TY - JOUR T1 - Assessing real-time Zika risk in the United States JF - bioRxiv DO - 10.1101/056648 SP - 056648 AU - Lauren A Castro AU - Spencer J Fox AU - Xi Chen AU - Kai Liu AU - Steve Bellan AU - Nedialko B Dimitrov AU - Alison P Galvani AU - Lauren Ancel Meyers Y1 - 2017/01/01 UR - http://biorxiv.org/content/early/2017/03/22/056648.abstract N2 - Background Confirmed local transmission of Zika Virus (ZIKV) in Texas and Florida have heightened the need for early and accurate indicators of self-sustaining transmission in high risk areas across the southern United States. Given ZIKV’s low reporting rates and the geographic variability in suitable conditions, a cluster of reported cases may reflect diverse scenarios, ranging from independent introductions to a self-sustaining local epidemic.Methods We present a quantitative framework for real-time ZIKV risk assessment that captures uncertainty in case reporting, importations, and vector-human transmission dynamics.Results We assessed county-level risk throughout Texas, as of summer 2016, and found that importation risk was concentrated in large metropolitan regions, while sustained ZIKV transmission risk is concentrated in the southeastern counties including the Houston metropolitan region and the Texas-Mexico border (where the sole autochthonous cases have occurred in 2016). We found that counties most likely to detect cases are not necessarily the most likely to experience epidemics, and used our framework to identify triggers to signal the start of an epidemic based on a policymakers propensity for risk.Conclusions This framework can inform the strategic timing and spatial allocation of public health resources to combat ZIKV throughout the US, and highlights the need to develop methods to obtain reliable estimates of key epidemiological parameters.ZIKVZika virusDENVDengue VirusCHIKVChikungunya VirusSEIR modelSusceptible-Exposed-Infectious-Recovered epidemiological modelWHOWorld Health Organization ER -