title: Estimated Zika virus importations to Europe by travellers from Brazil.
abstract: BACKGROUND
  Given the interconnectivity of Brazil with the rest of the world, Zika virus (ZIKV) infections have the potential to spread rapidly around the world via viremic travellers. The extent of spread depends on the travel volume and the endemicity in the exporting country. In the absence of reliable surveillance data, we did mathematical modelling to estimate the number of importations of ZIKV from Brazil into Europe.
  
  
  METHODS
  We applied a previously developed mathematical model on importations of dengue to estimate the number of ZIKV importations into Europe, based on the travel volume, the probability of being infected at the time of travel, the population size of Brazil, and the estimated incidence of ZIKV infections.
  
  
  RESULTS
  Our model estimated between 508 and 1,778 imported infections into Europe in 2016, of which we would expect between 116 and 355 symptomatic Zika infections; with the highest number of importations being into France, Portugal and Italy.
  
  
  CONCLUSIONS
  Our model identified high-risk countries in Europe. Such data can assist policymakers and public health professionals in estimating the extent of importations in order to prepare for the scale up of laboratory diagnostic assays and estimate the occurrence of Guillain-Barré Syndrome, potential sexual transmission, and infants with congenital ZIKV syndrome.
authors.affiliation: Department of Medicine, University of Sao Paolo, Sao Paolo, Brazil.|London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Massad
authors.affiliation: School of Computer Engineering, Nanyang Technological University, Singapore.
authors.forename: Ser-Han
authors.initials: SH
authors.lastname: Tan
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
authors.forename: Kamran
authors.initials: K
authors.lastname: Khan
authors.affiliation: Institute of Public Health, University of Heidelberg, Germany.|Department Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden.|Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; anneliesws@gmail.com.
authors.forename: Annelies
authors.initials: A
authors.lastname: Wilder-Smith
keywords: Brazil; Europe; Zika virus; importations; travel