Estimate of the reproduction number of the 2015 Zika virus outbreak in Barranquilla, Colombia, and estimation of the relative role of sexual transmission

TL;DR

This study estimates the basic reproduction number (R0) of the 2015 Zika virus outbreak in Barranquilla, Colombia, highlighting the significant role of sexual transmission alongside mosquito-borne spread.

Contribution

It provides one of the first R0 estimates for a Zika outbreak in the Americas and quantifies the contribution of sexual transmission to overall cases.

Findings

Estimated R0 of 3.8 for the outbreak

Approximately 23% of cases due to sexual transmission

First quantification of sexual transmission's impact in the region

Abstract

Background: In 2015, the Zika arbovirus (ZIKV) began circulating in the Americas, rapidly expanding its global geographic range in explosive outbreaks. Unusual among mosquito-borne diseases, ZIKV has been shown to also be sexually transmitted, although sustained autochthonous transmission due to sexual transmission alone has not been observed, indicating the reproduction number (R0) for sexual transmission alone is less than 1. Critical to the assessment of outbreak risk, estimation of the potential attack rates, and assessment of control measures, are estimates of the basic reproduction number, R0. Methods: We estimated the R0 of the 2015 ZIKV outbreak in Barranquilla, Colombia, through an analysis of the exponential rise in clinically identified ZIKV cases (n = 359 to the end of November, 2015). Findings: The rate of exponential rise in cases was rho=0.076 days-1, with 95 percent CI [0.066,0.087] days-1. We used a vector-borne disease model with additional direct transmission to estimate the R0; assuming the R0 of sexual transmission alone is less than 1, we estimated the total R0 = 3.8 [2.4,5.6], and that the fraction of cases due to sexual transmission was 0.23 [0.01,0.47] with 95 percent confidence. Interpretation: This is among the first estimates of R0 for a ZIKV outbreak in the Americas, and also among the first quantifications of the relative impact of sexual transmission.