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. 2020 Dec 29;6(1):5.
doi: 10.3390/tropicalmed6010005.

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

Emily W Harville  1 , Van T Tong  2 , Suzanne M Gilboa  2 , Cynthia A Moore  2 , Maria Luisa Cafferata  3   4 , Jackeline Alger  5   6   7 , Luz Gibbons  3 , Carolina Bustillo  8   9 , Allison Callejas  10 , Mario Castillo  10 , Jenny Fúnes  10   11 , Jorge García  5   6 , Gustavo Hernández  10 , Wendy López  5   6 , Carlos Ochoa  12   13 , Fátima Rico  11   14 , Heriberto Rodríguez  15 , Concepción Zúniga  6   16 , Alvaro Ciganda  4 , Candela Stella  3 , Giselle Tomasso  4 , Pierre Buekens  1
Affiliations

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

Emily W Harville et al. Trop Med Infect Dis. .

Abstract

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.

Keywords: Central America; Zika virus; measurement; microcephaly; neonate.

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Conflict of interest statement

The authors declare no conflict of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Figures

Figure 1
Figure 1
Instructions for use of SECA 212 insertion tapes posted in the room where newborns were measured, Zika in Pregnancy in Honduras (ZIPH) (2016). Hospital Escuela, Tegucigalpa, Honduras. Sign translates, “Always use the Seca tape to measure head circumference.”
Figure 1
Figure 1
Instructions for use of SECA 212 insertion tapes posted in the room where newborns were measured, Zika in Pregnancy in Honduras (ZIPH) (2016). Hospital Escuela, Tegucigalpa, Honduras. Sign translates, “Always use the Seca tape to measure head circumference.”
Figure 2
Figure 2
Distribution of head circumference at birth in the Zika in Pregnancy in Honduras (ZIPH) cohort (n = 579).
Figure 3
Figure 3
Distribution of head circumference in the Zika in Pregnancy in Honduras cohort (2016) and the Uruguay SIP surveillance system (2010–2015).
See this image and copyright information in PMC

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