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Times to Key Events in the Course of Zika Infection and their Implications for Surveillance: A Systematic Review and Pooled Analysis

Justin Lessler, Cassandra T. Ott, Andrea C. Carcelen, Jacob M. Konikoff, Joe Williamson, Qifang Bi, Nicholas G. Reich, Derek A. T. Cummings, Lauren M. Kucirka, Lelia H. Chaisson
doi: https://doi.org/10.1101/041913
Justin Lessler
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore MD, USA. 21205.
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  • For correspondence: justin@jhu.edu
Cassandra T. Ott
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Andrea C. Carcelen
3Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Jacob M. Konikoff
4Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Joe Williamson
5Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Qifang Bi
6Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Nicholas G. Reich
7Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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Derek A. T. Cummings
8Department of Biology, Emerging Pathogens Institute, University of Florida
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Lauren M. Kucirka
9Department of Surgery, Johns Hopkins University School of Medicine and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lelia H. Chaisson
10Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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ABSTRACT

Background Evidence suggests that Zika virus has driven a 10-fold increase in babies born with microcephaly in Brazil, prompting the WHO to declare a Public Health Emergency of International Concern. However, little is known about the natural history of infection. These data are critical for implementing surveillance and control measures such as protecting the blood supply.

Methods We conducted a systematic review and pooled analysis to estimate the distribution of times from Zika infection to symptom onset, seroconversion, and viral clearance, and analyzed their implications for surveillance and blood supply safety.

Results Based on 25 cases, we estimate the median incubation period of Zika virus infection is 5.9 days (95% CI: 4.4-7.6), and that 95% of those who do develop symptoms will do so by 11.1 days post-infection (95% CI: 7.6-18.0). On average seroconversion occurs 9.0 days (95% CI, 7.0-11.6) after infection, and virus is detectable in blood for 9.9 days (95% CI: 6.8-21.4). In 5% of cases detectable virus persists for over 18.9 days (95% CI: 12.6-79.5). The baseline (no screening) risk of a Zika infected blood donation increases by approximately 1 in 10,000 for every 1 per 100,000 person-days increase in Zika incidence. Symptom based screening reduces this by 7% (RR 0.93, 95% CI 0.86-0.99), and antibody screening by 29% (RR 0.71, 95% CI: 0.28-0.88).

Conclusions Symptom or antibody-based surveillance can do little to reduce the risk of Zika contaminated blood donations. High incidence areas may consider PCR testing to identify lots safe for use in pregnant women.

Copyright 
The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.
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Posted March 02, 2016.
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Times to Key Events in the Course of Zika Infection and their Implications for Surveillance: A Systematic Review and Pooled Analysis
Justin Lessler, Cassandra T. Ott, Andrea C. Carcelen, Jacob M. Konikoff, Joe Williamson, Qifang Bi, Nicholas G. Reich, Derek A. T. Cummings, Lauren M. Kucirka, Lelia H. Chaisson
bioRxiv 041913; doi: https://doi.org/10.1101/041913
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Times to Key Events in the Course of Zika Infection and their Implications for Surveillance: A Systematic Review and Pooled Analysis
Justin Lessler, Cassandra T. Ott, Andrea C. Carcelen, Jacob M. Konikoff, Joe Williamson, Qifang Bi, Nicholas G. Reich, Derek A. T. Cummings, Lauren M. Kucirka, Lelia H. Chaisson
bioRxiv 041913; doi: https://doi.org/10.1101/041913

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