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

Journal
Cell. 2019 Aug 22;178(5):1057-1071.e11. doi: 10.1016/j.cell.2019.07.018.

Authors
Grubaugh ND, Saraf S, Gangavarapu K, Watts A, Tan AL, Oidtman RJ, Ladner JT, Oliveira G, Matteson NL, Kraemer MUG, Vogels CBF, Hentoff A, Bhatia D, Stanek D, Scott B, Landis V, Stryker I, Cone MR, Kopp EW 4th, Cannons AC, Heberlein-Larson L, White S, Gillis LD, Ricciardi MJ, Kwal J, Lichtenberger PK, Magnani DM, Watkins DI, Palacios G, Hamer DH; GeoSentinel Surveillance Network, Gardner LM, Perkins TA, Baele G, Khan K, Morrison A, Isern S, Michael SF, Andersen KG.

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.

Media Coverage
New York Times – Zika Was Soaring Across Cuba. Few Outside the Country Knew
Science – Infected Travelers Reveal Cuba’s ‘Hidden’ Zika Outbreak
Nature – Cuba’s Untold Zika Outbreak Uncovered
Nature Medicine – Tracking Hidden Zika
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

Blogs
NIH Director’s Blog – Uncovering a Hidden Zika Outbreak in Cuba
NIAID Now – Tracing Zika’s Genetic History

Video Abstract