The global threat of Zika virus to pregnancy: epidemiology, clinical perspectives, mechanisms, and impact.

Phillipe Boeuf,James G Beeson,Michelle J L Scoullar,Heidi E Drummer,Jack S Richards

doi:10.1186/s12916-016-0660-0

Phillipe Boeuf, James G Beeson + Show 3 more

Open Access

https://doi.org/10.1186/s12916-016-0660-0

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Abstract

Zika virus (ZIKV) is a mosquito-borne flavivirus that has newly emerged as a significant global threat, especially to pregnancy. Recent major outbreaks in the Pacific and in Central and South America have been associated with an increased incidence of microcephaly and other abnormalities of the central nervous system in neonates. The causal link between ZIKV infection during pregnancy and microcephaly is now strongly supported. Over 2 billion people live in regions conducive to ZIKV transmission, with ~4 million infections in the Americas predicted for 2016. Given the scale of the current pandemic and the serious and long-term consequences of infection during pregnancy, the impact of ZIKV on health services and affected communities could be enormous. This further highlights the need for a rapid global public health and research response to ZIKV to limit and prevent its impact through the development of therapeutics, vaccines, and improved diagnostics. Here we review the epidemiology of ZIKV; the threat to pregnancy; the clinical consequences and broader impact of ZIKV infections; and the virus biology underpinning new interventions, diagnostics, and insights into the mechanisms of disease.

Highlights

Zika virus (ZIKV) infection was previously considered to be of modest public health concern, causing only mild fever, rash, and arthralgia in 20 % of patients, with 80 % of infections being asymptomatic [1]
The first trimester of pregnancy is a crucial period for brain development and ZIKV infection early in pregnancy is likely to be more strongly associated with microcephaly than infections later in pregnancy, as demonstrated in French Polynesia [21]
ZIKV can infect human neural progenitor cells and attenuate their growth [29]. These findings have been replicated in a mouse model in which ZIKV targets primarily neural progenitor cells, causing their cell-cycle arrest, apoptosis, and inhibition of differentiation, resulting in cortical thinning and microcephaly [30]. This and other animal models have recently provided evidence that ZIKV infection can lead to microcephaly, indicating that a causal link between early pregnancy ZIKV infection and microcephaly is plausible in humans

Summary

Introduction

Zika virus (ZIKV) infection was previously considered to be of modest public health concern, causing only mild fever, rash, and arthralgia in 20 % of patients, with 80 % of infections being asymptomatic [1]. Two recent reports of neuroimaging in a total of 46 infants with likely ZIKV-associated microcephaly demonstrated severe brain damage in almost all cases [15,16,17].

Results

Conclusion