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Changing Viral Epidemiology: the future‐ (re)emerging infections: Zika21,22
• Zika virus (ZIKV) is an arthropod‐borne flavivirus that was first isolated in 1947 in a sentinel rhesus monkey from the Zika forest in Uganda, in the context of yellow fever surveillance.
• It is mainly transmitted to humans by Aedes aegypti, a mosquito of tropical and subtropical areas that is also the vector of other major flaviviruses, such as Dengue virus.
• Until recently, ZIKV had only been associated with sporadic cases of benign human infection in Africa and Asia that were characterized by fever and rash.
• More than a million people were infected in total between 2015 and 2016.
• The risk of developing congenital microcephaly, as recognized in Brazil in January 2016, is higher if the infection occurs during the first trimester of pregnancy and was globally estimated to affect approximately 5% of foetuses and infants born to ZIKV‐infected mothers.
• An unprecedented epidemic of congenital microcephaly in neonates, contributed to the growing worldwide concern. Indeed, the World Health Organization (WHO) declared in February 2016 that ZIKV disease was a “Public Health Emergency of International Concern.”
• The need to resolve this international health crisis was felt as a moral duty among many, prompting collaborative efforts between clinicians and researchers. As an example, the European Union has invested €45 million in ZIKV research.
Changing Viral Epidemiology: Strategies & lessons learnt
• Research efforts advanced quickly, in particular in characterizing the congenital‐associated syndrome associated with ZIKV infection, and their underlying molecular mechanisms.
• Serological and RT–PCR assays allowed rapid diagnosis and were deployed in the field during the outbreak.
• Epidemiological and medical research used existing surveillance programmes for vertically transmitted infections, and registries that monitor fetal abnormalities.
• Pathogenesis research built on work with cell and animal models (rodents and non‐human primates) and clinical cohorts to study recently emerged arboviruses, such as chikungunya virus, and other flaviviruses and pathogens associated with congenital pathologies (TORCH).
• Recent advances in human neural stem cell biology and technical developments to generate two‐ and three‐dimensional human in vitro culture models have been instrumental in beginning to decipher the underlying mechanisms of ZIKV‐associated neuropathology.
• Several potentially useful drugs have been identified in preclinical testing and viable vaccine candidates are advancing quickly through the different discovery phases.
• Although the ZIKV outbreak is now over in Latin America, answering these outstanding scientific questions will help to better prepare us for probable future re‐emergences of ZIKV.
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