Projecting the end of the Zika virus epidemic in Latin America: a modelling analysis

Kathleen M O’Reilly; Rachel Lowe; W John Edmunds; Philippe Mayaud; Adam Kucharski; Rosalind M Eggo; Sebastian Funk; Deepit Bhatia; Kamran Khan; Moritz U Kraemar; Annelies Wilder-Smith; Laura C Rodrigues; Patricia Brasil; Eduardo Massad; Thomas Jaenisch; Simon Cauchemez; Oliver J Brady; Laith Yakob

Suspected cases are based on the presence of pruritic (itchy) maculopapular rash together with two or more symptoms such as fever, or polyarthralgia (multiple joint pains), or periarticular oedema (joint swelling), or conjunctival hyperaemia (eye blood vessel dilation) without secretion and itch. 23, 24 Confirmed and suspected cases were included in this analysis because ZIKV detection may have low sensitivity due to a narrow window of viraemia and many samples, particularly from the earlier phase of the epidemic remain untested due to laboratories being overloaded during the epidemic. 24 Inclusion of suspected cases in the analysis may reduce specificity due to the non-specific clinical manifestations of ZIKV and similar circulating arboviruses, including dengue. The reporting of ZIKV cases will vary considerably between settings and is thought to depend on the arbovirus surveillance system already in place, additional surveillance specifically established for ZIKV and other viruses and the likelihood of an individual self-reporting with symptoms consistent with ZIKV infection.