{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T13:55:11Z","timestamp":1768917311581,"version":"3.49.0"},"reference-count":34,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Vysnova","award":["SC-2018-3045-TU"],"award-info":[{"award-number":["SC-2018-3045-TU"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as \u201csevere microcephaly\u201d) and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Inform\u00e1tico Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71\u20132.93) had HC &lt; 2SD, including two (0.35%, 95% CI 0.04\u20131.24) with HC &lt; 3SD, and 11 (1.9%, 95% CI, 0.79\u20133.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution.<\/jats:p>","DOI":"10.3390\/tropicalmed6010005","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T19:55:25Z","timestamp":1609271725000},"page":"5","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0319-0922","authenticated-orcid":false,"given":"Emily W.","family":"Harville","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3970-1440","authenticated-orcid":false,"given":"Van T.","family":"Tong","sequence":"additional","affiliation":[{"name":"Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne M.","family":"Gilboa","sequence":"additional","affiliation":[{"name":"Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia A.","family":"Moore","sequence":"additional","affiliation":[{"name":"Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9928-5522","authenticated-orcid":false,"given":"Maria Luisa","family":"Cafferata","sequence":"additional","affiliation":[{"name":"Instituto de Efectividad Clinica y Sanitaria, Buenos Aires 1414, Argentina"},{"name":"Unidad de Investigaci\u00f3n Cl\u00ednica y Epidemiol\u00f3gica, Montevideo 11600, Uruguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackeline","family":"Alger","sequence":"additional","affiliation":[{"name":"Departamento de Laboratorio Cl\u00ednico, Hospital Escuela, Tegucigalpa 11101, Honduras"},{"name":"Instituto de Enfermedades Infecciosas y Parasitolog\u00eda Antonio Vidal, Tegucigalpa 11101, Honduras"},{"name":"Unidad de Investigaci\u00f3n Cient\u00edfica, Facultad de Ciencias M\u00e9dicas, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luz","family":"Gibbons","sequence":"additional","affiliation":[{"name":"Instituto de Efectividad Clinica y Sanitaria, Buenos Aires 1414, Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Bustillo","sequence":"additional","affiliation":[{"name":"Departamento de Ginecolog\u00eda y Obstetricia, Hospital Escuela, Tegucigalpa 11101, Honduras"},{"name":"Departamento de Ginecolog\u00eda y Obstetricia, Facultad de Ciencias M\u00e9dicas, UNAH, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9590-2880","authenticated-orcid":false,"given":"Allison","family":"Callejas","sequence":"additional","affiliation":[{"name":"Servicio de Neonatolog\u00eda, Departamento de Pediatr\u00eda, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Castillo","sequence":"additional","affiliation":[{"name":"Servicio de Neonatolog\u00eda, Departamento de Pediatr\u00eda, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny","family":"F\u00fanes","sequence":"additional","affiliation":[{"name":"Servicio de Neonatolog\u00eda, Departamento de Pediatr\u00eda, Hospital Escuela, Tegucigalpa 11101, Honduras"},{"name":"Departamento de Pediatr\u00eda, Facultad de Ciencias M\u00e9dicas, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Departamento de Laboratorio Cl\u00ednico, Hospital Escuela, Tegucigalpa 11101, Honduras"},{"name":"Instituto de Enfermedades Infecciosas y Parasitolog\u00eda Antonio Vidal, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Departamento de Pediatr\u00eda, Hospital de Especialidades San Felipe, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"Departamento de Laboratorio Cl\u00ednico, Hospital Escuela, Tegucigalpa 11101, Honduras"},{"name":"Instituto de Enfermedades Infecciosas y Parasitolog\u00eda Antonio Vidal, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Ochoa","sequence":"additional","affiliation":[{"name":"Servicio de Maternidad, Hospital de Especialidades San Felipe, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F\u00e1tima","family":"Rico","sequence":"additional","affiliation":[{"name":"Departamento de Pediatr\u00eda, Facultad de Ciencias M\u00e9dicas, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"},{"name":"Departamento de Pediatr\u00eda, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heriberto","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Sub-Direcci\u00f3n, Hospital de Especialidades San Felipe, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Concepci\u00f3n","family":"Z\u00faniga","sequence":"additional","affiliation":[{"name":"Instituto de Enfermedades Infecciosas y Parasitolog\u00eda Antonio Vidal, Tegucigalpa 11101, Honduras"},{"name":"Departamento de Vigilancia de la Salud, Hospital Escuela, Tegucigalpa 11101, Honduras"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvaro","family":"Ciganda","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n Cl\u00ednica y 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"601","DOI":"10.2105\/AJPH.2016.303113","article-title":"The Epidemic of Zika Virus-Related Microcephaly in Brazil: Detection, Control, Etiology, and Future Scenarios","volume":"106","author":"Teixeira","year":"2016","journal-title":"Am. 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