Prevalence of asymptomatic Zika virus infection: A systematic review: A systematic review

Michelle M. Haby, Mariona Pinart, Vanessa Elias, Ludovic Reveiz

Research output: Contribution to journalScientific reviewpeer-review

96 Scopus citations


Objective To conduct a systematic review to estimate the prevalence of asymptomatic Zika virus infection in the general population and in specific population groups. Methods We searched PubMed®, Embase® and LILACS online databases from inception to 26 January 2018. We included observational epidemiological studies where laboratory testing was used to confirm positive exposure of participants to Zika virus and in which Zika virus symptom status was also recorded. We excluded studies in which having symptoms of Zika virus was a criterion for inclusion. The main outcome assessed was percentage of all Zika virus-positive participants who were asymptomatic. We used a quality-effects approach and the double arcsine transformation for the meta-analysis. Findings We assessed 753 studies for inclusion, of which 23 were included in the meta-analysis, totalling 11 305 Zika virus-positive participants. The high degree of heterogeneity in the studies (I2 = 99%) suggests that the pooled prevalence of asymptomatic Zika viruspositive participants was probably not a robust estimate. Analysis based on subgroups of the population (general population, returned travellers, blood donors, adults with Guillain–Barre syndrome, pregnant women and babies with microcephaly) was not able to explain the heterogeneity. Funnel and Doi plots showed major asymmetry, suggesting selection bias or true heterogeneity. Conclusion Better-quality research is needed, using standardized methods, to determine the true prevalence of asymptomatic Zika virus and whether it varies between populations or over time.

Translated title of the contributionPrevalencia de la infección asintomática del virus de Zika: Una revisión sistemática
Original languageAmerican English
Pages (from-to)402-413D
JournalBulletin of the World Health Organization
Issue number6
StatePublished - Jun 2018

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© 2018, World Health Organization. All rights reserved.


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