Systematic Review concludes Zika Virus as cause of birth defects and Guillain-Barre syndrome

Structure of the Zika Virus

A systematic review of the evidence confirms that infection with mosquito-borne Zika virus is a cause of Guillain-Barre Syndrome (GBS), in addition to microcephaly and other congenital brain abnormalities, according to a study published in PLOS Medicine by Nicola Low of the University of Bern, Switzerland, and colleagues in the World Health Organization (WHO) Zika Causality Working Group. 

In March 2016, WHO stated that there was a strong scientific consensus that Zika virus is a cause of GBS, microcephaly, and other neurological disorders. However, decisions about causality must be assessed systematically to guide public health actions. In the new work, the WHO group defined specific questions about the relationship between Zika virus and clinical outcomes, setting a framework of ten dimensions to define causality. They then reviewed existing literature for studies that addressed the outcomes - either GBS or congenital brain abnormalities - and convened a panel of experts to assess the review findings. 

Based on 72 studies published up to May 30, 2016, that included data on Zika and congenital brain abnormalities, the team concluded that at least eight of the ten criteria for causality were met. Based on 36 studies published in the same time frame with data on Zika and GBS, the researchers concluded that at least seven of the ten criteria for causality were met. In addition, papers published after the initial literature review - between May 30 and July 29, 2016 - strengthened the initial findings that Zika virus is causative of brain abnormalities and GBS. 

Rapid and systematic reviews with frequent updating and open disseminating are now needed, both for appraisal of the evidence about Zika virus infection and for the next public health threats that will emerge

However, there are remaining questions about the link that will need to be addressed with continuing studies. The review was funded by the World Health Organization (, contract numbers 2016/611294-0 and 2016/630126-0 awarded to NL) and the Swiss National Science Foundation (, SNSF special action fund and project grant 320030_170069 awarded to NL). The WHO Zika Causality Working Group was involved in interpretation of the data and the decision to publish. 

​Article: Zika Virus Infection as a Cause of Congenital Brain Abnormalities and Guillain-Barré Syndrome: Systematic Review, Krauer F, Riesen M, Reveiz L, Oladapo OT, Martínez-Vega R, Porgo TV, et al., PLOS Medicine, doi: 10.1371/journal.pmed.1002203, published 3 January 2016...

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