BackgroundDengue is a mosquito-borne virus that causes extensive morbidity and economic loss in many tropical and subtropical regions of the world. Often present in cities, dengue virus is rapidly spreading due to urbanization, climate change and increased human movements. Dengue cases are often heterogeneously distributed throughout cities, suggesting that small-scale determinants influence dengue urban transmission. A better understanding of these determinants is crucial to efficiently target prevention measures such as vector control and education. The aim of this study was to determine which socioeconomic and environmental determinants were associated with dengue incidence in an urban setting in the Pacific.MethodologyAn ecological study was performed using data summarized by neighborhood (i.e. the neighborhood is the unit of analysis) from two dengue epidemics (2008–2009 and 2012–2013) in the city of Nouméa, the capital of New Caledonia. Spatial patterns and hotspots of dengue transmission were assessed using global and local Moran’s I statistics. Multivariable negative binomial regression models were used to investigate the association between dengue incidence and various socioeconomic and environmental factors throughout the city.Principal findingsThe 2008–2009 epidemic was spatially structured, with clusters of high and low incidence neighborhoods. In 2012–2013, dengue incidence rates were more homogeneous throughout the city. In all models tested, higher dengue incidence rates were consistently associated with lower socioeconomic status (higher unemployment, lower revenue or higher percentage of population born in the Pacific, which are interrelated). A higher percentage of apartments was associated with lower dengue incidence rates during both epidemics in all models but one. A link between vegetation coverage and dengue incidence rates was also detected, but the link varied depending on the model used.ConclusionsThis study demonstrates a robust spatial association between dengue incidence rates and socioeconomic status across the different neighborhoods of the city of Nouméa. Our findings provide useful information to guide policy and help target dengue prevention efforts where they are needed most.

BackgroundThe effectiveness of preventive measures depends on prevailing attitudes and mindsets within a population. Perceived risk is central to a shift in mindset and behaviour. The present study aims to investigate the perceived severity, vulnerability and precautionary behaviour adopted in response to the influenza A (H1N1) epidemic that broke out in 2009 on Reunion Island (Indian Ocean). As no H1N1 vaccination was available at the time, non-medical interventions appeared of crucial importance to the control of the epidemic.MethodsA cross sectional survey was conducted in Reunion Island between November 2009 and April 2010 within 2 months of the passage of the influenza A (H1N1) epidemic wave. Individual contacts representing 725 households (one contact per household) were interviewed by telephone using validated questionnaires on perceived risks. Mean scores were calculated for perceived severity, vulnerability, efficacy of preventive measures and precautionary behaviour. Univariate analysis was applied to identify preventive measures and attitudes and multivariate analysis was used to study the determinants of precautionary behaviour.ResultsMore than 95% of contacted persons accepted to participate to the survey. Eighty seven percent of respondents believed that prevention was possible. On average, three out of six preventive measures were deemed effective. Spontaneously, 57% of the respondents reported that they took one or more preventive measures. This percentage increased to 87% after the interviewer detailed possible precautions one by one. The main precautions taken were frequent hand washing (59%) and avoidance of crowded places (34%). In multivariate logistic regression analysis the following factors were significantly associated with taking one or more preventive measures: young age, previous vaccination against seasonal influenza, having had seasonal influenza in the last five years, effectiveness of the preventive measures taken and low standards of education.ConclusionInhabitants of Reunion Island have expressed a preventive approach adapted to the realities of the H1N1 pandemic, a feature that likely reflects some preparedness gained after the large and severe chikungunya epidemic that hit the island in 2006. The degree of severity was well assessed despite the initial alarmist messages disseminated by national and international media. Precautions that were undertaken matched the degree of severity of the epidemic and the recommendations issued by health authorities. Further qualitative studies are needed to help adapting public messages to the social and cultural realities of diverse communities and to prevent misconceptions.

FT and SG conceived and designed the study, collected the data, analysed the data and wrote the manuscript. MT, DP and MD analysed the data. FT conceived the interactive map and DP coded it. All authors proofread and approved the final manuscript.

Ce document a été généré automatiquement le 30 avril 2019. EchoGéo est mis à disposition selon les termes de la licence Creative Commons Attribution-Pas d'Utilisation Commerciale-Pas de Modification 4.0 International L'île d'Anjouan figure de la balkanisation de l'archipel des Comores

Parmi le grand nombre possible d’aléas dans le sud-ouest de l'océan Indien (cyclones, pluies torrentielles, volcanisme, tsunami, maladies infectieuses …) certains sont plus dévastateurs et présents que d'autres. L'épidémie de chikungunya, qui s'est déroulée de 2004 à 2006, est sans doute l'événement majeur de santé publique qui a marqué les hommes, les sociétés et les esprits aussi. Cette épidémie a touché les Etats et territoires de la région avec des prévalences de 25 à 60 %. Pour essayer de caractériser les contours de la vulnérabilité et déterminer des effets de contexte nous avons mené une analyse des niveaux de développement humain, social et sanitaire des pays concernés. S'il est établi que les facteurs d'émergence à l'échelle régionale sont très largement liés à des variables socio-spatiales néanmoins, à aléa égal le risque n’est pas proportionnellement plus important dans les pays réputés les plus vulnérables. A l'échelle de La Réunion, une analyse des données de l'environnement socio-spatial et épidémiologique, avec près de 3 000 cas géoréférencés durant la première phase de l'épidémie, permet d'établir les principaux quartiers à risques de l'île.