The Risk of sustained sexual transmission of Zika is underestimated
Allard, Antoine (Centre de Recerca Matemàtica)
Althouse, Benjamin M. (New Mexico State University)
Hébert-Dufresne, Laurent (University of Vermont)
Scarpino, Samuel V. (Northeastern University (Boston, Mass.))

Data:	2017
Resum:	Pathogens often follow more than one transmission route during outbreaks-from needle sharing plus sexual transmission of HIV to small droplet aerosol plus fomite transmission of influenza. Thus, controlling an infectious disease outbreak often requires characterizing the risk associated with multiple mechanisms of transmission. For example, during the Ebola virus outbreak in West Africa, weighing the relative importance of funeral versus health care worker transmission was essential to stopping disease spread. As a result, strategic policy decisions regarding interventions must rely on accurately characterizing risks associated with multiple transmission routes. The ongoing Zika virus (ZIKV) outbreak challenges our conventional methodologies for translating case-counts into route-specific transmission risk. Critically, most approaches will fail to accurately estimate the risk of sustained sexual transmission of a pathogen that is primarily vectored by a mosquito-such as the risk of sustained sexual transmission of ZIKV. By computationally investigating a novel mathematical approach for multi-route pathogens, our results suggest that previous epidemic threshold estimates could under-estimate the risk of sustained sexual transmission by at least an order of magnitude. This result, coupled with emerging clinical, epidemiological, and experimental evidence for an increased risk of sexual transmission, would strongly support recent calls to classify ZIKV as a sexually transmitted infection. The national and international community is grappling with how to respond to the ongoing Zika virus outbreak. One of the most uncertain aspects of this disease is its potential for sustained sexual transmission. Recent studies have suggested that there are large differences in the age- and sex-specific Zika virus attack rates-with women of childbearing age having the highest incidence of infection-and that the risk of sustained sexual transmission may be low. Here we investigate the novel epidemiological behavior of an infection that is transmitted both sexually and by a mosquito vector. Using data-driven simulations, we demonstrate how conventional methods can substantially underestimate the risk of sustained sexual transmission for Zika outbreaks. More specifically, we find that the threshold for large-scale, sustained sexual transmission could easily be underestimated by a factor of ten or higher using existing models. Finally, we discuss how such an underestimate will lead to ineffective responses and a drastic underestimation of the risk associated with Zika persistence and re-emergence.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PLOS pathogens, Vol. 13, issue 9 (Sep. 2017) , e1006633, ISSN 1553-7374

DOI: 10.1371/journal.ppat.1006633
PMID: 28934370

12 p, 2.4 MB

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