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The expanding spectrum of modes of transmission of Zika virus: a global concern

During recent years, but particularly since 2015, concern on Zika virus has grown for multiple reasons, such as its association with the occurrence of Guillain–Barré syndrome and microcephaly [1, 2]. Nevertheless, in addition to all epidemiological implications of the outbreak in Latin America [3] the number of affected cases continue to rise and expected to reach over four million in 2016, adding to this the possibility of new modes of transmission.

Zika virus is a zoonotic pathogen, naturally and experimentally hosted in non-human primates [4] as well as experimentally in Swiss albino mices [5, 6]. Then, rhesus monkeys can be the source in natural habitats of human infections, through the bite of Aedes aegypti and A. albopictus (multiple other species and genus have been implicated) (Fig. 1), in infected monkeys and later transmission to susceptible human hosts.

Fig. 1
figure 1

Summary of reported forms of transmission of Zika virus

Zika virus is predominantly a vector-borne disease (Fig. 1), although after the epidemics in the Pacific region it was clear that transplacental and perinatal transmission [7, 8] could also occur. However, the associated risk of microcephaly has been identified and highlighted much more recently as evidences continue to be added in different studies (Fig. 1) [8, 9].

Before the current epidemics not a single study raised that relationship, and, right now a significant number of pregnant women and their newborns are being monitored in Brazil [9], Colombia and other countries in the region for central nervous system anomalies. Zika has been detected in newborns, placenta and umbilical cords, as well in pregnant women by RT-PCR [8, 9]. There have been no reports detecting viable and potentially infective virus in breast milk up to now.

In addition to mother-to-child transmission, during the last decade, cases of sexual transmission have been reported [1012], representing a non-vector borne form of transmission of Zika virus (Fig. 1). Zika virus has been detected in human saliva [13], blood, semen and urine [14]. It has been recently detected in semen and urine of, respectively, a patient after 62 days of infection [15] and another patient after 14 days of infection [16]. Also spread of the virus through blood transfusion and organ transplantation have been reported or suspected [17]. Zika virus infections have been documented through laboratory exposure [18].

Another emerging aspect of this zoonosis has been the possible transmission through bites of monkeys and other non-human primates (Fig. 1). This has also been recently reported [19].

Summarizing, Zika virus is primarily a vector-borne disease (mainly by A. aegypti), but there are also secondary modes of transmission (mother-to-child, sexual, blood transfusion, transplantation, non-human primate bites) (Fig. 1). This imply that prevention and control should consider all these ways of transmission, providing strategies to reduce new infections from this arbovirus that still need further basic, epidemiological and clinical assessment in order to clarify and understand its real impact on human health. Zika represents a real challenge for the medical and scientific community as well as for the world [20].


  1. Heymann DL, Hodgson A, Sall AA, Freedman DO, Staples JE, Althabe F, Baruah K, Mahmud G, Kandun N, Vasconcelos PFC, et al. Zika virus and microcephaly: why is this situation a PHEIC? Lancet. 2016;387(10020):719–21.

    Article  PubMed  Google Scholar 

  2. Rodriguez-Morales AJ. Zika and microcephaly in Latin America: an emerging threat for pregnant travelers? Travel Med Infect Dis. 2016;14(1):5–6.

    Article  PubMed  Google Scholar 

  3. Campos GS, Bandeira AC, Sardi SI. Zika virus outbreak, Bahia, Brazil. Emerg Infect Dis. 2015;21(10):1885–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rodriguez-Morales AJ. Zika: the new arbovirus threat for Latin America. J Infect Dev Ctries. 2015;9(6):684–5.

    Article  PubMed  Google Scholar 

  5. Dick GW. Zika virus. II. Pathogenicity and physical properties. Trans R Soc Trop Med Hyg. 1952;46(5):521–34.

    Article  CAS  PubMed  Google Scholar 

  6. Dick GW, Kitchen SF, Haddow AJ. Zika virus. I. Isolations and serological specificity. Trans R Soc Trop Med Hyg. 1952;46(5):509–20.

    Article  CAS  PubMed  Google Scholar 

  7. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro Surveill. 2014;19(13):20751.

    Article  PubMed  Google Scholar 

  8. Mlakar J, Korva M, Tul N, Popovic M, Poljsak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodusek V et al. Zika virus associated with microcephaly. N Engl J Med 2016.

  9. Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DD, Cavalcanti DP, Pessoa A, Doriqui MJ, Neri JI, Neto JM, Wanderley HY, et al. Possible association between Zika virus infection and microcephaly—Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(3):59–62.

    Article  PubMed  Google Scholar 

  10. Patino-Barbosa AM, Medina I, Gil-Restrepo AF, Rodriguez-Morales AJ. Zika: another sexually transmitted infection? Sex Transm Infect. 2015;91(5):359.

    PubMed  Google Scholar 

  11. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential sexual transmission of Zika virus. Emerg Infect Dis. 2015;21(2):359–61.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Foy BD, Kobylinski KC, Chilson Foy JL, Blitvich BJ, Travassos da Rosa A, Haddow AD, Lanciotti RS, Tesh RB. Probable non-vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis. 2011;17(5):880–2.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Musso D, Roche C, Nhan TX, Robin E, Teissier A, Cao-Lormeau VM. Detection of Zika virus in saliva. J Clin Virol. 2015;68:53–5.

    Article  PubMed  Google Scholar 

  14. Gourinat AC, O’Connor O, Calvez E, Goarant C, Dupont-Rouzeyrol M. Detection of Zika virus in urine. Emerg Infect Dis. 2015;21(1):84–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Barry A, Pasco H, Babak A, Sarah L, Daniel C, Emma JA, Andrew JS, Timothy JB, Roger H. Detection of Zika virus in semen. Emerg Infect Dis. 2016. doi:10.3201/eid2205.160107.

  16. de M Campos R, Cirne-Santos C, Meira GLS, Santos LLR, de Meneses MD, Friedrich J, Jansen S, Ribeiro MS, da Cruz IC, Schmidt-Chanasit J et al. Prolonged detection of Zika virus RNA in urine samples during the ongoing Zika virus epidemic in Brazil. J Clin Virol. 2016;77(4):69–70.

  17. Marano G, Pupella S, Vaglio S, Liumbruno GM, Grazzini G. Zika virus and the never-ending story of emerging pathogens and transfusion medicine. Blood transfus. 2015. doi:10.2450/2015.0066-15.

    Google Scholar 

  18. Hennessey M, Fischer M, Staples JE. Zika Virus spreads to new areas—region of the Americas, May 2015–January 2016. MMWR Morb Mortal Wkly Rep. 2016;65(3):55–8.

    Article  PubMed  Google Scholar 

  19. Leung GH, Baird RW, Druce J, Anstey NM. Zika virus infection in Australia following a monkey bite in Indonesia. Southeast Asian J Trop Med Public Health. 2015;46(3):460–4.

    PubMed  Google Scholar 

  20. Rodriguez-Morales AJ, Villamil-Gomez W. The challenge of Zika in Colombia and Latin America: an international health emergency. Infectio. 2016;20(2):59–61.

    Article  Google Scholar 

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Authors’ contributions

ARM coordinated the writing of the manuscript, wrote initial draft and performed review of the literature. AB edited manuscript and performed review of the literature. CFP edited manuscript. All authors read and approved the final manuscript.

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The authors declare that they have no competing interests.

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Correspondence to Alfonso J. Rodriguez-Morales.

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Rodriguez-Morales, A.J., Bandeira, A.C. & Franco-Paredes, C. The expanding spectrum of modes of transmission of Zika virus: a global concern. Ann Clin Microbiol Antimicrob 15, 13 (2016).

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