Epidemic preparedness: Prenatal Zika virus screening during the next epidemic

Abstract

Zika virus (ZIKV) is a vectorborne infectious agent of global public health significance due to its potential to cause severe teratogenic outcomes. The question of whether health systems should consider adopting screening programmes for ZIKV infections during pregnancy warrants consideration. In this analysis, we apply the Wilson-Jungner framework to appraise the potential utility of a prenatal ZIKV screening programme, outline potential screening strategies within the case-finding pathway, and consider other epidemiological factors that may influence the planning of such a screening programme. Our evaluation of a potential prenatal ZIKV screening programme highlights factors affirming its usefulness, including the importance of Congenital Zika Syndrome as a public health problem and the existence of analogous congenital prenatal screening programmes for STORCH agents (syphilis, toxoplasmosis, others (eg, human immunodeficiency virus, varicella-zoster virus, parvovirus B19), rubella, cytomegalovirus, and herpes simplex virus). However, our assessment also reveals key barriers to implementation, such as the need for more accurate diagnostic tests, effective antiviral treatments, increased social service capacity, and surveillance. Given that the reemergence of ZIKV is likely, we provide a guiding framework for policymakers and public health leaders that can be further elaborated and adapted to different contexts in order to reduce the burden of adverse ZIKV-related birth outcomes during future outbreaks.

Keywords: Arboviruses; Child health; Maternal health; Public Health; Screening; Zika virus.

Figure 1

Potential ZIKV screening strategies during pregnancy. This flow chart illustrates the progression for different CZS screening strategies during pregnancy with options for increased confirmatory testing depending on resources available. CZS, Congenital Zika Syndrome; GA, gestational age; IgM, immunoglobulin M; PRNT, plaque reduction neutralisation test; RT-PCR, reverse transcription-polymerase chain reaction; ZIKV, Zika virus.