Estimating under-observation and the full size of the 2016 Zika epidemic in Rio de Janeiro.

The 2015-16 Zika epidemic spread quickly from north to south in Brazil. Two striking features were the much higher incidence in young adult women due to sexual transmission, and the serious congenital malformations and miscarriages associated to Zika infection in pregnant women. In this paper we use case reporting data along with live-birth records to reconstruct the full size of the epidemic through a Bayesian probabilistic graph model representing the Zika transmission probabilities of observation (case reporting) and of birth loss (through miscarriage or abortion). We find that the probability of observing (reporting) a Zika case is different between men and women and ranges between 10 to 13%. From these estimates we reconstruct the full size of the Zika epidemic in Rio de Janeiro in 2015-16.