Congenital Zika Syndrome

1. Disease Information

1.1 Concise overview

Congenital Zika syndrome (CZS) is a specific pattern of congenital anomalies and long-term neurodevelopmental disabilities caused by vertical (mother-to-child) transmission of Zika virus (ZIKV) during pregnancy, with the central nervous system (CNS) as the primary target and frequent multisystem involvement (ocular, musculoskeletal, feeding/swallowing, and other neurologic comorbidities). (martelli2024clinicalspectrumof pages 1-2, crisantolopez2023congenitalzikasyndrome pages 1-2)

1.2 Key identifiers (ontology/classification)

• ICD-11: Congenital Zika virus infection KA62.0 (explicitly stated as the ICD-11 classification in a 2024 Brazil-focused clinical spectrum update). Publication date: 2024-07; URL: https://doi.org/10.1590/0037-8682-0153-2024 (martelli2024clinicalspectrumof pages 2-3)
• MeSH (related concept): Zika Virus Infection (MeSH concept id D000071243) appears in ClinicalTrials.gov structured metadata (not specific to congenital infection, but relevant controlled vocabulary). (NCT03110770 chunk 4)
• MONDO ID / ICD-10 / Orphanet / OMIM / MeSH for “Congenital Zika Syndrome”: Not available from the retrieved full-text evidence in this run; only ICD-11 KA62.0 was explicitly reported. (martelli2024clinicalspectrumof pages 2-3, crisantolopez2023congenitalzikasyndrome pages 8-10)

1.3 Common synonyms / alternative names

• “Congenital Zika syndrome (CZS)” (martelli2024clinicalspectrumof pages 1-2, crisantolopez2023congenitalzikasyndrome pages 1-2)
• “Congenital Zika virus infection” (ICD-11 KA62.0 term; also used as a primary label in the 2024 Brazil review) (martelli2024clinicalspectrumof pages 2-3)
• “Zika-related microcephaly” is frequently used to refer to severe CZS presentations in cohort literature. (mirandafilho2025characterizationof843 pages 2-3)

1.4 Evidence provenance (individual patients vs aggregated)

Evidence in this report is derived from both (i) aggregated resources (systematic reviews, meta-analyses, surveillance reviews) and (ii) primary cohorts (prospective cohorts, pooled individual-participant data analyses, caregiver studies using validated scales). (mirandafilho2025characterizationof843 pages 2-3, rabe2025areviewof pages 4-5, melo2023congenitalzikasyndrome pages 11-12)

2. Etiology

2.1 Disease causal factors

Primary cause: In utero ZIKV infection (vertical transmission), which can occur even when maternal infection is asymptomatic; congenital manifestations arise from placental infection and fetal neurotropism with injury to neural progenitors and neurodevelopmental disruption. (crisantolopez2023congenitalzikasyndrome pages 4-5, wong2025zikavirusand pages 3-5)

2.2 Risk factors

• Gestational timing: Earlier maternal infection increases risk of adverse outcomes. A matched cohort study reported that 44% of pregnancies with first-trimester maternal infection had at least one adverse child event, and first-trimester infection had OR 11.2 (95% CI 3.6–35.0) for adverse outcomes vs third trimester. Publication date: 2025-01; URL: https://doi.org/10.1542/peds.2024-067552 (venancio2025earlyandlongterm pages 1-3)
• Population-level risk of congenital outcomes among infected pregnancies: A large systematic review/meta-analysis estimated CZS proportion 4.65% (95% CI 3.38–6.67%) among ZIKV-infected pregnancies. Publication date: 2026-02; URL: https://doi.org/10.1038/s44360-025-00051-4 (mccain2026asystematicreview pages 1-2)

2.3 Protective factors

Evidence for protective factors is limited and heterogeneous. In one longitudinal cohort of normocephalic preschool children in Colombia (not restricted to CZS cases), daycare/school attendance was associated with a lower risk of neurodevelopmental delay, while prenatal ZIKV exposure was not significantly associated with delay in that cohort; this represents a social/environmental protective association rather than biological protection. (shah2024analysisofcongenital pages 13-15)

2.4 Gene–environment interactions (GxE)

A key hypothesized interaction is prior flavivirus immunity and antibody-dependent enhancement (ADE) mechanisms at the maternal–fetal interface, which may facilitate placental infection/transfer via Fcγ receptor pathways (conceptualized in placental-interface reviews). (wong2025zikavirusand pages 2-3)

3. Phenotypes (clinical spectrum)

3.1 Core phenotype summary (current understanding)

CZS is defined by a recognizable phenotype including severe/disproportionate microcephaly, characteristic neuroimaging abnormalities (calcifications, ventriculomegaly, cortical atrophy/malformations), ocular lesions (retinal/optic nerve), congenital contractures (arthrogryposis/clubfoot), and frequent neurologic comorbidities such as epilepsy and dysphagia. (martelli2024clinicalspectrumof pages 1-2, martelli2024clinicalspectrumof pages 2-3)

3.2 Quantitative phenotype frequencies and statistics (selected recent syntheses)

A consolidated phenotype-frequency table with suggested HPO terms and quantitative ranges is provided below.

Table: These tables summarize the main congenital Zika syndrome phenotypes with quantitative frequency estimates and the most useful recent epidemiology statistics. They are designed for rapid knowledge-base extraction and link each major claim to supporting context IDs.

Key statistics from pooled and review evidence include: - Neuroimaging hallmarks: calcifications and ventriculomegaly are among the most consistent abnormalities (often ~80% in pooled cohorts; very high proportions in clinicopathologic summaries). (mirandafilho2025characterizationof843 pages 2-3, shah2024analysisofcongenital pages 13-15) - Epilepsy: reported prevalence varies with ascertainment/severity and follow-up, ranging from ~30–80% across pooled cohorts and up to ~71% cumulative incidence by age 2 in some microcephaly cohorts. (martelli2024clinicalspectrumof pages 2-3, mirandafilho2025characterizationof843 pages 2-3) - Feeding/swallowing dysfunction: dysphagia is frequently reported (broad ranges across cohorts/reviews), with severe oropharyngeal dysphagia particularly enriched among children with Zika-related microcephaly. (martelli2024clinicalspectrumof pages 3-4)

3.3 Age of onset, progression, severity

• Onset: Congenital, with abnormalities present at birth or emerging postnatally (e.g., postnatal microcephaly can occur). (mirandafilho2025characterizationof843 pages 2-3)
• Progression: Many outcomes are chronic and severe, including persistent motor impairment and epilepsy; severe disability drives long-term care needs. (martelli2024clinicalspectrumof pages 3-4, shah2024analysisofcongenital pages 13-15)

3.4 Quality of life and family impact

A 2023 integrative review (31 studies) described caregiver burdens spanning social, psychological, economic/material, and health domains, with quantified mental-health burdens in some studies (e.g., 40% mild-to-severe depressive symptoms in one study; 24% mild-to-severe anxiety; 13% high/clinically relevant stress in another). Publication date: 2023-05; URL: https://doi.org/10.1590/1413-81232023285.14852022en (melo2023congenitalzikasyndrome pages 11-12)

4. Genetic / Molecular Information

4.1 Causal genes

CZS is not classically a monogenic disease; the causal factor is infectious (ZIKV). However, host genetic modifiers of susceptibility and severity have been reported. (santos2023associationbetweengenetic pages 1-2, marques2025geneticmodifiersof pages 10-13)

4.2 Pathogenic variants / modifier loci (host genetics)

A 2023 case–control candidate-gene study (Brazil; 245 individuals including mother–infant pairs) reported associations between: - TREM1 rs2234246 with CZS occurrence (e.g., CC genotype OR reported ~4.91 in one comparison; log-additive effects in mothers and children), and - CXCL8 rs4073 and TLR7 rs179008 with severity of microcephaly in affected children. Publication date: 2023-03; URL: https://doi.org/10.1038/s41598-023-30342-3 (santos2023associationbetweengenetic pages 4-5, santos2023associationbetweengenetic pages 1-2)

A 2025 scoping review summarized 23 candidate genes across 13 studies (mixed designs including WES, discordant twin transcriptomics, and candidate-gene cohorts) as potential modifiers; named examples include MTOR (rs2295079) and immune-pathway polymorphisms (e.g., IL28B rs8099917, TNF variants) while emphasizing small sample sizes and need for replication. Publication date: 2025-01; URL: https://doi.org/10.1101/2025.01.02.25319896 (marques2025geneticmodifiersof pages 10-13)

4.3 Epigenetics and chromosomal abnormalities

No specific epigenetic signatures or recurrent chromosomal abnormalities were identified in the retrieved evidence for this run.

5. Environmental Information

5.1 Infectious agent

• Pathogen: Zika virus (ZIKV), primarily mosquito-borne (Aedes spp.) with additional sexual and vertical transmission routes. (rabe2025areviewof pages 1-2, martelli2024clinicalspectrumof pages 1-2)

5.2 Environmental/lifestyle contributors

Environmental conditions that facilitate Aedes proliferation (standing water, household exposure, and broader ecological suitability) indirectly increase risk of maternal infection; prevention focuses on vector control and personal protective measures. (crisantolopez2023congenitalzikasyndrome pages 8-10)

6. Mechanism / Pathophysiology (current model)

6.1 Causal chain from trigger to clinical manifestations

Trigger: Maternal ZIKV infection during pregnancy → placental infection and vertical transmission → fetal CNS infection and/or placental insufficiency/inflammatory injury → neurodevelopmental disruption → congenital malformations and long-term neurologic disability. (wong2025zikavirusand pages 3-5, wong2025zikavirusand pages 1-2)

Key mechanistic steps supported by recent reviews: 1. Placental tropism and vertical transmission: ZIKV infects placental cell types including undifferentiated cytotrophoblasts and Hofbauer cells (placental macrophages), establishing intra-placental replication/persistence that can facilitate transfer to fetal circulation. (wong2025zikavirusand pages 3-5) 2. Entry factors and receptors: Receptor/attachment factor usage includes AXL, TYRO3, and TIM1 (including on Hofbauer cells and trophoblast-associated compartments); placental-interface reviews describe receptor-mediated entry as contributory but potentially redundant across systems. (crisantolopez2023congenitalzikasyndrome pages 4-5, wong2025zikavirusand pages 3-5) 3. Innate immune evasion: ZIKV NS5 antagonizes type I interferon responses by promoting STAT2 degradation, suppressing interferon-stimulated gene programs and enabling dissemination. (crisantolopez2023congenitalzikasyndrome pages 4-5, wong2025zikavirusand pages 3-5) 4. Neural progenitor injury: ZIKV infects radial glia/neural progenitors; congenital neuropathogenesis reviews emphasize cell cycle dysregulation, mitochondrial fragmentation, ER stress/unfolded protein response, and p53-mediated intrinsic apoptosis as central pathways leading to loss of progenitor pools and microcephaly. (metzler2024zikavirusneuropathogenesis—research pages 1-2) 5. Inflammation and placental dysfunction: Infection triggers inflammatory signaling, oxidative/ER stress, and metabolic reprogramming in placental cells, contributing to placental insufficiency and adverse fetal outcomes; maternal immune activation cytokines (e.g., IL-6, TNF-α) are implicated in amplifying fetal neurodevelopmental injury. (wong2025zikavirusand pages 1-2, wong2025zikavirusand pages 3-5)

6.2 Suggested ontology terms (examples)

• GO biological process (suggested): type I interferon signaling pathway; response to virus; apoptotic process; ER stress response / unfolded protein response; regulation of cell cycle; neurogenesis. (metzler2024zikavirusneuropathogenesis—research pages 1-2, crisantolopez2023congenitalzikasyndrome pages 4-5)
• Cell types (CL, suggested): Hofbauer cell (placental macrophage); trophoblast subtypes (cytotrophoblast/extravillous trophoblast/syncytiotrophoblast); radial glia; neural progenitor cell; microglia. (wong2025zikavirusand pages 3-5, metzler2024zikavirusneuropathogenesis—research pages 1-2)

7. Anatomical Structures Affected

7.1 Primary organs and systems

• CNS/brain: primary target; includes cortical development abnormalities, ventriculomegaly, calcifications, and brain parenchymal loss. (martelli2024clinicalspectrumof pages 2-3, shah2024analysisofcongenital pages 13-15)
• Eye/visual system: retinal and optic nerve lesions. (shah2024analysisofcongenital pages 10-12, shah2024analysisofcongenital pages 13-15)
• Musculoskeletal system: congenital contractures/arthrogryposis and long-term spasticity/hypertonia. (martelli2024clinicalspectrumof pages 1-2, shah2024analysisofcongenital pages 13-15)

7.2 Tissue/cell level localization

Placenta (trophoblast lineages and fetal macrophages) is a key site of replication/persistence relevant to transmission; fetal neurogenic zones (ventricular/subventricular regions) are implicated in neural progenitor injury. (wong2025zikavirusand pages 3-5, shah2024analysisofcongenital pages 13-15)

8. Temporal Development (onset and progression)

• Onset: congenital; may present at birth or evolve (e.g., postnatal microcephaly). (mirandafilho2025characterizationof843 pages 2-3)
• Critical period: First-trimester maternal infection is strongly associated with higher risk of adverse outcomes in at least one controlled cohort. (venancio2025earlyandlongterm pages 1-3)

9. Inheritance and Population

9.1 Epidemiology and geographic distribution

• As of December 2023, autochthonous mosquito-borne ZIKV transmission had been documented in 92 countries/territories. Publication date: 2025-02; URL: https://doi.org/10.4269/ajtmh.24-0420 (rabe2025areviewof pages 1-2)
• In Brazil, surveillance recorded 1,858 confirmed CZS cases between 2015 and epidemiological week 31 of 2023, with a large number of suspected cases under investigation. (martelli2024clinicalspectrumof pages 1-2)
• A systematic review/meta-analysis estimated CZS among infected pregnancies: 4.65% (95% CI 3.38–6.67%). (mccain2026asystematicreview pages 1-2)

9.2 Sex ratio / demographic patterns

The retrieved evidence did not provide a consistent, pooled sex ratio for CZS; cohort-level details exist but were not systematically extractable from the provided snippets.

10. Diagnostics

10.1 Laboratory testing and key constraints

Recent diagnostic synthesis emphasizes two major limitations: - Short NAT window in blood due to transient viremia (often within ~≤7 days of symptom onset), and - Serologic cross-reactivity among flaviviruses (especially dengue vs Zika), complicating IgG/IgM interpretation and requiring confirmatory neutralization testing (PRNT). Publication date: 2025-04; URL: https://doi.org/10.1038/s44298-025-00114-z (madere2025flavivirusinfectionsand pages 5-6, madere2025flavivirusinfectionsand pages 1-2)

10.2 Imaging

Brain CT/MRI abnormalities (cortical atrophy, ventriculomegaly, calcifications) are used as structural markers of severity and part of clinical evaluation of suspected CZS. (martelli2024clinicalspectrumof pages 1-2)

10.3 Differential diagnosis

When congenital infection is suspected, evaluation should exclude other teratogenic infections (e.g., CMV, rubella, toxoplasmosis, syphilis), which is explicitly recommended in clinical management summaries. (crisantolopez2023congenitalzikasyndrome pages 8-10)

11. Outcome / Prognosis

11.1 Neurodevelopmental outcomes after exposure (with and without CZS)

Outcomes vary markedly by whether an infant has classic CZS/microcephaly versus antenatal exposure without congenital findings. - In a matched cohort (Brazil), in utero exposure was associated with IRR 2.7 (95% CI 1.4–5.1) for adverse outcomes overall and increased risks of motor and cognitive delays; early gestational infection showed higher risk. (venancio2025earlyandlongterm pages 1-3) - In a Nicaragua prospective cohort of normocephalic children, adjusted preschool neurodevelopment scores did not differ significantly between exposed and unexposed groups, underscoring heterogeneity across settings and study designs. Publication date: 2024-07; URL: https://doi.org/10.1016/S2214-109X(24)00176-1 (max2024neurodevelopmentinpreschool pages 1-3)

11.2 Mortality

A 2024 systematic clinicopathologic review summarized markedly increased early-childhood mortality in severe CZS presentations (reported as ~11.3-fold higher risk up to 36 months in one cited estimate). (shah2024analysisofcongenital pages 13-15)

12. Treatment

12.1 Current standard of care (real-world implementation)

There is no specific curative treatment for CZS; management is supportive and multidisciplinary, requiring constant monitoring, early intervention/rehabilitation, feeding/nutrition management, and management of epilepsy and motor impairment. (crisantolopez2023congenitalzikasyndrome pages 1-2, shah2024analysisofcongenital pages 13-15)

Suggested MAXO terms (examples; not exhaustively evidenced in retrieved text): - MAXO:0000102 (rehabilitation), MAXO:0000427 (physical therapy), MAXO:0000415 (speech therapy), MAXO:0000600 (nutritional support), MAXO:0000747 (seizure management) — included as ontology suggestions based on the supportive-care emphasis. (shah2024analysisofcongenital pages 13-15, crisantolopez2023congenitalzikasyndrome pages 8-10)

12.2 Experimental / investigational countermeasures

Preclinical evidence summarized in an animal-model review notes repurposed antivirals (e.g., sofosbuvir) in nonhuman primate contexts, but these are not established human therapies for congenital disease in the retrieved evidence. (gardinali2025congenitalzikavirus pages 3-4)

13. Prevention

13.1 Primary prevention

Prevention focuses on reducing maternal infection risk: - Vector control and personal protection: reduction of breeding sites, window/door screens, bed nets, covering clothing, and repellents (e.g., DEET, picaridin/icaridin) are recommended in clinical prevention summaries. (crisantolopez2023congenitalzikasyndrome pages 8-10) - Reproductive counseling and sexual transmission precautions: guidance on delaying conception after exposure and barrier protection for partners is described in clinical guidance summaries. (crisantolopez2023congenitalzikasyndrome pages 8-10)

13.2 Vaccines (status: clinical development, not licensed)

Multiple Zika vaccines have been evaluated in clinical trials; several have completed early-phase studies: - mRNA vaccine (mRNA-1893; Moderna): Phase 2, randomized observer-blind placebo-controlled; COMPLETED; enrollment 808; completion date 2024-07-26; results posted Sept 2025. ClinicalTrials.gov: NCT04917861. (NCT04917861 chunk 1) - DNA vaccine (VRC 5283 plasmid; NIAID): Phase 2/2B randomized vaccine vs placebo; COMPLETED; enrollment 2428; completed 2019-10-04. ClinicalTrials.gov: NCT03110770. (NCT03110770 chunk 1) - Inactivated whole-virus vaccine (VLA1601; Valneva): Phase 1 randomized double-blind dose-finding; COMPLETED; ~150 participants; two-dose regimen (Day 1/29). ClinicalTrials.gov: NCT06334393. (NCT06334393 chunk 1)

These trials are aimed at preventing ZIKV infection (and downstream congenital disease) but do not constitute current standard-of-care prevention in routine practice given the absence of a licensed vaccine in the retrieved evidence. (rabe2025areviewof pages 1-2, NCT04917861 chunk 1)

14. Other Species / Natural Disease

ZIKV congenital outcomes are modeled across species; the evidence here primarily supports experimental susceptibility rather than naturally occurring veterinary disease burdens.

15. Model Organisms (mechanism and translational research)

15.1 Major model systems and what they recapitulate

• Human brain organoids / iPSC-derived neural progenitors: reproduce preferential infection of neural progenitors and outcomes such as reduced organoid size, thinner cortical layers, and increased cell death; useful for mechanistic dissection and therapeutic screening but lower throughput and complex. (metzler2024zikavirusneuropathogenesis—research pages 13-14)
• Mouse models (often IFN-pathway modified or humanized): widely used but require immune manipulation because ZIKV immune-evasion interactions (e.g., NS5–STAT2) are species-specific; models can reproduce fetal loss, growth restriction, brain malformations, and neurodevelopmental phenotypes. (metzler2024zikavirusneuropathogenesis—research pages 13-14, horvath2025ahumanizedmouse pages 1-5)
• Nonhuman primates (rhesus macaques): high translational relevance for placental infection and fetal outcomes; costly and lower throughput; reported fetal demise around ~26% in early gestation infection in one summary. (metzler2024zikavirusneuropathogenesis—research pages 13-14)

15.2 Limitations

Key limitations include differences in placentation/anatomy and interferon biology across species, and the need for immune suppression/genetic modification in many rodent studies, which can distort the human-like spectrum. (gardinali2025congenitalzikavirus pages 2-3, metzler2024zikavirusneuropathogenesis—research pages 13-14)

Expert opinion and synthesis (authoritative analyses)

• Surveillance-focused experts emphasize that ZIKV remains a public-health threat due to re-emergence potential, diagnostic limitations, and ongoing transmission across many regions, recommending targeted surveillance and clear testing algorithms. (rabe2025areviewof pages 1-2)
• Brazil-focused clinical experts stress heterogeneity of outcomes (including children without abnormalities at birth) and the need for standardized protocols and long-term cohort follow-up with appropriate controls. (martelli2024clinicalspectrumof pages 1-2, martelli2024clinicalspectrumof pages 3-4)

Evidence limitations / gaps for knowledge-base completion

• Formal identifiers beyond ICD-11 KA62.0 (e.g., MONDO, Orphanet, ICD-10, MeSH descriptor specifically for congenital Zika syndrome) were not directly retrievable in the provided full-text evidence, and should be filled by direct ontology lookup (e.g., ICD-11 MMS browser, MONDO, MeSH). (martelli2024clinicalspectrumof pages 2-3, crisantolopez2023congenitalzikasyndrome pages 8-10)
• Some mechanistic claims remain model-dependent; receptor usage and ADE-related hypotheses require careful interpretation and human validation. (wong2025zikavirusand pages 2-3)

References

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12. (mccain2026asystematicreview pages 1-2): Kelly McCain, Anna Vicco, Christian Morgenstern, Thomas Rawson, Tristan M. Naidoo, Sangeeta Bhatia, Dominic P. Dee, Patrick Doohan, Keith Fraser, Anna-Maria Hartner, Sequoia I. Leuba, Shazia Ruybal-Pesántez, Richard J. Sheppard, H. Juliette T. Unwin, Kelly Charniga, Zulma M. Cucunubá, Gina Cuomo-Dannenburg, Natsuko Imai-Eaton, Edward S. Knock, Adam Kucharski, Mantra Kusumgar, Paul Liétar, Rebecca K. Nash, Sabine van Elsland, Aaron Morris, Alpha Forna, Amy Dighe, Anna-Maria Hartner, Anne Cori, Arran Hamlet, Ben Lambert, Bethan Cracknell Daniels, Charles Whittaker, Cosmo Santoni, Cyril Geismar, Dariya Nikitin, David Jorgensen, Dominic P. Dee, Edward S. Knock, Hayley Thompson, Isobel Routledge, Jack Wardle, Janetta Skarp, Joseph Hicks, Kanchan Parchani, Kieran Drake, Lily Geidelberg, Lorenzo Cattarino, Mara Kont, Marc Baguelin, Pablo N. Perez-Guzman, Paula Christen, Rebecca Nash, Richard Fitzjohn, Richard Sheppard, Rob Johnson, Sabine van Elsland, Sequoia I. Leuba, Shazia Ruybal-Pesántez, Sreejith Radhakrishnan, Tristan M. Naidoo, Zulma M. Cucunubá, Nuno R. Faria, Anne Cori, Ruth McCabe, and Ilaria Dorigatti. A systematic review and meta-analysis of zika virus epidemiology. Nature Health, 1:355-367, Feb 2026. URL: https://doi.org/10.1038/s44360-025-00051-4, doi:10.1038/s44360-025-00051-4. This article has 1 citations.

13. (shah2024analysisofcongenital pages 13-15): Dhaara Shah, Dhairavi Shah, Olivia Mua, and Rana Zeine. Analysis of congenital zika syndrome clinicopathologic findings reported in the 8 years since the brazilian outbreak. Exploration of Neuroprotective Therapy, pages 82-99, Feb 2024. URL: https://doi.org/10.37349/ent.2024.00072, doi:10.37349/ent.2024.00072. This article has 3 citations.

14. (wong2025zikavirusand pages 2-3): Sam Chak Sum Wong, Joshua Fung, Pak-Ting Hau, Yanjie Guo, Philip C. N. Chiu, Hong Wa Yung, Gilman Kit Hang Siu, Franklin Wang-Ngai Chow, and Cheuk-Lun Lee. Zika virus and the fetal-maternal interface: deciphering the mechanisms of placental infection and implications for pregnancy outcomes. Jul 2025. URL: https://doi.org/10.1080/22221751.2025.2532681, doi:10.1080/22221751.2025.2532681. This article has 6 citations and is from a domain leading peer-reviewed journal.

15. (martelli2024clinicalspectrumof pages 3-4): Celina Maria Turchi Martelli, Fanny Cortes, Sinval Pinto Brandão-Filho, Marilia Dalva Turchi, Wayner Vieira de Souza, Thalia Velho Barreto de Araújo, Ricardo Arraes de Alencar Ximenes, and Demócrito de Barros Miranda-Filho. Clinical spectrum of congenital zika virus infection in brazil: update and issues for research development. Revista da Sociedade Brasileira de Medicina Tropical, Jul 2024. URL: https://doi.org/10.1590/0037-8682-0153-2024, doi:10.1590/0037-8682-0153-2024. This article has 12 citations.

16. (shah2024analysisofcongenital pages 10-12): Dhaara Shah, Dhairavi Shah, Olivia Mua, and Rana Zeine. Analysis of congenital zika syndrome clinicopathologic findings reported in the 8 years since the brazilian outbreak. Exploration of Neuroprotective Therapy, pages 82-99, Feb 2024. URL: https://doi.org/10.37349/ent.2024.00072, doi:10.37349/ent.2024.00072. This article has 3 citations.

17. (shah2024analysisofcongenital pages 1-3): Dhaara Shah, Dhairavi Shah, Olivia Mua, and Rana Zeine. Analysis of congenital zika syndrome clinicopathologic findings reported in the 8 years since the brazilian outbreak. Exploration of Neuroprotective Therapy, pages 82-99, Feb 2024. URL: https://doi.org/10.37349/ent.2024.00072, doi:10.37349/ent.2024.00072. This article has 3 citations.

18. (mccain2026asystematicreview pages 7-7): Kelly McCain, Anna Vicco, Christian Morgenstern, Thomas Rawson, Tristan M. Naidoo, Sangeeta Bhatia, Dominic P. Dee, Patrick Doohan, Keith Fraser, Anna-Maria Hartner, Sequoia I. Leuba, Shazia Ruybal-Pesántez, Richard J. Sheppard, H. Juliette T. Unwin, Kelly Charniga, Zulma M. Cucunubá, Gina Cuomo-Dannenburg, Natsuko Imai-Eaton, Edward S. Knock, Adam Kucharski, Mantra Kusumgar, Paul Liétar, Rebecca K. Nash, Sabine van Elsland, Aaron Morris, Alpha Forna, Amy Dighe, Anna-Maria Hartner, Anne Cori, Arran Hamlet, Ben Lambert, Bethan Cracknell Daniels, Charles Whittaker, Cosmo Santoni, Cyril Geismar, Dariya Nikitin, David Jorgensen, Dominic P. Dee, Edward S. Knock, Hayley Thompson, Isobel Routledge, Jack Wardle, Janetta Skarp, Joseph Hicks, Kanchan Parchani, Kieran Drake, Lily Geidelberg, Lorenzo Cattarino, Mara Kont, Marc Baguelin, Pablo N. Perez-Guzman, Paula Christen, Rebecca Nash, Richard Fitzjohn, Richard Sheppard, Rob Johnson, Sabine van Elsland, Sequoia I. Leuba, Shazia Ruybal-Pesántez, Sreejith Radhakrishnan, Tristan M. Naidoo, Zulma M. Cucunubá, Nuno R. Faria, Anne Cori, Ruth McCabe, and Ilaria Dorigatti. A systematic review and meta-analysis of zika virus epidemiology. Nature Health, 1:355-367, Feb 2026. URL: https://doi.org/10.1038/s44360-025-00051-4, doi:10.1038/s44360-025-00051-4. This article has 1 citations.

19. (rabe2025areviewof pages 1-2): Ingrid B. Rabe, Susan L. Hills, Joana M. Haussig, Allison T. Walker, Thais dos Santos, José Luis San Martin, Gamaliel Gutierrez, Jairo Mendez-Rico, José Cruz Rodriguez, Douglas Elizondo-Lopez, Gabriel Gonzalez-Escobar, Emmanuel Chanda, Samira M. Al Eryani, Chiori Kodama, Aya Yajima, Manish Kakkar, Masaya Kato, Pushpa R. Wijesinghe, Sudath Samaraweera, Hannah Brindle, Hasitha Tissera, James Kelley, Eve Lackritz, and Diana P. Rojas. A review of the recent epidemiology of zika virus infection. The American Journal of Tropical Medicine and Hygiene, 112:1026-1035, Feb 2025. URL: https://doi.org/10.4269/ajtmh.24-0420, doi:10.4269/ajtmh.24-0420. This article has 63 citations.

20. (rabe2025areviewof pages 3-4): Ingrid B. Rabe, Susan L. Hills, Joana M. Haussig, Allison T. Walker, Thais dos Santos, José Luis San Martin, Gamaliel Gutierrez, Jairo Mendez-Rico, José Cruz Rodriguez, Douglas Elizondo-Lopez, Gabriel Gonzalez-Escobar, Emmanuel Chanda, Samira M. Al Eryani, Chiori Kodama, Aya Yajima, Manish Kakkar, Masaya Kato, Pushpa R. Wijesinghe, Sudath Samaraweera, Hannah Brindle, Hasitha Tissera, James Kelley, Eve Lackritz, and Diana P. Rojas. A review of the recent epidemiology of zika virus infection. The American Journal of Tropical Medicine and Hygiene, 112:1026-1035, Feb 2025. URL: https://doi.org/10.4269/ajtmh.24-0420, doi:10.4269/ajtmh.24-0420. This article has 63 citations.

21. (santos2023associationbetweengenetic pages 1-2): Camilla Natália Oliveira Santos, Lucas Sousa Magalhães, Adriana Barbosa de Lima Fonseca, Ana Jovina Barreto Bispo, Roseane Lima Santos Porto, Juliana Cardoso Alves, Cliomar Alves dos Santos, Jaira Vanessa de Carvalho, Angela Maria da Silva, Mauro Martins Teixeira, Roque Pacheco de Almeida, Priscila Lima dos Santos, and Amélia Ribeiro de Jesus. Association between genetic variants in trem1, cxcl10, il4, cxcl8 and tlr7 genes with the occurrence of congenital zika syndrome and severe microcephaly. Scientific Reports, Mar 2023. URL: https://doi.org/10.1038/s41598-023-30342-3, doi:10.1038/s41598-023-30342-3. This article has 22 citations and is from a peer-reviewed journal.

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24. (wong2025zikavirusand pages 1-2): Sam Chak Sum Wong, Joshua Fung, Pak-Ting Hau, Yanjie Guo, Philip C. N. Chiu, Hong Wa Yung, Gilman Kit Hang Siu, Franklin Wang-Ngai Chow, and Cheuk-Lun Lee. Zika virus and the fetal-maternal interface: deciphering the mechanisms of placental infection and implications for pregnancy outcomes. Jul 2025. URL: https://doi.org/10.1080/22221751.2025.2532681, doi:10.1080/22221751.2025.2532681. This article has 6 citations and is from a domain leading peer-reviewed journal.

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33. (metzler2024zikavirusneuropathogenesis—research pages 13-14): Anna D. Metzler and Hengli Tang. Zika virus neuropathogenesis—research and understanding. Pathogens, 13:555, Jul 2024. URL: https://doi.org/10.3390/pathogens13070555, doi:10.3390/pathogens13070555. This article has 23 citations.

34. (horvath2025ahumanizedmouse pages 1-5): Allison R. Horvath, Clara M. Abdelmalek, Eunbin Park, Aubrey P. Alexander, Sadhana A. Maheswaran, Arnav H. Patel, Nandi G. Patel, Janet E. Ruan, Ademide T. Adeyemo, Erin C. Li, Katherine E. Helmicki, Stephen Lin, Paul C. Wang, Zhen Li, Li Wang, Heather A. Gordish-Dressman, Tarik F. Haydar, Tamer A. Mansour, and Youssef A. Kousa. A humanized mouse model system mimics prenatal zika infection and reveals premature differentiation of neural stem cells. bioRxiv, Feb 2025. URL: https://doi.org/10.1101/2025.02.21.639556, doi:10.1101/2025.02.21.639556. This article has 2 citations.

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