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CoverA new CViSB study investigating smoldering ‘hidden’ outbreaks of Zika in the Americas was published on the cover of Cell. In this paper we used travel surveillance and genomic epidemiology to answer a simple question – “in 2017, was the epidemic over?”. The short answer, is no – read the rest of the study for the long answer.

The Zika epidemic in the Americas has challenged surveillance and control. As the epidemic appears to be waning, it is unclear whether transmission is still ongoing, which is exacerbated by discrepancies in reporting. To uncover locations with lingering outbreaks, we investigated travel-associated Zika cases to identify transmission not captured by reporting. We uncovered an unreported outbreak in Cuba during 2017, a year after peak transmission in neighboring islands. By sequencing Zika virus, we show that the establishment of the virus was delayed by a year and that the ensuing outbreak was sparked by long-lived lineages of Zika virus from other Caribbean islands. Our data suggest that, although mosquito control in Cuba may initially have been effective at mitigating Zika virus transmission, such measures need to be maintained to be effective. Our study highlights how Zika virus may still be “silently” spreading and provides a framework for understanding outbreak dynamics.

Travel Surveillance and Genomics Uncover a Hidden Zika Outbreak during the Waning Epidemic

Media Coverage
New York Times – Zika Was Soaring Across Cuba. Few Outside the Country Knew
Science – Infected Travelers Reveal Cuba’s ‘Hidden’ Zika Outbreak
GenomeWeb – Unreported Zika Outbreak in Cuba Uncovered With Genomics, Travel Surveillance
PBS NOVA – Researchers Ese Viral Genomes to Uncover a Zika Outbreak in Cuba
KPBS – Scripps Researchers Create Disease Detecting Method To Uncover Zika Outbreaks
The San Diego Union-Tribune – Hidden Zika Outbreak Detected with New Surveillance Method Developed by Scripps Research Scientists
El Nuevo Herald – La OPS ‘Escondió’ un Brote de Zika en Cuba, Según el NYT

Press Releases
Scripps Research – Discovery of ‘Hidden’ Outbreak Hints that Zika virus can Spread Silently
Yale – Yale Researchers Detect Unreported Zika Outbreak
Cell – An Unreported Zika Outbreak in 2017 Detected through Travel Surveillance and Genetics

Video Abstract