Table 4.
Sensitivity analyses for each outcome by trimester of maternal infection
|
Vertical transmission rate after maternal infection in pregnancy |
CZS after congenital infection |
OPZRO after congenital infection, given no CZS |
Diagnostic sensitivity |
CZS after maternal infection in pregnancy |
CZS or OPZRO after maternal infection in pregnancy |
||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| T1 | T2 | T3 | T1 | T2 | T3 | T1 | T2 | T3 | T1 | T2 | T3 | T1 | T2 | T3 | T1 | T2 | T3 | ||
| Base case | 46% | 28% | 25% | 19% | 11% | 3% | 42% | 46% | 43% | 42% | 85% | 80% | 9% | 3% | 1% | 24% | 14% | 11% | |
| Between-trial variation: base case assumes that 95% of study-specific outcomes are within a factor of 2 above or below the median | |||||||||||||||||||
| Factor of 1·0: fixed effect | 28% | 23% | 22% | 22% | 10% | 3% | 33% | 31% | 33% | 62% | 96% | 89% | 6% | 2% | 1% | 14% | 9% | 8% | |
| Factor of 1·5: random effect | 48% | 26% | 26% | 22% | 15% | 4% | 40% | 44% | 42% | 45% | 88% | 82% | 8% | 3% | 1% | 22% | 13% | 10% | |
| Factor of 3·0: random effect | 48% | 29% | 26% | 20% | 12% | 4% | 43% | 47% | 44% | 39% | 82% | 78% | 9% | 3% | 1% | 26% | 15% | 12% | |
| Factor of 1200: random effect | 46% | 31% | 26% | 36% | 24% | 8% | 45% | 49% | 46% | 35% | 78% | 75% | 16% | 7% | 2% | 30% | 19% | 13% | |
| Classification of fetal loss outcomes with undetermined status as OPZRO, CZS, or asymptomatic: base case classifies them as OPZRO | |||||||||||||||||||
| CZS | 45% | 28% | 25% | 35% | 16% | 8% | 38% | 46% | 42% | 45% | 78% | 79% | 16% | 5% | 2% | 27% | 15% | 12% | |
| Asymptomatic | 49% | 26% | 24% | 18% | 11% | 3% | 29% | 43% | 40% | 38% | 87% | 80% | 9% | 3% | 1% | 20% | 13% | 10% | |
| Removal of data, one study at a time, and removal of all data | |||||||||||||||||||
| Pomar et al (2018)16 | 48% | 28% | 21% | 24% | 12% | 5% | 46% | 39% | 56% | 27% | 64% | 73% | 11% | 3% | 1% | 27% | 13% | 12% | |
| Nogueira et al (2018)18 | 43% | 24% | 22% | 22% | 14% | 4% | 45% | 51% | 39% | 40% | 83% | 74% | 9% | 3% | 1% | 24% | 14% | 9% | |
| Hoen et al (2018)17 | 47% | 37% | 30% | 14% | 10% | 2% | 47% | 52% | 46% | 42% | 75% | 75% | 7% | 4% | 1% | 25% | 21% | 14% | |
| Rodó et al (2019)19 | 44% | 31% | 27% | 16% | 8% | 0% | 41% | 42% | 40% | 49% | 84% | 80% | 7% | 2% | 1% | 22% | 14% | 11% | |
| Brasil et al (2016)15 | 39% | 21% | 21% | 21% | 11% | 5% | 34% | 36% | 41% | 43% | 90% | 81% | 8% | 2% | 1% | 18% | 9% | 9% | |
| Merriam et al (2020)21 | 48% | 29% | 26% | 20% | 11% | 3% | 43% | 47% | 43% | 41% | 84% | 79% | 9% | 3% | 1% | 26% | 15% | 12% | |
| Conners et al (2017)20 | 51% | 33% | 29% | 17% | 9% | 3% | 40% | 42% | 42% | 46% | 85% | 82% | 8% | 3% | 1% | 25% | 16% | 13% | |
| All data removed | 50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% | 18% | 18% | 18% | 34% | 34% | 34% | |
| Lower diagnostic sensitivity with OPZRO and asymptomatic outcomes relative to CZS: base case has equal diagnostic sensitivity | |||||||||||||||||||
| Log odds ratio 0·5 | 51% | 30% | 26% | 17% | 10% | 3% | 39% | 44% | 42% | 49% | 85% | 84% | 8% | 3% | 1% | 25% | 15% | 12% | |
| Definition of CZS not 100% specific for congenital Zika virus: base-case positive predictive value is 100% | |||||||||||||||||||
| Positive predictive value 80% | 51% | 28% | 25% | 14% | 8% | 2% | 42% | 46% | 44% | 36% | 82% | 78% | 7% | 2% | 1% | 25% | 14% | 11% | |
| Positive predictive value 60% | 64% | 32% | 27% | 10% | 6% | 2% | 36% | 45% | 44% | 24% | 73% | 74% | 6% | 2% | 0% | 27% | 15% | 12% | |
Data are posterior median percent. CZS=congenital Zika syndrome. OPZRO=other potentially Zika-virus-related outcome. T1=trimester 1. T2=trimester 2. T3=trimester 3.