1. The condition sought should be an important health problem | ZIKV infection during pregnancy may lead to cases of CZS, which can pose a significant burden at the individual, family, and societal level.
| | Public health surveillance for ZIKV epidemics to inform the timing and type of prenatal ZIKV screening programme. Research on the long-term health, social and economic impacts of CZS on affected children, families, and communities.
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2. There should be a suitable test or examination | | | Combining highly specific molecular tests and highly sensitive serological tests to allow for more accurate identification of ZIKV infections. Research to develop diagnostic tests with enhanced sensitivity and specificity. Research to evaluate performance of tests in settings with endemic flavivirus circulation.
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3. The natural history of the condition, including development from latent to declared disease, should be adequately understood | | Significant heterogeneity remains in the risk estimates of adverse outcomes associated with prenatal ZIKV exposure, in part due to inconsistencies in the range of outcomes assessed. The prognosis of children with prenatal ZIKV exposure remains uncertain beyond 5 years of age.
| Expansion of infrastructure and governance policies for sustained data sharing between Zika cohort studies. Research using individual participant data meta-analyses of pregancy and paediatric cohorts and standardised outcomes to improve the precision of risk estimates. Research using paediatric cohort studies and linked electronic health records to follow up children with prenatal ZIKV exposure born with or without apparent manifestations of CZS.
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4. There should be a recognisable latent or early symptomatic stage | | Antivirals for impeding vertical transmission of ZIKV are not currently available. Prenatal and postnatal testing to identify offspring who may be ZIKV-exposed but uninfected remains limited. A large portion of ZIKV infections are asymptomatic.
| Public health efforts to improve antenatal care attendance. Monitoring of children with prenatal ZIKV exposure who present asymptomatically at birth for developmental delays and late-onset sequelae of congenital infections. Research to develop antiviral treatments to block vertical transmission. Research to improve the safety and effectiveness of testing for offspring infection status (eg, via amniocentesis or neonatal serum/urine testing).
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5. The test should be acceptable to the population | | | |
6. There should be an agreed policy on whom to treat as patients | | | Prenatal counselling following positive screening test result. Postnatal clinical and social support for children with prenatal exposure to ZIKV and their families. Research to evaluate indirect effects of CZS on caregivers’ mental health, social support, and lived experiences.
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7. There should be an accepted treatment for patients with recognised disease | | | Expanded access to specialised treatment programmes for children with CZS. Research to develop vaccines to prevent ZIKV infection during pregnancy. Research to develop antiviral treatments to prevent vertical transmission.
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8. Facilities for diagnosis and treatment should be available | | | Public health efforts to improve accessibility and affordability of tests. Research to develop rapid, low-cost, point-of-care testing. Research into effectiveness of interventions in clinically relevant subgroups to inform targeted treatment.
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9. The cost of case finding should be economically balanced in relation to possible expenditure on medical care as a whole | | | Enhancing capacity to rapidly integrate ZIKV screening into existing prenatal testing platforms during outbreak situations. Research to develop multiplex prenatal screening assays, including ZIKV testing.
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10. Case finding should be a continuing process and not as a once-and-for-all project | Ultrasound may be used with or in lieu of laboratory testing to detect cases of CZS. Routine paediatric evaluations and developmental screening may be used to detect CZS-related anomalies at a later stage.
| | Increased monitoring of pregnancies during an outbreak situation. Continued monitoring of symptomatic and asymptomatic children with prenatal ZIKV exposure for developmental delays and late-onset sequelae of congenital infections. Research evaluating paired mother-offspring testing to detect congenital infections postnatally.
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