A systematic review and meta-analysis of Zika virus epidemiology

Zika virus (ZIKV), classified as a priority pathogen by the World Health Organization, is an Aedes-borne arbovirus that can cause neurological complications and birth defects in newborns of mothers infected during pregnancy. We conducted a systematic review of peer-reviewed studies reporting ZIKV epidemiological parameters, transmission models and outbreaks (PROSPERO CRD42023393345) to characterize its transmissibility, seroprevalence, risk factors, disease sequelae and natural history. We performed meta-analyses of the proportions of congenital Zika syndrome, pregnancy loss among ZIKV-infected mothers and symptomatic cases. We extracted information from 574 studies. Across 418 included studies assigned a high-quality score, we extracted 969 parameters, 127 outbreak records and 154 models. Using random-effects models, we estimated proportions of congenital Zika syndrome (4.65%, 95% confidence interval (CI): 3.38-6.67%), pregnancy loss (2.48%, 95% CI: 1.62-3.78%) and symptomatic cases (51.20%, 95% CI: 38.00-64.23%). Seroprevalence estimates (n = 354) were retrieved beyond South America and French Polynesia. Basic reproduction number estimates (n = 77) ranged between 1.12 and 7.4. We found 66 human epidemiological delay estimates, including the intrinsic incubation period (n = 11, range: 4-12.1 days), infectious period (n = 15, range: 3-50 days), extrinsic incubation period (n = 22, range: 5.1-24.2 days) and serial interval (n = 27, range: 7.4-32.9 days). These data are available in the R package 'epireview' (version 1.4.5). We provide a comprehensive systematic summary of ZIKV epidemiology, revealing large heterogeneities and inconsistencies in the reporting of parameter estimates, study designs and parameter definitions and underscoring the need for standardized epidemiological definitions.