BackgroundDengue is a major international public health concern, one of the most important arthropod-borne diseases. More than 3.5 billion people are at risk of dengue infection and there are an estimated 390 million dengue infections annually. This prolific increase has been connected to societal changes such as population growth and increasing urbanization generating intense agglomeration leading to proliferation of synanthropic mosquito species. Quantifying the spatio-temporal epidemiology of dengue in large cities within the context of a Geographic Information System is a first step in the identification of socio-economic risk factors.Methodology/Principal FindingsThis Project has been approved by the ethical committee of Institut Pasteur. Data has been anonymized and de-identified prior to geolocalisation and analysis. A GIS was developed for Delhi, enabling typological characterization of the urban environment. Dengue cases identified in the Delhi surveillance system from 2008 to 2010 were collated, localised and embedded within this GIS. The spatio-temporal distribution of dengue cases and extent of clustering were analyzed. Increasing distance from the forest in Delhi reduced the risk of occurrence of a dengue case. Proximity to a hospital did not increase risk of a notified dengue case. Overall, there was high heterogeneity in incidence rate within areas with the same socio-economical profiles and substantial inter-annual variability. Dengue affected the poorest areas with high density of humans, but rich areas were also found to be infected, potentially because of their central location with respect to the daily mobility network of Delhi. Dengue cases were highly clustered in space and there was a strong relationship between the time of introduction of the virus and subsequent cluster size. At a larger scale, earlier introduction predicted the total number of cases.Conclusions/SignificanceDENV epidemiology within Delhi has a forest fire signature. The stochastic nature of this invasion process likely smothers any detectable socio-economic risk factors. However, the significant finding that the size of the dengue case cluster depends on the timing of its emergence emphasizes the need for early case detection and implementation of effective mosquito control. A better understanding of the role of population mobility in contributing to dengue risk could also help focus control on areas at particular risk of dengue virus importation.

The expansion in the geographical distribution of vector-borne diseases is a much emphasized consequence of climate change, as are the consequences of urbanization for diseases that are already endemic, which may be even more important for public health. In this paper, we focus on dengue, the most widespread urban vector-borne disease. Largely urban with a tropical/subtropical distribution and vectored by a domesticated mosquito, Aedes aegypti, dengue poses a serious public health threat. Temperature plays a determinant role in dengue epidemic potential, affecting crucial parts of the mosquito and viral life cycles. The urban predilection of the mosquito species will further exacerbate the impact of global temperature change because of the urban heat island effect. Even within a city, temperatures can vary by 10 °C according to urban land use, and diurnal temperature range (DTR) can be even greater. DTR has been shown to contribute significantly to dengue epidemic potential. Unraveling the importance of within-city temperature is as important for dengue as for the negative health consequences of high temperatures that have thus far been emphasized, for example, pollution and heat stroke. Urban and landscape planning designed to mitigate the non-infectious negative effects of temperature should additionally focus on dengue, which is currently spreading worldwide with no signs of respite.

Dengue, the most widespread urban vector-borne disease, is transmitted to human by the mosquito Aedes aegypti. Its distribution in urban areas is heterogeneous over time and space. In time, it is linked to seasonal variations such as warm and cold seasons, as well as rainy and dry seasons. In space, it is linked to social and environmental conditions, which alternate between rich and deprived neighborhoods, vegetated and densely built areas. These variations in terms of land cover can affect surface and air temperature. As a result of its influence on the mosquito's life cycle, temperature plays a crucial part in dengue epidemics potential. Thus, deciphering the thermal variations effects within cities could lead to the identification of precise thermal comfort zones, favorable to the survival of mosquito populations during inter-epidemic periods. The maps that could be produced as a result would enable health authorities to target specific areas. Most cities are equipped with meteorological stations. However, the network is generally not dense enough to precisely identify thermal comfort zones. Remote sensing can be used as a tool to solve this issue. The methodological objective of this paper is to assess the potential of the TVX (Temperature-Vegetation indeX) approach applied to MODIS thermal images for the purpose of estimating daily minimum and maximum air temperatures in the city of Bangkok, Thailand. The TVX approach has been seldom used over urban areas due to the heterogeneous nature of cities in terms of land cover. However, our study shows that in vegetated cities such as Bangkok, the TVX method provides valuable results which can be used to assess thermal niche of A. aegypti.

Cet article de présentation introduit un projet de recherche : Lieux de SOins, LIeux de SAnté ? (LISO LISA), de l'Institut de Recherche Interdisciplinaire en Sciences de l'Homme (IRISH). Celui-ci se propose de revisiter la géographie de l'hôpital et de chercher à l'étendre vers de nouveaux horizons. Le moment semble particulièrement adapté dans la mesure où de nombreuses constructions, complètes ou partielles, ont été menées ces dernières années et que les budgets restreints ne permettront plus ce type d'investissements avant longtemps. Centrer le propos sur les «paysages thérapeutiques », permet de présenter un concept en passe de devenir un classique de la géographie de la santé anglophone. Au delà, nous souhaitons contribuer à montrer que l'on peut aussi se servir de lui pour développer des méthodes. Celles-ci permettent de proposer de nouveaux critères permettant de discuter la qualité de vie des patients et des professionnels de santé dans les établissements hospitaliers.

La diffusion et l'émergence des risques sanitaires constituent une préoccupation très présente dans les discours actuels sur la mondialisation et les changements climatiques. La dengue y occupe une place de choix depuis qu'elle a été diagnostiquée sporadiquement aux portes de l'Europe et que son vecteur fréquente une part croissante de nos territoires nationaux. Cette question souvent traitée en termes de causalité trouve dans cet article une remise en perspective extrêmement utile, montrant que le risque ne naît pas d'une succession d'événements mais bien d'une articulation complexe de facteurs. En cela, les auteurs nous proposent d'interpréter la variabilité de l'expression de la maladie comme le produit aussi bien d'interactions à l'interface natures/sociétés que d'un dialogue entre disciplines, remettant en cause tout déterminisme dans la dynamique de ce risque sanitaire. La RédactionRésumé -La dengue est une infection virale à transmission vectorielle qui touche, pour l'instant, essentiellement les pays de la zone tropicale et subtropicale. Nous développons un cadre systémique et complexe pour l'étude de cette maladie, qui permet à la fois de décomposer ses différentes entités -hôte, vecteur, virus, environnement -tout en affirmant le poids de leurs interactions dans ses dynamiques potentielles. L'étude de cette complexité systémique s'enrichit d'un cadre méthodologique qui permet d'intégrer dans un même modèle des dynamiques biologiques et sociales, dans des environnements changeants. Ce cadre de recherche implique de nouvelles pratiques, il rend indispensable une collaboration étroite des sciences sociales, environnementales, biologiques et informatiques, sans oublier l'implication des populations et des acteurs locaux de santé publique.Abstract -Dengue, a complex disease. Dengue is a widespread mosquito-borne viral infection in tropical and subtropical countries causing an estimated 500 million infections per year of which more than 20,000 result in severe disease. Since the 1970s dengue has spread and become endemic in more than 100 countries and there is concern that dengue will spread into temperate regions. The peridomestic niche of the primary mosquito vector, Aedes aegypti, results in dengue being a largely urban and periurban disease where the high population densities cause major epidemics. Although a number of risk factors have been identified at different spatial scales of analysis, their general relevance is debatable. Very local scale environmental factors can determine both the abundance of mosquitoes and their ability to transmit the virus. Thus the environmental complexity of urban settings coupled with heterogeneity in human population density yield potentially complex interactions in highly differentiated local conditions that are difficult to assess. We are developing a complex framework to enable a more tractable understanding of dengue epidemiology. This framework enables the disentanglement of actors, host, vector, virus and environment, all the while asserting the dynamic contributi...