Epidemic Comparison of Ebola and Zika—the Only Two Neglected Tropical Diseases with Vertical Transmission Potential and Associated with Public Health Emergency of International Concern—among Childbearing Women

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Background: Comparative epidemiological evidence on Ebola virus disease (EVD) and Zika virus disease (ZVD) in women of childbearing age (WCBA) is limited, hindering understanding of their mother-to-child transmission (MTCT) potential and maternal–neonatal protection. This study aimed to compare EVD and ZVD epidemiology in WCBA, assess sex-specific differences, and examine the association between ZVD incidence and live births to inform maternal–neonatal protection and disease control. Methods: Data on incidence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of EVD and ZVD (2011– 2023) among WCBA and other populations were extracted from the Global Burden of Disease 2023 study. Cumulative cases, age-standardised incidence rates (ASIRs), and mortality-to-incidence ratios (MIRs) were calculated. Sex-specific differences and correlations between ZVD ASIRs and live births were assessed. Results: During 2012– 2022, WCBA generally experienced higher cumulative and annual EVD incidence than males aged 15– 49 years in Sub-Saharan Africa; higher ZVD incidences were also observed among WCBA in Latin America and Caribbean, although no differences were significant. In main-endemic super-regions, EVD exhibited low incidence but extremely high fatality (MIR 0.39– 0.70) in WCBA, with DALYs primarily driven by YLLs; whereas ZVD showed high incidence but low fatality (MIR 1.92 × 10 − 6 – 9.45 × 10 − 6 ), with DALYs mainly driven by YLDs. Two EVD outbreaks occurred amid low endemicity in Sub-Saharan Africa, while a ZVD outbreak occurred in 2016 during persistent endemicity in Latin America and Caribbean. ZVD ASIRs in WCBA were strongly correlated with corresponding live births in Latin America and Caribbean, Brazil (2011– 2022), and constitute countries/territories and Brazilian states in 2016. Conclusion: Strengthened EVD monitoring in Sub-Saharan Africa and a Latin America-Caribbean-centred strategy for ZVD prevention targeting WCBA may improve maternal-neonatal protection and control of neglected tropical diseases with MTCT potential. Keywords: Ebola virus disease, Zika virus disease, women of childbearing age, mother-to-child transmission, comparative analysis, global burden of disease study 2023

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