Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng spa por |
Título da fonte: | Cadernos de Saúde Pública |
Texto Completo: | https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289 |
Resumo: | 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. |
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Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected casesMicrocefalia en el estado de Pernambuco, Brasil: características epidemiológicas y evaluación de la precisión diagnóstica de los puntos de corte adoptados para la notificación de casosMicrocefalia no Estado de Pernambuco, Brasil: características epidemiológicas e avaliação da acurácia diagnóstica dos pontos de corte adotados para notificação de casoMicrocephalyZika Virus InfectionEpidemiological SurveillanceData AccuracyMicrocefaliaInfección por el Virus ZikaVigilancia EpidemiológicaExactitud de los DatosMicrocefaliaInfecção por Zika VírusVigilância EpidemiológicaConfiabilidade dos DadosThe 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.El aumento de las notificaciones de casos de microcefalia en Pernambuco, Brasil, y en el Nordeste caracterizó una epidemia que condujo al Ministerio de Salud a decretar una emergencia nacional de salud pública. En un primer momento, el Ministerio de Salud definió como casos sospechosos a recién nacidos de 37 semanas o más de edad gestacional (EG) y con perímetro cefálico (PC) ≤ 33cm, siendo, en diciembre de 2015, reducida esa medida a 32cm. Este estudio tuvo por objetivo estimar la precisión, sensibilidad y especificidad de diferentes puntos de corte para el PC, utilizando curvas ROC y, como patrones oro, las curvas de Fenton y de Intergrowth (2014). Se describieron los casos notificados en Pernambuco entre 2 de agosto de 2015 y 28 de noviembre de 2015, según sexo y categorías de EG. Los métodos de Fenton y de Intergrowth proporcionan curvas de crecimiento para el PC ,de acuerdo con EG y sexo, considerando positivos para microcefalia los recién nacidos con un PC debajo del percentil 3 de estas distribuciones. De los 684 casos notificados, 599 fueron recién nacidos a término/pos-término. Para estos, los análisis con curvas ROC muestran, según Fenton, que el punto de corte que presentó una mayor área bajo la curva ROC, con sensibilidad mayor que especificidad, fue 32cm, para ambos sexos. Por el método de Intergrowth los puntos de corte, respetando los mismos criterios, son 32cm y 31,5cm para los sexos masculino y femenino, respectivamente. El punto de corte identificado, según Fenton (32cm), coincidió con la recomendación del Ministerio de Salud. Adoptándose Intergrowth como patrón, la elección sería 32 cm para el sexo masculino y 31,5cm para el sexo femenino. Como conclusión, se apunta la necesidad de realizar análisis críticos y continuados para evaluar puntos de corte, incluyendo otras características para definición de casoO aumento das notificações de casos de microcefalia em Pernambuco, Brasil, e no Nordeste caracterizou uma epidemia que levou o Ministério da Saúde a decretar emergência nacional de saúde pública. Inicialmente, o Ministério da Saúde definiu como suspeitos recém-nascidos de 37 semanas ou mais de idade gestacional (IG) e com perímetro cefálico (PC) ≤ 33cm, tendo, em dezembro de 2015, reduzido essa medida para 32cm. Este estudo objetivou estimar a acurácia, a sensibilidade e a especificidade de diferentes pontos de corte para o PC, utilizando curvas ROC e, como padrões-ouro, as curvas de Fenton e de Intergrowth 2014. Foram descritos os casos notificados em Pernambuco entre 2 de agosto de 2015 e 28 de novembro de 2015, segundo sexo e categorias de IG. Os métodos de Fenton e Intergrowth fornecem curvas de crescimento para o PC de acordo com IG e sexo, considerando positivos para microcefalia os recém-nascidos com PC abaixo do percentil 3 dessas distribuições. Dos 684 casos notificados, 599 foram recém-nascidos a termo/pós-termo. Para esses, as análises com curvas ROC mostram, segundo Fenton, que o ponto de corte que apresentou maior área sob a curva ROC, com sensibilidade maior que especificidade, foi 32cm, para ambos os sexos. Pelo método Intergrowth, os pontos de corte, respeitando os mesmos critérios, são 32cm e 31,5cm, para os sexos masculino e feminino respectivamente. O ponto de corte identificado, segundo Fenton (32cm), coincidiu com a recomendação do Ministério da Saúde. Adotando-se Intergrowth como padrão, a escolha seria de 32cm, para o sexo masculino, e de 31,5cm, para o sexo feminino. Concluindo, aponta-se a necessidade de realizar análises críticas e continuadas para avaliar pontos de corte, incluindo outras características para a definição de caso.Reports in Public HealthCadernos de Saúde Pública2016-04-29info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmltext/htmltext/htmlapplication/pdfapplication/pdfapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289Reports in Public Health; Vol. 32 No. 4 (2016): AprilCadernos de Saúde Pública; v. 32 n. 4 (2016): Abril1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZengspaporhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13368https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13369https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13370https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13371https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13372https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13373Wayner Vieira de SouzaThalia Velho Barreto de AraújoMaria de Fátima P. Militão AlbuquerqueMaria Cynthia BragaRicardo Arraes de Alencar XimenesDemócrito de Barros Miranda-FilhoLuciana Caroline Albuquerque BezerraGeorge Santiago DimechPatrícia Ismael de CarvalhoRomildo Siqueira de AssunçãoRoselene Hans SantosWanderson Kleber de OliveiraLaura Cunha RodriguesCelina Maria Turchi Martelliinfo:eu-repo/semantics/openAccess2024-03-06T15:29:13Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/6289Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:07:11.719326Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true |
dc.title.none.fl_str_mv |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases Microcefalia en el estado de Pernambuco, Brasil: características epidemiológicas y evaluación de la precisión diagnóstica de los puntos de corte adoptados para la notificación de casos Microcefalia no Estado de Pernambuco, Brasil: características epidemiológicas e avaliação da acurácia diagnóstica dos pontos de corte adotados para notificação de caso |
title |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases |
spellingShingle |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases Wayner Vieira de Souza Microcephaly Zika Virus Infection Epidemiological Surveillance Data Accuracy Microcefalia Infección por el Virus Zika Vigilancia Epidemiológica Exactitud de los Datos Microcefalia Infecção por Zika Vírus Vigilância Epidemiológica Confiabilidade dos Dados |
title_short |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases |
title_full |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases |
title_fullStr |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases |
title_full_unstemmed |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases |
title_sort |
Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases |
author |
Wayner Vieira de Souza |
author_facet |
Wayner Vieira de Souza Thalia Velho Barreto de Araújo Maria de Fátima P. Militão Albuquerque Maria Cynthia Braga Ricardo Arraes de Alencar Ximenes Demócrito de Barros Miranda-Filho Luciana Caroline Albuquerque Bezerra George Santiago Dimech Patrícia Ismael de Carvalho Romildo Siqueira de Assunção Roselene Hans Santos Wanderson Kleber de Oliveira Laura Cunha Rodrigues Celina Maria Turchi Martelli |
author_role |
author |
author2 |
Thalia Velho Barreto de Araújo Maria de Fátima P. Militão Albuquerque Maria Cynthia Braga Ricardo Arraes de Alencar Ximenes Demócrito de Barros Miranda-Filho Luciana Caroline Albuquerque Bezerra George Santiago Dimech Patrícia Ismael de Carvalho Romildo Siqueira de Assunção Roselene Hans Santos Wanderson Kleber de Oliveira Laura Cunha Rodrigues Celina Maria Turchi Martelli |
author2_role |
author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Wayner Vieira de Souza Thalia Velho Barreto de Araújo Maria de Fátima P. Militão Albuquerque Maria Cynthia Braga Ricardo Arraes de Alencar Ximenes Demócrito de Barros Miranda-Filho Luciana Caroline Albuquerque Bezerra George Santiago Dimech Patrícia Ismael de Carvalho Romildo Siqueira de Assunção Roselene Hans Santos Wanderson Kleber de Oliveira Laura Cunha Rodrigues Celina Maria Turchi Martelli |
dc.subject.por.fl_str_mv |
Microcephaly Zika Virus Infection Epidemiological Surveillance Data Accuracy Microcefalia Infección por el Virus Zika Vigilancia Epidemiológica Exactitud de los Datos Microcefalia Infecção por Zika Vírus Vigilância Epidemiológica Confiabilidade dos Dados |
topic |
Microcephaly Zika Virus Infection Epidemiological Surveillance Data Accuracy Microcefalia Infección por el Virus Zika Vigilancia Epidemiológica Exactitud de los Datos Microcefalia Infecção por Zika Vírus Vigilância Epidemiológica Confiabilidade dos Dados |
description |
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. |
publishDate |
2016 |
dc.date.none.fl_str_mv |
2016-04-29 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289 |
url |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289 |
dc.language.iso.fl_str_mv |
eng spa por |
language |
eng spa por |
dc.relation.none.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13368 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13369 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13370 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13371 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13372 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/6289/13373 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html text/html text/html application/pdf application/pdf application/pdf |
dc.publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
dc.source.none.fl_str_mv |
Reports in Public Health; Vol. 32 No. 4 (2016): April Cadernos de Saúde Pública; v. 32 n. 4 (2016): Abril 1678-4464 0102-311X reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
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Fundação Oswaldo Cruz (FIOCRUZ) |
instacron_str |
FIOCRUZ |
institution |
FIOCRUZ |
reponame_str |
Cadernos de Saúde Pública |
collection |
Cadernos de Saúde Pública |
repository.name.fl_str_mv |
Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ) |
repository.mail.fl_str_mv |
cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br |
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1798943382631874560 |