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

Coordinated response efforts during the early stages of the Zika epidemic were ultimately contingent on countries detecting cases and reporting them to international health agencies (Lessler et al., 2016) , including PAHO. For Zika virus and other Aedes aegypti mosquito-borne virusesincluding dengue and chikungunya viruses -that disproportionately impact those with limited resources (Braga et al., 2010; Gardner et al., 2018; Netto et al., 2017) , accurate local reporting is especially problematic. Not only are people in poor living conditions more likely to be exposed to infected mosquitoes, but such communities often have less access to adequate healthcare, resulting in more cases going undetected (Hotez, 2016; LaBeaud, 2008) . Pockets of virus transmission that occur in countries with inadequate reporting can therefore facilitate 'hidden' outbreaks, increasing the risk of infected travelers causing outbreaks in new regions of the world. Thus, underreported or unrecognized local outbreaks may prolong epidemics, and hinder global efforts aimed at halting virus spread.