Intended for healthcare professionals

Letters Microcephaly in Europe

Harness shared data in international Zika registry

BMJ 2016; 355 doi: (Published 05 October 2016) Cite this as: BMJ 2016;355:i5319
  1. David Baud, maternal-fetal medicine specialist1,
  2. Patrick Gérardin, epidemiologist2,
  3. Audrey Merriam, maternal-fetal medicine fellow3,
  4. Marco P Alves, virologist4,
  5. Didier Musso, infectious disease specialist5,
  6. Blaise Genton, tropical medicine specialist6,
  7. Alice Panchaud, teratogen counsellor7
  1. 1Materno-Fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant,” University Hospital, 1011 Lausanne, Switzerland; Institute of Microbiology, Faculty of Biology and Medicine, University of Lausanne and University Hospital, Lausanne, Switzerland
  2. 2Pôle Femme Mère Enfant, Centre d’Investigation Clinique (INSERM CIC1410), UM 134 PIMIT “Processus Infectieux en Milieu Insulaire Tropical” (Université de La Réunion, CNRS 9192, INSERM U 1187, IRD 249), CHU Réunion, Saint Pierre, Réunion
  3. 3Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
  4. 4Institute of Virology and Immunology, Department of Infectious Diseases and Pathobiology, University of Bern, Switzerland
  5. 5Unit of Emerging Infectious Diseases, Institut Louis Malardé, Tahiti, French Polynesia
  6. 6Swiss Tropical and Public Health Institute, Basel, Switzerland; Infectious Disease Service and Department of Ambulatory Care, University Hospital Lausanne, Lausanne, Switzerland
  7. 7Swiss Teratogen Information Service, University Hospital, 1011 Lausanne, Switzerland; Division of Clinical Pharmacology, University Hospital, 1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
  1. david.baud{at}

We welcome the paper by Morris and colleagues on the prevalence of microcephaly in Europe.1 The authors state that increases in prevalence such as expected with Zika virus in a non-endemic region would be unlikely to be detected in Europe through routine surveillance.

As a newly identified teratogen, Zika requires global and dedicated tools to allow comprehensive characterisation of the risks associated with its materno-fetal transmission. Nearly a year after the first reported increase in microcephaly in Brazil,2 the magnitude of the risks of materno-fetal transmission and the associated potential cofactors remain unclear.

Case reports and congenital anomaly surveillance systems are indispensable tools in detecting new teratogens and have been effective in Brazil’s Zika outbreak. However, since these tools will probably not provide global information or allow in-depth comprehension of the link between a teratogen and its risks, we need epidemiological studies, such as case-control studies and cohort studies with appropriate follow-up.

To facilitate these studies we have launched an international web registry,3 enrolling pregnant women, prospectively and anonymously, at any gestational age as soon as Zika exposure is suspected (eg, mosquito bite, unprotected sex) and ideally before any additional screening (a prospective registry). Follow-up information on other risk factors and on pregnancy, fetal, and neonatal outcomes is gathered after birth. Any healthcare provider supporting the registry by providing well documented exposures will be regarded as a collaborator of the registry in any future peer reviewed scientific publication (see The collected data will be available to research groups that have a clear, non-redundant research question and approval from a biomedical research ethics committee.

We hope that this centralised dataset of shared information will allow research to progress in acquiring a comprehensive characterisation of the risks associated with Zika materno-fetal transmission.



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