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In total, 484 participants were recruited in two sites, Recife and Rio de Janeiro. Social and economic information was collected in a survey from the carers of cases and controls, and detailed healthcare utilisation was recorded for each child in the Rio de Janeiro cohort prospectively in a database. We used this information to estimate the cost per child with severe, moderate and no CZS and incremental cost per child with severe and moderate versus no CZS from a disaggregated societal perspective. These estimates were incorporated into an economic burden model to estimate the incremental burden of the CZS epidemic in Brazil over 5 years and 10 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The societal cost per child with severe CZS was US$50\u2009523 to 10 years of age (born in 2015 and 2016), substantially higher than the costs for moderate CZS (US$29 283) and without CZS (US$12 331). The incremental economic burden of severe versus no CZS in Brazil over 10 years was US$69.4\u2009million from the household and US$129.0\u2009million from the government perspective. For moderate CZS, these figures amounted to US$204.1 million and US$86.6\u2009million. Over 10 years, 97% of the total societal economic cost of severe CZS is borne by the government, but only 46% for moderate CZS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>The economic burden of CZS is high at the household, provider and government levels. The compensatory government payments helped to alleviate some of the additional costs incurred by families with a child qualifying for the disability benefits, and could be scaled to include the children with moderate CZS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2022-008784","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T12:40:14Z","timestamp":1657888814000},"page":"e008784","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["The economic burden of congenital Zika Syndrome in Brazil: an overview at 5 years and 10 years"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7694-4233","authenticated-orcid":false,"given":"Silke","family":"Fernandes","sequence":"first","affiliation":[{"name":"Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia","family":"Pinto","sequence":"additional","affiliation":[{"name":"Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia","family":"Barros","sequence":"additional","affiliation":[{"name":"Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elisabeth Lopes","family":"Moreira","sequence":"additional","affiliation":[{"name":"Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Th\u00e1lia Velho Barreto","family":"de Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil, Recife, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tereza Maciel","family":"Lyra","sequence":"additional","affiliation":[{"name":"Aggeu Magalh\u00e3es Institute, FIOCRUZ\/PE and Federal University of Pernambuco, Recife, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Valongueiro","sequence":"additional","affiliation":[{"name":"Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil, Recife, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireia","family":"Jofre-Bonet","sequence":"additional","affiliation":[{"name":"Office of Health Economics and Department of Economics, City University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8952-0023","authenticated-orcid":false,"given":"Hannah","family":"Kuper","sequence":"additional","affiliation":[{"name":"International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"2025073014193694000_7.7.e008784.1","unstructured":"PAHO . 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