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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Trop. Dis</journal-id>
<journal-title>Frontiers in Tropical Diseases</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Trop. Dis</abbrev-journal-title>
<issn pub-type="epub">2673-7515</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fitd.2024.1369608</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Tropical Diseases</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Durable cellular immune response against inactivated ZIKV and envelope proteins in ZIKV-infected women during pregnancy</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Apostolico</surname><given-names>Juliana de Souza</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x2020;</sup></xref>
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<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Lunardelli</surname><given-names>Vict&#xf3;ria Alves Santos</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn002"><sup>&#x2020;</sup></xref>
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<contrib contrib-type="author">
<name>
<surname>Boscardin</surname><given-names>Silvia Beatriz</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
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<contrib contrib-type="author">
<name>
<surname>Botosso</surname><given-names>Viviane Fongaro</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
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<contrib contrib-type="author">
<name>
<surname>Astray</surname><given-names>Renato Mancini</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
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<contrib contrib-type="author">
<name>
<surname>Kalil</surname><given-names>Jorge</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
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<contrib contrib-type="author">
<name>
<surname>de Almeida</surname><given-names>Roque Pacheco</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
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<contrib contrib-type="author">
<name>
<surname>Cunha-Neto</surname><given-names>Edecio</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<xref ref-type="aff" rid="aff7"><sup>7</sup></xref>
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<contrib contrib-type="author" corresp="yes">
<name>
<surname>Rosa</surname><given-names>Daniela Santoro</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>*</sup></xref>
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<aff id="aff1"><sup>1</sup><institution>Departamento de Microbiologia, Imunologia e Parasitologia, Universidade Federal de S&#xe3;o Paulo - Escola Paulista de Medicina (UNIFESP/EPM)</institution>, <addr-line>S&#xe3;o Paulo</addr-line>, <country>Brazil</country></aff>
<aff id="aff2"><sup>2</sup><institution>Departamento de Parasitologia, Instituto de Ci&#xea;ncias Biom&#xe9;dicas, Universidade de S&#xe3;o Paulo</institution>, <addr-line>S&#xe3;o Paulo</addr-line>, <country>Brazil</country></aff>
<aff id="aff3"><sup>3</sup><institution>Instituto de Investiga&#xe7;&#xe3;o em Imunologia (III), Instituto Nacional de Ci&#xea;ncia e Tecnologia (INCT)</institution>, <addr-line>S&#xe3;o Paulo</addr-line>, <country>Brazil</country></aff>
<aff id="aff4"><sup>4</sup><institution>Instituto Butantan</institution>, <addr-line>S&#xe3;o Paulo</addr-line>, <country>Brazil</country></aff>
<aff id="aff5"><sup>5</sup><institution>Laborat&#xf3;rio de Imunologia, Instituto do Cora&#xe7;&#xe3;o (InCor), Hospital das Cl&#xed;nicas- Faculdade de Medicina- Universidade de S&#xe3;o Paulo (HCFMUSP)</institution>, <addr-line>S&#xe3;o Paulo</addr-line>, <country>Brazil</country></aff>
<aff id="aff6"><sup>6</sup><institution>Laborat&#xf3;rio de Biologia Molecular, Departamento de Medicina, Hospital Universit&#xe1;rio, Universidade Federal de Sergipe</institution>, <addr-line>Aracaju</addr-line>, <country>Brazil</country></aff>
<aff id="aff7"><sup>7</sup><institution>Laborat&#xf3;rio de Investiga&#xe7;&#xe3;o M&#xe9;dica (LIM-19), Hospital das Cl&#xed;nicas- Faculdade de Medicina- Universidade de S&#xe3;o Paulo (HC- FMUSP)</institution>, <addr-line>S&#xe3;o&#xa0;Paulo</addr-line>, <country>Brazil</country></aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Antonio Carlos De Albuquerque Bandeira, Faculdade de Tecnologia e Ci&#xea;ncias, Brazil</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Gubio Campos, Federal University of Bahia (UFBA), Brazil</p>
<p>Beatriz Arns, Moinhos de Vento Hospital, Brazil</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Daniela Santoro Rosa, <email xlink:href="mailto:dsrosa@unifesp.br">dsrosa@unifesp.br</email>
</p>
</fn>
<fn fn-type="equal" id="fn002">
<p>&#x2020;These authors have contributed equally to this work</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>26</day>
<month>04</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>5</volume>
<elocation-id>1369608</elocation-id>
<history>
<date date-type="received">
<day>12</day>
<month>01</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>01</day>
<month>04</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2024 Apostolico, Lunardelli, Boscardin, Botosso, Astray, Kalil, de Almeida, Cunha-Neto and Rosa</copyright-statement>
<copyright-year>2024</copyright-year>
<copyright-holder>Apostolico, Lunardelli, Boscardin, Botosso, Astray, Kalil, de Almeida, Cunha-Neto and Rosa</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec>
<title>Introduction</title>
<p>Zika virus (ZIKV) infection has been associated to Guillain-Barr&#xe9; syndrome in adults and congenital malformations during pregnancy, leading to the manifestation of congenital Zika syndrome (CZS). The ZIKV envelope protein (E<sub>ZIKV</sub>), prominently displayed on the virus surface, is a primary target for the humoral immune response. However, limited information exists regarding its capacity to induce cellular immunity, particularly in pregnant women with a history of ZIKV infection. The E<sub>ZIKV</sub> protein comprises three domains: the central domain (EDI), a dimerization domain (EDII), and a domain responsible for binding to the cell surface receptor (EDIII). To examine the regions of E<sub>ZIKV</sub> targeted by cellular immunity, we examined cellular immune responses in a cohort of mothers infected with ZIKV, whose infants exhibited microcephaly.</p>
</sec>
<sec>
<title>Methods</title>
<p>To assess the ZIKV-specific response, we used inactivated virus and different recombinant viral envelope proteins (E<sub>ZIKV</sub>, EDI/II<sub>ZIKV</sub> and EDIII<sub>ZIKV</sub>). All women in the study contracted the infection during pregnancy, with 72% experiencing symptoms such as fever, rash, joint pain, and retro-orbital pain. Peripheral blood mononuclear cells (PMBC) were collected post- ZIKV diagnosis confirmation, with a median time of 18 months (IQR 13.5-19) after parturition. Using the ELISpot assay, we quantified specific interferon-gamma (IFN&#x3b3;) producing cells by stimulating PBMC with either inactivated ZIKV particles or equimolar amounts of recombinant E<sub>ZIKV</sub>, EDI/II<sub>ZIKV</sub> and EDIII<sub>ZIKV</sub>.</p>
</sec>
<sec>
<title>Results and discussion</title>
<p>Our findings demonstrate the induction of IFN-&#x3b3; producing cells in PBMC from ZIKV-convalescent mothers, whose infants manifested microcephaly, upon stimulation with both inactivated ZIKV particles and recombinant proteins. The identification of immunodominant regions within ZIKV can contribute for the development of targeted treatments and vaccine candidates tailored for pregnant women.</p>
</sec>
</abstract>
<kwd-group>
<kwd>Zika virus</kwd>
<kwd>cellular immune response</kwd>
<kwd>T cells</kwd>
<kwd>pregnancy</kwd>
<kwd>microcephaly</kwd>
</kwd-group>
<contract-num rid="cn001">465434/2014</contract-num>
<contract-sponsor id="cn001">Conselho Nacional de Desenvolvimento Cient&#xed;fico e Tecnol&#xf3;gico<named-content content-type="fundref-id">10.13039/501100003593</named-content>
</contract-sponsor>
<counts>
<fig-count count="5"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="53"/>
<page-count count="10"/>
<word-count count="3882"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Emerging Tropical Diseases</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Zika virus (ZIKV), a mosquito-borne flavivirus closely related to yellow fever, dengue, and West Nile viruses (<xref ref-type="bibr" rid="B1">1</xref>) has undergone rapid global dissemination since 2015, with over 80 countries reporting local transmission (<xref ref-type="bibr" rid="B2">2</xref>). While primarily transmitted by <italic>Aedes</italic> mosquitos, non-vector transmission can also occur including sexual contact, transfusion, and vertical transmission from mother to child (<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B4">4</xref>).</p>
<p>Most ZIKV infections are asymptomatic, with a minority causing self-limited acute febrile illnesses characterized by fever, headache, arthralgia, myalgia, fatigue, and rash (<xref ref-type="bibr" rid="B5">5</xref>). However, in adults, ZIKV infection has been sporadically associated with Guillain-Barr&#xe9; syndrome (GBS) (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>). In pregnant women, the virus can persist for weeks in the reproductive tract (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B9">9</xref>), and fetal infection has been associated with congenital malformations such as brain calcification, microcephaly, and spontaneous abortion, defining the Congenital Zika Syndrome (CZS) (<xref ref-type="bibr" rid="B10">10</xref>&#x2013;<xref ref-type="bibr" rid="B12">12</xref>).</p>
<p>Studies suggest that approximately 20% of infants born to mothers exposed to Zika virus during pregnancy, who initially exhibited no signs of birth defects, later displayed impaired cognitive development and other neurological abnormalities (<xref ref-type="bibr" rid="B13">13</xref>, <xref ref-type="bibr" rid="B14">14</xref>).</p>
<p>The rapid global spread of ZIKV and its association with neurological complications highlight the urgent need for an effective vaccine and specific treatment. Despite scientific efforts, no licensed therapeutic or prophylactic vaccines against ZIKV have been developed until now (<xref ref-type="bibr" rid="B15">15</xref>).</p>
<p>The ZIKV genome is a single-stranded positive-sense RNA (ssRNA) that encodes a polyprotein, subsequently cleaved into three structural proteins (Capsid (C), Premembrane/Membrane (prM/M) and Envelope (E)) and seven non-structural proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5), vital for virus replication and assembly (<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B17">17</xref>). The Envelope (E) protein orchestrates viral assembly, binds to cell receptors, and is essential for the subsequent fusion of the membrane involved in virus entry into the target cell (<xref ref-type="bibr" rid="B18">18</xref>). Similar to other flaviviruses, the ZIKV E protein comprises three distinct domains: the central domain (EDI), the fusion peptide-containing dimerization domain (EDII), and the cell surface receptor-binding (EDIII) (<xref ref-type="bibr" rid="B19">19</xref>).</p>
<p>Several studies have demonstrated the highly antigenic structure of the E protein, serving as the primary target for host antibody responses, including several neutralizing antibodies (<xref ref-type="bibr" rid="B20">20</xref>, <xref ref-type="bibr" rid="B21">21</xref>). While the humoral response is fundamental in protection against ZIKV infection, the involvement of CD4<sup>+</sup> and CD8<sup>+</sup> T cell responses is essential for complete virus elimination. Despite various animal studies highlighting the importance of CD4<sup>+</sup> and CD8<sup>+</sup> T cell responses against ZIKV (<xref ref-type="bibr" rid="B22">22</xref>&#x2013;<xref ref-type="bibr" rid="B27">27</xref>), limited and conflicting data exist regarding the preferred target regions for human-specific cellular immune response to ZIKV (<xref ref-type="bibr" rid="B28">28</xref>, <xref ref-type="bibr" rid="B29">29</xref>). Furthermore, despite ZIKV&#x2019;s unique impact on fetal health, few studies have investigated the immune response of pregnant women. A recent longitudinal study with 10 non-pregnant women with acute ZIKV infection revealed that CD8<sup>+</sup> T cell responses are directed more towards non-structural antigens, while CD4<sup>+</sup> T cell responses are more balanced between structural and non-structural antigens (<xref ref-type="bibr" rid="B30">30</xref>). Similarly, ZIKV-specific CD4+ memory T cell responses were observed in mothers infected with ZIKV during pregnancy, with no discernible differences in T cell responses between children affected or unaffected by CZS (<xref ref-type="bibr" rid="B31">31</xref>).</p>
<p>In this study, we investigated whether ZIKV inactivated particles and different ZIKV-envelope proteins induce cellular-mediated immunity after ZIKV infection in cells from convalescent mothers of newborns with microcephaly <italic>in vitro</italic>.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<title>Materials and methods</title>
<sec id="s2_1">
<title>Participants</title>
<p>A dual-center study was conducted at the Hospital Universit&#xe1;rio da Universidade Federal de Sergipe and Universidade Federal de S&#xe3;o Paulo. Cryopreserved peripheral blood mononuclear cells (PBMC) from 32 ZIKV-infected women, who delivered babies with microcephaly, were used. Participant characteristics are detailed in <xref ref-type="table" rid="T1"><bold>Table&#xa0;1</bold></xref>. PBMCs were collected post ZIKV-positive diagnosis via ELISA (IgG Euroimunn) approximately 18 months (IQR 13.5-19) after parturition. Additionally, 10 healthy ZIKV-seronegative participants were recruited at Universidade Federal de S&#xe3;o Paulo and utilized as controls. All participants provided written informed consent, and the study received approval from the local ethics committee (CAAE: 54835916.2.0000.5546 and CAAE: 80487717.7.0000.5505).</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Cohort of participants exposed to Zika virus during pregnancy that gave birth to babies affected by microcephaly.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" align="left">ID</th>
<th valign="middle" align="left">Age (years)</th>
<th valign="middle" align="left">Period of <break/>pregnancy which <break/>symptoms occur</th>
<th valign="middle" align="left">Symptoms</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left">001</td>
<td valign="top" align="left">20</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="top" align="left">004</td>
<td valign="top" align="left">36</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Skin rash</td>
</tr>
<tr>
<td valign="top" align="left">005</td>
<td valign="top" align="left">29</td>
<td valign="bottom" align="left">first and second trimester of pregnancy</td>
<td valign="bottom" align="left">Fever, skin rash</td>
</tr>
<tr>
<td valign="top" align="left">006</td>
<td valign="top" align="left">28</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Arthralgia, skin rash, myalgia, retro-orbital pain</td>
</tr>
<tr>
<td valign="top" align="left">009</td>
<td valign="top" align="left">26</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="bottom" align="left">012</td>
<td valign="bottom" align="left">30</td>
<td valign="bottom" align="left">second trimester of pregnancy</td>
<td valign="bottom" align="left">Fever, arthralgia, skin rash, retro-orbital pain, myalgia</td>
</tr>
<tr>
<td valign="bottom" align="left">013</td>
<td valign="bottom" align="left">41</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Fever, arthralgia, skin rash, conjunctivitis, retro-orbital pain, myalgia</td>
</tr>
<tr>
<td valign="bottom" align="left">015</td>
<td valign="bottom" align="left">40</td>
<td valign="bottom" align="left">first trimester of pregnancy</td>
<td valign="bottom" align="left">Fever, arthralgia, skin rash, conjunctivitis, retro-orbital pain, myalgia, lymphadenopathy</td>
</tr>
<tr>
<td valign="bottom" align="left">019</td>
<td valign="bottom" align="left">24</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="bottom" align="left">021</td>
<td valign="bottom" align="left">26</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Skin rash</td>
</tr>
<tr>
<td valign="bottom" align="left">025</td>
<td valign="bottom" align="left">17</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="bottom" align="left">026</td>
<td valign="bottom" align="left">21</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="bottom" align="left">031</td>
<td valign="bottom" align="left">17</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Skin rash</td>
</tr>
<tr>
<td valign="bottom" align="left">033</td>
<td valign="bottom" align="left">28</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Fever, arthralgia, myalgia, skin rash</td>
</tr>
<tr>
<td valign="bottom" align="left">035</td>
<td valign="bottom" align="left">37</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Fever</td>
</tr>
<tr>
<td valign="bottom" align="left">037</td>
<td valign="bottom" align="left">19</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Fever, arthralgia, myalgia, skin rash</td>
</tr>
<tr>
<td valign="bottom" align="left">038</td>
<td valign="bottom" align="left">25</td>
<td valign="bottom" align="left">eighth month of pregnancy</td>
<td valign="bottom" align="left">Fever, arthralgia, skin rash, myalgia, retro-orbital pain</td>
</tr>
<tr>
<td valign="bottom" align="left">040</td>
<td valign="bottom" align="left">19</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Fever, rash skin</td>
</tr>
<tr>
<td valign="bottom" align="left">041</td>
<td valign="bottom" align="left">27</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="bottom" align="left">044</td>
<td valign="bottom" align="left">15</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Fever, skin rash</td>
</tr>
<tr>
<td valign="bottom" align="left">047</td>
<td valign="bottom" align="left">23</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">arthralgia, myalgia, skin rash, retro-orbital pain</td>
</tr>
<tr>
<td valign="bottom" align="left">048</td>
<td valign="bottom" align="left">19</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="bottom" align="left">051</td>
<td valign="bottom" align="left">17</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
<tr>
<td valign="bottom" align="left">053</td>
<td valign="bottom" align="left">38</td>
<td valign="bottom" align="left">third month of pregnancy</td>
<td valign="bottom" align="left">Fever, arthralgia, skin rash, myalgia, retro-orbital pain</td>
</tr>
<tr>
<td valign="bottom" align="left">054</td>
<td valign="bottom" align="left">40</td>
<td valign="bottom" align="left">third trimester of pregnancy</td>
<td valign="bottom" align="left">Skin rash, myalgia</td>
</tr>
<tr>
<td valign="bottom" align="left">055</td>
<td valign="bottom" align="left">20</td>
<td valign="bottom" align="left">third month of pregnancy</td>
<td valign="bottom" align="left">Arthralgia, skin rash, retro-orbital pain</td>
</tr>
<tr>
<td valign="bottom" align="left">056</td>
<td valign="bottom" align="left">28</td>
<td valign="bottom" align="left">second month of pregnancy</td>
<td valign="bottom" align="left">Arthralgia, skin rash, retro-orbital pain, myalgia</td>
</tr>
<tr>
<td valign="bottom" align="left">057</td>
<td valign="bottom" align="left">19</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">Fever</td>
</tr>
<tr>
<td valign="bottom" align="left">060</td>
<td valign="bottom" align="left">N/S</td>
<td valign="bottom" align="left">sixth month of pregnancy</td>
<td valign="bottom" align="left">Skin rash</td>
</tr>
<tr>
<td valign="bottom" align="left">062</td>
<td valign="bottom" align="left">21</td>
<td valign="bottom" align="left">first month of pregnancy</td>
<td valign="bottom" align="left">Arthralgia, skin rash, retro-orbital pain</td>
</tr>
<tr>
<td valign="bottom" align="left">067</td>
<td valign="bottom" align="left">29</td>
<td valign="bottom" align="left">second month of pregnancy</td>
<td valign="bottom" align="left">Fever, arthralgia, skin rash, retro-orbital pain</td>
</tr>
<tr>
<td valign="bottom" align="left">068</td>
<td valign="bottom" align="left">19</td>
<td valign="bottom" align="left">not specified</td>
<td valign="bottom" align="left">not specified</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s2_2">
<title>Sample collection</title>
<p>PBMC were isolated from participant blood using Ficoll-Paque (GE Healthcare) density-gradient sedimentation. Subsequently, PBMC were washed twice in Hank&#x2019;s balanced salt solution (Gibco) and cryopreserved in 90% fetal bovine serum (FBS; Gibco) and 10% dimethyl sulfoxide (DMSO; Sigma). Cryopreserved cells were stored in liquid nitrogen until use.</p>
</sec>
<sec id="s2_3">
<title>Inactivated Zika virus particles</title>
<p>ZIKV-Br (GenBank accession number MH882531.1) was provided by Dr. Danielle Bruna Leal de Oliveira (Laborat&#xf3;rio de Virologia Cl&#xed;nica e Molecular, University of S&#xe3;o Paulo, Brazil). Virus propagation was performed using <italic>Aedes albopictus</italic> mosquito cells (clone C6/36), as previously described (<xref ref-type="bibr" rid="B32">32</xref>). The virus was precipitated with 50% polyethylene glycol (Synth), resuspended in DMEM (Gibco) plus 25 mM HEPES (Gibco), and stored at -80&#xb0;C until use. For inactivation, we exposed virus preparations to UV light for up to 60 minutes (<xref ref-type="bibr" rid="B33">33</xref>).</p>
</sec>
<sec id="s2_4">
<title>Expression and purification of recombinant E<sub>ZIKV</sub> protein and its ectodomains EDI/II<sub>ZIKV</sub> and EDIII<sub>ZIKV</sub>
</title>
<p>The <italic>E. coli</italic> BL21 (DE3) RIL strain, harboring the plasmids pET21a-E, pET21a-EDI/II and pET21a-EDIII (<xref ref-type="bibr" rid="B34">34</xref>, <xref ref-type="bibr" rid="B35">35</xref>), were cultivated in LB medium containing 100 &#xb5;g/mL ampicillin exactly as described by Lunardelli et&#xa0;al., 2022. After induction with 0.01mM Isopropyl &#x3b2;-D-thiogalactoside (IPTG, Sigma), bacterial pellets were suspended and lysed in the APLAB-10 homogenizer (ARTEPE&#xc7;AS, Brazil). The inclusion bodies were solubilized in a urea-containing solution, and the recombinant protein was refolded and purified using nickel affinity chromatography with a HisPur&#x2122; Ni-NTA Superflow Agarose column (Thermo Scientific&#x2122;), as recommended by the manufacturer. Purified E<sub>ZIKV</sub>, EDI/II<sub>ZIKV</sub> and EDIII<sub>ZIKV</sub> were assessed by 15% SDS-PAGE gel under reducing conditions.</p>
</sec>
<sec id="s2_5">
<title>Dot blot</title>
<p>Approximately 10 &#x3bc;L containing 2x10<sup>5</sup> PFU of inactivated ZIKV or 10 &#x3bc;L containing 3 &#x3bc;g of BSA (negative control) were added to nitrocellulose membranes (Hybond-C extra nitrocellulose &#x2013; GE Healthcare). After drying, the membranes were blocked with PBS Tween 20 (PBST) (0.02% v/v), non-fat milk (5% w/v) and BSA (2.5% w/v) or PBS BSA (5% w/v, for human sample), for 2 h at room temperature (rt). Next, the membranes were washed three times with PBST (0,05% v/v) and incubated with monoclonal pan-flavivirus antibody 4G2 (1 &#x3bc;g/mL) or human serum (ZIKV-infected patient or healthy individual, 1:500) for 2 h at rt. After 3 washes with PBST (0.05% v/v) the membranes were incubated with horseradish peroxidase-labeled goat anti-mouse IgG (1:5000; KPL) or alkaline phosphatase AffinePure goat anti-human IgG (1:2000; Jackson ImmunoResearch) for 1 h. After 3 washes with PBST, the reaction was developed with a chemiluminescence detection system ECL (GE Healthcare) or NBT/BCIP (Thermo Fisher Scientific) according to manufacturer&#x2019;s instructions and analyzed by Alliance 4.7 software (Uvitec; Cambridge).</p>
</sec>
<sec id="s2_6">
<title>Western blot</title>
<p>Approximately 1 &#x3bc;g of recombinant E<sub>ZIKV</sub>, EDI/II<sub>ZIKV</sub> or EDIII<sub>ZIKV</sub> proteins were subjected to SDS-PAGE gel electrophoresis under reducing conditions and transferred to nitrocellulose membranes (Hybond-C extra nitrocellulose &#x2013; GE Healthcare). Next, the membrane was blocked with PBS BSA (5% w/v), overnight at 4&#xb0;C. The membrane was washed three times with PBST (0,05% v/v) and incubated human serum (ZIKV-infected patient, 1:500) for 2 h. After 3 washes with PBST (0.05% v/v) the membrane was incubated with alkaline phosphatase AffinePure goat anti-human IgG (1:2000; Jackson ImmunoResearch) for 1 h. After 3 washes with PBST, the reaction was developed with NBT/BCIP (Thermo Fisher Scientific) according to manufacturer&#x2019;s instructions and analyzed by Alliance 4.7 software (Uvitec; Cambridge).</p>
</sec>
<sec id="s2_7">
<title>Detection of IFN-&#x3b3; producing cells by ELISPOT</title>
<p>The ELISPOT assay was performed using human IFN-<bold>&#x3b3;</bold> ELISPOT Ready-SET-Go! (eBiosciences) according to manufacturer&#x2019;s instructions. At the time of the assay, PBMC were rapidly thawed in a 37&#xb0;C water bath, washed and transferred to tubes containing R10 (RPMI supplemented with 10% of fetal bovine serum, 2 mM l-glutamine, 1% v/v vitamin solution, 1 mM sodium pyruvate, 1% v/v non-essential amino acids solution, 40 &#x3bc;g/mL of gentamicin, 2-mercaptoethanol (all from Gibco), 20 &#x3bc;g/mL of Ciprofloxacin (Ciprobacter, Isofarma) and 30 U/mL of recombinant IL-2 (Zodiac) and incubated in a 5% CO<sub>2</sub> chamber at 37&#xb0;C for 20 hours. After this period, cells were counted, checked for viability by Trypan blue dye exclusion (only samples with 80% or more viable cells were used) and resuspended (concentration 2x10<sup>6</sup> cells/mL; 100 &#x3bc;l/well &#x2013; 2x10<sup>5</sup> cells/well) in R10. Then the cells were stimulated with inactivated ZIKV particles (1x10<sup>5</sup> PFU/well), equimolar amounts of recombinant E<sub>ZIKV</sub> (10 &#x3bc;g/mL) protein and its ectodomains EDI/II<sub>ZIKV</sub> (7.78 &#x3bc;g/mL) and EDIII<sub>ZIKV</sub> (2.44 &#x3bc;g/mL), medium alone as negative control or phorbol 12-myristate 13-acetate (PMA) and ionomycin (50 ng/mL and 1 &#x3bc;g/mL, respectively) as positive control. Spots were counted using an AID ELISPOT Reader System (Autoimmun Diagnostika GmbH, Germany). The number of IFN-<bold>&#x3b3;</bold> producing cells/10<sup>6</sup> PBMC was calculated after subtracting the negative control values and the cutoff was 22 spots for inactivated ZIKV and 64; 65; 96 spots per million cells for E<sub>ZIKV</sub>, EDI/II<sub>ZIKV</sub> and EDIII<sub>ZIKV</sub>, respectively.</p>
</sec>
<sec id="s2_8">
<title>Data analysis</title>
<p>Statistical significance (<italic>p</italic>-values) was calculated by Kruskal-Wallis followed by Dunn&#x2019;s <italic>post hoc</italic> test for multiple comparisons (ZIKV vs E<sub>ZIKV</sub> and ectodomains) or Mann-Whitney test. Statistical analysis and graphical representation were conducted using GraphPad Prism version 9.0 software.</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<title>Results</title>
<sec id="s3_1">
<title>Characteristics of convalescent samples</title>
<p>All 32 mothers delivered babies with microcephaly attributed to ZIKV infection. The majority (21/32 or 65.62%) were unable to specify the exact onset of ZIKV-related symptoms. Seven (21.87%) participants reported symptom initiation during the first trimester of pregnancy, and the remaining (4/32 or 12.5%) during the second or third trimester. Seventy-two percent (72%) of the participants presented one or more symptoms, including fever (18.3%), rash (29.5%), arthralgia (16.9%), conjunctivitis (2.8%), retro-orbital pain (15.4%), myalgia (15.49%) and lymphadenopathy (1.4%) (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1A</bold></xref>). Blood samples were collected post ZIKV diagnosis confirmation, with a median time of 18 months (IQR 13.5-19) after delivery. Serum samples were tested for IgG detection for both ZIKV and DENV infection, following the Brazilian Ministry of Health recommendations. All participants tested positive for ZIKV and DENV, with significantly higher reactivity against ZIKV (<xref ref-type="fig" rid="f1"><bold>Figure&#xa0;1B</bold></xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Cohort characteristics. <bold>(A)</bold> Schematic diagram of symptoms from convalescent mothers of newborns with microcephaly; <bold>(B)</bold> Antibody response against dengue virus (DENV) and Zika virus (ZIKV) by ELISA (IgG Euroimunn). Statistical significance was tested by Mann-Whitney test. ****p&lt;0.0001.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fitd-05-1369608-g001.tif"/>
</fig>
</sec>
<sec id="s3_2">
<title>Antigenicity of the recombinant proteins and inactivated virus</title>
<p>E<sub>ZIKV</sub> (50kDa), EDI/II<sub>ZIKV</sub> (36kDa) and EDIII<sub>ZIKV</sub> (11kDa) were purified by affinity chromatography. To assess whether the recombinant proteins retained their antigenicity, a western blot analysis was conducted using serum from a convalescent individual infected with ZIKV. The serum antibodies recognized all E<sub>ZIKV</sub> recombinant proteins indicating that the recombinant proteins retained their antigenic properties (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;1A</bold></xref>). Subsequently, serum from a ZIKV-infected individual and the monoclonal antibody 4G2 (pan flavivirus) recognized the inactivated ZIKV by dot blot analysis (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;1B</bold></xref>), confirming that it retained conformational and antigenic properties post inactivation. In contrast, no recognition of the inactivated ZIKV was observed by the control serum (ZIKV<sup>-</sup>).</p>
</sec>
<sec id="s3_3">
<title>Inactivated ZIKV and different E-proteins induce specific IFN&#x3b3;-secreting cells from convalescent mothers</title>
<p>To analyze whether PBMC from convalescent mothers could produce specific IFN-&#x3b3; against inactivated virus or different ZIKV-envelope proteins, an ELISpot assay was performed. Initially, PBMC from all participants produced IFN-<bold>&#x3b3;</bold> when stimulated with inactivated ZIKV particles (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2</bold></xref>), with most (31/32) displaying a higher number of IFN-&#x3b3;-producing cells compared to PBMC from healthy controls. Subsequently, the response against the recombinant E<sub>ZIKV</sub> protein and its ectodomains was evaluated. The majority of PBMC from infected participants produced IFN-&#x3b3; when stimulated with recombinant E<sub>ZIKV</sub> protein (90.6% of positivity, <xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3A</bold></xref>), and its ectodomains EDI/II<sub>ZIKV</sub> (96.9% of positivity) and EDIII<sub>ZIKV</sub> (90.6% of positivity) (<xref ref-type="fig" rid="f3"><bold>Figures&#xa0;3B, C</bold></xref>, respectively). Only one participant (#068) presented values below the cutoff (22 spots). In contrast, PBMC from healthy controls exhibited a low number of specific IFN-&#x3b3; producing cells when stimulated with inactivated ZIKV particles (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2</bold></xref>), E<sub>ZIKV</sub> protein, or its ectodomains (<xref ref-type="fig" rid="f3"><bold>Figure&#xa0;3</bold></xref>). Notably, PBMC of participant #068 failed to produce IFN-&#x3b3; against all stimuli tested, despite the high antibody titers against ZIKV in the serum. A comparison of the number of IFN-&#x3b3; producing cells among all stimuli (<xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4A</bold></xref>) revealed a difference in the magnitude of the response. In general, when a sample was positive for the E<sub>ZIKV</sub> protein, it also responded to its ectodomains, suggesting that the ectodomains are as antigenic as the entire E<sub>ZIKV</sub> protein. Samples from healthy controls showed numbers of IFN-&#x3b3;-producing cells below their respective cutoffs (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;2</bold></xref>).</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Peripheral blood mononuclear cells (PBMC) of convalescent mothers of newborns with microcephaly produce ZIKV-specific IFN-&#x3b3;. PBMC were cultured in the presence of inactivated ZIKV (10<sup>5</sup> PFU) for 24 h to evaluate the number of IFN&#x3b3;-producing cells by ELISpot assay. SFU, spot-forming units. Cutoff = 22.63 SFU/10<sup>6</sup> cells.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fitd-05-1369608-g002.tif"/>
</fig>
<fig id="f3" position="float">
<label>Figure&#xa0;3</label>
<caption>
<p>Convalescent PBMC produce IFN-&#x3b3; against recombinant E<sub>ZIKV</sub> and its ectodomains. PBMC were cultured in the presence of recombinant E<sub>ZIKV</sub> protein <bold>(A)</bold> or its ectodomains EDI/EDII<sub>ZIKV</sub> <bold>(B)</bold> and EDIII<sub>ZIKV</sub> <bold>(C)</bold> for 24 h to evaluate the number of IFN-&#x3b3;-producing cells by ELISpot assay. Cells were cultured with equimolar amounts of recombinant E<sub>ZIKV</sub> protein or its ectodomains. SFU, spot-forming units. Cutoff E<sub>ZIKV</sub> = 64 SFU/10<sup>6</sup> cells; EDI/EDII<sub>ZIKV</sub> = 65.86 SFU/10<sup>6</sup> cells and EDIII<sub>ZIKV</sub> = 96.51 SFU/10<sup>6</sup> cells.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fitd-05-1369608-g003.tif"/>
</fig>
<fig id="f4" position="float">
<label>Figure&#xa0;4</label>
<caption>
<p>Comparison of the number of IFN-&#x3b3; producing cells. <bold>(A)</bold> PBMC were cultured in the presence of inactivated ZIKV (10<sup>5</sup> PFU), E<sub>ZIKV</sub> protein or its ectodomains EDI/EDII<sub>ZIKV</sub> and EDIII<sub>ZIKV</sub> (equimolar amounts) for 24 h to evaluate the number of IFN-&#x3b3;-producing cells by ELISpot assay. SFU, spot forming units. Cutoff E<sub>ZIKV</sub> = 64 SFU/10<sup>6</sup> cells; EDI/EDII<sub>ZIKV</sub> = 65.86 SFU/10<sup>6</sup> cells and EDIII<sub>ZIKV</sub> = 96.51 SFU/10<sup>6</sup> cells. Statistical significance was tested using the Kruskal-Wallis and Dunn&#x2019;s <italic>post hoc</italic> tests for multiple comparisons. <bold>(B)</bold> Heat map showing the number of IFN-&#x3b3;-producing cells (SFU) for each stimulus. NS, Non-significant.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fitd-05-1369608-g004.tif"/>
</fig>
<p>
<xref ref-type="fig" rid="f4"><bold>Figure&#xa0;4B</bold></xref> displays the magnitude of the IFN-&#x3b3; response for each participant. Overall, a high specific cellular response was observed, with patient #057 presenting the highest magnitude against the three recombinant proteins tested. Additional analysis (<xref ref-type="fig" rid="f5"><bold>Figure&#xa0;5</bold></xref>) revealed a significant correlation of IFN-&#x3b3; production between ZIKV virus particles and all recombinant proteins, suggesting that the recombinant proteins preserved their structures similarly to the native virus. Furthermore, no significant correlation was observed between the number of symptoms and cellular immunity against the virus nor to recombinant proteins (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;3</bold></xref>).</p>
<fig id="f5" position="float">
<label>Figure&#xa0;5</label>
<caption>
<p>Correlation of IFN-&#x3b3; response. Spearman correlation was used to evaluate the correlation between the number of IFN-&#x3b3;-producing cells when stimulated with ZIKV inactivated versus E<sub>ZIKV</sub> <bold>(A)</bold>, ZIKV inactivated versus EDI/II<sub>ZIKV</sub> <bold>(B)</bold>, ZIKV inactivated versus EDIII<sub>ZIKV</sub> <bold>(C)</bold>, E<sub>ZIKV</sub> versus EDI/II<sub>ZIKV</sub> <bold>(D)</bold>, E<sub>ZIKV</sub> versus EDIII<sub>ZIKV</sub> <bold>(E)</bold>, and EDI/II<sub>ZIKV</sub> versus EDIII<sub>ZIKV</sub> <bold>(F)</bold>.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fitd-05-1369608-g005.tif"/>
</fig>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<title>Discussion</title>
<p>The recent global spread of ZIKV infection, together with its association with neurologic morbidity in neonates and adults, underscores the urgent need for a safe and effective vaccine against this virus. Success in developing vaccines for flavivirus, such as the yellow fever and Japanese encephalitis viruses, demonstrated the feasibility of vaccine-induced immunity (<xref ref-type="bibr" rid="B36">36</xref>, <xref ref-type="bibr" rid="B37">37</xref>). However, existing vaccines based on live attenuated viruses have limitations, with contraindications for certain populations, such as children (&lt;6months of age), pregnant women, and immunocompromised individuals (<xref ref-type="bibr" rid="B38">38</xref>, <xref ref-type="bibr" rid="B39">39</xref>). In this study, we aimed to better understand the specific regions of E<sub>ZIKV</sub> targeted by cellular immunity, with a focus on understanding T cell responses in PBMC from women infected with ZIKV during pregnancy. All mothers in the cohort delivered babies with microcephaly and tested seropositive for both ZIKV and DENV.</p>
<p>The ZIKV envelope protein, essential for virus entry, is the main antigen that triggers the host immune response (<xref ref-type="bibr" rid="B18">18</xref>). The EDIII<sub>ZIKV</sub> domain, in particular, has shown promise as a vaccine candidate, inducing protection against ZIKV challenge in mice (<xref ref-type="bibr" rid="B40">40</xref>&#x2013;<xref ref-type="bibr" rid="B42">42</xref>). Furthermore, antibodies generated against EDIII persist for a long period of time (<xref ref-type="bibr" rid="B43">43</xref>). Our study revealed that not only the entire envelope protein (E<sub>ZIKV</sub>) but also its structural domains, EDI/II<sub>ZIKV</sub> and EDIII<sub>ZIKV,</sub> induced robust adaptive immune responses.</p>
<p>Characterization of the immune response against the ZIKV in animal models has been extensively investigated by various studies (<xref ref-type="bibr" rid="B22">22</xref>, <xref ref-type="bibr" rid="B23">23</xref>, <xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B44">44</xref>), including our group, revealing increased recognition of envelope regions by the adaptive immune response, presenting promising implications for the ZIKV diagnosis and vaccine development (<xref ref-type="bibr" rid="B35">35</xref>, <xref ref-type="bibr" rid="B45">45</xref>). However, elucidating the immune response against ZIKV in humans poses challenges, primarily attributable to a substantial decline in the reported cases.</p>
<p>A recent study, using PBMC from ZIKV-infected pregnant women, analyzed the immune response 2-3 years post-infection. This study demonstrated sustained CD4<sup>+</sup> T cell immunity, but the same was not observed for CD8<sup>+</sup> T cells. Intriguingly, the T cell response of the mothers against ZIKV did not exhibit a clear correlation with the clinical outcomes of their children (<xref ref-type="bibr" rid="B31">31</xref>). Using PBMC from convalescent ZIKV patients, we detected a specific cellular immune response 1.5 years post-infection, suggesting that natural infection induces the generation of memory T cells capable of producing IFN-&#x3b3; against the inactivated virus and various E<sub>ZIKV</sub> proteins.</p>
<p>A longitudinal study involving 10 nonpregnant ZIKV-infected women observed the presence of ZIKV antibodies and virus-specific CD4<sup>+</sup> and CD8<sup>+</sup> T cells (<xref ref-type="bibr" rid="B30">30</xref>). Indeed, structural proteins of ZIKV, including E, prM, and C, emerged as major targets for both CD4<sup>+</sup> and CD8<sup>+</sup> T cell responses (<xref ref-type="bibr" rid="B28">28</xref>). Notably, the immune response against ZIKV is detectable during acute infection, with CD4<sup>+</sup> T cell responses primarily targeting E, prM, C and NS5 (<xref ref-type="bibr" rid="B46">46</xref>). Prior exposure to DENV was suggested to influence the T cell response to subsequent ZIKV infection (<xref ref-type="bibr" rid="B28">28</xref>), with cross-reactive T cells potentially expanded via stimulation with ZIKV peptides (<xref ref-type="bibr" rid="B47">47</xref>).</p>
<p>Considering the co-circulation of DENV and ZIKV in Brazil (<xref ref-type="bibr" rid="B48">48</xref>), it is probable that our cohort was exposed to DENV before ZIKV, supported by the positive serology for DENV. However, the chronological sequence of DENV exposure and ZIKV infection remains uncertain and could potentially influence or alter the observed responses. We cannot exclude the possibility that DENV exposure could have occurred after ZIKV infection and may have skewed or altered the responses in some way. Although several studies evaluated T cell immune responses against ZIKV proteins in DENV immune or non-immune participants (<xref ref-type="bibr" rid="B27">27</xref>, <xref ref-type="bibr" rid="B49">49</xref>&#x2013;<xref ref-type="bibr" rid="B51">51</xref>), the precise influence of a previous DENV exposure on ZIKV response modulation remains unclear. A study indicated that acute ZIKV infection proceeded by DENV infection had limited effects on T cells (<xref ref-type="bibr" rid="B30">30</xref>, <xref ref-type="bibr" rid="B52">52</xref>). In DENV-na&#xef;ve/ZIKV-infected patients, CD4<sup>+</sup> and CD8<sup>+</sup> T cell responses targeted envelope proteins (<xref ref-type="bibr" rid="B53">53</xref>). Thus, even without being able to state whether previous exposure to the DENV virus can interfere with the modulation of the response against ZIKV, all mothers presented strong immune response against envelope proteins when compared to control individuals, thus demonstrating that the E<sub>ZIKV</sub>-immune response is long-term and specific.</p>
<p>Finally, interpretation of our findings must consider certain limitations. A longitudinal study, following volunteers during the acute phase rather than just convalescence, would provide a more comprehensive understanding of acquired immunity to ZIKV. Additionally, the sample size was limited, and it would be valuable to compare immune responses from mothers who were infected and did not have babies with microcephaly. Unfortunately, such cases were not available and further studies are required to address these issues.</p>
<p>In summary, our findings highlight the recognition of ZIKV envelope protein regions by memory T cells in mothers 1.5 years post-infection. These results provide important insights into vulnerable regions of viral proteins, contributing to the development of specific treatments (monoclonal antibodies) and an effective and safe vaccine suitable for administration to pregnant women.</p>
</sec>
<sec id="s5" sec-type="conclusion">
<title>Conclusion</title>
<p>Taken together, our data reveal that distinct E<sub>ZIKV</sub> proteins elicited specific IFN-&#x3b3; production in PBMC derived from women previously infected with ZIKV. This feature holds significant promise for helping the design of safe ZIKV vaccines tailored for pregnant women.</p>
</sec>
<sec id="s6" sec-type="data-availability">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="s7" sec-type="ethics-statement">
<title>Ethics statement</title>
<p>The studies involving humans were approved by ethics committee from Federal University of Sergipe and Federal University of S&#xe3;o Paulo committee (CAAE: 54835916.2.0000.5546 and CAAE: 80487717.7.0000.5505). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.</p>
</sec>
<sec id="s8" sec-type="author-contributions">
<title>Author contributions</title>
<p>JA: Data curation, Formal analysis, Investigation, Methodology, Validation, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. VL: Data curation, Formal analysis, Investigation, Methodology, Validation, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. SB: Conceptualization, Methodology, Resources, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing. VF: Resources, Writing &#x2013; original draft. RMA: Resources, Writing &#x2013; original draft. JK: Conceptualization, Funding acquisition, Methodology, Resources, Writing &#x2013; original draft. RPA: Resources, Writing &#x2013; original draft. EC-N: Conceptualization, Funding acquisition, Methodology, Resources, Writing &#x2013; original draft. DR: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing &#x2013; original draft, Writing &#x2013; review &amp; editing.</p>
</sec>
</body>
<back>
<sec id="s9" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by Funda&#xe7;&#xe3;o de Amparo &#xe0; Pesquisa do Estado de S&#xe3;o Paulo (grant numbers 2017-1741-7; 2021/13004-0), Conselho Nacional de Desenvolvimento Cient&#xed;fico e Tecnol&#xf3;gico (CNPq/DECIT/CAPES grant number 440400/2016-3; (INCT/CNPq-iii grant 465434/2014). DR, SB, JK and ECN are recipients of CNPq fellowships.</p>
</sec>
<sec id="s10" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s11" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s12" sec-type="supplementary-material">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fitd.2024.1369608/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fitd.2024.1369608/full#supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet_1.docx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
</sec>
<ref-list>
<title>References</title>
<ref id="B1">
<label>1</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Gatherer</surname> <given-names>D</given-names>
</name>
<name>
<surname>Kohl</surname> <given-names>A</given-names>
</name>
</person-group>. <article-title>Zika virus: A previously slow pandemic spreads rapidly through the americas</article-title>. <source>J Gen Virol</source>. (<year>2016</year>) <volume>97</volume>:<page-range>269&#x2013;73</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1099/jgv.0.000381</pub-id>
</citation>
</ref>
<ref id="B2">
<label>2</label>
<citation citation-type="book">
<person-group person-group-type="author">
<collab>WHO</collab>
</person-group>. <source>Zika Virus, Microcephaly, Guillain-Barr&#xe9; Syndrome</source>. <person-group person-group-type="editor">
<name>
<surname>Report</surname> <given-names>S</given-names>
</name>
</person-group>, editor. <publisher-name>World Health Organization</publisher-name> (<year>2017</year>).</citation>
</ref>
<ref id="B3">
<label>3</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brooks</surname> <given-names>JT</given-names>
</name>
<name>
<surname>Friedman</surname> <given-names>A</given-names>
</name>
<name>
<surname>Kachur</surname> <given-names>RE</given-names>
</name>
<name>
<surname>LaFlam</surname> <given-names>M</given-names>
</name>
<name>
<surname>Peters</surname> <given-names>PJ</given-names>
</name>
<name>
<surname>Jamieson</surname> <given-names>DJ</given-names>
</name>
</person-group>. <article-title>Update: interim guidance for prevention of sexual transmission of Zika virus - United States, july 2016</article-title>. <source>MMWR Morb Mortal Wkly Rep</source>. (<year>2016</year>) <volume>65</volume>:<page-range>745&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.15585/mmwr.mm6529e2</pub-id>
</citation>
</ref>
<ref id="B4">
<label>4</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Collins</surname> <given-names>MH</given-names>
</name>
<name>
<surname>Waggoner</surname> <given-names>JJ</given-names>
</name>
</person-group>. <article-title>Detecting vertical Zika transmission: emerging diagnostic approaches for an emerged flavivirus</article-title>. <source>ACS Infect Dis</source>. (<year>2019</year>) <volume>5</volume>:<page-range>1055&#x2013;69</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1021/acsinfecdis.9b00003</pub-id>
</citation>
</ref>
<ref id="B5">
<label>5</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Haddow</surname> <given-names>AD</given-names>
</name>
<name>
<surname>Schuh</surname> <given-names>AJ</given-names>
</name>
<name>
<surname>Yasuda</surname> <given-names>CY</given-names>
</name>
<name>
<surname>Kasper</surname> <given-names>MR</given-names>
</name>
<name>
<surname>Heang</surname> <given-names>V</given-names>
</name>
<name>
<surname>Huy</surname> <given-names>R</given-names>
</name>
<etal/>
</person-group>. <article-title>Genetic characterization of Zika virus strains: geographic expansion of the asian lineage</article-title>. <source>PloS Negl Trop Dis</source>. (<year>2012</year>) <volume>6</volume>:<elocation-id>e1477</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pntd.0001477</pub-id>
</citation>
</ref>
<ref id="B6">
<label>6</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Cao-Lormeau</surname> <given-names>VM</given-names>
</name>
<name>
<surname>Blake</surname> <given-names>A</given-names>
</name>
<name>
<surname>Mons</surname> <given-names>S</given-names>
</name>
<name>
<surname>Lastere</surname> <given-names>S</given-names>
</name>
<name>
<surname>Roche</surname> <given-names>C</given-names>
</name>
<name>
<surname>Vanhomwegen</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Guillain-barre syndrome outbreak associated with Zika virus infection in French Polynesia: A case-control study</article-title>. <source>Lancet</source>. (<year>2016</year>) <volume>387</volume>:<page-range>1531&#x2013;9</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S0140-6736(16)00562-6</pub-id>
</citation>
</ref>
<ref id="B7">
<label>7</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Styczynski</surname> <given-names>AR</given-names>
</name>
<name>
<surname>Malta</surname> <given-names>J</given-names>
</name>
<name>
<surname>Krow-Lucal</surname> <given-names>ER</given-names>
</name>
<name>
<surname>Percio</surname> <given-names>J</given-names>
</name>
<name>
<surname>Nobrega</surname> <given-names>ME</given-names>
</name>
<name>
<surname>Vargas</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Increased rates of guillain-barre syndrome associated with Zika virus outbreak in the salvador metropolitan area, Brazil</article-title>. <source>PloS Negl Trop Dis</source>. (<year>2017</year>) <volume>11</volume>:<elocation-id>e0005869</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pntd.0005869</pub-id>
</citation>
</ref>
<ref id="B8">
<label>8</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Govero</surname> <given-names>J</given-names>
</name>
<name>
<surname>Esakky</surname> <given-names>P</given-names>
</name>
<name>
<surname>Scheaffer</surname> <given-names>SM</given-names>
</name>
<name>
<surname>Fernandez</surname> <given-names>E</given-names>
</name>
<name>
<surname>Drury</surname> <given-names>A</given-names>
</name>
<name>
<surname>Platt</surname> <given-names>DJ</given-names>
</name>
<etal/>
</person-group>. <article-title>Zika virus infection damages the testes in mice</article-title>. <source>Nature</source>. (<year>2016</year>) <volume>540</volume>:<page-range>438&#x2013;42</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nature20556</pub-id>
</citation>
</ref>
<ref id="B9">
<label>9</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tang</surname> <given-names>WW</given-names>
</name>
<name>
<surname>Young</surname> <given-names>MP</given-names>
</name>
<name>
<surname>Mamidi</surname> <given-names>A</given-names>
</name>
<name>
<surname>Regla-Nava</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>K</given-names>
</name>
<name>
<surname>Shresta</surname> <given-names>S</given-names>
</name>
</person-group>. <article-title>A mouse model of Zika virus sexual transmission and vaginal viral replication</article-title>. <source>Cell Rep</source>. (<year>2016</year>) <volume>17</volume>:<page-range>3091&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.celrep.2016.11.070</pub-id>
</citation>
</ref>
<ref id="B10">
<label>10</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Brasil</surname> <given-names>P</given-names>
</name>
<name>
<surname>Pereira</surname> <given-names>JP</given-names>
<suffix>Jr.</suffix>
</name>
<name>
<surname>Moreira</surname> <given-names>ME</given-names>
</name>
<name>
<surname>Ribeiro Nogueira</surname> <given-names>RM</given-names>
</name>
<name>
<surname>Damasceno</surname> <given-names>L</given-names>
</name>
<name>
<surname>Wakimoto</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Zika virus infection in pregnant women in rio de janeiro</article-title>. <source>N Engl J Med</source>. (<year>2016</year>) <volume>375</volume>:<page-range>2321&#x2013;34</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1056/NEJMoa1602412</pub-id>
</citation>
</ref>
<ref id="B11">
<label>11</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Franca</surname> <given-names>GV</given-names>
</name>
<name>
<surname>Schuler-Faccini</surname> <given-names>L</given-names>
</name>
<name>
<surname>Oliveira</surname> <given-names>WK</given-names>
</name>
<name>
<surname>Henriques</surname> <given-names>CM</given-names>
</name>
<name>
<surname>Carmo</surname> <given-names>EH</given-names>
</name>
<name>
<surname>Pedi</surname> <given-names>VD</given-names>
</name>
<etal/>
</person-group>. <article-title>Congenital Zika virus syndrome in Brazil: A case series of the first 1501 livebirths with complete investigation</article-title>. <source>Lancet</source>. (<year>2016</year>) <volume>388</volume>:<page-range>891&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/S0140-6736(16)30902-3</pub-id>
</citation>
</ref>
<ref id="B12">
<label>12</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Kleber de Oliveira</surname> <given-names>W</given-names>
</name>
<name>
<surname>Cortez-Escalante</surname> <given-names>J</given-names>
</name>
<name>
<surname>De Oliveira</surname> <given-names>WT</given-names>
</name>
<name>
<surname>do Carmo</surname> <given-names>GM</given-names>
</name>
<name>
<surname>Henriques</surname> <given-names>CM</given-names>
</name>
<name>
<surname>Coelho</surname> <given-names>GE</given-names>
</name>
<etal/>
</person-group>. <article-title>Increase in reported prevalence of microcephaly in infants born to women living in areas with confirmed Zika virus transmission during the first trimester of pregnancy - Brazil, 2015</article-title>. <source>MMWR Morb Mortal Wkly Rep</source>. (<year>2016</year>) <volume>65</volume>:<page-range>242&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.15585/mmwr.mm6509e2</pub-id>
</citation>
</ref>
<ref id="B13">
<label>13</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Einspieler</surname> <given-names>C</given-names>
</name>
<name>
<surname>Utsch</surname> <given-names>F</given-names>
</name>
<name>
<surname>Brasil</surname> <given-names>P</given-names>
</name>
<name>
<surname>Panvequio Aizawa</surname> <given-names>CY</given-names>
</name>
<name>
<surname>Peyton</surname> <given-names>C</given-names>
</name>
<name>
<surname>Hydee Hasue</surname> <given-names>R</given-names>
</name>
<etal/>
</person-group>. <article-title>Association of infants exposed to prenatal Zika virus infection with their clinical, neurologic, and developmental status evaluated via the general movement assessment tool</article-title>. <source>JAMA Netw Open</source>. (<year>2019</year>) <volume>2</volume>:<elocation-id>e187235</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1001/jamanetworkopen.2018.7235</pub-id>
</citation>
</ref>
<ref id="B14">
<label>14</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Mulkey</surname> <given-names>SB</given-names>
</name>
<name>
<surname>Arroyave-Wessel</surname> <given-names>M</given-names>
</name>
<name>
<surname>Peyton</surname> <given-names>C</given-names>
</name>
<name>
<surname>Bulas</surname> <given-names>DI</given-names>
</name>
<name>
<surname>Fourzali</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Jiang</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Neurodevelopmental abnormalities in children with in utero Zika virus exposure without congenital Zika syndrome</article-title>. <source>JAMA Pediatr</source>. (<year>2020</year>) <volume>174</volume>:<page-range>269&#x2013;76</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1001/jamapediatrics.2019.5204</pub-id>
</citation>
</ref>
<ref id="B15">
<label>15</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lunardelli</surname> <given-names>VAS</given-names>
</name>
<name>
<surname>Apostolico</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Fernandes</surname> <given-names>ER</given-names>
</name>
<name>
<surname>Santoro Rosa</surname> <given-names>D</given-names>
</name>
</person-group>. <article-title>Zika virus-an update on the current efforts for vaccine development</article-title>. <source>Hum Vaccin Immunother</source>. (<year>2021</year>) <volume>17</volume>:<page-range>904&#x2013;8</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1080/21645515.2020.1796428</pub-id>
</citation>
</ref>
<ref id="B16">
<label>16</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sirohi</surname> <given-names>D</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>L</given-names>
</name>
<name>
<surname>Klose</surname> <given-names>T</given-names>
</name>
<name>
<surname>Pierson</surname> <given-names>TC</given-names>
</name>
<name>
<surname>Rossmann</surname> <given-names>MG</given-names>
</name>
<etal/>
</person-group>. <article-title>The 3.8 a resolution cryo-em structure of Zika virus</article-title>. <source>Science</source>. (<year>2016</year>) <volume>352</volume>:<page-range>467&#x2013;70</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1126/science.aaf5316</pub-id>
</citation>
</ref>
<ref id="B17">
<label>17</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Faye</surname> <given-names>O</given-names>
</name>
<name>
<surname>Freire</surname> <given-names>CC</given-names>
</name>
<name>
<surname>Iamarino</surname> <given-names>A</given-names>
</name>
<name>
<surname>Faye</surname> <given-names>O</given-names>
</name>
<name>
<surname>de Oliveira</surname> <given-names>JV</given-names>
</name>
<name>
<surname>Diallo</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Molecular evolution of Zika virus during its emergence in the 20(Th) century</article-title>. <source>PloS Negl Trop Dis</source>. (<year>2014</year>) <volume>8</volume>:<elocation-id>e2636</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pntd.0002636</pub-id>
</citation>
</ref>
<ref id="B18">
<label>18</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Dai</surname> <given-names>L</given-names>
</name>
<name>
<surname>Song</surname> <given-names>J</given-names>
</name>
<name>
<surname>Lu</surname> <given-names>X</given-names>
</name>
<name>
<surname>Deng</surname> <given-names>YQ</given-names>
</name>
<name>
<surname>Musyoki</surname> <given-names>AM</given-names>
</name>
<name>
<surname>Cheng</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>Structures of the Zika virus envelope protein and its complex with a flavivirus broadly protective antibody</article-title>. <source>Cell Host Microbe</source>. (<year>2016</year>) <volume>19</volume>:<fpage>696</fpage>&#x2013;<lpage>704</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.chom.2016.04.013</pub-id>
</citation>
</ref>
<ref id="B19">
<label>19</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Whitehead</surname> <given-names>SS</given-names>
</name>
<name>
<surname>Blaney</surname> <given-names>JE</given-names>
</name>
<name>
<surname>Durbin</surname> <given-names>AP</given-names>
</name>
<name>
<surname>Murphy</surname> <given-names>BR</given-names>
</name>
</person-group>. <article-title>Prospects for a dengue virus vaccine</article-title>. <source>Nat Rev Microbiol</source>. (<year>2007</year>) <volume>5</volume>:<page-range>518&#x2013;28</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nrmicro1690</pub-id>
</citation>
</ref>
<ref id="B20">
<label>20</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Stettler</surname> <given-names>K</given-names>
</name>
<name>
<surname>Beltramello</surname> <given-names>M</given-names>
</name>
<name>
<surname>Espinosa</surname> <given-names>DA</given-names>
</name>
<name>
<surname>Graham</surname> <given-names>V</given-names>
</name>
<name>
<surname>Cassotta</surname> <given-names>A</given-names>
</name>
<name>
<surname>Bianchi</surname> <given-names>S</given-names>
</name>
<etal/>
</person-group>. <article-title>Specificity, cross-reactivity, and function of antibodies elicited by Zika virus infection</article-title>. <source>Science</source>. (<year>2016</year>) <volume>353</volume>:<page-range>823&#x2013;6</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1126/science.aaf8505</pub-id>
</citation>
</ref>
<ref id="B21">
<label>21</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Sapparapu</surname> <given-names>G</given-names>
</name>
<name>
<surname>Fernandez</surname> <given-names>E</given-names>
</name>
<name>
<surname>Kose</surname> <given-names>N</given-names>
</name>
<name>
<surname>Bin</surname> <given-names>C</given-names>
</name>
<name>
<surname>Fox</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Bombardi</surname> <given-names>RG</given-names>
</name>
<etal/>
</person-group>. <article-title>Neutralizing human antibodies prevent Zika virus replication and fetal disease in mice</article-title>. <source>Nature</source>. (<year>2016</year>) <volume>540</volume>:<page-range>443&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nature20564</pub-id>
</citation>
</ref>
<ref id="B22">
<label>22</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Elong Ngono</surname> <given-names>A</given-names>
</name>
<name>
<surname>Vizcarra</surname> <given-names>EA</given-names>
</name>
<name>
<surname>Tang</surname> <given-names>WW</given-names>
</name>
<name>
<surname>Sheets</surname> <given-names>N</given-names>
</name>
<name>
<surname>Joo</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>Mapping and role of the Cd8+ T cell response during primary Zika virus infection in mice</article-title>. <source>Cell Host Microbe</source>. (<year>2017</year>) <volume>21</volume>:<fpage>35</fpage>&#x2013;<lpage>46</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.chom.2016.12.010</pub-id>
</citation>
</ref>
<ref id="B23">
<label>23</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lucas</surname> <given-names>CGO</given-names>
</name>
<name>
<surname>Kitoko</surname> <given-names>JZ</given-names>
</name>
<name>
<surname>Ferreira</surname> <given-names>FM</given-names>
</name>
<name>
<surname>Suzart</surname> <given-names>VG</given-names>
</name>
<name>
<surname>Papa</surname> <given-names>MP</given-names>
</name>
<name>
<surname>Coelho</surname> <given-names>SVA</given-names>
</name>
<etal/>
</person-group>. <article-title>Critical role of Cd4(+) T cells and ifngamma signaling in antibody-mediated resistance to Zika virus infection</article-title>. <source>Nat Commun</source>. (<year>2018</year>) <volume>9</volume>:<fpage>3136</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41467-018-05519-4</pub-id>
</citation>
</ref>
<ref id="B24">
<label>24</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hassert</surname> <given-names>M</given-names>
</name>
<name>
<surname>Wolf</surname> <given-names>KJ</given-names>
</name>
<name>
<surname>Schwetye</surname> <given-names>KE</given-names>
</name>
<name>
<surname>DiPaolo</surname> <given-names>RJ</given-names>
</name>
<name>
<surname>Brien</surname> <given-names>JD</given-names>
</name>
<name>
<surname>Pinto</surname> <given-names>AK</given-names>
</name>
</person-group>. <article-title>Cd4+T cells mediate protection against Zika associated severe disease in a mouse model of infection</article-title>. <source>PloS Pathog</source>. (<year>2018</year>) <volume>14</volume>:<elocation-id>e1007237</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.ppat.1007237</pub-id>
</citation>
</ref>
<ref id="B25">
<label>25</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Scott</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Lebratti</surname> <given-names>TJ</given-names>
</name>
<name>
<surname>Richner</surname> <given-names>JM</given-names>
</name>
<name>
<surname>Jiang</surname> <given-names>X</given-names>
</name>
<name>
<surname>Fernandez</surname> <given-names>E</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>H</given-names>
</name>
<etal/>
</person-group>. <article-title>Cellular and humoral immunity protect against vaginal Zika virus infection in mice</article-title>. <source>J Virol</source>. (<year>2018</year>) <volume>92</volume>(<issue>7</issue>):<elocation-id>e00038-18</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/JVI.00038-18</pub-id>
</citation>
</ref>
<ref id="B26">
<label>26</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Elong Ngono</surname> <given-names>A</given-names>
</name>
<name>
<surname>Young</surname> <given-names>MP</given-names>
</name>
<name>
<surname>Bunz</surname> <given-names>M</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>Z</given-names>
</name>
<name>
<surname>Hattakam</surname> <given-names>S</given-names>
</name>
<name>
<surname>Vizcarra</surname> <given-names>E</given-names>
</name>
<etal/>
</person-group>. <article-title>Cd4+ T cells promote humoral immunity and viral control during Zika virus infection</article-title>. <source>PloS Pathog</source>. (<year>2019</year>) <volume>15</volume>:<elocation-id>e1007474</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.ppat.1007474</pub-id>
</citation>
</ref>
<ref id="B27">
<label>27</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Regla-Nava</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Elong Ngono</surname> <given-names>A</given-names>
</name>
<name>
<surname>Viramontes</surname> <given-names>KM</given-names>
</name>
<name>
<surname>Huynh</surname> <given-names>AT</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>YT</given-names>
</name>
<name>
<surname>Nguyen</surname> <given-names>AT</given-names>
</name>
<etal/>
</person-group>. <article-title>Cross-reactive dengue virus-specific Cd8(+) T cells protect against Zika virus during pregnancy</article-title>. <source>Nat Commun</source>. (<year>2018</year>) <volume>9</volume>:<fpage>3042</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41467-018-05458-0</pub-id>
</citation>
</ref>
<ref id="B28">
<label>28</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Grifoni</surname> <given-names>A</given-names>
</name>
<name>
<surname>Pham</surname> <given-names>J</given-names>
</name>
<name>
<surname>Sidney</surname> <given-names>J</given-names>
</name>
<name>
<surname>O&#x2019;Rourke</surname> <given-names>PH</given-names>
</name>
<name>
<surname>Paul</surname> <given-names>S</given-names>
</name>
<name>
<surname>Peters</surname> <given-names>B</given-names>
</name>
<etal/>
</person-group>. <article-title>Prior dengue virus exposure shapes T cell immunity to Zika virus in humans</article-title>. <source>J Virol</source>. (<year>2017</year>) <volume>91</volume>(<issue>24</issue>):<elocation-id>e01469-17</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/JVI.01469-17</pub-id>
</citation>
</ref>
<ref id="B29">
<label>29</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Delgado</surname> <given-names>FG</given-names>
</name>
<name>
<surname>Torres</surname> <given-names>KI</given-names>
</name>
<name>
<surname>Castellanos</surname> <given-names>JE</given-names>
</name>
<name>
<surname>Romero-Sanchez</surname> <given-names>C</given-names>
</name>
<name>
<surname>Simon-Loriere</surname> <given-names>E</given-names>
</name>
<name>
<surname>Sakuntabhai</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Improved Immune Responses against Zika Virus after Sequential Dengue and Zika Virus Infection in Humans</article-title>. <source>Viruses</source>. (<year>2018</year>) <volume>10</volume>(<issue>9</issue>):<fpage>480</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.3390/v10090480</pub-id>
</citation>
</ref>
<ref id="B30">
<label>30</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tonnerre</surname> <given-names>P</given-names>
</name>
<name>
<surname>Melgaco</surname> <given-names>JG</given-names>
</name>
<name>
<surname>Torres-Cornejo</surname> <given-names>A</given-names>
</name>
<name>
<surname>Pinto</surname> <given-names>MA</given-names>
</name>
<name>
<surname>Yue</surname> <given-names>C</given-names>
</name>
<name>
<surname>Blumel</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Evolution of the innate and adaptive immune response in women with acute Zika virus infection</article-title>. <source>Nat Microbiol</source>. (<year>2020</year>) <volume>5</volume>:<fpage>76</fpage>&#x2013;<lpage>83</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41564-019-0618-z</pub-id>
</citation>
</ref>
<ref id="B31">
<label>31</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Badolato-Correa</surname> <given-names>J</given-names>
</name>
<name>
<surname>Carvalho</surname> <given-names>FR</given-names>
</name>
<name>
<surname>Paiva</surname> <given-names>IA</given-names>
</name>
<name>
<surname>Familiar-Macedo</surname> <given-names>D</given-names>
</name>
<name>
<surname>Dias</surname> <given-names>HG</given-names>
</name>
<name>
<surname>Pauvolid-Correa</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>Differential longevity of memory Cd4 and Cd8 T cells in a cohort of the mothers with a history of zikv infection and their children</article-title>. <source>Front Immunol</source>. (<year>2021</year>) <volume>12</volume>:<elocation-id>610456</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2021.610456</pub-id>
</citation>
</ref>
<ref id="B32">
<label>32</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Medina</surname> <given-names>F</given-names>
</name>
<name>
<surname>Medina</surname> <given-names>JF</given-names>
</name>
<name>
<surname>Colon</surname> <given-names>C</given-names>
</name>
<name>
<surname>Vergne</surname> <given-names>E</given-names>
</name>
<name>
<surname>Santiago</surname> <given-names>GA</given-names>
</name>
<name>
<surname>Munoz-Jordan</surname> <given-names>JL</given-names>
</name>
</person-group>. <article-title>Dengue virus: isolation, propagation, quantification, and storage</article-title>. <source>Curr Protoc Microbiol</source>. (<year>2012</year>). doi:&#xa0;<pub-id pub-id-type="doi">10.1002/9780471729259.mc15d02s27</pub-id>
</citation>
</ref>
<ref id="B33">
<label>33</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Muller</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Harms</surname> <given-names>M</given-names>
</name>
<name>
<surname>Schubert</surname> <given-names>A</given-names>
</name>
<name>
<surname>Jansen</surname> <given-names>S</given-names>
</name>
<name>
<surname>Michel</surname> <given-names>D</given-names>
</name>
<name>
<surname>Mertens</surname> <given-names>T</given-names>
</name>
<etal/>
</person-group>. <article-title>Inactivation and environmental stability of Zika virus</article-title>. <source>Emerg Infect Dis</source>. (<year>2016</year>) <volume>22</volume>:<page-range>1685&#x2013;7</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.3201/eid2209.160664</pub-id>
</citation>
</ref>
<ref id="B34">
<label>34</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Amaral</surname> <given-names>MP</given-names>
</name>
<name>
<surname>Apostolico</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Tomita</surname> <given-names>N</given-names>
</name>
<name>
<surname>Coirada</surname> <given-names>FC</given-names>
</name>
<name>
<surname>Lunardelli</surname> <given-names>VAS</given-names>
</name>
<name>
<surname>Fernandes</surname> <given-names>ER</given-names>
</name>
<etal/>
</person-group>. <article-title>Homologous prime-boost with Zika virus envelope protein and poly (I:C) induces robust specific humoral and cellular immune responses</article-title>. <source>Vaccine</source>. (<year>2020</year>) <volume>38</volume>:<page-range>3653&#x2013;64</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.vaccine.2020.03.037</pub-id>
</citation>
</ref>
<ref id="B35">
<label>35</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lunardelli</surname> <given-names>VAS</given-names>
</name>
<name>
<surname>de Souza Apostolico</surname> <given-names>J</given-names>
</name>
<name>
<surname>Souza</surname> <given-names>HFS</given-names>
</name>
<name>
<surname>Coirada</surname> <given-names>FC</given-names>
</name>
<name>
<surname>Martinho</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Astray</surname> <given-names>RM</given-names>
</name>
<etal/>
</person-group>. <article-title>Zikv-envelope proteins induce specific humoral and cellular immunity in distinct mice strains</article-title>. <source>Sci Rep</source>. (<year>2022</year>) <volume>12</volume>:<fpage>15733</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-022-20183-x</pub-id>
</citation>
</ref>
<ref id="B36">
<label>36</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Garske</surname> <given-names>T</given-names>
</name>
<name>
<surname>Van Kerkhove</surname> <given-names>MD</given-names>
</name>
<name>
<surname>Yactayo</surname> <given-names>S</given-names>
</name>
<name>
<surname>Ronveaux</surname> <given-names>O</given-names>
</name>
<name>
<surname>Lewis</surname> <given-names>RF</given-names>
</name>
<name>
<surname>Staples</surname> <given-names>JE</given-names>
</name>
<etal/>
</person-group>. <article-title>Yellow fever in Africa: estimating the burden of disease and impact of mass vaccination from outbreak and serological data</article-title>. <source>PloS Med</source>. (<year>2014</year>) <volume>11</volume>:<elocation-id>e1001638</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pmed.1001638</pub-id>
</citation>
</ref>
<ref id="B37">
<label>37</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Hu</surname> <given-names>XT</given-names>
</name>
<name>
<surname>Li</surname> <given-names>QF</given-names>
</name>
<name>
<surname>Ma</surname> <given-names>C</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>ZX</given-names>
</name>
<name>
<surname>He</surname> <given-names>LF</given-names>
</name>
<name>
<surname>Tang</surname> <given-names>TT</given-names>
</name>
<etal/>
</person-group>. <article-title>Reduction patterns of Japanese encephalitis incidence following vaccine introduction into long-term expanded program on immunization in yunnan province, China</article-title>. <source>Infect Dis Poverty</source>. (<year>2019</year>) <volume>8</volume>:<fpage>102</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1186/s40249-019-0608-7</pub-id>
</citation>
</ref>
<ref id="B38">
<label>38</label>
<citation citation-type="web">
<person-group person-group-type="author">
<collab>WHO</collab>
</person-group>. <article-title>Detection and Investigation of Serious Adverse Events Following Yellow Fever Vaccination</article-title>. Available online at: <uri xlink:href="https://appswhoint/iris/bitstream/handle/10665/70251/WHO_HSE_GAR_ERI_20102_engpdf;jsessionid=00CE1944BF3BB748F23372FB80C8AA48?sequence=1">https://appswhoint/iris/bitstream/handle/10665/70251/WHO_HSE_GAR_ERI_20102_engpdf;jsessionid=00CE1944BF3BB748F23372FB80C8AA48?sequence=1</uri> (Accessed <access-date>1 July 2021</access-date>).</citation>
</ref>
<ref id="B39">
<label>39</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Bae</surname> <given-names>HG</given-names>
</name>
<name>
<surname>Domingo</surname> <given-names>C</given-names>
</name>
<name>
<surname>Tenorio</surname> <given-names>A</given-names>
</name>
<name>
<surname>de Ory</surname> <given-names>F</given-names>
</name>
<name>
<surname>Munoz</surname> <given-names>J</given-names>
</name>
<name>
<surname>Weber</surname> <given-names>P</given-names>
</name>
<etal/>
</person-group>. <article-title>Immune response during adverse events after 17d-derived yellow fever vaccination in europe</article-title>. <source>J Infect Dis</source>. (<year>2008</year>) <volume>197</volume>:<page-range>1577&#x2013;84</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1086/587844</pub-id>
</citation>
</ref>
<ref id="B40">
<label>40</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yang</surname> <given-names>M</given-names>
</name>
<name>
<surname>Dent</surname> <given-names>M</given-names>
</name>
<name>
<surname>Lai</surname> <given-names>H</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>H</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>Q</given-names>
</name>
</person-group>. <article-title>Immunization of Zika virus envelope protein domain iii induces specific and neutralizing immune responses against Zika virus</article-title>. <source>Vaccine</source>. (<year>2017</year>) <volume>35</volume>:<page-range>4287&#x2013;94</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.vaccine.2017.04.052</pub-id>
</citation>
</ref>
<ref id="B41">
<label>41</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yang</surname> <given-names>M</given-names>
</name>
<name>
<surname>Lai</surname> <given-names>H</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>H</given-names>
</name>
<name>
<surname>Chen</surname> <given-names>Q</given-names>
</name>
</person-group>. <article-title>Virus-like particles that display Zika virus envelope protein domain iii induce potent neutralizing immune responses in mice</article-title>. <source>Sci Rep</source>. (<year>2017</year>) <volume>7</volume>:<fpage>7679</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-017-08247-9</pub-id>
</citation>
</ref>
<ref id="B42">
<label>42</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Tai</surname> <given-names>W</given-names>
</name>
<name>
<surname>He</surname> <given-names>L</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Sun</surname> <given-names>S</given-names>
</name>
<name>
<surname>Zhao</surname> <given-names>G</given-names>
</name>
<name>
<surname>Luo</surname> <given-names>C</given-names>
</name>
<etal/>
</person-group>. <article-title>Critical neutralizing fragment of Zika virus ediii elicits cross-neutralization and protection against divergent Zika viruses</article-title>. <source>Emerg Microbes Infect</source>. (<year>2018</year>) <volume>7</volume>:<elocation-id>7</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41426-017-0007-8</pub-id>
</citation>
</ref>
<ref id="B43">
<label>43</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Yu</surname> <given-names>L</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>R</given-names>
</name>
<name>
<surname>Gao</surname> <given-names>F</given-names>
</name>
<name>
<surname>Li</surname> <given-names>M</given-names>
</name>
<name>
<surname>Liu</surname> <given-names>J</given-names>
</name>
<name>
<surname>Wang</surname> <given-names>J</given-names>
</name>
<etal/>
</person-group>. <article-title>Delineating antibody recognition against Zika virus during natural infection</article-title>. <source>JCI Insight</source>. (<year>2017</year>) <volume>2</volume>(<issue>12</issue>):<elocation-id>e93042</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1172/jci.insight.93042</pub-id>
</citation>
</ref>
<ref id="B44">
<label>44</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lima</surname> <given-names>NS</given-names>
</name>
<name>
<surname>Rolland</surname> <given-names>M</given-names>
</name>
<name>
<surname>Modjarrad</surname> <given-names>K</given-names>
</name>
<name>
<surname>Trautmann</surname> <given-names>L</given-names>
</name>
</person-group>. <article-title>T cell immunity and Zika virus vaccine development</article-title>. <source>Trends Immunol</source>. (<year>2017</year>) <volume>38</volume>:<fpage>594</fpage>&#x2013;<lpage>605</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1016/j.it.2017.05.004</pub-id>
</citation>
</ref>
<ref id="B45">
<label>45</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lunardelli</surname> <given-names>VAS</given-names>
</name>
<name>
<surname>Almeida</surname> <given-names>BDS</given-names>
</name>
<name>
<surname>Apostolico</surname> <given-names>JS</given-names>
</name>
<name>
<surname>Rezende</surname> <given-names>T</given-names>
</name>
<name>
<surname>Yamamoto</surname> <given-names>MM</given-names>
</name>
<name>
<surname>Pereira</surname> <given-names>SS</given-names>
</name>
<etal/>
</person-group>. <article-title>Diagnostic and vaccine potential of Zika virus envelope protein (E) derivates produced in bacterial and insect cells</article-title>. <source>Front Immunol</source>. (<year>2023</year>) <volume>14</volume>:<elocation-id>1071041</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2023.1071041</pub-id>
</citation>
</ref>
<ref id="B46">
<label>46</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Lai</surname> <given-names>L</given-names>
</name>
<name>
<surname>Rouphael</surname> <given-names>N</given-names>
</name>
<name>
<surname>Xu</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Natrajan</surname> <given-names>MS</given-names>
</name>
<name>
<surname>Beck</surname> <given-names>A</given-names>
</name>
<name>
<surname>Hart</surname> <given-names>M</given-names>
</name>
<etal/>
</person-group>. <article-title>Innate, T-, and B-cell responses in acute human Zika patients</article-title>. <source>Clin Infect Dis</source>. (<year>2018</year>) <volume>66</volume>:<fpage>1</fpage>&#x2013;<lpage>10</lpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1093/cid/cix732</pub-id>
</citation>
</ref>
<ref id="B47">
<label>47</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Schouest</surname> <given-names>B</given-names>
</name>
<name>
<surname>Grifoni</surname> <given-names>A</given-names>
</name>
<name>
<surname>Pham</surname> <given-names>J</given-names>
</name>
<name>
<surname>Mateus</surname> <given-names>J</given-names>
</name>
<name>
<surname>Sydney</surname> <given-names>J</given-names>
</name>
<name>
<surname>Brien</surname> <given-names>JD</given-names>
</name>
<etal/>
</person-group>. <article-title>Pre-existing T cell memory against Zika virus</article-title>. <source>J Virol</source>. (<year>2021</year>) <volume>95</volume>(<issue>12</issue>):<elocation-id>e00132-21</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1128/JVI.00132-21</pub-id>
</citation>
</ref>
<ref id="B48">
<label>48</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Reynolds</surname> <given-names>CJ</given-names>
</name>
<name>
<surname>Suleyman</surname> <given-names>OM</given-names>
</name>
<name>
<surname>Ortega-Prieto</surname> <given-names>AM</given-names>
</name>
<name>
<surname>Skelton</surname> <given-names>JK</given-names>
</name>
<name>
<surname>Bonnesoeur</surname> <given-names>P</given-names>
</name>
<name>
<surname>Blohm</surname> <given-names>A</given-names>
</name>
<etal/>
</person-group>. <article-title>T cell immunity to Zika virus targets immunodominant epitopes that show cross-reactivity with other flaviviruses</article-title>. <source>Sci Rep</source>. (<year>2018</year>) <volume>8</volume>:<fpage>672</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41598-017-18781-1</pub-id>
</citation>
</ref>
<ref id="B49">
<label>49</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Reynolds</surname> <given-names>CJ</given-names>
</name>
<name>
<surname>Watber</surname> <given-names>P</given-names>
</name>
<name>
<surname>Santos</surname> <given-names>CNO</given-names>
</name>
<name>
<surname>Ribeiro</surname> <given-names>DR</given-names>
</name>
<name>
<surname>Alves</surname> <given-names>JC</given-names>
</name>
<name>
<surname>Fonseca</surname> <given-names>ABL</given-names>
</name>
<etal/>
</person-group>. <article-title>Strong cd4 T cell responses to Zika virus antigens in a cohort of dengue virus immune mothers of congenital Zika virus syndrome infants</article-title>. <source>Front Immunol</source>. (<year>2020</year>) <volume>11</volume>:<elocation-id>185</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.3389/fimmu.2020.00185</pub-id>
</citation>
</ref>
<ref id="B50">
<label>50</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wen</surname> <given-names>J</given-names>
</name>
<name>
<surname>Elong Ngono</surname> <given-names>A</given-names>
</name>
<name>
<surname>Regla-Nava</surname> <given-names>JA</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>K</given-names>
</name>
<name>
<surname>Gorman</surname> <given-names>MJ</given-names>
</name>
<name>
<surname>Diamond</surname> <given-names>MS</given-names>
</name>
<etal/>
</person-group>. <article-title>Dengue virus-reactive Cd8(+) T cells mediate cross-protection against subsequent Zika virus challenge</article-title>. <source>Nat Commun</source>. (<year>2017</year>) <volume>8</volume>:<fpage>1459</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/s41467-017-01669-z</pub-id>
</citation>
</ref>
<ref id="B51">
<label>51</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Wen</surname> <given-names>J</given-names>
</name>
<name>
<surname>Tang</surname> <given-names>WW</given-names>
</name>
<name>
<surname>Sheets</surname> <given-names>N</given-names>
</name>
<name>
<surname>Ellison</surname> <given-names>J</given-names>
</name>
<name>
<surname>Sette</surname> <given-names>A</given-names>
</name>
<name>
<surname>Kim</surname> <given-names>K</given-names>
</name>
<etal/>
</person-group>. <article-title>Identification of Zika virus epitopes reveals immunodominant and protective roles for dengue virus cross-reactive Cd8(+) T cells</article-title>. <source>Nat Microbiol</source>. (<year>2017</year>) <volume>2</volume>:<fpage>17036</fpage>. doi:&#xa0;<pub-id pub-id-type="doi">10.1038/nmicrobiol.2017.36</pub-id>
</citation>
</ref>
<ref id="B52">
<label>52</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Grifoni</surname> <given-names>A</given-names>
</name>
<name>
<surname>Costa-Ramos</surname> <given-names>P</given-names>
</name>
<name>
<surname>Pham</surname> <given-names>J</given-names>
</name>
<name>
<surname>Tian</surname> <given-names>Y</given-names>
</name>
<name>
<surname>Rosales</surname> <given-names>SL</given-names>
</name>
<name>
<surname>Seumois</surname> <given-names>G</given-names>
</name>
<etal/>
</person-group>. <article-title>Cutting edge: transcriptional profiling reveals multifunctional and cytotoxic antiviral responses of Zika virus-specific Cd8(+) T cells</article-title>. <source>J Immunol</source>. (<year>2018</year>) <volume>201</volume>:<page-range>3487&#x2013;91</page-range>. doi:&#xa0;<pub-id pub-id-type="doi">10.4049/jimmunol.1801090</pub-id>
</citation>
</ref>
<ref id="B53">
<label>53</label>
<citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname>Ricciardi</surname> <given-names>MJ</given-names>
</name>
<name>
<surname>Magnani</surname> <given-names>DM</given-names>
</name>
<name>
<surname>Grifoni</surname> <given-names>A</given-names>
</name>
<name>
<surname>Kwon</surname> <given-names>YC</given-names>
</name>
<name>
<surname>Gutman</surname> <given-names>MJ</given-names>
</name>
<name>
<surname>Grubaugh</surname> <given-names>ND</given-names>
</name>
<etal/>
</person-group>. <article-title>Ontogeny of the B- and T-cell response in a primary Zika virus infection of a dengue-naive individual during the 2016 outbreak in Miami, Fl</article-title>. <source>PloS Negl Trop Dis</source>. (<year>2017</year>) <volume>11</volume>:<elocation-id>e0006000</elocation-id>. doi:&#xa0;<pub-id pub-id-type="doi">10.1371/journal.pntd.0006000</pub-id>
</citation>
</ref>
</ref-list>
</back>
</article>
