Children with Congenital Zika Syndrome are at a higher risk of hospitalization

The first generation of children affected by the microcephaly outbreak in 2015 are now around ten years old. Only a minority of these children survived their first year of life. Behind the condition that determines the lives of so many Brazilian children is the set of sequelae of Congenital Zika Syndrome (CZS), a disease that hinders the size of the head and the formation of neurons. They are those most vulnerable to serious complications, combined diseases, and long hospitalization periods, according to research by the Center for the Integration of Data and Knowledge for Health (Cidacs/Fiocruz Bahia), published in the International Journal of Infectious Diseases.

As it manifests itself more significantly in poor countries and in unequal populations, Zika syndrome receives little attention worldwide. In Brazil alone, the disease has accumulated 20,000 suspected cases. Some of them have a common identity: they are the children of mothers who live in hot regions with high mosquito density. That is because the infection occurs during pregnancy by the Zika virus, which is transmitted to pregnant women by the same vector as dengue, Aedes aegypti.

Doctor and leader of the study, João Guilherme Tedde says that the research is one of the first to assess the risks of hospitalization in patients with CZS throughout early childhood. "We analyzed the main causes and frequency of hospitalizations, as well as the length of hospital stays, to guide more effective decisions in the treatment of children affected by the syndrome," he explains.

The study compared 2,000 cases of children with CZS with almost 2.6 million cases of children without the syndrome. The team of researchers assessed the rates of hospitalizations, their main reasons, and their length during the first four years of life. This research was made possible thanks to the use of data from the Cohort of 100 Million Brazilians.

Syndrome aggravates hospitalization

The main conclusion of the study is that children with CZS had hospitalization rates between 3 and 7 times higher than children without the syndrome. And, besides going to hospital more frequently, children with the syndrome were hospitalized for much longer periods than children without the syndrome in the first four years of life. In the CZS group, hospitalizations occurred due to congenital malformations, neurological diseases, and respiratory and infectious causes.

"These patients face a higher morbidity burden than those without CZS," says Tedde. This means that children with the syndrome are hospitalized more often, face lengthy hospital stays, and are at risk of combined diseases. "In addition to conditions typical of their age, such as infections and respiratory diseases, these children have complications directly related to CZS," says Tedde, concluding that each condition can act as a risk factor for the other, in a kind of vicious circle.

Another important finding shows that while children without CZS progressively decreased their hospitalization rates over time, children with the syndrome maintained high rates throughout the period assessed. This means that CZS carriers are at prolonged risk of falling ill and being hospitalized, aggravating existing health conditions, increasing costs, and generating additional suffering for children and their support network.

Unequal country, unequal health

The Northeast is the region of the country with the highest number of cases of children with CZS. The syndrome affects low-income families, often dependent on the Unified Health System (SUS) and conditional cash transfer programs. But how much does it cost to look after a child with CZS?

"Around 30% of the families of children with CZS reported care expenses that exceeded 40% of their annual income," says Tedde, author of the research. In addition to the financial cost being disproportionate to the income of many households, the syndrome takes an immeasurable emotional toll on families.

"Our findings point to the urgency of drawing up structured care plans, focusing on the outpatient management of children with CZS. The aim should be to optimize basic health conditions and minimize the risk of complications leading to further hospitalizations," Tedde stresses.

In addition to this study, preliminary results from another study by the same team showed that for children with the Syndrome, the risk of death is 30 times higher for respiratory diseases, 28 times higher for infectious diseases, and 57 times higher for nervous system diseases.

Among the challenges ahead, the authors see the urgency of developing a vaccine that offers lasting immunity against the Zika virus. This goal will only be achieved if society keeps its eyes open to this issue.

The study involved researchers from the London School of Hygiene & Tropical Medicine (LSHTM), the Institute of Collective Health at the Federal University of Bahia (ISC/UFBA), and other universities partners of Cidacs/Fiocruz Bahia.