Exploring the mechanisms behind the country-specific time of Zika virusimportation

The international spread of Zika virus (ZIKV) began in Brazil in 2015. To estimate the riskof observing imported ZIKV cases, we calculated effective distance, typically an excellent predictorof arrival time, from airline network data. However, we eventually concluded that, for ZIKV, effectivedistance alone is not an adequate predictor of arrival time, which we partly attributed to the difficultyof diagnosing and ascertaining ZIKV infections. Herein, we explored the mechanisms behind theobserved time delay of ZIKV importation by country, statistically decomposing the delay into twoparts: the actual time to importation from Brazil and the reporting delay. The latter was modeled as afunction of the gross domestic product (GDP) and other variables that influence underlying diagnosticcapacity in a given country. We showed that a high GDP per capita is a good predictor of shortreporting delay. ZIKV infection is generally mild and, without substantial laboratory capacity, casescan be underestimated. This study successfully demonstrates this phenomenon and emphasizes theimportance of accounting for reporting delays as part of the data generating process for estimatingtime to importation.