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Vital Signs: Update on Zika Virus–Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure — U.S. Zika Pregnancy Registry, 2016

A recent CDC report shows that 10% of laboratory confirmed Zika pregnancies in the US had "birth defect reported." However, I cannot seem to find an attempt to compare this to a base rate in the US of a similar population. Is there existing information or a way to determine the Attributable Risk (difference in rate of a condition between an exposed population and an unexposed population).

10% sounds scary, but without a base rate, it's not very meaningful in the context of determining how dangerous the Zika virus is.

EDIT (for clarification):

I'm primarily concerned with the method in which birth defects were collected. 'Clinical experts reviewed reported information to ensure that each fetus or infant with birth defects met the criteria of the USZPR case definition.', but this seems to have been done only with the Zika-positive groups and not with a Zika-negative group. They compare it to a pre-Zika baseline, in which inclusion to the surveillance was different and determination/clinical review of each case was different. Did they (or another research group) perform clinical evaluation of birth defects during the surveillance period on Zika-nagative pregnancies using the same methodology?

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The article cited in the question (Vital Signs: Update on Zika Virus–Associated Birth Defects and Evaluation of All U.S. Infants with Congenital Zika Virus Exposure — U.S. Zika Pregnancy Registry, 2016) gives the base rate for the definition of "birth defect" that they use:

The baseline prevalence of defects consistent with those that have been observed with congenital Zika virus infection was approximately 2.9 per 1,000 live births in the pre-Zika years (4). The initial findings from the USZPR represent an approximate twentyfold increase in Zika virus–associated birth defects among pregnant women with laboratory evidence of possible recent Zika virus infection, with an approximate thirtyfold increase in brain abnormalities and/or microcephaly.

The reference for that background is Baseline Prevalence of Birth Defects Associated with Congenital Zika Virus Infection - Massachusetts, North Carolina, and Atlanta, Georgia, 2013-2014.:

These data, from Massachusetts (2013), North Carolina (2013), and Atlanta, Georgia (2013–2014), included 747 infants and fetuses with one or more of the birth defects meeting the case definition (pre-Zika prevalence = 2.86 per 1,000 live births). Brain abnormalities or microcephaly were the most frequently recorded (1.50 per 1,000), followed by neural tube defects and other early brain malformations† (0.88), eye abnormalities without mention of a brain abnormality (0.31), and other consequences of central nervous system (CNS) dysfunction without mention of brain or eye abnormalities (0.17). During January 15–September 22, 2016, the U.S. Zika Pregnancy Registry (USZPR) reported 26 infants and fetuses with these same defects among 442 completed pregnancies (58.8 per 1,000) born to mothers with laboratory evidence of possible Zika virus infection during pregnancy (2). Although the ascertainment methods differed, this finding was approximately 20 times higher than the proportion of one or more of the same birth defects among pregnancies during the pre-Zika years.


According to Estimating the Number of Pregnant Women Infected With Zika Virus and Expected Infants With Microcephaly Following the Zika Virus Outbreak in Puerto Rico, 2016. the background of microcephaly in Puerto Rico was around 12 cases per year, while they estimated 180 cases would occur in the presence of Zika.

We estimated an IQR of 5900 to 10 300 pregnant women (median, 7800) might be infected during the initial ZIKV outbreak in Puerto Rico. Of these, an IQR of 100 to 270 infants (median, 180) may be born with microcephaly due to congenital ZIKV infection from mid-2016 to mid-2017. In the absence of a ZIKV outbreak, an IQR of 9 to 16 cases (median, 12) of congenital microcephaly are expected in Puerto Rico per year.

This is modeling, not pure observation, but was based on observed risk. The paper is online full-text (I think) so you can follow through the assumptions if you want.

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  • $\begingroup$ thank you for the information. Unfortunately, the answer I'm looking for is slightly different. I just want the rate of "birth defects" in the US in a way similarly defined by the CDC. The rate of microcephaly alone is far to narrow when considering all "birth defects", and I would be hesitant to use Puerto Rico rates, because of obvious differences when compared to the continental US. $\endgroup$ – Underminer Apr 12 '17 at 12:43
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    $\begingroup$ That answer seems to be in the first paragraph of the article you cited, so I'm not sure exactly what you are looking for. I updated my answer anyway $\endgroup$ – iayork Apr 12 '17 at 13:36
  • $\begingroup$ I'm primarily concerned with the method in which birth defects were collected. 'Clinical experts reviewed reported information to ensure that each fetus or infant with birth defects met the criteria of the USZPR case definition.' but this was done only with the Zika-positive groups and not with a Zika-negative group. They compare it to a pre-Zika baseline, in which inclusion to the surveillance was different and determination/clinical review of each case was different. Did they not perform similar tests during the surveillance period on Zika-nagative pregnancies? $\endgroup$ – Underminer Apr 12 '17 at 20:09
  • $\begingroup$ With the moving goalposts and the changing demands, it seems like you have some weird axe to grind, and comments are not the place for it, so you're on your own. $\endgroup$ – iayork Apr 12 '17 at 23:05
  • $\begingroup$ your information is helpful. Typically, attributable risk is done by tracking the exposed and unexposed population in the same way. I'm interested if this has been done by the CDC or some other group. $\endgroup$ – Underminer Apr 13 '17 at 13:24

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