Persistence of Zika Virus in Body Fluids — Final Report

Abstract

BACKGROUND To estimate the frequency and duration of detectable Zika virus (ZIKV) RNA in human body fluids, we prospectively assessed a cohort of newly infected participants in Puerto Rico. METHODS We evaluated samples obtained from 150 participants (including 55 men) in whom ZIKV RNA was detected on reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay in urine or blood in an enhanced arboviral clinical surveillance site. We collected serum, urine, saliva, semen, and vaginal secretions weekly for the first month and then at 2, 4, and 6 months. All specimens were tested by means of RT-PCR, and serum was tested with the use of anti–ZIKV IgM enzyme-linked immunosorbent assay. Among the participants with ZIKV RNA in any specimen at week 4, biweekly collection continued until all specimens tested negative. We used parametric Weibull regression models to estimate the time until the loss of ZIKV RNA detection in each body fluid and reported the findings in medians and 95th percentiles. RESULTS The medians and 95th percentiles for the time until the loss of ZIKV RNA detection were 14 days (95% confidence interval [CI], 11 to 17) and 54 days (95% CI, 43 to 64), respectively, in serum; 8 days (95% CI, 6 to 10) and 39 days (95% CI, 31 to 47) in urine; and 34 days (95% CI, 28 to 41) and 81 days (95% CI, 64 to 98) in semen. Few participants had detectable ZIKV RNA in saliva or vaginal secretions. CONCLUSIONS The prolonged time until ZIKV RNA clearance in serum in this study may have implications for the diagnosis and prevention of ZIKV infection. Current sexual-prevention guidelines recommend that men use condoms or abstain from sex for 6 months after ZIKV exposure; in 95% of the men in this study, ZIKV RNA was cleared from semen after about 3 months. (Funded by the Centers for Disease Control and Prevention.)

Rapid diagnosis of Zika virus through saliva and urine by Loop-mediated isothermal amplification (LAMP)

“…Urine collection is also easy and non-invasive, and studies reported that ZIKV RNA can be detected more frequently in urine than in blood during the acute phase [13]. …”

Zika Virus Infects Human Sertoli Cells and Modulates the Integrity of the In Vitro Blood-Testis Barrier Model

“…Although the contribution of the sexual route to disease transmission may be difficult to predict in areas where ZIKV is endemic, it certainly complicates virus epidemiology in regions of nonendemicity where the mosquito vector is absent. A recent cohort study reported that 56% of males positive for ZIKV in serum were also positive for the virus in semen, and the median time until the loss of ZIKV RNA in semen was 34 days, compared to 14 days in serum, thus suggesting a much longer infectious phase of ZIKV than of other flaviviruses traditionally transmitted via mosquitoes (6). Considering the lack of any measures approved to clear ZIKV infection and the detection of RNA of other reemerging pathogens such as Ebola virus in semen (4,7), it has become critical to understand the mechanisms associated with testicular infection by ZIKV.…”

Zika virus infection: Clinical overview with a summary of Japanese cases

“…In contrast, a recent study carried out in Latin America including 150 individuals with Zika virus infection reported that the mean period until the disappearance of the virus was longer in serum (14 days) than in urine (9 days). 45 This contrasting result may be affected by the presence of the five pregnant women in the participant population; the Zika virus has been shown to be detected in serum for longer periods of time during pregnancy. 46 Positive antibody test results are defined as an increase of fourfold of antibody titer in paired sera.…”