Zika resources


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30 September 2016; Last updated 14 March 2017

A new page in the history of Public Health in the 21st century was turned when the word realized, during one of the new outbreaks of ZIKA virus, that infection in a pregnant women could be transmitted to the foetus, causing  microcephaly – and we now know – other manifestation of Congenital Zika Syndrome (CZS). This flavivirus, transmitted by mosquitoes, mostly A. aegypti, was identified more than 60 years ago, and was not considered to be of public health importance until it started to cause outbreaks in 2007. It was only in 2015, an epidemic of microcephaly was identified in Brazil, with space and time correlation to an epidemic of Zika, that the possibility of a Congenital Zika Syndrome was suspected; there never had been an epidemic of congenital infections with a newly discovered virus, or by a mosquito transmitted virus, and the few organism known to cause congenital infections did not include flavivirus. Zika continued spread, with 70 countries or territories reporting mosquito transmitted Zika since 2015. The World Health Organization (WHO) declared the epidemic a Public Health Emergency of International concern. The process of establishing causality followed with great speed.

It is not clear why the virus is causing outbreaks and congenital syndrome now. It may be that it was circulating in Africa and Asia at sporadic levels causing high levels of population immunity, and the outbreaks were triggered by the introduction of the virus on totally susceptible populations in the Americas islands in the Pacific Ocean and the coast of Africa. If this is the case, the world will suffer epidemics for a few years, and transmission will settle in sporadic, low levels, like rubella before the introduction of vaccines. It is possible also that the mutation on the virus – the version circulating in the outbreak areas is different from that circulating in Africa and Asia – are behind the rapid spread and the CZS. Whatever the reason, given the current expansion, the potential is for a major increase in the numbers of Zika congenital infections.

Because we monitored microcephaly as the marker of the epidemic, this is the manifestation we know most about. Features include neurologic damage to the brain, mostly visible at radiological image, mostly to cortical subcortical areas of the brain, to the brain stem; and visual and hearing abnormalities. Follow up will identify anomalies in children apparently normal at birth as well as evolution; marked development delays, dysphagia and epilepsy seem frequent. Studies of the impact on families, society and health services are ongoing and will provide information necessary to provide needed support for affected children and families as well as for planning for health and other services. Given the number of the outbreaks – Zika has now been identified in 60 countries – other manifestations of post-natal Zika became apparent, and these include rare but severe neurologic complications, including Guillan-Barre.

Zika is different from Ebola: In Ebola, most of the deaths and the outbreaks themselves could have been avoided by tools we have and know work, but lacked the political will to do so: provision of sufficient infrastructure, more and better health facilities, with capacity for diagnosis and isolation access to water (in homes and health facilities). Zika is different; mosquitoes are hard to control: the world has tried to reduce A. aegypti populations to control dengue, without much success, for decades, and right now we have neither good tests, nor treatments, nor vaccines. A major effort is leading to progress towards vaccines, treatments and better diagnostic tests and methods for mosquito control. Reproductive rights of women are back on the agenda, with recognition of the need for free, local, efficient access to contraception for women wishing to postpone pregnancy until the worst of the epidemic is over or a vaccine is developed and implemented, and for women infected with Zika during pregnancy, the right to legal, safe termination of pregnancy when this is their choice.

Laura headshot for websiteAuthor, Laura C Rodrigues is the Professor of Infectious Disease Epidemiolgy, Faculty  of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.



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Systematic Reviews

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Bastos C.M., D’Avila O.P., Umpierre R.N., et al. Microcephaly and Zika Virus: clinical features and associations. Rev Bras Med Fam Comunidade. 2016;11(38):1-10. http://dx.doi.org/10.5712/rbmfc11(38)1297

Besnard M., Eyrolle-Guignot D., Guillemette-Artur P., et al. Congenital cerebral malformations and dysfunction in foetuses and newborns following the 2013 to 2014 Zika Virus epidemic in French Polynesia. Euro Surveill. 2016;21(13). Article 4.

Bowman L.R., Donegan S., McCall P.J. Is Dengue vector control deficient in effectiveness or evidence? Systematic review and meta-analysis. PLoS Neglected Tropical Diseases. 2016: March 17.

Charrel R.N., Leparc-Goffart I., Pas S., et al. State of knowledge on Zika Virus for an adequate laboratory response [Submitted]. Bull World Health Organ E-pub: 10 Feb 2016. doi: http://dx.doi.org/10.2471/BLT.16.171207.

Chibueze E.C., Tirado V., da Silva Lopes K., et al. Zika Virus infection in pregnancy: A systematic review of disease course and complications [Submitted]. Bull World Health Organ. E-pub: 9 June 2016. doi: http://dx.doi.org/10.2471/BLT.16.178426.

Chibueze E.C., Parsons A.J.Q., da Silva Lopes K., et al. Accuracy of ultrasound scanning relative to reference tests for prenatal diagnosis of microcephaly in the context of Zika Virus infection: A systematic review of diagnostic test accuracy [Submitted]. Bull World Health Organ. E-pub: 25 May 2016. doi: http://dx.doi.org/10.2471/BLT.16.178301.

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Gautret P., Mockenhaupt F., Grobusch M.P., et al. Arboviral and other illnesses in travellers returning from Brazil, June 2013 to May 2016: Implications for the 2016 Olympic and Paralympic Games. Euro Surveill. 2016;21(27):pii=30278. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.27.30278.

Grischott F., Puhan M., Hatz C., Schlagenhauf P. Non-vector-borne transmission of Zika virus: A systematic review. Travel Medicine and Infectious Disease. 2016:14;313-30. http://dx.doi.org/10.1016/j.tmaid.2016.07.002.

Hamer D.H., Barbre K.A., Chen L.H., et al. Travel-associated Zika Virus Disease acquired in the Americas through February 2016: A geosentinel analysis. Ann Intern Med. 2017;166:99-108. doi:10.7326/M16-1842

Ibrahim NK. Zika virus: Epidemiology, current phobia and preparedness for upcoming mass gatherings, with examples from World Olympics and Pilgrimage. Pak J Med Sci. 2016 Jul-Aug;32(4):1038-43. doi: 10.12669/pjms.324.10038.

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Krauer F., Riesen M., Reveiz L., et al. Zika virus infection as cause of congenital brain abnormalities and Guillain-Barre syndrome: systematic review. WHO Zika Casualty Working Group 2016. http://dx.doi.org/10.1101/073098.

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Mo, Y., Salada, B.M.A., and Anantharajah Tambyah, P. Zika virus – a review for clinicians. British Medical Bulletin, 2016, 1–12 doi: 10.1093/bmb/ldw023. [Note, not currently free access.]

Patel, R. V., Shaeer, K. M., Patel, P., et al. EPA-registered repellents for mosquitoes transmitting emerging viral disease. Pharmacotherapy, 2016;36:1272–80. doi:10.1002/phar.1854 [Note, not currently free access.]

Pileggi V.N., Braga G.C., Bellissimo-Rodrigues F., et al. A rapid review of personal protective measures for preventing Zika Virus infection among pregnant women. [Submitted]. Bull World Health Organ. E-pub: 21 July 2016. doi: http://dx.doi.org/10.2471/BLT.16.182592.

Plourde, A. R., & Bloch, E. M. A literature review of Zika VirusEmerging Infectious Diseases, 2016:22(7);1185-92. https://dx.doi.org/10.3201/eid2207.151990.

Posen, H.J., Keystone, J.S., Gubbay, J.B., et al. Epidemiology of Zika Virus, 1947-2007BMJ Global Health, 2016:1(2), e000087. Accessed October 03, 2016. http://dx.doi.org/10.1136/bmjgh-2016-000087.

Venkatraman A., Mukhija D., Kumar N., et al. Zika virus misinformation on the internet. Travel Med Infect Dis. 2016 Jul-Aug;14(4):421-2. doi: 10.1016/j.tmaid.2016.05.018.

Waddell L.A., Greig J.D. Scoping review of the Zika Virus literature. PLoS ONE 2016;11(5): e0156376. doi:10.1371/journal.pone.0156376.

Wu J., Huang D.Y., Ma J.T., et al. Available evidence of association between Zika Virus and Microcephaly. Chin Med J 2016;129:2347-56.

Vector control in Dengue Virus

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Boyce, R., Lenhart, A., Kroeger, A., et al. Bacillus thuringiensis israellensis (Bti) for the control of dengue vectors: Systematic literature review. Trop Med Int Health, 2013;18:564–77. doi:10.1111/tmi.12087.

Esu E., Lenhart A., Smith L., et al. Effectiveness of peridomestic space spraying with insecticide on dengue transmission: systematic review. Trop Med Int Health. 2010 May;15(5):619-31. doi: 10.1111/j.1365-3156.2010.02489.x. Epub 2010 Mar 8.

Han, W. W., Lazaro, A., McCall, P. J., et al. Efficacy and community effectiveness of larvivorous fish for dengue vector control. Trop Med Int Health, 2015;20:1239–56. doi:10.1111/tmi.12538.

Heintze C., Velasco Garrido M., Kroeger A. What do community based dengue control programmes achieve: A systematic review of published evaluations. Trans R Soc Trop Med Hyg 2007;101(4):317-25 doi:10.1016/j.trstmh.2006.08.007.

Lazaro A., Han W.W., Manrique-Saide P., et al. Community effectiveness of copepods for dengue vector control: Systematic review. Trop Med Int Health 2015;20:685–706. doi:10.1111/tmi.12485.

Wilson A.L., Dhiman R.C., Kitron U., et al. Benefit of insecticide treated nets, curtains and screening on vector borne diseases excluding malaria: A systematic review and meta analysis. PLoS Negl Trop Dis 2014;8(10):e3228. doi:10.1371/journal.pntd.0003228.

Zubair M., Ashraf M., Ahsan A., et al. Dengue viral infections in Pakistan and other Asian countries: A comprehensive review. J Pak Med Assoc. 2016;66(7):884-8.

Diagnostic Reviews

Bingham A.M., Cone M., Mock V., et al. Comparison of test results for Zika Virus RNA in urine, serum and saliva specimens from persons with travel-associated Zika Virus Disease – Florida 2016. MMWR Morb Mortal Wkly Rep 2016;65. doi: dx.doi.org/10.15585/mmwr.mm6518e2.

Eboigbodin K.E., Brummer M., Ojalehto T., et al. Rapid molecular diagnostic test for Zika Virus with low demands on sample preparation and instrumentation. Diagn Microbiol Infect Dis 2016;86:369-71. doi.org/10.1016/j.diagmicrobio.2016.08.027.

Song J., Mauk M.G., Hackett B.A., et al. Instrument-free point-of-care molecular detection of Zika Virus. Analytical Chemistry 2016 88 (14), 7289-7294. doi: 10.1021/acs.analchem.6b01632.

Waggoner J.J., Gresh L., Mohamed-Hadley A., et al. Single-reaction multiplex reverse transcription PCR for detection of Zika, Chikungunya and Dengue viruses. Emerg Infect Dis 2016;22(7):1295-7. dx.doi.org/10.3201/eid2207.160326.


Brooks JT, Friedman A, Kachur RE, et al. Update: Interim guidance for prevention of sexual transmission of Zika virus – United States, July 2016. MMWR Morb Mortal Wkly Rep 2016;65:745–747. DOI: http://dx.doi.org/10.15585/mmwr.mm6529e2.

Oduyebo T., Petersen E.E., Rasmussen S.A., et al. Update: Interim guidelines for health care providers caring for pregnant women and women of reproductive age with possible Zika Virus exposure — United States, 2016. MMWR Morb Mortal Wkly Rep 2016;65:122–127. DOI: http://dx.doi.org/10.15585/mmwr.mm6505e2.

Oster A.M., Russell K., Stryker J.E., et al. Update: Interim guidance for prevention of sexual transmission of Zika Virus – United States 2016. MMWR Morb Mortal Wkly Rep 2016;65:323–325. DOI: http://dx.doi.org/10.15585/mmwr.mm6512e3.

Zika Working Group on behalf of the Committee to Advise on Tropical Medicine and Travel (CATMAT). Canadian recommendations on the prevention and treatment of Zika virus: Update. Can Comm Dis Rep 2016;42:101-11.


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