In Reply We appreciate the opportunity to respond to Zimmerman and colleagues. While we recognize the ultimate success of the rubella campaign, we believe its lessons inform an approach that will better serve women and children in the context of Zika vaccination.

First, the authors argue that caution was an “appropriate” means to avoid the theoretical possibility of vaccine-induced teratogenesis, given limited safety data. We do not contest the relevance of this consideration, but offer that the narrow focus on it came at a cost. Ramifications included the unanticipated paradoxical effect, but also the ongoing exposure of unvaccinated pregnant women to a known teratogen, wild-type rubella virus. Infection before 12 weeks’ gestation is associated with a 90% risk of congenital rubella syndrome.¹ This reflects a tendency—common in pregnancy—to notice the risks of medical intervention over the risks of nonintervention.² Rubella reminds us that what we fear most may not be the only, nor the greatest, threat.

回覆我们感谢有机会回应Zimmerman及其同事。尽管我们认识到风疹运动的最终成功，但我们相信它的经验教训为在寨卡疫苗接种的情况下更好地为妇女和儿童提供服务的方法提供了参考。

首先，作者认为，在安全性数据有限的情况下，谨慎是避免疫苗引起的致畸作用的理论上的“适当”手段。我们不反对这种考虑的相关性，但提出对此进行狭focus的关注是有代价的。后果包括未曾预料到的悖论效应，还包括未接种疫苗的孕妇持续暴露于已知的致畸原，野生型风疹病毒。妊娠前12周感染有90％的先天性风疹综合症风险。¹这反映出一种趋势，在怀孕期间很常见，这种趋势是注意医疗干预的风险超过不干预的风险。²风疹提醒我们，我们最担心的可能不是唯一的威胁，也不是最大的威胁。