Health Disparities
Racial and Ethnic Inequalities in Zika Virus Infection and Congenital Zika Syndrome in Latin America: A Scoping Review. Céline Goulart* Céline Goulart Khardjatou Marianne Djigo Mabel Carabali Jay S. Kaufman
Zika (ZIKV), a virus primarily transmitted by mosquito bites can also be transmitted during pregnancy to the fetus, leading to several congenital malformations collectively known as congenital Zika syndrome (CZS). ZIKV was declared a public health emergency in 2016. Today, 89 countries and territories have reported transmission, while no vaccine to prevent ZIKV exists. ZIKV/CZS burden is not evenly distributed across populations, with higher burden among Black or non-white people. We conducted a scoping review to assess if and how ethnic/racial inequalities are measured in the context of ZIKV and CZS among pregnant individuals and their offspring in Latin America. Quantitative peer-reviewed literature was retrieved from 7 databases. Extracted data were analyzed descriptively to measure the frequency of: race/ethnicity variables (used as descriptors, confounders, or effect measure modifiers); study methods; ascertainment of ZIKV/CZS; study outcomes (disaggregated by race/ethnicity and measures of occurrence/association); and measures of inequalities (simple and complex). A bias assessment was conducted to determine the risk of selection, misclassification, or confounding bias, measures taken to address the bias, and whether race/ethnicity variables were used appropriately. From 518 articles identified, 13 papers were included, all from Brazil. Ten studies used race solely as a descriptive variable. Two studies considered race as a proxy for racism. One study used complex measures of inequality to examine race. Biases existed in all studies, with potential misclassification of ZIKV or CZS present in most studies, likely due to limited access to adequate testing. Few studies assessed the relationship between racial/ethnic inequalities and ZIKV, and those that exist rarely employ specific measures of inequality in their analyses. Our research highlights methodological gaps in the assessment of racial inequalities in the context of infectious diseases in Latin America.