Zika epidemic peaking in Latin America

Zika should soon run its course in Latin America.

Within the next couple of years, the epidemic that has battered the region since 2015 will largely be over, researchers estimate in a paper online July 14 in Science.

“If we’re not past the peak already, we’re very close to it,” says study coauthor Neil Ferguson of Imperial College London. After this outbreak winds down, it may be a decade ­— at least — before another large-scale Zika epidemic hits the region.

The new timeline could help vaccine researchers get a jump on future outbreaks, and might make health officials rethink advice to pregnant women trying to avoid Zika-related birth defects. Ferguson’s work also suggests something counterintuitive: Current efforts to kill Zika-carrying mosquitoes might actually make it easier for the virus to reemerge.

“It’s an important and timely analysis,” says infectious disease researcher Oliver Pybus of the University of Oxford. “Policy makers would be wise to read it carefully.”

Brazil reported the first cases of Zika in May 2015. Since then, the mosquito-borne virus has spread to 48 countries. Scientists have now widely accepted Zika as a cause of microcephaly, a devastating birth defect that leaves babies with shrunken heads and brains, as well as other serious problems (SN Online: 6/28/16). 

Scientists and health officials have hustled to fight Zika, but they’ve had trouble keeping up. Mosquito-control efforts haven’t helped much, says Ferguson, and a safe and effective vaccine could still be years away. What’s more, advice to postpone pregnancy isn’t always realistic, he says.

Predicting the epidemic’s course could refine current Zika-fighting strategies.

Ferguson and colleagues made a computer simulation of Zika transmission within Latin America, using data from 35 countries that have reported cases. The team factored in such variables as seasonal climate variation, the ease with which Zika jumps from person to mosquito to person, and human travel patterns between countries.

After the current outbreak ends, simulations show that some 30 years could pass before Zika transmission picks up again. Once infected with Zika, people are immune to the virus, Ferguson says, capping an epidemic’s length and buying some time before a resurgence. He can’t say for sure that another major outbreak is still three decades away — but suspects a lull could last at least one decade.

Zika has “been burning through the population,” Ferguson says. “Sooner or later, it starts to run out of people to infect.”

The virus doesn’t need to infect everybody to peter out — just enough to generate herd immunity. At that point, so many people are immune to Zika that it can’t easily spread, protecting those still uninfected.

Killing mosquitoes — a strategy some countries have used to curb Zika’s reach — could actually hinder herd immunity, letting the next epidemic strike sooner, the team’s simulations suggest. With mosquito control that’s only marginally effective, a second wave of Zika hits about five years earlier than with no mosquito control at all, the simulations indicate.

“It makes sense theoretically,” says epidemiologist Mikkel Quam of Umeå University in Sweden. But considering that the cost of herd immunity might be more babies born with birth defects, he says, “any way to reduce infection is worth doing now, even if it means potentially more epidemics in years to come.”

Immunity to Zika could pose problems for vaccine development, Ferguson says. By the time researchers have something that’s safe to use, it will be hard to find a group of people to test it in. “This was a problem at the end of the Ebola epidemic as well,” he says.

Still, Ferguson says it’s an opportunity to think creatively. In the future, for instance, researchers could prequalify trial sites and get clinicians on the ground early, so when (and if) Zika hits somewhere else, say southeast Asia, they’re ready to go.

He also thinks his simulation could help health officials more clearly lay out the risks to pregnant women. Though the epidemic in Latin America will last roughly three years, his team estimates, individual outbreaks within the region can taper off after three to six months. 

By tailoring recommendations to different locations, officials could limit the period of time they’re advising women to delay pregnancy.