“…Large numbers of imported cases can distort estimates of the reproduction number, 19,30,31 especially when infected travelers are not typical of community-acquired cases (for example, the age structure of imported vs. local cases 32 ). Changes in reporting rates can lead to inaccuracies in estimates of the reproduction number, 10,14,33 and when the reproduction number is close to one, the stochastic nature of the early stages of an outbreak can cause it to be overestimated. 34 Finally, differences in infectivity or susceptibility between population groups can lead to differences in estimates of the reproduction number if the disease is largely confined to one group.…”