Taylor-Robinson Andrew W
Infectious Diseases Research Group, School of Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia.
Res Rep Trop Med. 2016 Jul 5;7:11-15. doi: 10.2147/RRTM.S108992. eCollection 2016.
Following the first report in May 2015 of the unexpected emergence of Zika in north east Brazil, there has been an explosive epidemic of this infection across Latin America. The outbreak has caused alarm among social and news media as to the virulence and transmission potential of the mosquito-borne virus. This debate is heightened by the proximity, both in time and distance, to the forthcoming Olympic Games to be held in Rio de Janeiro this August, provoking fears for the safety of athletes and spectators alike. The threat, real or perceived, is exacerbated by the movement between nations in the same or separate continents of persons who act unwittingly as asymptomatic carriers. Pregnant females are considered at greatest risk because microcephaly in newborn infants is linked to, if not yet proven as caused by, Zika infection. In February this year, the World Health Organization declared that further to the then unconfirmed association between the virus and the clinical manifestations of microcephaly and also Guillain-Barré syndrome, the Zika epidemic was a "public health emergency of international concern". No anti-Zika therapy, vaccine or drug, is currently available and while the production of the former has now been prioritized by multiple funding agencies, the history of infectious disease vaccine development indicates that this may take several years to reach the market place. The fact that Zika is a close relative of yellow fever and Japanese encephalitis viruses, for both of which there are already effective vaccines, provides a rational basis for the fast-tracked laboratory-based preparation of a candidate vaccine. However, undertaking clinical trials on pregnant females provides ethical and practical hurdles to overcome before licensure is granted for public administration. Meanwhile, public health management strategies, including mosquito control programs to reduce breeding, are needed to limit the global spread of this re-emerging disease.
2015年5月巴西东北部意外出现寨卡病毒的首次报告后，这种感染在拉丁美洲爆发流行。此次疫情引发了社会和新闻媒体对这种蚊媒病毒的毒性和传播潜力的警觉。由于距离今年8月将在里约热内卢举行的奥运会在时间和空间上都很近，这场辩论愈演愈烈，引发了对运动员和观众安全的担忧。无论这种威胁是真实存在还是人们感觉到的，在同一大陆或不同大陆国家之间流动的无症状携带者的活动都加剧了这种威胁。孕妇被认为风险最大，因为新生儿小头畸形即便尚未被证实由寨卡病毒感染所致，但也与之有关联。今年2月，世界卫生组织宣布，鉴于当时病毒与小头畸形以及格林-巴利综合征临床表现之间尚未得到证实的关联，寨卡疫情是“国际关注的突发公共卫生事件”。目前尚无抗寨卡病毒的疗法、疫苗或药物，虽然多个资助机构已将前者的研发列为优先事项，但传染病疫苗研发的历史表明，这可能需要数年时间才能上市。寨卡病毒与黄热病病毒和日本脑炎病毒亲缘关系很近，而后两者都已有有效的疫苗，这为基于实验室快速研制候选疫苗提供了合理依据。然而，在获得公共管理许可之前，对孕妇进行临床试验存在伦理和实际障碍需要克服。与此同时，需要采取公共卫生管理策略，包括控制蚊虫滋生的项目，以限制这种再次出现的疾病在全球的传播。
