Highlights
- •Transmission, effects on pregnancy, and travel were the top 3 Zika themes on Twitter.
- •News media, public health institutions, and grassroots users exert the most influence.
- •News media play an important role during EIDOS by spreading information via Twitter.
- •Grassroots users are very visible; they amplify social concerns and conspiracy theories.
- •Social media analytics can strengthen public health agencies' efforts during EIDOs.
Background
This paper goes beyond detecting specific themes within Zika-related chatter on Twitter,
to identify the key actors who influence the diffusive process through which some
themes become more amplified than others.
Methods
We collected all Zika-related tweets during the 3 months immediately after the first
U.S. case of Zika. After the tweets were categorized into 12 themes, a cross-section
were grouped into weekly datasets, to capture 12 amplifier/user groups, and analyzed
by 4 amplification modes: mentions, retweets, talkers, and Twitter-wide amplifiers.
Results
We analyzed 3,057,130 tweets in the United States and categorized 4997 users. The
most talked about theme was Zika transmission (~58%). News media, public health institutions,
and grassroots users were the most visible and frequent sources and disseminators
of Zika-related Twitter content. Grassroots users were the primary sources and disseminators
of conspiracy theories.
Conclusions
Social media analytics enable public health institutions to quickly learn what information
is being disseminated, and by whom, regarding infectious diseases. Such information
can help public health institutions identify and engage with news media and other
active information providers. It also provides insights into media and public concerns,
accuracy of information on Twitter, and information gaps. The study identifies implications
for pandemic preparedness and response in the digital era and presents the agenda
for future research and practice.
Graphical abstract

Graphical Abstract
Key Words
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Article info
Publication history
Published online: January 04, 2018
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.