Topic: Zika Vaccine?

Zika virus is an RNA virus of the family of Flaviviruses. It is an enveloped,

single-stranded positive-sense linear icosahedral virus. The flavivirus family
includes HCV, Yellow fever, Dengue, St. Louis encephalitis, and West Nile
virus. However, Zika virus specifically has been gaining much attention in the
media recently due to its potential association with Guillan-Barre syndrome,
and microcephaly in fetuses through placental transmission.
Zika virus is transmitted by the Aedes mosquito. Human transmission by
sexual contact has also been reported. The zika virus can infect a wide range
of hosts, most notably the monkey and humans.
Zika infection is very common. A few census report the incidence of zika
virus infection to be approximately 7% in some high-risk countries, especially
in Africa and Asia. In May 2015, Brazil reported the first outbreak of Zika
virus in the Americas. The majority of infections (up to 80%) go unnoticed,
due to the infection usually being self-limited and mild.
While the infection is non-specific and well-tolerated, there is special
attention given to this virus because of its potential link to congenital
malformations from transplacental transmission. Half a year after the Brazil
virus outbreak was reported, the incidence of microcephaly increased by 20
times. This previously incredibly rare finding was reported in 1248 new cases
in 2015. Some studies have tested the placental fluid of fetuses diagnosed
with microcephaly in high-risk areas and have found positive zika virus
results to be unanimous.
There has been much controversy about whether Zika virus actually causes
microcephaly. After all, correlation does not imply causation. In addition,
some argue that the increased number of cases of microcephaly may in fact
be due to the fact that we are now more aware and likely to test for it, or
that we have better methods of testing for it. However, as of March 30, 2015,
the World Health Organization has stated that there is strong scientific
consensus that Zika virus does in fact cause microcephaly through placental
transmission, Guillan-Barre syndrome, and other neurological disorders.
Now that the debate surrounding the actual association between Zika virus
and these disorders is somewhat settled, it seems appropriate to consider
next steps moving forward. Since this disease is spreading (reported cases in
North America), it is crucial that we act quickly and efficiently. This is an

incredibly time-sensitive issue, since people are pregnant now and will be
tomorrow.
Vaccines may be a promising solution to the problem. Although it is difficult
to engineer vaccines for every pathogen, many laboratories are coming close
to having a prototype of a vaccine they hope will be the answer. Phase 1
trials are set to start at the beginning this summer. However, Phase 1 trials
are just the beginning as there are phase 2 and phase 3 trials to be done,
and the very earliest that a vaccine could be widely distributed is 2018,
according to reports by BBC.

In addition, there are some concerns that must be kept in mind when
developing such a vaccine. Since this Zika virus has been linked not only to
microcephaly, but also to Guillan-barre syndrome, it changes how we must
approach the problem. Guillan-barre is an autoimmune condition. Most often,
it occurs after infection by bacteria Campylobacter jejuni. It is not the actual
bacteria that causes the syndrome, but rather, the activated immune system
that overreacts and mounts an extreme host response. In doing so, the
immune system attacks structures that may momecularly mimic the
pathogen. The immune system attacks peripheral myelin and destroys
Schwann cells, causing inflammation and demyelination of peripheral nerves
and motor fibers. This results in the clinic symptoms of symmetric ascending
muscle weakness/paralysis beginning in the lower extremities. Facial
paralysis is see in 50% of cases, and autonomic dysregulation or sensory
abnormalities (such as cardiac irregularities, hypertension, hypotension) may
also occur. Paralysis can affect the diaphragm, causing respiratory failure.
While the mortality rate is rather low, this is obviously a debilitating disease
that one should be wary of.
This leads us to question the use of vaccines in preventing Zika virus
transmission. Since vaccines contain either killed or attenuated components
of the virus to stimulate the hosts immune system to recognizing the
antigen in the future, there is a chance that the act of introducing these
molecules and activating the immune response may lead to Guillan-barre. It
is still unclear what exactly causes the molecular mimicry and overactivation
of the immune system seen in Guillan-barre. Thus, it is not impossible that
even killed viral particles could start an immune response leading to Guillanbarre.
We thus need some more data. If we are to compare the risk of microcephaly
to the risk of Guillan-barre, and whether we as a community are willing to
take either risk over the other, we must have hard data to make an informed
decision. Since this is a time-sensitive issue, it is imperative that research be

done now, and that we remain aware of the downfalls of each potential
option.