Impact of age-specific immunity on the timing and burden of the next Zika virus outbreak

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Abstract
The 2015–2017 epidemics of Zika virus (ZIKV) in the Americas caused widespread infection, followed by protective immunity. The timing and burden of the next Zika virus outbreak remains unclear. We used an agent-based model to simulate the dynamics of age-specific immunity to ZIKV, and predict the future age-specific risk using data from Managua, Nicaragua. We also investigated the potential impact of a ZIKV vaccine. Assuming lifelong immunity, the risk of a ZIKV outbreak will remain low until 2035 and rise above 50% in 2047. The imbalance in age-specific immunity implies that people in the 15–29 age range will be at highest risk of infection during the next ZIKV outbreak, increasing the expected number of congenital abnormalities. ZIKV vaccine development and licensure are urgent to attain the maximum benefit in reducing the population-level risk of infection and the risk of adverse congenital outcomes. This urgency increases if immunity is not lifelong. Zika virus (ZIKV) caused a major outbreak in the Americas between 2015–2017. It remains unclear if immunity after infection offers life-long protection at an individual level and how long herd immunity can protect a population against a new ZIKV outbreak. Data from Managua, Nicaragua showed an imbalance in protective immunity after ZIKV infection across different age-strata. We used this data to parameterize an individual based mathematical model to predict the future risk of a new ZIKV outbreak and to evaluate the effect of loss of immunity and the introduction of vaccination. We found that the 15–29 age range will be at highest risk of infection during the next ZIKV outbreak, increasing the expected number of congenital abnormalities. We show that vaccination could curb the risk of infection and could extend to herd immunity, but introduction within the next decade is crucial to provide the most benefit.
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  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (320030_176233)

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