Zika virus: persisting tissue reservoirs and their potential for clinically relevant pathology

The rapid spread of Zika virus through the Caribbean and Americas appears associated with greater levels of congenital zika and Guillain-Barre syndromes than previously seen. In addition, new disease pathologies such as persisting sexual transmission and severe liver injury have been identified. With zika vaccines years away from licensing an understanding of potential long-term health consequences following adult infection needs to be gained, especially where organs from infected people may be used for transplantation. To model the pathology of human Zika virus infection Old World and New World non-human primates were sub-cutaneously infected with a Caribbean Zika virus isolate. Following termination during primary viremia or later time points post peripheral viral clearance FFPE tissue sections were analysed for Zika virus RNA (RNAscope) and host responses (immunohistochemistry). Zika virus RNA was detected in multiple tissues from 3dpc with low levels of viral RNA detectable by RNAscope through to 101 dpc. New World non-human primates retained higher levels of persisting virus within tissues, notably within spleen, small intestine, kidney, liver and genital tissues. Differing pathologies were observed with Zika virus detected clustered within kidney glomeruli and associated with liver inflammatory infiltrates within New World species. Such pathologies are being documented in adults with resolved primary infection symptoms. This includes clinical complications following solid organ transplantation where immune suppression may allow viral reactivation either from the patient or transplanted organ. In the absence of a protective vaccine the potential risks from persisting viral reservoirs needs to be understood to ensure appropriate clinical management.