title: Travel Volume to the United States from Countries and U.S. Territories with Local Zika Virus Transmission.
abstract: BACKGROUND
  Air, land, and sea transportation can facilitate rapid spread of infectious diseases. In May 2015 the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil. As of March 8, 2016, the U.S. Centers for Disease Control and Prevention (CDC) had issued travel notices for 33 countries and 3 U.S. territories with local Zika virus transmission.
  
  
  METHODS
  Using data from five separate datasets from 2014 and 2015, we estimated the annual number of passenger journeys by air and land border crossings to the United States from the 33 countries and 3 U.S. territories listed in the CDC's Zika travel notices as of March 8, 2016. We also estimated the annual number of passenger journeys originating in and returning to the United States (primarily on cruises) with visits to seaports in areas with local Zika virus transmission. Because of the adverse pregnancy and birth outcomes that have been associated with Zika virus disease, the number of passenger journeys completed by women of childbearing age and pregnant women was also estimated.
  
  
  RESULTS
  An estimated 216.3 million passenger journeys by air, land, and sea are made annually to the United States from areas with local Zika virus transmission (as of March 8). The destination states with the largest numbers of arrivals were Texas (by land) and Florida (by air and sea). An estimated 51.7 million passenger journeys were made by women of childbearing age and an estimated 2.3 million were made by pregnant women.
  
  
  CONCLUSIONS
  Travel volume analyses provide important information that can be used to effectively target public health interventions as well as direct public health resources and efforts at local, regional, and country-specific levels.
authors.affiliation: Eagle Medical Services, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Nelson
authors.affiliation: Eagle Medical Services, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Morrison
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Joseph
authors.affiliation: Karna, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Abbey
authors.initials: A
authors.lastname: Wojno
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: R Ryan
authors.initials: RR
authors.lastname: Lash
authors.affiliation: Eagle Medical Services, LLC for Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Yoni
authors.initials: Y
authors.lastname: Haber
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Berro
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, USA; Departments of Medicine and Epidemiology, Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Cetron
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Ardath
authors.initials: A
authors.lastname: Grills