@article{cb90443f4990409eb156c394f730e41d,
title = "Travel Surveillance and Genomics Uncover a Hidden Zika Outbreak during the Waning Epidemic",
abstract = "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. Video Abstract: [Formula presented] A combination of travel surveillance and clinical virus genomic sequencing of infected travelers provides a framework for detecting hidden outbreaks, such as an unreported Zika outbreak in Cuba during 2017.",
keywords = "Zika epidemic, Zika virus, clinical sequencing, genomic epidemiology, infectious disease genomics, phylogenetics, travel surveillance, virus sequencing",
author = "{GeoSentinel Surveillance Network} and Grubaugh, {Nathan D.} and Sharada Saraf and Karthik Gangavarapu and Alexander Watts and Tan, {Amanda L.} and Oidtman, {Rachel J.} and Ladner, {Jason T.} and G. Oliveira and Matteson, {Nathaniel L.} and Kraemer, {Moritz U.G.} and Vogels, {Chantal B.F.} and A. Hentoff and Deepit Bhatia and Danielle Stanek and B. Scott and Vanessa Landis and Ian Stryker and Cone, {Marshall R.} and Kopp, {Edgar W.} and Cannons, {Andrew C.} and Lea Heberlein-Larson and Stephen White and Gillis, {Leah D.} and Ricciardi, {Michael J.} and Jaclyn Kwal and Lichtenberger, {Paola K.} and Magnani, {Diogo M.} and Watkins, {David I.} and Gustavo Palacios and Hamer, {Davidson H.} and Gardner, {Lauren M.} and Perkins, {T. Alex} and Guy Baele and Kamran Khan and Andrea Morrison and Sharon Isern and Michael, {Scott F.} and Andersen, {Kristian G.}",
note = "Funding Information: We thank R. Robles-Sikisaka, M. Pauthner, E. Spencer, M.R. Wiley, K. Prieto, S. Taylor, and P. Jack for laboratory support and the ECDC for graciously providing data regarding travel-associated Zika virus infections. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Army, CDC, ECDC, or the FL-DOH. R.J.O. received support from the Arthur J. Schmitt Leadership Fellowship in Science and Engineering and from an Eck Institute for Global Health Graduate Fellowship. M.U.G.K. is supported by The Branco Weiss Fellowship—Society in Science, administered by the ETH Zurich , and acknowledges funding from a training grant from the National Institute of Child Health and Human Development ( T32HD040128 ). C.B.F.V. is supported by NWO Rubicon 019.181EN.004 . GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine, is supported by a cooperative agreement ( U50CK00189 ) from the Centers for Disease Control and Prevention as well as the International Society of Travel Medicine and the Public Health Agency of Canada . G.B. acknowledges support from the Interne Fondsen KU Leuven / Internal Funds KU Leuven under grant agreement C14/18/094 . T.A.P. received support from a RAPID award from the National Science Foundation ( DEB 1641130 ) and a Young Faculty Award from the Defense Advanced Research Projects Agency ( D16AP0014 ). S.I. and S.F.M. are supported by NIH NIAID R01AI099210 . K.G.A. is a Pew Biomedical Scholar and is supported by NIH NCATS CTSA UL1TR002550 , NIAID contract HHSN272201400048C , NIAID R21AI137690 , NIAID U19AI135995 , and The Ray Thomas Foundation . Funding Information: We thank R. Robles-Sikisaka, M. Pauthner, E. Spencer, M.R. Wiley, K. Prieto, S. Taylor, and P. Jack for laboratory support and the ECDC for graciously providing data regarding travel-associated Zika virus infections. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Army, CDC, ECDC, or the FL-DOH. R.J.O. received support from the Arthur J. Schmitt Leadership Fellowship in Science and Engineering and from an Eck Institute for Global Health Graduate Fellowship. M.U.G.K. is supported by The Branco Weiss Fellowship?Society in Science, administered by the ETH Zurich, and acknowledges funding from a training grant from the National Institute of Child Health and Human Development (T32HD040128). C.B.F.V. is supported by NWO Rubicon 019.181EN.004. GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine, is supported by a cooperative agreement (U50CK00189) from the Centers for Disease Control and Prevention as well as the International Society of Travel Medicine and the Public Health Agency of Canada. G.B. acknowledges support from the Interne Fondsen KU Leuven/Internal Funds KU Leuven under grant agreement C14/18/094. T.A.P. received support from a RAPID award from the National Science Foundation (DEB 1641130) and a Young Faculty Award from the Defense Advanced Research Projects Agency (D16AP0014). S.I. and S.F.M. are supported by NIH NIAID R01AI099210. K.G.A. is a Pew Biomedical Scholar and is supported by NIH NCATS CTSA UL1TR002550, NIAID contract HHSN272201400048C, NIAID R21AI137690, NIAID U19AI135995, and The Ray Thomas Foundation. All contributions are listed in order of authorship. Designed the Experiments, N.D.G. L.M.G. T.A.P. G.B. K.K. A.M. S.S. S.I. S.F.M. and K.G.A.; Provided Samples or Data, N.D.G. S.S. K.G. A.W. A.L.T. J.T.L. M.U.G.K. A.H. D.B. D.S. B.S. V.L. I.S. M.R.C. E.W.K. A.C.C. L.H.-L. S.W. L.D.G. M.J.R. J.K. P.K.L. D.M.M. D.I.W. G.P. D.H.H. GeoSentinel Contributors, K.K. A.M. S.I. and S.F.M.; Performed the Sequencing, N.D.G. S.S. G.O. and N.L.M.; Analyzed the Data, N.D.G. S.S. K.G. R.J.O. J.T.L. C.B.F.V. T.A.P. G.B. and K.G.A.; Wrote Manuscript, N.D.G. S.S. and K.G.A.; Edited Manuscript, K.G. R.J.O. M.U.G.K. C.B.F.V. L.D.G. L.M.G. T.A.P. G.B. A.M. S.I. and S.F.M. All authors read and approved the manuscript. The authors declare no competing interests. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",
year = "2019",
month = aug,
day = "22",
doi = "10.1016/j.cell.2019.07.018",
language = "English",
volume = "178",
pages = "1057--1071.e11",
journal = "Cell",
issn = "0092-8674",
publisher = "Cell Press",
number = "5",
}