An evaluation of WHO emergency guidelines for Zika virus disease

Abstract

Background: In the face of an unclear causal association between Zika virus in utero exposure and congenital abnormalities and urgent demand for guidance, the World Health Organization (WHO) had to produce timely and trustworthy guidelines during the 2016 Public Health Emergency of International Concern (PHEIC).

Methods: This is a cross-sectional evaluation of WHO emergency guidelines produced during the Zika virus disease PHEIC from 1 February to 18 November 2016. We assessed adherence to WHO publication requirements and the reporting of guideline development processes associated with trustworthiness. In the absence of quality appraisal tools for guidelines developed under compressed timeframes, we applied the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.

Results: We included 21 guidelines (13 de novo and 8 updates). Six guidelines used a formal evidence review process. Most guidelines involved external experts in the development process and collected declarations of interest. Peer review was reported in six documents. Most emergency guidelines included updating plans. The highest scoring AGREE II domain was clarity of presentation (median score 78%); the lowest scoring domain was applicability (median score 18%).

Conclusion: WHO developed moderate- to high-quality emergency guidelines in the challenging context of a PHEIC. We found improvement opportunities for WHO guideline development teams in the use of evidence to formulate recommendations, the collection of declarations of interest, reporting of conflicts of interest, and the use of existing WHO organizational quality assurance processes.

Keywords: AGREE II; World Health Organization; Zika virus disease; evaluation studies; evidence-based practice; global health; guidelines; methods; quality control.

Figure 1

Zika virus disease guidelines publication timeline Note: The Public Health Emergency of International Concern was declared on 1 February 2016.

Figure 2

Zika virus disease guidelines AGREE II scores Note: AGREE II quality domain scores (vertical axis) are based on standardized scores of the four independent reviewers for each domain (horizontal axis) (11‐13). The boxes represent the interquartile ranges, and the middle line the median score. The whiskers represent the ranges.