A systematic review and meta-analysis of Zika virus epidemiology
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Zika virus (ZIKV), classified as a priority pathogen by the World Health Organization, is an Aedes-borne arbovirus that can cause neurological complications and birth defects in newborns of mothers infected during pregnancy. We conducted a systematic review of peer-reviewed studies reporting ZIKV epidemiological parameters, transmission models and outbreaks (PROSPERO CRD42023393345) to characterize its transmissibility, seroprevalence, risk factors, disease sequelae and natural history. We performed meta-analyses of the proportions of congenital Zika syndrome, pregnancy loss among ZIKV-infected mothers and symptomatic cases. We extracted information from 574 studies. Across 418 included studies assigned a high-quality score, we extracted 969 parameters, 127 outbreak records and 154 models. Using random-effects models, we estimated proportions of congenital Zika syndrome (4.65%, 95% confidence interval (CI): 3.38–6.67%), pregnancy loss (2.48%, 95% CI: 1.62–3.78%) and symptomatic cases (51.20%, 95% CI: 38.00–64.23%). Seroprevalence estimates (n = 354) were retrieved beyond South America and French Polynesia. Basic reproduction number estimates (n = 77) ranged between 1.12 and 7.4. We found 66 human epidemiological delay estimates, including the intrinsic incubation period (n = 11, range: 4–12.1 days), infectious period (n = 15, range: 3–50 days), extrinsic incubation period (n = 22, range: 5.1–24.2 days) and serial interval (n = 27, range: 7.4–32.9 days).
These data are available in the R package ‘epireview’ (version 1.4.5). We provide a comprehensive systematic summary of ZIKV epidemiology, revealing large heterogeneities and inconsistencies in the reporting of parameter estimates, study designs and parameter definitions and underscoring the need for standardized epidemiological definitions.
These data are available in the R package ‘epireview’ (version 1.4.5). We provide a comprehensive systematic summary of ZIKV epidemiology, revealing large heterogeneities and inconsistencies in the reporting of parameter estimates, study designs and parameter definitions and underscoring the need for standardized epidemiological definitions.
Date Issued
2026-03-01
Date Acceptance
2025-12-18
Citation
Nature Health, 2026, 1 (3), pp.355-367
ISSN
3005-0693
Publisher
Nature Research
Start Page
355
End Page
367
Journal / Book Title
Nature Health
Volume
1
Issue
3
Copyright Statement
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1038/s44360-025-00051-4
Publication Status
Published
Date Publish Online
2026-02-13