The Zika epidemic began long before anyone noticed

The Zika virus probably arrived in the Western Hemisphere from somewhere in the Pacific more than a year before it was detected, a new genetic analysis of the epidemic shows. Researchers also found that as Zika fanned outward from Brazil, it entered neighboring countries and South Florida multiple times without being noticed.

Although Zika quietly took root in northeastern Brazil in late 2013 or early 2014, many months passed before Brazilian health authorities received reports of unexplained fever and skin rashes. Zika was finally confirmed as the culprit in May 2015.
The World Health Organization did not declare the epidemic a public health emergency until February 2016, after babies of Zika-infected mothers began to be born with severe neurological problems. Zika, which is carried by mosquitoes, infected an estimated 1 million people in Brazil alone in 2015, and is now thought to be transmitted in 84 countries, territories and regions.

Although Zika’s path was documented starting in 2015 through records of human cases, less was known about how the virus spread so silently before detection, or how outbreaks in different parts of Central and South America were connected. Now two groups working independently, reporting online May 24 in Nature, have compared samples from different times and locations to read the history recorded in random mutations of the virus’s 10 genes.

One team, led by scientists in the United Kingdom and Brazil, drove more than 1,200 miles across Brazil — “a Top Gear–style road trip,” one scientist quipped — with a portable device that could produce a complete catalog of the virus’s genes in less than a day. A second team, led by researchers at the Broad Institute of MIT and Harvard, analyzed more than 100 Zika genomes from infected patients and mosquitoes in nine countries and Puerto Rico. Based on where the cases originated, and the estimated rate at which genetic changes appear, the scientists re-created Zika’s evolutionary timeline.

Together, the studies revealed an epidemic that was silently churning long before anyone knew. “We found that in each of the regions we could analyze, Zika virus circulated undetected for many months, up to a year or longer, before the first locally transmitted cases were reported,” says Bronwyn MacInnis, an infectious disease geneticist at the Broad Institute, in Cambridge, Mass. “This means the outbreak in these regions was under way much earlier than previously thought.”

Although the epidemic exploded out of Brazil, the scientists also found a remote possibility of early settlement in the Caribbean. “It’s not immediately clear whether Zika stopped off somewhere else in the Americas before it got to northeast Brazil,” said Oliver Pybus, who studies evolution and infectious disease at the University of Oxford in England.
In a third study reported in Nature, researchers from more than two dozen institutions followed a trail of genetic clues to determine when and how Zika made its way to Florida. Those researchers concluded that Zika was introduced multiple times into the Miami area, most likely from the Caribbean, before local mosquitoes picked it up. The number of human cases increased in step with the rise in mosquito populations, said Kristian Andersen, an infectious disease researcher at the Scripps Research Institute in La Jolla, Calif. “Focusing on getting rid of mosquitoes is an effective way of preventing human cases,” he says.
Stealth spread
An analysis of more than 100 Zika genomes revealed that the virus showed up in nine countries 4.5 to 9 months earlier than the first confirmed cases of Zika virus infection. Colors indicate the distribution of groups of closely related strains of the virus.

Hover over/tap map to explore Zika’s spread in the Americas.
Previous studies have found traces of the virus’s footprints across the Americas, but none included so many different samples, says Young-Min Lee of Utah State University, who has also studied Zika’s genes. The current studies provide a higher-resolution look at the timing of the epidemic’s spread, he says, but in terms of Zika’s origins and progression from country to country, “overall the big picture is consistent with what we suspected.”

In addition to revealing Zika’s history, genetic studies are also valuable in fighting current and future disease outbreaks. Since diagnostic tests and even vaccine development are based on Zika’s genetics, it’s important to monitor mutations during an outbreak. Researchers developed quick-turnaround genomic analyses for Ebola in recent years, for example, that could aid a faster response during the next outbreak.

In the future, faster analysis of viral threats in the field might improve the odds of stopping the next epidemic, Lee says. It’s possible for a single infected traveler stepping off a plane to spark an epidemic long before doctors notice. “If one introduction [of a virus] can cause an outbreak, you have a very narrow window to try to contain it.”