In a study published in The Lancet Infectious Diseases, Raquel Burger-Calderon and colleagues characterise the clinical profile of Zika virus infection and assess the performance of WHO and Pan American Health Organization case definitions in a large paediatric cohort from Nicaragua. They show that Zika disease primarily manifests with undifferentiated fever or afebrile rash, and that the occurrence of symptoms increases with age. As a result, Zika in children is likely to be missed by recommended case definitions more frequently than in adults. Sensitivity improved with age, as older cases presented with more symptoms, but at most, only half of the symptomatic cases were captured. The most commonly presenting symptom was rash; other symptoms, such as arthralgia and periarticular oedema, were equally rare in cases with and without Zika. The study testing algorithm helped identify that previous dengue infection did not change the clinical presentation of Zika. Cases only identified by serology were milder than were PCR positive cases, suggesting that studies that only used PCR positivity to confirm cases might be more aligned with recommended case definitions. In summary, these definitions missed most cases and mainly captured cases in older children with dengue-like illness. The authors call for case definitions to be revised to better capture the full clinical spectrum of Zika virus.

中文翻译：

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平衡寨卡病毒病例定义的敏感性和特异性。

在发表在《柳叶刀传染病》上的一项研究中、Raquel Burger-Calderon 及其同事描述了寨卡病毒感染的临床特征，并在来自尼加拉瓜的一个大型儿科队列中评估了 WHO 和泛美卫生组织病例定义的表现。他们表明寨卡病主要表现为未分化的发热或无热性皮疹，并且症状的出现随着年龄的增长而增加。因此，与成人相比，推荐的病例定义可能更容易遗漏儿童中的寨卡病毒。敏感性随着年龄的增长而提高，因为老年病例出现更多症状，但最多只有一半的有症状病例被捕获。最常见的症状是皮疹；其他症状，如关节痛和关节周围水肿，在有和没有寨卡病毒的情况下同样罕见。研究测试算法有助于确定先前的登革热感染并未改变寨卡病毒的临床表现。仅通过血清学鉴定的病例比 PCR 阳性病例温和，这表明仅使用 PCR 阳性来确认病例的研究可能更符合推荐的病例定义。总之，这些定义遗漏了大多数病例，主要是捕获了患有登革热样疾病的年龄较大的儿童的病例。作者呼吁修订病例定义，以更好地捕捉寨卡病毒的完整临床谱。这些定义漏掉了大多数病例，主要是捕获了患有登革热样疾病的年龄较大的儿童的病例。作者呼吁修订病例定义，以更好地捕捉寨卡病毒的完整临床谱。这些定义漏掉了大多数病例，主要是捕获了患有登革热样疾病的年龄较大的儿童的病例。作者呼吁修订病例定义，以更好地捕捉寨卡病毒的完整临床谱。