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标题：History, Epidemiology, and Clinical Manifestations of Zika: A Systematic Review
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作者：Enny S. Paixão ; Florisneide Barreto ; Maria da Glória Teixeira 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2016
卷号：106
期号：4
页码：606-612
DOI：10.2105/AJPH.2016.303112
语种：English
出版社：American Public Health Association
摘要：Objectives. To describe salient epidemiological characteristics of Zika virus outbreaks across the world and to examine the clinical presentations, complications, and atypical manifestations related to their occurrence in recent history. Methods. We conducted a systematic review of the literature by searching through MEDLINE, Embase, and Global Health Library, as well as the epidemiological bulletins and alerts from the World Health Organization, the Pan American Health Organization, and the European Centre for Disease Prevention and Control over the period 1954 to 2016. Results. The search yielded 547 records. We retained 333 for further analysis, to which we added 11 epidemiological bulletins from various sources. Of these, we systematically reviewed 52 articles and reports, revealing some epidemiological features and patterns of spread of the Zika virus worldwide, as well as pathological outcomes suspected to be linked to Zika outbreaks. Neurologic disorders among zika patients were similar in Brazil and French Polynesia but a causal link is not established. Incidence of zika infection in pregnant women is not known. In Brazil, during the zika outbreak the incidence of microcephaly increased more than 20 times. Among 35 infants with microcephaly, born from women suspected to have Zika infection during pregnancy in northeast Brazil, 74% of the mothers reported rash during the first and second trimester. Conclusions. On February 1, 2016, The World Health Organization declared the ongoing Zika crisis an emergency and that, although not yet scientifically proven, the link between the virus and growing numbers of microcephaly cases was “strongly suspected.” However, the causal relationship between zika and microcephaly is not universally accepted. Public Health Implications. The current situation with regard to Zika is not encouraging, because there is no vaccine, no treatment, and no good serological test, and vector control remains a challenge. Among diseases emerging in the 21st century, Zika is raising one of the greatest amounts of concern for public health globally. Zika virus (ZIKV) has presented as outbreaks since 2007; however, more recently, it has become the main suspected cause of an unusual and completely unexpected microcephaly epidemic, exposing the urgent needs for knowledge about this disease. Zika fever is an exanthematous disease, related to dengue fever, West Nile, and yellow fever. 1 This infection is characterized by symptoms that can last 1 week, with a clinical presentation similar to that of other arbovirus infections such as chikungunya and dengue, including mild fever, rash, arthralgia, arthritis, myalgia, headache, conjunctivitis, and edema. Severe cases involving hospitalization are uncommon, and deaths are rare. 2 This disease is caused by a flavivirus, isolated for the first time in 1947 from the blood of a sentinel rhesus monkey ( Macacamulatta ) in the Zika forest near Entebbe, Uganda. 3 Zika virus has been isolated from Aedes africanus , 4 Aedes luteocephalus , 5 Aedes aegypti , 6 Aedes albopictus , 7,8 Aedes furcifer, 9 and Aedes vittatus 5,9 mosquitos and, therefore, although A aegypti is the main vector in the Brazil epidemic, all of these Aedes species are probably involved in the transmission of ZIKV to humans. Zika was the predominant virus identified during the Yap Island outbreak, even though it was not isolated from Aedes hensilli . The evidence that this species was the most likely vector of dengue made this the suspected vector of ZIKV in Micronesia. 10 Aedes species present special difficulty to vector control agencies, mainly because they can reproduce in extremely small amounts of water (e.g., the water in a bottle cap) and their eggs are extremely hardy (e.g., the eggs can survive drying for more than a year). Recently, a large increase was observed in the circulation of ZIKV worldwide, which initially was endemic only in Africa and Asia. Cases have been reported in countries of Europe, Oceania, and the Americas, particularly in Latin America where it is rapidly spreading to new areas. 11 From places with established autochthonous transmission, such as Brazil, viremic travelers have the capacity to introduce ZIKV into new countries, where Aedes mosquitoes would become infected and perpetuate local transmission cycles. In South America, Brazil had large concentration of cases of Zika, especially in the Northeast region, and serious complications occurred simultaneously with the outbreak of this arbovirus. Until this moment, only 1 review on Zika has been published, 12 and that was before the virus’s introduction in the American region. Thus, we decided to produce another review with the newly available information, and to identify gaps in the available knowledge about this disease. The aim of our systematic review was to describe the current knowledge on the epidemiological characteristics, frequency, spatial distribution, clinical presentation, and complications or atypical manifestations related to the occurrence of Zika outbreaks.