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. 2019 Nov 3;9(11):e032275.
doi: 10.1136/bmjopen-2019-032275.

Health outcomes associated with Zika virus infection in humans: a systematic review of systematic reviews

Raphael Ximenes  1 , Lauren C Ramsay  2   3 , Rafael Neves Miranda  2 , Shaun K Morris  4   5 , Kellie Murphy  6 , Beate Sander  2   3   7   8 ; RADAM-LAC Research Team
Collaborators, Affiliations

Health outcomes associated with Zika virus infection in humans: a systematic review of systematic reviews

Raphael Ximenes et al. BMJ Open. .

Abstract

Objective: With the emergence of Zika virus (ZIKV) disease in Central and South America in the mid-2010s and recognition of the teratogenic effects of congenital exposure to ZIKV, there has been a substantial increase in new research published on ZIKV. Our objective is to synthesise the literature on health outcomes associated with ZIKV infection in humans.

Methods: We conducted a systematic review (SR) of SRs following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE, Embase, Cochrane and LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) databases from inception to 22 July 2019, and included SRs that reported ZIKV-associated health outcomes. Three independent reviewers selected eligible studies, extracted data and assessed the quality of included SRs using the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews 2) tool. Conflicts were resolved by consensus or consultation with a third reviewer.

Results: The search yielded 1382 unique articles, of which 21 SRs met our inclusion criteria. The 21 SRs ranged from descriptive to quantitative data synthesis, including four meta-analyses. The most commonly reported ZIKV-associated manifestations and health outcomes were microcephaly, congenital abnormalities, brain abnormalities, neonatal death and Guillain-Barré syndrome. The included reviews were highly heterogeneous. The overall quality of the SRs was critically low with all studies having more than one critical weakness.

Conclusion: The evolving nature of the literature on ZIKV-associated health outcomes, together with the critically low quality of existing SRs, demonstrates the need for high-quality SRs to guide patient care and inform policy decision making.

Prospero registration number: CRD42018091087.

Keywords: Guillain-Barré syndrome; Zika virus infection; congenital Zika syndrome; epidemiology; microcephaly; neurology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of search results and study selection.
Figure 2
Figure 2
Overlap between studies cited in at least five systematic reviews.
Figure 3
Figure 3
Individual study results of quality assessment using AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews 2)—result for all questions of AMSTAR 2 tool.
Figure 4
Figure 4
Individual study results of quality assessment using AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews 2)—critical domains of AMSTAR 2 tool.
See this image and copyright information in PMC

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