The emergence of zika virus as a global health security threat: A review and a consensus statement of the INDUSEM Joint working Group (JWG)

Abstract

The Zika virus (ZIKV), first discovered in 1947, has emerged as a global public health threat over the last decade, with the accelerated geographic spread of the virus noted during the last 5 years. The World Health Organization (WHO) predicts that millions of cases of ZIKV are likely to occur in the Americas during the next 12 months. These projections, in conjunction with suspected Zika-associated increase in newborn microcephaly cases, prompted WHO to declare public health emergency of international concern. ZIKV-associated illness is characterized by an incubation period of 3-12 days. Most patients remain asymptomatic (i.e., ~80%) after contracting the virus. When symptomatic, clinical presentation is usually mild and consists of a self-limiting febrile illness that lasts approximately 2-7 days. Among common clinical manifestations are fever, arthralgia, conjunctivitis, myalgia, headache, and maculopapular rash. Hospitalization and complication rates are low, with fatalities being extremely rare. Newborn microcephaly, the most devastating and insidious complication associated with the ZIKV, has been described in the offspring of women who became infected while pregnant. Much remains to be elucidated about the timing of ZIKV infection in the context of the temporal progression of pregnancy, the corresponding in utero fetal development stage(s), and the risk of microcephaly. Without further knowledge of the pathophysiology involved, the true risk of ZIKV to the unborn remains difficult to quantify and remediate. Accurate, portable, and inexpensive point-of-care testing is required to better identify cases and manage the current and future outbreaks of ZIKV, including optimization of preventive approaches and the identification of more effective risk reduction strategies. In addition, much more work needs to be done to produce an effective vaccine. Given the rapid geographic spread of ZIKV in recent years, a coordinated local, regional, and global effort is needed to generate sufficient resources and political traction to effectively halt and contain further expansion of the current outbreak.

Zika Virus Infection during Pregnancy and Congenital Abnormalities

“…These mosquitoes are similar to those believed to transmit dengue and yellow fever (Sikka et al, 2016). ZIKV transmission is also believed to occur through sexual activities (Hills et al, 2016).…”

Reproductive planning in times of Zika: getting pregnant or delaying plans? The opinion of the Brazilian Society of Assisted Reproduction Committee - a basis for a bioethical discussion

“…Forty-two ZIKV-positive women (58%) underwent ultrasound examination, and 12 cases of fetal abnormalities were detected. The adverse outcomes reported in the study included two intrauterine deaths at 36 and 38 weeks of gestation; five cases of intrauterine growth restriction with/without microcephaly; seven cases of CNS injury, especially ventricular calcifications; seven fetuses with abnormal changes in amniotic fluid volume or flow changes in the brain or umbilical arteries (Sikka et al ., 2016). …”

Prior Dengue Virus Exposure Shapes T Cell Immunity to Zika Virus in Humans

“…he pandemic rise of Zika virus (ZIKV) has recently commanded the attention of the general public and medical research community alike (1)(2)(3)(4). ZIKV is a flavivirus most closely related to dengue virus (DENV) (5,6) but also related with Japanese encephalitis virus (JEV), West Nile virus (WNV), and yellow fever virus (YF), all of which are transmitted primarily by mosquitoes (7).…”