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Article

Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas

1
Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
2
Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
3
Instituto de Efectividad Clinica y Sanitaria, Buenos Aires 1414, Argentina
4
Unidad de Investigación Clínica y Epidemiológica, Montevideo 11600, Uruguay
5
Departamento de Laboratorio Clínico, Hospital Escuela, Tegucigalpa 11101, Honduras
6
Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa 11101, Honduras
7
Unidad de Investigación Científica, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras
8
Departamento de Ginecología y Obstetricia, Hospital Escuela, Tegucigalpa 11101, Honduras
9
Departamento de Ginecología y Obstetricia, Facultad de Ciencias Médicas, UNAH, Tegucigalpa 11101, Honduras
10
Servicio de Neonatología, Departamento de Pediatría, Hospital Escuela, Tegucigalpa 11101, Honduras
11
Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras
12
Departamento de Pediatría, Hospital de Especialidades San Felipe, Tegucigalpa 11101, Honduras
13
Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa 11101, Honduras
14
Departamento de Pediatría, Hospital Escuela, Tegucigalpa 11101, Honduras
15
Sub-Dirección, Hospital de Especialidades San Felipe, Tegucigalpa 11101, Honduras
16
Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa 11101, Honduras
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2021, 6(1), 5; https://doi.org/10.3390/tropicalmed6010005
Received: 18 November 2020 / Revised: 14 December 2020 / Accepted: 18 December 2020 / Published: 29 December 2020
(This article belongs to the Special Issue Zika in Infants and Children)
Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as “severe microcephaly”) and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Informático Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71–2.93) had HC < 2SD, including two (0.35%, 95% CI 0.04–1.24) with HC < 3SD, and 11 (1.9%, 95% CI, 0.79–3.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution. View Full-Text
Keywords: microcephaly; measurement; Central America; Zika virus; neonate microcephaly; measurement; Central America; Zika virus; neonate
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MDPI and ACS Style

Harville, E.W.; Tong, V.T.; Gilboa, S.M.; Moore, C.A.; Cafferata, M.L.; Alger, J.; Gibbons, L.; Bustillo, C.; Callejas, A.; Castillo, M.; Fúnes, J.; García, J.; Hernández, G.; López, W.; Ochoa, C.; Rico, F.; Rodríguez, H.; Zúniga, C.; Ciganda, A.; Stella, C.; Tomasso, G.; Buekens, P. Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas. Trop. Med. Infect. Dis. 2021, 6, 5. https://doi.org/10.3390/tropicalmed6010005

AMA Style

Harville EW, Tong VT, Gilboa SM, Moore CA, Cafferata ML, Alger J, Gibbons L, Bustillo C, Callejas A, Castillo M, Fúnes J, García J, Hernández G, López W, Ochoa C, Rico F, Rodríguez H, Zúniga C, Ciganda A, Stella C, Tomasso G, Buekens P. Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas. Tropical Medicine and Infectious Disease. 2021; 6(1):5. https://doi.org/10.3390/tropicalmed6010005

Chicago/Turabian Style

Harville, Emily W.; Tong, Van T.; Gilboa, Suzanne M.; Moore, Cynthia A.; Cafferata, Maria L.; Alger, Jackeline; Gibbons, Luz; Bustillo, Carolina; Callejas, Allison; Castillo, Mario; Fúnes, Jenny; García, Jorge; Hernández, Gustavo; López, Wendy; Ochoa, Carlos; Rico, Fátima; Rodríguez, Heriberto; Zúniga, Concepción; Ciganda, Alvaro; Stella, Candela; Tomasso, Giselle; Buekens, Pierre. 2021. "Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas" Trop. Med. Infect. Dis. 6, no. 1: 5. https://doi.org/10.3390/tropicalmed6010005

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