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

Michael J. Mina; L. Beryl Guterman; Kristen E. Allen; Saad B. Omer


Emerging Infectious Diseases. 2020;26(4):700-710. 

In This Article

Abstract and Introduction


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.


Zika virus is a flavivirus spread by Aedes mosquitoes that for >60 years remained only an esoteric threat to human health.[1] However, the recent Zika epidemic, which erupted in South America in 2015 and became the largest in history, brought the virus to prominence, particularly because infection has been linked to fetal microcephaly and other neurodevelopmental and neurologic sequelae.[2]

Although no longer classified a global emergency by the World Health Organization (WHO), Zika virus emergence and transmission continues globally, and WHO warns that Zika virus is set to remain as a long-term public health challenge.[3] Given the critical importance of preventing Zika virus infections, especially during pregnancy, transmission anywhere requires that nations remain vigilant and informed at local, state, and national levels to prevent and control introduction and onward transmission.[4,5] This imperative is especially important for countries such as the United States that simultaneously harbor the Aedes vectors and maintain essentially entirely susceptible populations.

Numerous models for the potential emergence of Zika virus in the United States focus largely on the ecologic niche of Aedes mosquitoes.[6–10] Projections that simultaneously consider vector dynamics and human demographics, including birth seasonality, to resolve both relative and absolute epidemic risk and potential control measures across space and time throughout the year are more limited.

Here we present a stochastic Zika virus compartment model that considers the overlap of vector dynamics and human demographics at the county level in the United States, including Puerto Rico. The model was used to profile the risk for Zika virus transmission, assuming an initial introduction into each county, including trimester-specific fetal exposures for each of the 3,208 counties and municipalities within the United States including Puerto Rico over time and under varying control measures. We tested 3 approaches to controlling Zika virus transmission and assessed their utility in preventing or abrogating Zika virus transmission. These approaches include reducing human–vector contact (i.e., behavior modification and ubiquitous technologies such as air conditioning, screens, and long clothing); depleting adult vectors (i.e., mosquito fumigation programs); and vaccination, which, should a successful candidate vaccine come to market, might reduce individual and community risk for infection once herd-immunity thresholds are achieved.[11]