Department of Population Health Science, University of Bristol Medical School, Bristol, UK.
Population Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, UK.
Lancet Infect Dis. 2020 Apr;20(4):e61-e68. doi: 10.1016/S1473-3099(20)30021-9. Epub 2020 Feb 19.
Our understanding of congenital infections is based on prospective studies of women infected during pregnancy. The EU has funded three consortia to study Zika virus, each including a prospective study of pregnant women. Another multi-centre study has been funded by the US National Institutes of Health. This Personal View describes the study designs required to research Zika virus, and questions whether funding academics in the EU and USA to work with collaborators in outbreak areas is an effective strategy. 3 years after the 2015-16 Zika virus outbreaks, these collaborations have taught us little about vertical transmission of the virus. In the time taken to approve funding, agree contracts, secure ethics approval, and equip laboratories, Zika virus had largely disappeared. By contrast, prospective studies based on local surveillance and standard-of-care protocols have already provided valuable data. Threats to fetal and child health pose new challenges for global preparedness requiring support for the design and implementation of locally appropriate protocols. These protocols can answer the key questions earlier than externally designed studies and at lower cost. Local protocols can also provide a framework for recruitment of unexposed controls that are required to study less specific outcomes. Other priorities include accelerated development of non-invasive tests, and longer-term storage of neonatal and antenatal samples to facilitate retrospective reconstruction of cohort studies.
我们对先天性感染的认识是基于对孕期感染女性的前瞻性研究。欧盟资助了三个研究寨卡病毒的联盟，每个联盟都包括对孕妇的前瞻性研究。美国国立卫生研究院还资助了另一项多中心研究。本文个人观点描述了研究寨卡病毒所需的研究设计，并质疑在欧盟和美国资助学者与疫情地区的合作者合作是否是一种有效的策略。在 2015-2016 年寨卡病毒爆发后的 3 年里，这些合作对病毒的垂直传播几乎没有提供任何新的认识。在批准资金、签订合同、确保伦理批准和装备实验室所需的时间里，寨卡病毒已经基本消失了。相比之下，基于当地监测和标准护理方案的前瞻性研究已经提供了有价值的数据。对胎儿和儿童健康的威胁给全球准备工作带来了新的挑战，需要支持设计和实施适合当地的协议。这些协议可以比外部设计的研究更早地回答关键问题，并且成本更低。当地的协议也可以为招募未暴露的对照组提供框架，这些对照组是研究不太具体的结果所必需的。其他优先事项包括加速开发非侵入性测试，以及长期储存新生儿和产前样本，以方便回顾性重建队列研究。
