Big Data to Knowledge Analytics Reveals the Zika Virus Epidemic as Only One of Multiple Factors Contributing to a Year-Over-Year 28-Fold Increase in Microcephaly Incidence

Myriam Patricia Cifuentes, Clara Mercedes Suarez, Ricardo Cifuentes, Noel Malod-Dognin, Sam Windels, Jose Fernando Valderrama, Paul D. Juarez, R. Burciaga Valdez, Cynthia Colen, Charles Phillips, Aramandla Ramesh, Wansoo Im, Maureen Lichtveld, Charles Mouton, Nataša Pržulj, Darryl B. Hood

Research output: Contribution to journalArticlepeer-review


During the 2015–2016 Zika Virus (ZIKV) epidemic in Brazil, the geographical distributions of ZIKV infection and microcephaly outbreaks did not align. This raised doubts about the virus as the single cause of the microcephaly outbreak and led to research hypotheses of alternative explanatory factors, such as environmental variables and factors, agrochemical use, or immunizations. We investigated context and the intermediate and structural determinants of health inequalities, as well as social environment factors, to determine their interaction with ZIKV-positive- and ZIKV-negative-related microcephaly. The results revealed the identification of 382 associations among 382 nonredundant variables of Zika surveillance, including multiple determinants of environmental public health factors and variables obtained from 5565 municipalities in Brazil. This study compared those factors and variables directly associated with microcephaly incidence positive to ZIKV and those associated with microcephaly incidence negative to ZIKV, respectively, and mapped them in case and control subnetworks. The subnetworks of factors and variables associated with low birth weight and birthweight where birth incidence served as an additional control were also mapped. Non-significant differences in factors and variables were observed, as were weights of associations between microcephaly incidence, both positive and negative to ZIKV, which revealed diagnostic inaccuracies that translated to the underestimation of the scope of the ZIKV outbreak. A detailed analysis of the patterns of association does not support a finding that vaccinations contributed to microcephaly, but it does raise concerns about the use of agrochemicals as a potential factor in the observed neurotoxicity arising from the presence of heavy metals in the environment and microcephaly not associated with ZIKV. Summary: A comparative network inferential analysis of the patterns of variables and factors associated with Zika virus infections in Brazil during 2015–2016 coinciding with a microcephaly epidemic identified multiple contributing determinants. This study advances our understanding of the cumulative interactive effects of exposures to chemical and non-chemical stressors in the built, natural, physical, and social environments on adverse pregnancy and health outcomes in vulnerable populations.

Original languageEnglish (US)
Article number9051
JournalInternational Journal of Environmental Research and Public Health
Issue number15
StatePublished - Aug 2022
Externally publishedYes


  • Big Data to Knowledge (BD2K)
  • Zika Virus (ZIKV)
  • agrochemicals
  • chemical and non-chemical stressors
  • comparative network inferential analysis
  • environmental public health
  • microcephaly
  • public health exposome (PHE)
  • vulnerable populations

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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