A revised manuscript submitted to PLOS Neglected Tropical Diseases
With the sudden emergence of Zika virus as an evolving epidemic we are confronted with the need to simultaneously study and understand a new disease and to develop countermeasures. In many ways Zika presents a much more complex challenge than Ebola, and it may impact more lives. It is vector borne, and therefore its range of transmission will be determined by vector ecosystem. It cannot be significantly contained by limiting movement or contact of people. Acute infection may be unapparent, so patients cannot be quarantined. It exerts its most devastating effects on the unborn fetus with a delay to diagnosis. The transplacental pathology is not understood. Zika virus associated disease has an autoimmune component. It is epidemic in a region with a high degree of global connectivity; cases will be widely disseminated. The Zika epidemic is moving very rapidly. Research reagents, animal models, and fundamental science knowledge are much less well developed than they were for Ebola. On the other hand, decades of experience with dengue, yellow fever, and West Nile have equipped us with familiarity with ADE and flavivirus vaccine development strategies. Zika virus is likely a harbinger of future diseases driven by ecosystem change and global interconnectedness.
Perhaps the biggest challenge with Zika will be to recognize it for what it is: a new disease which does not fit the epidemiology or response paradigm of Ebola or dengue and which will demand effort, resources, unparalleled collaboration, and above all open mindedness in formulating responses.