Análise do acompanhamento e diagnóstico de gestantes e recém-nascidos com suspeita de infecção por Zika vírus no Espírito Santo, Brasil: acertos e pontos de melhoria para futuras epidemias

Abstract

Zika virus (ZIKV) infection gained prominence in 2015 following a marked increase in cases of microcephaly and other congenital abnormalities among newborns of women infected during pregnancy, ultimately leading to the recognition of Congenital Zika Syndrome (CZS). This longitudinal descriptive study aimed to analyze changes in epidemiological surveillance, diagnostic methods, and the classification of suspected CZS cases in the state of Espírito Santo, Brazil, using data from the unified RESP-Microcephaly/DATASUS database from 2015 to 2024. Case incidence and temporal trends were analyzed, as well as associations between maternal infection, vertical transmission, clinical manifestations, diagnostic methods, and neonatal outcomes, using chi-square tests, odds ratios (OR), and binomial logistic regression. A total of 851 suspected cases of ZIKV infection during pregnancy were analyzed, according to data availability for each variable. The number of investigated cases peaked in 2016, followed by a progressive decline in notifications in subsequent years. Newborns of mothers with confirmed ZIKV infection had higher odds of CZS confirmation (OR = 5.1; 95% CI: 2.28–11.4; *p* < 0.001), supporting the occurrence of vertical transmission. Maternal clinical manifestations were significantly associated with confirmed infection, whereas the clinical characteristics evaluated in newborns were not. Among newborns, only IgM serology and PCR were significantly associated with diagnosis, although these were the least frequently used tests, whereas imaging examinations, which were more commonly performed, showed no significant association with case confirmation. In addition, maternal signs and symptoms showed greater diagnostic discrimination than the clinical characteristics assessed in newborns. These findings suggest limitations in the diagnostic strategy adopted for newborns and a possible underestimation of infection incidence, highlighting the need to strengthen prenatal follow-up, expand access to more informative laboratory diagnostic methods, and improve epidemiological investigation, thereby contributing to more effective responses to future epidemics.