Early detection of perceived risk among users of a UK travel health website compared with internet search activity and media coverage during the 2015-2016 Zika virus outbreak: an observational study.

OBJECTIVES: The Zika virus (ZIKV) outbreak in the Americas in 2015-2016 posed a novel global threat due to the association with congenital malformations and its rapid spread. Timely information about the spread of the disease was paramount to public health bodies issuing travel advisories. This paper looks at the online interaction with a national travel health website during the outbreak and compares this to trends in internet searches and news media output. METHODS: Time trends were created for weekly views of ZIKV-related pages on a UK travel health website, relative search volumes for 'Zika' on Google UK, ZIKV-related items aggregated by Google UK News and rank of ZIKV travel advisories among all other pages between 15 November 2015 and 20 August 2016. RESULTS: Time trends in traffic to the travel health website corresponded with Google searches, but less so with media items due to intense coverage of the Rio Olympics. Travel advisories for pregnant women were issued from 7 December 2015 and began to increase in popularity (rank) from early January 2016, weeks before a surge in interest as measured by Google searches/news items at the end of January 2016. CONCLUSIONS: The study showed an amplification of perceived risk among users of a national travel health website weeks before the initial surge in public interest. This suggests a potential value for tools to detect changes in online information seeking behaviours for predicting periods of high demand where the routine capability of travel health services could be exceeded.