, 45.23 to 72.11) for nervous system diseases.
The risk of death was highest at the age of 2 years for all causes of death for children with CZS.
Children with CZS at 2 years of age had approximately 45 times greater risk of death from all causes.
"Children with CZS at 2 years of age had approximately 45 times greater risk of death from all causes, approximately 70 times greater risk of death from infectious and parasitic diseases, and more than 100 times greater risk of death from nervous system diseases, compared with children without CZS at the same age in adjusted models," the authors note.
"The results underscore the importance of active surveillance for ZIKV transmission, the need for vaccine and antiviral development to reduce vertical transmission, and adequate care for these children, especially during and after infectious disease epidemics," they add.