Comprehensive Profiling of Zika Virus Risk with Natural and Artificial Mitigating Strategies, United States

Emerg Infect Dis. 2020 Apr;26(4):700-710. doi: 10.3201/eid2604.181739. Epub 2020 Apr 17.


Zika virus is transitioning to become a long-term public health challenge, and countries should remain informed of the risk for emergence. We developed a stochastic epidemiologic model to profile risk for Zika virus emergence, including trimester-specific fetal risk across time, in all 3,208 counties in the United States, including Puerto Rico. Validation against known transmission in North America demonstrated accuracy to predict epidemic dynamics and absolute case counts across scales (R2 = 0.98). We found that, although sporadic single transmission events could occur in most US counties, outbreaks will likely be restricted to the Gulf Coast region and to late spring through autumn. Seasonal fluctuations in birth rates will confer natural population-level protection against early-trimester infections. Overall, outbreak control will be more effective and efficient than prevention, and vaccination will be most effective at >70% coverage. Our county-level risk profiles should serve as a critical resource for resource allocation.

Keywords: United States; Zika; control; mosquitoborne diseases; risk profiling; transmission; vector-borne infections; viruses.

MeSH terms

  • Disease Outbreaks / prevention & control
  • Humans
  • North America
  • Puerto Rico / epidemiology
  • United States / epidemiology
  • Zika Virus Infection* / epidemiology
  • Zika Virus Infection* / prevention & control
  • Zika Virus*