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Population-based microcephaly surveillance in the United States, 2009 to 2013
An analysis of potential sources of variation
Cragan, J. D., Isenburg, J. L., Parker, S. E., Alverson, C. J., Meyer, R. E., Stallings, E. B., Kirby, R. S., Lupo, P. J., Liu, J. S., Seagroves, A., Ethen, M. K., Cho, S. J., Evans, M. A., Liberman, R. F., Fornoff, J., Browne, M. L., Rutkowski, R. E., Nance, A. E., Anderka, M., ... Mai, C. T. (2016). Population-based microcephaly surveillance in the United States, 2009 to 2013: An analysis of potential sources of variation. Birth Defects Research Part A - Clinical and Molecular Teratology, 106(11), 972-982. https://doi.org/10.1002/bdra.23587
Background: Congenital microcephaly has been linked to maternal Zika virus infection. However, ascertaining infants diagnosed with microcephaly can be challenging. Methods: Thirty birth defects surveillance programs provided data on infants diagnosed with microcephaly born 2009 to 2013. The pooled prevalence of microcephaly per 10,000 live births was estimated overall and by maternal/infant characteristics. Variation in prevalence was examined across case finding methods. Nine programs provided data on head circumference and conditions potentially contributing to microcephaly. Results: The pooled prevalence of microcephaly was 8.7 per 10,000 live births. Median prevalence (per 10,000 live births) was similar among programs using active (6.7) and passive (6.6) methods; the interdecile range of prevalence estimates was wider among programs using passive methods for all race/ethnicity categories except Hispanic. Prevalence (per 10,000 live births) was lowest among non-Hispanic Whites (6.5) and highest among non-Hispanic Blacks and Hispanics (11.2 and 11.9, respectively); estimates followed a U-shaped distribution by maternal age with the highest prevalence among mothers