Clinical Characterisation of Zika Virus Infection in the Context of Co-circulating Arboviruses in Latin America - the WHO-IDAMS-ISARIC Protocol

Abstract

Knowledge of the clinical manifestations and natural history of disease in patients infected with Zika and co-circulating arboviruses (including Chikungunya and Dengue) in Latin America remains incomplete. Currently, clinical characterisation is mostly reliant on retrospective cohort studies or publications from individual centres with highly variable sample sizes. While important, this process is slow due to its reliance on the outcome of interest (usually a disease complication) already having occurred, and fractured, as individual facilities may only see a small proportion of affected patients. Prospective clinical characterisation and laboratory sampling protocols meet a number of complementary objectives in emerging infectious disease outbreaks. They contribute to: 1.Developing case definitions 2.Understanding the clinical features of the disease, including acute and persistent symptoms or complications, and their underlying pathophysiology. 3.Determining the best treatment options and timing. 4.Determining the period of communicability. 5.Providing real-time data that can inform public health and clinical interventions. To help meet these objectives, WHO and ISARIC have previously partnered to develop clinical characterisation protocols for severe acute respiratory illness, and viral haemorrhagic fevers. These protocols are provided open access and have a tiered approach so that research can be undertaken in resource poor settings. IDAMS are presently undertaking arboviral clinical characterisation studies in the region. In response to the Zika outbreak, the WHO-IDAMS-ISARIC protocol has been developed to offer a master clinical characterisation protocol that includes a standardised natural history data collection tool (case report form) with the option for biological sampling for Zika, Dengue and Chikungunya viruses