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Microcephaly in Australian children, 2016–2018: national surveillance study
  1. Carlos Nunez1,2,
  2. Anne Morris1,2,3,
  3. Cheryl A Jones3,4,
  4. Nadia Badawi1,3,5,
  5. Gareth Baynam6,7,
  6. Michele Hansen7,
  7. Elizabeth J Elliott1,2,3
  1. 1Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2The Australian Paediatric Surveillance Unit, Sydney, New South Wales, Australia
  3. 3The Sydney Children’s Hospitals Network (Westmead), Sydney, NSW, Australia
  4. 4Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Professor of Cerebral Plasy, Macquarie Group Foundation, The CP Research Institute, Sydney, NSW, Australia
  6. 6Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital Perth, Perth, Western Australia, Australia
  7. 7Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Carlos Nunez, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW 2006, Australia; Carlos.NunezMiranda{at}


Objective To describe infants aged <12 months reported with microcephaly to the Australian Paediatric Surveillance Unit (APSU) following emergence of Zika virus infection internationally.

Design, setting and patients National, active, monthly surveillance for microcephaly using the APSU. Microcephaly was defined as occipitofrontal circumference (OFC) of more than 2 SDs below the mean for age, gender and gestation.

Main outcome measures Clinical spectrum, aetiology and birth prevalence of microcephaly reported by paediatricians.

Results Between June 2016 and July 2018, 106 notifications were received, with clinical details provided for 96 (91%). After excluding ineligible notifications, 70 cases were confirmed, giving an annual birth prevalence of 1.12 (95% CI 0.88 to 1.42) per 10 000 live births. Of the total number of cases, 47 (67%) had primary microcephaly (at birth); and 25 (36%) had severe microcephaly (OFC >3 SDs). Birth defects were reported in 42 (60%). Of 49 infants with developmental assessment details available, 25 (51%) had failed to reach all milestones. Vision impairment was reported in 14 (26%). The cause of microcephaly was unknown in 60%: 13 (19%) had been diagnosed with genetic disorders; 22 (39%) had anomalies on neuroimaging. No congenital or probable Zika infection was identified. Severe microcephaly was more often associated with hearing impairment than microcephaly of >2 SDs but ≤3 SDs below the mean (p<0.007). Indigenous children and children with socioeconomic advantage were over-represented among children with microcephaly.

Conclusion Novel national data on microcephaly highlight the high proportion of idiopathic cases. This has implications for prevention and management and suggests the need for a standardised diagnostic approach and ongoing surveillance mechanism in Australia.

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  • Contributors EJE substantially contributed to the conception or design of the work; CN, AM and EJE contributed to the analysis or interpretation of data; and all authors critically revised the manuscript and approved the final version.

  • Funding This work was funded by the Australian Government Department of Health. APSU activities are supported by The University of Sydney, Faculty of Medicine and Health, Discipline of Child and Adolescent Health; Kids Research at the Sydney Children’s Hospital Network (Westmead); and the Royal Australasian College of Physicians (Division of Paediatrics and Child Health). EJE is supported by an National Health and Medical Research Council (NHMRC) Medical Research Future Fund (MRFF) Practitioner Fellowship (#1135959).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Sydney Children’s Hospitals Network Human Research Ethics Committee (LNR/16/SCHN/227).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data are: deidentified participant data. Protocol and Case report form are available at

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