By Ana Espino | Published on March 11, 2026 | 3 min read
Zika virus (ZIKV), an arbovirus
primarily transmitted by Aedes aegypti, caused a major epidemic in Latin
America between 2015 and 2018, with more than 500,000 reported cases and an
unexpected rise in congenital malformations, particularly microcephaly.
Since 2017, global incidence has
declined. However, the virus remains
endemic in 92 countries, with particularly
high risk in Latin America and the Caribbean. Recent outbreaks in Asia in 2024
highlight the persistence of epidemic potential.
The absence of an approved vaccine
or specific antiviral treatment remains a major limitation, particularly for
pregnant women and immunocompromised patients. This review, published in 2025
in Current Opinion in HIV and AIDS, provides a global update on
epidemiology, transmission, diagnosis, clinical manifestations, and recent
preventive advances.
Are we truly prepared for another
epidemic?
The authors conducted a narrative
review of recent publications (2022–2024), including epidemiological data,
clinical trials, and diagnostic innovations.
Epidemiology and transmission
Global average seroprevalence is
estimated at 21%, with a peak of 39% in the Americas. Among women of
reproductive age, incidence peaked in 2016 at 174 per 100,000 before declining
by 52% between 2016 and 2021.
Transmission closely depends on
vector dynamics. Interactions between the mosquito microbiota and the virus
influence vector competence. Climate change may expand the geographic
distribution of vectors toward temperate regions.
Diagnosis: a specificity challenge
Serological cross-reactivity with
dengue remains a major obstacle. New multi-epitope proteins and ZIKV-specific
synthetic molecules are under development to improve serological specificity.
Multiplex PCR approaches and wastewater surveillance represent promising tools
for early detection.
Clinical manifestations and
maternal–fetal risk
Although most infections are mild,
three major complications are described: Guillain–Barré syndrome, rare immune
thrombocytopenia, and, most importantly, congenital Zika syndrome.
A Brazilian meta-analysis involving
1,548 exposed pregnancies reported a microcephaly risk of 2.6% and a risk of
functional neurological abnormalities of 18.7%. Mortality risk among children
with congenital Zika syndrome is increased by a factor of 11.3.
No significant increase in
complications has been confirmed in people living with HIV.
Prevention and therapeutic
perspectives
Several vaccine platforms are
currently in phase 1 trials: inactivated vaccines, DNA vaccines, adenoviral
vectors, and mRNA vaccines. The mRNA-1893 candidate has shown a robust and
durable neutralizing response.
Monoclonal antibodies targeting the
viral envelope protein represent a promising strategy, although the risk of
antibody-dependent enhancement (ADE) in the context of cross-immunity with
dengue remains a major challenge.
Regarding antivirals, only
galidesivir has reached phase 1 clinical trials, with an acceptable safety
profile.
Preventing before the next peak
Zika virus remains endemic in many
tropical regions despite the absence of a recent major epidemic. The main
challenge remains preventing congenital complications, particularly in pregnant
women.
This review aimed to update
epidemiological data and evaluate progress in diagnostic and vaccine
development. Significant advances have been made in improving serological
testing and vaccine research, but no preventive or curative solution is yet
available in routine clinical practice.
The main limitation lies in the
current low circulation of the virus, which hampers the conduct of phase 3
trials.
In the long term, the implementation
of global surveillance tools, improved diagnostic tests capable of
distinguishing ZIKV from dengue, and the availability of effective vaccines
will be critical to preventing a new epidemic wave and protecting the most
vulnerable populations.
About the author – Ana EspinoPhD in Immunology, specialized in Virology
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
