Researching Zika in pregnancy: lessons for global preparedness
Researching Zika in pregnancy: lessons for global preparedness
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DOI：
10.1016/s1473-3099(20)30021-9
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发表时间：
2020-04-01
影响因子：
56.3
通讯作者：
Giaquinto, Carlo
中科院分区：
文献类型：
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作者：
Ades, A. E.;Thorne, Claire;Giaquinto, Carlo
我们对先天性感染的理解是基于对怀孕期间感染的妇女的前瞻性研究。欧盟资助了三个财团研究寨卡病毒，每个财团都包括一项针对孕妇的前瞻性研究。另一项多中心研究由美国国立卫生研究院资助。这个个人观点描述了研究寨卡病毒所需的研究设计，并质疑资助欧盟和美国的学者与疫情地区的合作者合作是否是一种有效的策略。在2015-16寨卡病毒爆发3年后，这些合作几乎没有教会我们有关病毒垂直传播的知识。在批准资金、同意合同、获得伦理批准和装备实验室所花的时间里，寨卡病毒基本上已经消失了。相比之下，基于当地监测和标准治疗方案的前瞻性研究已经提供了有价值的数据。对胎儿和儿童健康的威胁对全球防范工作提出了新的挑战，需要支持制定和执行适合当地情况的规程。这些方案可以比外部设计的研究更早地以更低的成本回答关键问题。当地方案还可以提供一个框架，用于招募研究不太具体的结果所需的未暴露对照。其他优先事项包括加速非侵入性检测的开发，以及新生儿和产前样本的长期储存，以促进队列研究的回顾性重建。
Our understanding of congenital infections is based on prospective studies of women infected during pregnancy. The EU has funded three consortia to study Zika virus, each including a prospective study of pregnant women. Another multi-centre study has been funded by the US National Institutes of Health. This Personal View describes the study designs required to research Zika virus, and questions whether funding academics in the EU and USA to work with collaborators in outbreak areas is an effective strategy. 3 years after the 2015-16 Zika virus outbreaks, these collaborations have taught us little about vertical transmission of the virus. In the time taken to approve funding, agree contracts, secure ethics approval, and equip laboratories, Zika virus had largely disappeared. By contrast, prospective studies based on local surveillance and standard-of-care protocols have already provided valuable data. Threats to fetal and child health pose new challenges for global preparedness requiring support for the design and implementation of locally appropriate protocols. These protocols can answer the key questions earlier than externally designed studies and at lower cost. Local protocols can also provide a framework for recruitment of unexposed controls that are required to study less specific outcomes. Other priorities include accelerated development of non-invasive tests, and longer-term storage of neonatal and antenatal samples to facilitate retrospective reconstruction of cohort studies.