Outbreak of Zika virus infection in Singapore: an epidemiological, entomological, virological, and clinical analysis  Zheng Jie Marc Ho, MPH, Hapuarachchige Chanditha Hapuarachchi, PhD, Timothy Barkham, Angela Chow, PhD, Lee Ching Ng, PhD, Jian Ming Vernon Lee, PhD, Yee Sin Leo, FRCP, Kiesha Prem, BSc (Hons), Yue Hui Georgina Lim, BSc (Hons), Paola F de Sessions, PhD, Maia A Rabaa, PhD, Chee Seng Chong, PhD, Cheong Huat Tan, PhD, Jayanthi Rajarethinam, BEng, Junhao Tan, MS, Danielle E Anderson, PhD, Xinmei Ong, BS, Alex R Cook, PhD, Chia Yin Chong, FRCPCH, Li Yang Hsu, MPH, Grace Yap, BVSc, Yee Ling Lai, BSc, Tanu Chawla, PhD, Louise Pan, BS, Shuzhen Sim, PhD, I-Cheng Mark Chen, PhD, Koh Cheng Thoon, MMed, Chee Fu Yung, FFPH, Jia Hui Li, MRCPCH, Hee Ling Deborah Ng, MRCP, Khine Nandar, MPH, Peng Lim Ooi, MPH, Raymond Tzer Pin Lin, FRCPA, Pauline Aw, BS, Anna Uehara, MPH, Partha Pratim De, MSc, Wendy Soon, PhD, Martin Lloyd Hibberd, PhD, Huck Hui Ng, PhD, Sebastian Maurer-Stroh, PhD, October M Sessions, PhD Zheng Jie Marc Ho, MPH, Hapuarachchige Chanditha Hapuarachchi, PhD, Timothy Barkham, Angela Chow, PhD, Lee Ching Ng, PhD, Jian Ming Vernon Lee, PhD, Yee Sin Leo, FRCP, Kiesha Prem, BSc (Hons), Yue Hui Georgina Lim, BSc (Hons), Paola F de Sessions, PhD, Maia A Rabaa, PhD, Chee Seng Chong, PhD, Cheong Huat Tan, PhD, Jayanthi Rajarethinam, BEng, Junhao Tan, MS, Danielle E Anderson, PhD, Xinmei Ong, BS, Alex R Cook, PhD, Chia Yin Chong, FRCPCH, Li Yang Hsu, MPH, Grace Yap, BVSc, Yee Ling Lai, BSc, Tanu Chawla, PhD, Louise Pan, BS, Shuzhen Sim, PhD, I-Cheng Mark Chen, PhD, Koh Cheng Thoon, MMed, Chee Fu Yung, FFPH, Jia Hui Li, MRCPCH, Hee Ling Deborah Ng, MRCP, Khine Nandar, MPH, Peng Lim Ooi, MPH, Raymond Tzer Pin Lin, FRCPA, Pauline Aw, BS, Anna Uehara, MPH, Partha Pratim De, MSc, Wendy Soon, PhD, Martin Lloyd Hibberd, PhD, Huck Hui Ng, PhD, Sebastian Maurer-Stroh, PhD, October M Sessions, PhD  The Lancet Infectious Diseases  Volume 17, Issue 8, Pages 813-821 (August 2017) DOI: 10.1016/S1473-3099(17)30249-9 Copyright © 2017 Elsevier Ltd Terms and Conditions

Figure 1 Geographical distribution of Zika virus infections Clustering of confirmed cases of Zika virus infection in Singapore (A) and the Kallang-Aljunied neighbourhood (B). Yellow regions show Zika virus infection clusters. Coloured dots represent Zika virus sequence groups, with blue dots representing those with high nucleotide sequence identity; dots in shades of orange and red are from distinct groups. (C and D) Breeding percentage of Aedes aegypti among the Aedes spp mosquitoes (Aedes albopictus and A aegypti) by subzones in Singapore (C) and the Kallang-Aljunied neighbourhood (D). Darker shades of red represent higher proportions of A aegypti breeding sites. Southern Peninsular Malaysia is located to the north of Singapore in A and C. The Lancet Infectious Diseases 2017 17, 813-821DOI: (10.1016/S1473-3099(17)30249-9) Copyright © 2017 Elsevier Ltd Terms and Conditions

Figure 2 Local transmission of Zika virus, August to November, 2016 (A) Cumulative autochthonous cases of confirmed Zika virus infection in Singapore from July 31 to Nov 30, 2016 (dots), and exponential growth model estimated from the initial exponential growth phase. 455 confirmed cases of Zika virus infection and 79 suspected cases were documented as of Nov 30. (B) The serial interval distribution of ten geographically isolated case pairs. The solid red line is the product limit estimate, the pink polygon is the 95% CI from the complimentary log-log method, and the white dot and bar are the mean and 95% Student CI. The Lancet Infectious Diseases 2017 17, 813-821DOI: (10.1016/S1473-3099(17)30249-9) Copyright © 2017 Elsevier Ltd Terms and Conditions

Figure 3 Temporal scale of the expansion of the Zika virus Asian genotype Maximum clade credibility tree with red branches showing the Singaporean outbreak clade. Posterior support for nodes is represented by the size of the black circle at each node (visible circles have about 85% support or greater). The Lancet Infectious Diseases 2017 17, 813-821DOI: (10.1016/S1473-3099(17)30249-9) Copyright © 2017 Elsevier Ltd Terms and Conditions