PAHO/WHO Regional research agenda related to Zika virus infection. Development of a research agenda for characterizing the Zika outbreak and its public health implications in the Americas

Background: Since its first detection in Brazil in 2015, the Zika virus (ZIKV) has spread rapidly to most of the subregions of the Americas. As of April 2016, ZIKV autochthonous transmission has been confirmed in 35 countries and territories of South America, Central America and the Caribbean. The Emergency Committee of the World Health Organization (WHO) advised that the clusters of microcephaly cases and other neurological disorders in endemic areas constitute a public health emergency of international concern (PHEIC). The global prevention and control strategy launched by WHO/PAHO as a strategic response framework encompasses surveillance, response activities, and research. There is an urgent need for additional research to better characterize the ZIKV outbreak and respond to this public health emergency, especially those issues related to means of transmission and infection during pregnancy and Guillain-Barré syndrome (GBS). Goals and objectives The goal of the research agenda is to support the development of evidence needed to strengthen public health guidance and actions essential for limiting the impact of the ZIKV outbreak. By identifying areas of high priority research, results from this report will assist in creating a coordinated research agenda for the Region. Methods We used the Delphi process, an iterative and systematic method of developing consensus within a group. An initial literature review was conducted to locate gaps of research and institutional research agendas related to the ZIKV. Information was systematically extracted and recorded to create a preliminary Delphi survey. A face-to-face meeting consultation was conducted at the PAHO on March 1-2, 2016, which highlighted additional gaps of research and difficulties in coordination. Results from the Delphi survey 1 and gaps of research presented at the face-to-face meeting formed the lines of research of the final Delphi survey. Experts evaluated their agreement to the proposed research lines in relation to each statement using a 5-point Likert scale and indicated the need for short, medium and long-term implementation.

Results: 52 experts representing 28 international public health and research institutions participated in the final Delphi consensus activity to set the final PAHO/WHO Regional research priorities. Gaps of research identified as critical and very important and need to be implemented in the short-term were identified in each of the six subtopics including: virus, vectors and reservoirs (3); epidemiology (6); disease pathogenesis and consequences of infection (3); public health interventions and clinical management (3); health systems and services (3), and research and development of products (4). Results of the critical and very important areas of research are displayed in Table 1.