{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T16:07:24Z","timestamp":1779898044672,"version":"3.53.1"},"reference-count":22,"publisher":"Wiley","issue":"19","license":[{"start":{"date-parts":[[2019,10,22]],"date-time":"2019-10-22T00:00:00Z","timestamp":1571702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2019,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Population\u2010level changes in microcephaly incidence risk (IR) could signal circulation of neurotropic pathogens or potential emerging teratogen exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective population cohort study, we estimated the IR of hospitalizations with a microcephaly ICD\u20109\u2010CM discharge diagnosis code among infants \u22641 year over a 15\u2010year period (1999\u20132013) using the Electronic Health Record (EHR) database from all hospital discharges in California from the Office of Statewide Hospital Planning and Development (OSHPD) database. We calculated the overall and yearly IRs per 10,000 live births (LBs) and per 10,000 hospitalizations in infants \u22641 year, and explored the impact in the IR estimates when children with microcephaly associated comorbidities were excluded or not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 8,860,153 hospital discharges of infants \u22641 year in the OSHPD database over this 15\u2009year period, we identified 6,004 hospitalizations with a microcephaly discharge diagnosis code; 3,526 of those were in neonates \u226430\u2009days. The IR of microcephaly hospitalizations for infants \u22641 year was 7.70\/10,000 LB (for neonates it was 4.52\/10,000 LB) and 6.78 per 10,000 hospitalizations \u22641 year. There was large heterogeneity in the yearly microcephaly IRs (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> =\u200966.6%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>EHR collected data could be used as a complementary approach to track epidemiologic changes in microcephaly IRs. However, standardization in the use of microcephaly discharge diagnosis code and harmonization in the types of additional comorbidities to be excluded across analyses is mandatory to allow for prompt identification of true changes in microcephaly rates over time.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1604","type":"journal-article","created":{"date-parts":[[2019,10,22]],"date-time":"2019-10-22T16:25:58Z","timestamp":1571761558000},"page":"1535-1542","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Congenital microcephaly hospitalizations in California infants: 1999\u20132013"],"prefix":"10.1002","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3979-5851","authenticated-orcid":false,"given":"Maya R.","family":"Krasnow","sequence":"first","affiliation":[{"name":"Department of Health Research and Policy Stanford University School of Medicine  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne A.","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Department of Health Research and Policy Stanford University School of Medicine  Stanford California"},{"name":"Division of Infectious Diseases, Department of Pediatrics Stanford University School of Medicine  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Despina G.","family":"Contopoulos\u2010Ioannidis","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics Stanford University School of Medicine  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181b783f7"},{"key":"e_1_2_7_3_1","unstructured":"California Department of Public Health. (2017 December 1).Aedes aegypti and Aedes albopictus Mosquitoes in California Detection Sites by County\/City. Retrieved fromhttps:\/\/www.cdph.ca.gov\/Programs\/CID\/DCDC\/CDPH%20Document%20Library\/AedesDistributionMap.pdf"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","unstructured":"California Department of Public Health. (2018 December 7).CDPH monthly update on number of Zika virus infections in California. Retrieved fromhttps:\/\/www.cdph.ca.gov\/Programs\/CID\/DCDC\/CDPH%20Document%20Library\/TravelAssociatedCasesofZikaVirusinCA.pdf DOI:https:\/\/doi.org\/10.1007\/s13665-018-0210-7","DOI":"10.1007\/s13665-018-0210-7"},{"key":"e_1_2_7_5_1","unstructured":"Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities. Major birth defects data from population\u2010based birth defects surveillance programs in the United States 2\u20136\u20102010 (2013).https:\/\/www.nbdpn.org\/docs\/DataDirectory2013_NBDPN_AR_2016DEC15.pdf"},{"key":"e_1_2_7_6_1","unstructured":"Centers for Disease Control and Prevention. (2017 March).Birthweight and gestation. Retrieved fromhttps:\/\/www.cdc.gov\/nchs\/fastats\/birthweight.htm"},{"key":"e_1_2_7_7_1","unstructured":"Centers for Disease Control and Prevention. (2018a April 30).Data & statistics on birth defects. Retrieved from Centers for Disease Control and Prevention website:https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/data.html"},{"key":"e_1_2_7_8_1","unstructured":"Centers for Disease Control and Prevention. (2018b February).Estimated potential range of Aedes aegypti and Aedes albopictus in the United States 2017. Retrieved fromhttps:\/\/www.cdc.gov\/zika\/pdfs\/Zika-mosquito-maps.pdf"},{"key":"e_1_2_7_9_1","unstructured":"Centers for Disease Control and Prevention. (2019a April 16).Data & statistics on Zika and pregnancy. Retrieved from Centers for Disease Control and Prevention website:https:\/\/www.cdc.gov\/pregnancy\/zika\/data\/index.html"},{"key":"e_1_2_7_10_1","unstructured":"Centers for Disease Control and Prevention. (2019b May).Zika travel information. Retrieved fromhttps:\/\/wwwnc.cdc.gov\/travel\/page\/zika-travel-information"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23587"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","unstructured":"European Centre for Disease Prevention and Control. (2019 April 11).Zika virus transmission worldwide. Retrieved from European Centre for Disease Prevention and Control website:http:\/\/ecdc.europa.eu\/en\/publications\u2010data\/zika\u2010virus\u2010transmission\u2010worldwide DOI:https:\/\/doi.org\/10.1002\/jts.22439","DOI":"10.1002\/jts.22439"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6605a1"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja16.00966"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.08347"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002203"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600651"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4721"},{"key":"e_1_2_7_19_1","unstructured":"National Birth Defects Prevention Network. (2016).Guidelines for conducting birth defects surveillance. 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