Unequal burden of Zika-associated microcephaly among populations with public and private healthcare in Salvador, Brazil.

(1)Yale School of Public Health, New Haven, USA.

(2)Hospital Aliança, Salvador, Brazil.

(3)Fundação Oswaldo Cruz, Salvador, Brazil.

(4)Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil.

(5)Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.

(6)Programa de Pos-Graduacao em Ciencias da Saude, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.

(7)Instituto Evandro Chagas, Ministério da Saúde, Pará, Brazil.

(8)Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil; Harris Birthright Center for Fetal Medicine, King's College Hospital, London, UK; Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.

(9)Hospital Geral Roberto Santos, Secretária da Saúde do Estado da Bahia, Salvador, Brazil; Escola Paulista de Medicina, esc, São Paulo, Brazil.

(10)Yale School of Public Health, New Haven, USA; Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina da Bahia, Instituto da Saúde Coletiva and Hospital Universitário 8Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.

(11)Yale School of Public Health, New Haven, USA; Universidade Federal da Bahia, Salvador, Brazil. Electronic address: federico.costa@ufba.br.

OBJECTIVES: To describe the differences in clinical presentation and relative disease burden of congenital Zika syndrome (CZS)-associated microcephaly at 2 large hospitals in Salvador, Brazil that serve patients of different socioeconomic status (SES). METHODS: Clinical and serologic data were collected prospectively from pregnant women and their infants, who delivered at 2 study centers during the 2015-2016 Zika virus (ZIKV) epidemic in Salvador, Brazil. RESULTS: Pregnant women from Salvador, Brazil delivering in a low SES hospital had 3 times higher ZIKV exposure rate than women at a high SES hospital. However, different SES hospitals had similar prevalence of infants with CZS-associated microcephaly (10% vs 6%, p = 0.16) after controlling for ZIKV exposure in their mothers. CONCLUSIONS: Our study supports the positive association between low SES, high maternal ZIKV exposure, and high rates of CZS-associated microcephaly.