PONE-D-21-02674

Descriptive analysis of surveillance data for Zika virus disease and Zika virus-associated neurological complications in Colombia, 2015-2017

PLOS ONE

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study sought to describe the prevalence of neurological complications of Zika virus disease (ZVD) in Colombia reported during the 2015-2017 epidemic. The authors used an extensive and large dataset to address question of neurological complications from ZVD. Considering that Zika virus is now endemic in many countries, the current study provides important insights to understanding the risk of ZVD for those living in and traveling to those areas. The authors are to be commended for their thorough study and summary of the data, however, I have a few comments which I would like for the authors to consider before publication. My comments are outlined below.

1. The authors should describe the evidence for Zika virus (ZKV) being neurotrophic. Evidence of ZKV neurotropism is not only found in patients with Guillain-Barré syndrome (GBS) or congenital zika virus syndrome (CZS), but there is preclinical evidence from animal studies showing that zika virus can infect the central nervous system in both young and adult animals (rodents and nonhuman primates). Explaining the evidence for neurotropism can help to explain why more neurologic symptoms beyond GBS should be investigated after ZKV infection in patients (Discussion pg 16 ln 371-379).

2. According to the current study data the highest incidents of ZVD is shown in adults. However, the data also shows that children of both sexes are equally susceptible to ZVD. In fact, a recent prospective study of children in Columbia (Pacheco et al, 2021, Paediatr Perinat Epidemiol, 35: 92-97) demonstrates that 15% of children infected with Zika virus between 1-12 month of age had adverse neurologic, hearing or eye examinations at 20 - 30 months of age. An additional 12.8% received an alert score in the hearing domain. Considering the neurotropism of the virus and the considerable postnatal development from birth to young adulthood, it is important to include broader surveillance of this young population other than severe neurological complications (see also recent review Raper & Chahroudi, 2021, Trop Med Infect Dis, 6 (10): 1-12).

3. Discussion pg 14 Ln 331-334, the authors should briefly mention that the possibility of prior immunity is also not possible due to the timing and origins of the virus arriving in Latin America from French-Polynesia.

4. Discussion pg 14 Ln 344-346, if spending more time at home is an increased risk of mosquito bite and ZVD in older females, would this also be the case for young children?

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Reviewer #1: No

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Descriptive analysis of surveillance data for Zika virus disease and Zika virus-associated neurological complications in Colombia, 2015-2017

PONE-D-21-02674R1

Dear Dr. Charniga,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Berlin Londono

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I thank the authors for thoroughly addressing all of my comments and congratulations on this excellent work.

Reviewer #2: The manuscript is well written and conclusions are supported by the data. Authors have also addressed all the reviewer's questions satisfactorily.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No