Zika Virus Infection in the Elderly: Possible Relationship with Guillain-Barré Syndrome

Abstract

The Zika virus (ZIKV) outbreak in French Polynesia, in 2013, and in Brazil, in 2015, was correlated with neurological complications, which comprised, among others, congenital microcephaly and Guillain-Barré syndrome (GBS), which includes a group of acute autoimmune neuropathies generally reported after respiratory or gastrointestinal infectious diseases. Despite being relatively rare, the incidence rate of GBS rises with age, which makes GBS more frequent in the elderly, in whom it is also a more severe disease with slower recovery than in younger patients. Different forms of GBS have been described having diagnostic confirmation of a previous infection with the ZIKV virus. Although we do not have enough evidence that elderly people are a particularly susceptible population to developing GBS following ZIKV infection, this is plausible. We should consider this possibility, particularly taking into account that aging subjects are more susceptible to infections. In this context, a deeper understanding of how the immune system in the elderly functions in relation to ZIKV infection is necessary, as well as an understanding of what kind of alterations of the nervous system such an infection triggers in the elderly, beyond GBS. This will be relevant for better therapeutic interventions and for designing vaccine candidates that can be applied in an aging population, particularly those prone to develop ZIKV-induced autoimmunity.

Zika virus infects human blood mononuclear cells

“…A study performed in Slovenia revealed that after elective termination of pregnancy, ZIKV viral particles were detected in brain tissues of the fetus diagnosed with microcephaly [5] and ZIKV RNA was also identified in the amniotic fluid of pregnant women who delivered microcephalic babies [4]. Besides microcephaly, other neurological abnormalities were detected in babies born to infected mothers including cerebral calcifications, cerebellar dysplasia, ocular lesions, hearing loss and arthrogryposis [6]. Because ZIKV infection correlated with several neurological abnormalities during fetal development, the concept of congenital ZIKV syndrome has been proposed.…”

“…In adults, ZIKV infection is associated to Guillain-Barré syndrome [6, 7]. By March 2017, 31 countries and territories have reported cases of microcephaly and other central nervous system abnormalities possibly related to ZIKV infection during pregnancy, and 23 countries and territories have reported increased incidence of Guillain-Barré syndrome [8].…”

Transfusion-Transmitted Zika Virus Infection in Pregnant Mice Leads to Broad Tissue Tropism With Severe Placental Damage and Fetal Demise

“…ZIKV infection may trigger GBS (severe neuropathies) (Savino et al, 2017; Zhou et al, 2017; Hygino da Cruz et al, 2018; Wu et al, 2018) and it is closely associated with congenital Zika diseases (microcephaly and brain abnormalities) in humans (Franca et al, 2016; Shapiro-Mendoza et al, 2017; Zorrilla et al, 2017). ZIKV RNA replication has been identified in human brain and placental tissues (Bhatnagar et al, 2017).…”

In silico construction of a multiepitope Zika virus vaccine using immunoinformatics tools

“…Due to the risks related to the infection, including congenital malformations, prophylaxis against ZIKV infection is still an urgency, and the best answer is vaccinating people in risk areas, mostly susceptible populations. Pregnant women 7 , elderly 20 and immunocompromised individuals 21 deserve special attention. Several vaccine types against ZIKV are currently in phase I clinical trials, including DNA vaccines, mRNA-based, inactivated virus, peptide, and recombinant viral vectored vaccines 22 .…”