Ten years of Zika in Brazil: achievements, challenges and perspectives

Zika virus (ZIKV) infections have impacted public health in Brazil since 2015, primally due to Congenital Zika Virus Syndrome (CZVS) cases, which may lead to microcephaly and other clinical manifestations, such as hearing and visual impairments. More than ten years after the first diagnosis of Zika in Brazil, some progress has been made and the epidemiological scenario has improved considerably. However, despite these advances, more than a thousand ZIKV infections are reported annually in Brazil and new CZVS cases continue to be observed. Herein, we performed a retrospective and prospective analysis to assess the progress made and identify gaps and challenges that still need to be addressed. Overall, we believe that future ZIKV control efforts in Brazil must include: enhanced vector control measures; surveillance for potential vertebrate reservoirs; medical care for pregnant women, including prevention of infection and vertical transmission; sensitive and specific intrauterine CZVS diagnosis; ongoing support for children and families with CZVS cases; expansion of the national diagnostic network for arboviruses, including encouraging healthcare professionals to perform laboratory tests; assessment of the impactof the dengue vaccine, recently implemented in Brazil, on ZIKV infections; and affordable, sensitive and specific multiplex diagnostic strategies adequately validated for cross-reactivity with other arboviruses circulating in Brazil.