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Will Zika become the 2016 NTD of the Year?

PLOS Neglected Tropical Diseases (PLOS NTDs) co-Editors-in-Chief Peter J Hotez and Serap Aksoy discuss the threat of zika virus spread throughout the Americas and call for zika virus researchers to submit their research to PLOS NTDs or PLOS Currents: Outbreaks. You can read further about zika virus in our new PLOS Collection

There is little question that Ebola virus infection commanded most of the infectious and tropical disease headlines of 2014 and 2015. For very different reasons zika virus could become an important news item in 2016. Zika fever or zika virus infection is an arbovirus infection transmitted by several different species of Aedes mosquitoes, including Aedes aegypti in the New World, although it was previously shown to be transmitted by Ae. albopictus in Gabon. Therefore, both Ae. aegypti and Ae. albopictus could become important vectors in the Americas. Like many flaviviruses including dengue virus, zika virus typically causes fever, rash, headaches, and arthralgias and myalgias, as well as a non-purulent conjunctivitis, but some patients are also asymptomatic. An important differentiator regarding the zika virus, however, is that it also appears to be highly neurotropic, and has been linked to human neurological syndromes, including Guillain-Barré syndrome.

Zika
Countries that have past or current evidence of Zika virus transmission (as of December 2015)

Zika fever was believed to have been introduced into Latin America in 2014. Possibly it was imported from French Polynesia, with some speculation that zika virus was brought into northeastern Brazil during the 2014 FIFA World Cup . Our biggest concern about zika virus infection stems from the November and December 2015 alerts issued by the Pan American Health Organization (PAHO) of the World Health Organization (WHO), specifically regarding a large number of cases of congenital birth defects, and especially a neurodevastating birth defect known as microcephaly. The PAHO December 1 alert reports 1,248 cases of microcephaly in Brazil, a number associated with a 20-fold increase compared to previous years. The highest zika microcephaly rates are in Brazil’s northeastern region and states, although autochthonous transmission of zika fever is now occurring throughout many tropical areas of South America, in addition to Central America and Mexico.

The causal link between zika and microcephaly has still not been confirmed, but the preliminary evidence for an association is beginning to look pretty strong. According to PAHO, the pieces include work by the Brazilian Ministry of Health and scientists demonstrating zika virus genomic DNA in the blood and tissues of a baby with microcephaly, and detection in the amniotic fluid of two pregnant women whose fetus was diagnosed through ultrasonography with microcephaly. It therefore appears that zika will join a growing list of neglected tropical diseases (NTDs) that disproportionately affect female reproductive health, such as Chagas disease (maternal-to-child transmission and congenital infection), schistosomaisis (female genital schistosomiasis), and hookworm infection (widespread hookworm in pregnancy).

In this New Year that zika virus has now been found in the United States territory of Puerto Rico. This and the finding of zika in Martinique are promoting concerns that zika virus could gain a foothold in the Caribbean much like chikungunya did in 2013. Moreover given that both this region must also be considered vulnerable.

The transmission of zika virus in the New World presents multiple challenges, especially in the prevention of maternal infection and congenital transmission. For example, what is the best advice for a woman of reproductive age living in the affected areas with regards to family planning? What is the advice for pregnant women or women planning pregnancy who plan to travel to potentially affected areas including the Caribbean?

There are also potentially momentous economic implications, including the prospect of taking care of a generation of neurodevastated children in northeastern Brazil and possibly elsewhere in the Americas, in addition to the possible derailment of the tourist industry in parts of the Caribbean, Mesoamerica, and South America. Could zika further destabilize fragile nations such as Venezuela? If zika hits the US Gulf Coast this summer could there be an impact on the US Presidential election?

The development of a zika vaccine could be a game-changer. Is a vaccine feasible? Will it be developed and tested in a timely manner? Or will the zika vaccine suffer the same fate as the Ebola vaccine did in 2014-15 – too little, too late?

For all those reasons, we are treating zika virus with the utmost seriousness and launching a new PLOS Currents series and a PLOS NTDs collection. We look forward to receiving your manuscripts and input as we follow this important epidemic.

 

If you are currently conducting research related to the Zika virus, we recommend submitting to PLOS NTDs or PLOS Currents: Outbreaks.

The first journal solely devoted to the world’s most neglected tropical diseases, PLOS Neglected Tropical Diseases publishes leading research and commentary on all scientific, medical, political and public health aspects of these forgotten diseases affecting the world’s most neglected people. For more information on how to submit to PLOS NTDs, please visit http://journals.plos.org/plosntds/s/submit-now , or contact plosntds@plos.org.

PLOS Currents is a free online platform which aims to rapidly publish research in the area of ongoing disease outbreaks. They encourage the publication of preliminary results, articles covering epidemiological data or disease trends, and do not require full-length articles for submission. Articles undergo a streamlined peer-review process and will be published immediately upon acceptance. More information can be found here: http://currents.plos.org/outbreaks/, or contact currents@plos.org with any questions.

Discussion
  1. Hello there,
    I wondered whether there is any connection with the high incidence of microcephaly in the Zika-virus transfected area in Brazil (and other South-American countries), and environmental exposure to for example mercury?
    Kind regards,
    CJW Meulenberg, Ph.D.

  2. Brazilia introduced end of 2014 a new diphtheria/tetanus/polio/whooping cough vaccin, given to pregnant women at 22 weeks in their pregnancy. Did the pharmeutical company who developed this new vaccin also sell to other South-American coutries and was it used there, and what is the occurance of microcephaly?

    Dr. Cécil J.W. Meulenberg

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