Zika virus infection in the returning traveller: what every neurologist should know

Zika virus has been associated with a wide range of neurological complications. Neurologists in areas without current active transmission of the virus may be confronted with Zika-associated neurological disease, as a large number of returning travellers with Zika virus infection have been reported and the virus continues to spread to previously unaffected regions. This review provides an overview of Zika virus-associated neurological disease and aims to support neurologists who may encounter patients returning from endemic areas

Exile Vol. XI No. 1

FICTION By the Fire of the Chief by Peggy Schmidt 9-17 From the Diary of a Vanishing Man by Ed Brunner 19-29 Dialogue by Ken Booth 35-37 POETRY Johnny Joe by Bill West 6-7 Caterpillar by Barb Bergantz 17 Poem by Bonnie McCarthy 29 The Queen by Hugh Wilder 31 The Clown by Barb Bergantz 32 Poem by Gretchen Schenck 33 Treatise on Cosmology by P. M. Grout 37 Stimulus by Susan Sherwood 37 Depot by Susan Sherwood 39 GRAPHICS Pen and Ink by Dave Goodwin 7 Pen and Ink by Ramona Gibbs 8 Pen and Ink by Tod Riddell 18 Charcoal by Dave Goodwin 30 Woodcut by Parker Waite III 34 Woodcut by Lela Giles 3

Zika virus tropism and interactions in myelinating neural cell cultures: CNS cells and myelin are preferentially affected

The recent global outbreak of Zika virus (ZIKV) infection has been linked to severe neurological disorders affecting the peripheral and central nervous systems (PNS and CNS, respectively). The pathobiology underlying these diverse clinical phenotypes are the subject of intense research; however, even the principal neural cell types vulnerable to productive Zika infection remain poorly characterised. Here we used CNS and PNS myelinating cultures from wild type and Ifnar1 knockout mice to examine neuronal and glial tropism and short-term consequences of direct infection with a Brazilian variant of ZIKV. Cell cultures were infected pre- or post-myelination for various intervals, then stained with cell-type and ZIKV-specific antibodies. In bypassing systemic immunity using ex vivo culture, and the type I interferon response in Ifnar1 deficient cells, we were able to evaluate the intrinsic infectivity of neural cells. Through systematic quantification of ZIKV infected cells in myelinating cultures, we found that ZIKV infection is enhanced in the absence of the type I interferon responses and that CNS cells are considerably more susceptible to infection than PNS cells. In particular, we demonstrate that CNS axons and myelinating oligodendrocytes are especially vulnerable to injury. These results have implications for understanding the pathobiology of neurological symptoms associated with ZIKV infection. Furthermore, we provide a quantifiable ex vivo infection model that can be used for fundamental and therapeutic studies on viral neuroinvasion and its consequences

Exile Vol. XII No. 1

POETRY Elsinore by Alan Pavlik 8 Geraniums in Winter by Tom Getz 9 Clytemnestra by Sharon Hornberger 11-12 Panes by Bonnie Bishop 12 Vantage Point by Hugh Wilder 17 The Return by Alan Pavlik 18 Chiaroscuro by Bonnie Bishop 23 Poem by Gretchen Schenck 24 Waiting to Die by Kit Andrews 25 Poem by Trudi Spaeth 32 Dragon by Barbara Bergantz 33 After Alice by Barbara Bergantz 41-42 Reeds by Lauren Shakely 42 Inferno by Hugh Wilder 44 FICTION That Horrible War-Dream by James Jacobi 5-7 In a Family Way by Kathy Swiger 13-16 George by Buck Niehoff 19-23 Perfection by Susan Kurtz 27-32 Blue in Green by Alan Pavlik 35-40 The Streetcar Named Desire by Cem Kozlu 45-46 ART Whoever Dies, Dies in Pain by Nedra Veatch 4 Job and Patientia by Dan Thaxton 10 Specimen by David Goodwin 17 Isabel by Mary Davidson 26 Birds by Clare Conrad 34 Eli, Eli, Lama Sabacthani by Dan Thaxton Cover design by Jamie Foste

The legacy of ZikaPLAN: a transnational research consortium addressing Zika

Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission's flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases

ZikaPLAN: addressing the knowledge gaps and working towards a research preparedness network in the Americas.

Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network