Zika Virus Biology, Transmission, and Pathology: Chapter 4 - Inequality in Zika virus and congenital Zika syndrome

There are social inequalities in the occurrence of Zika virus (ZIKV) infection and congenital Zika syndrome (CZS). The chapter describes five processes linking socioeconomic position with the consequences of ZIKV infection. For each causal step differential exposure and differential vulnerability are described. The association between low income and substandard unhealthy housing is strong in most areas hit by the ZIKV epidemic, and there is a strong link between water supply, sanitary conditions, and vector density. Vector density influences ZIKV incidence depending on immunity and environmental stress influencing immunological function. The effect of ZIKV infection on CZS is modified by unknown causes creating high susceptibility in the poor areas in Northeast Brazil. Caring for a CZS disabled child implies heavy emotional and economical costs for families, particularly for women who are already poor.