International travelers and genomics uncover a ‘hidden’ Zika outbreak

Nathan D. Grubaugh; Sharada Saraf; Karthik Gangavarapu; Alexander Watts; Amanda L. Tan; Rachel J. Oidtman; Jason T. Ladner; Glenn Oliveira; Nathaniel L. Matteson; Moritz U.G. Kraemer; Chantal B.F. Vogels; Aaron Hentoff; Deepit Bhatia; Danielle Stanek; Blake Scott; Vanessa Landis; Ian Stryker; Marshall R. Cone; Edgar W. Kopp; Andrew C. Cannons; Lea Heberlein-Larson; Stephen White; Leah D. Gillis; Michael J. Ricciardi; Jaclyn Kwal; Paola K. Lichtenberger; Diogo M. Magnani; David I. Watkins; Gustavo Palacios; Davidson H. Hamer; Lauren M. Gardner; T. Alex Perkins; Guy Baele; Kamran Khan; Andrea Morrison; Sharon Isern; Scott F. Michael; Kristian G. Andersen

All available data suggest that the Zika epidemic is waning in the Americas (Fig. 1) . This includes the Zika outbreak in Cuba where, based on our travel data, the outbreak was significantly smaller in 2018 as compared to 2017 (Fig. 1B) . Cryptic Zika virus transmission is likely still occurring in regions of the Americas, however, incomplete surveillance and reporting make this difficult to confirm and quantify. Accurate Zika virus seroprevalence surveys (Balmaseda et al., 2017; Zambrana et al., 2018) are now needed to determine the extent of 'hidden' outbreaks of Zika, and to get more accurate measures of the true overall size of the epidemic. Open access to empirical mosquito abundance data is also critical for more precise forecasting of transmission potential and to evaluate control measures (Rund and Martinez, 2017) ; importantly, these efforts should be prioritized and more fully supported. Such initiatives, combined with our framework of using travelers as sentinels of Zika virus infections, can serve as complementary resources to detect, monitor, and reconstruct outbreaks when local surveillance is insufficient.