Poverty and Arbovirus Outbreaks: When Chikungunya Virus Hits More Precarious Populations Than Dengue Virus in French Guiana

Bonifay, Timothée; Douine, Maylis; Bonnefoy, C.; Hurpeau, Benoît; Nacher, Mathieu; Djossou, Félix; Epelboin, Loïc

doi:10.1093/ofid/ofx247

Cited by 37 publications

(41 citation statements)

References 26 publications

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“…In Rio de Janeiro city, areas in or near favelas were detected as hot spots for dengue [39]. Consistent with our findings, a study conducted in French Guiana indicated that, early in the epidemic, the poorest neighbourhoods would have a greater risk for CHIKV infection [41]. In the first dengue epidemic in a city of São Paulo state, Brazil, authors found a direct relationship between low socio-economic conditions and dengue [42].…”

Section: Dengue Chikungunya and Zika Multivariate Clusterssupporting

confidence: 89%

Space-time clusters of dengue, chikungunya, and Zika cases in the city of Rio de Janeiro

Freitas

Cruz

Lowe

et al. 2019

Preprint

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Brazil is a dengue-endemic country where all four dengue virus serotypes circulate and cause seasonal epidemics. Recently, chikungunya and Zika viruses were also introduced. In Rio de Janeiro city, the three diseases co-circulated for the first time in 2015-2016, resulting in what is known as the 'triple epidemic'. In this study, we identify space-time clusters of dengue, chikungunya, and Zika, to understand the dynamics and interaction between these simultaneously circulating arboviruses in a densely populated and heterogeneous city.We conducted a spatio-temporal analysis of weekly notified cases of the three diseases in Rio de Janeiro city (July 2015 -January 2017), georeferenced by 160 neighbourhoods, using Kulldorff's scan statistic with discrete Poisson probability models.There were 26549, 13662, and 35905 notified cases of dengue, chikungunya, and Zika, respectively.The 17 dengue clusters and 15 Zika clusters were spread all over the city, while the 14 chikungunya clusters were more concentrated in the North and Downtown areas. Zika clusters persisted over a longer period of time. The multivariate scan statistic -used to analyse the three diseases simultaneously -detected 17 clusters, nine of which included all three diseases. This is the first study exploring space-time clustering of dengue, chikungunya, and Zika in an intraurban area. In general, the clusters did not coincide in time and space. This is probably the result of the competition between viruses for host resources, and of vector-control attitudes promoted by previous arbovirus outbreaks. The main affected area -the North region -is characterised by a combination of high population density and low human development index, highlighting the importance of targeting interventions in this area. Spatio-temporal scan statistics have the potential to direct interventions to high-risk locations in a timely manner and should be considered as part of the municipal surveillance routine as a tool to optimize prevention strategies. an arboviral disease transmitted by Aedes mosquitoes, has been endemic in Brazil for decades, but vector-control strategies have not led to a significant reduction in the disease burden and were not sufficient to prevent chikungunya and Zika entry and establishment in the country. In Rio de Janeiro city, the first Zika and chikungunya epidemics were detected between 2015-2016, coinciding with a dengue epidemic. Understanding the behaviour of these diseases in a triple epidemic scenario is a necessary step for devising better interventions for prevention and outbreak response. We applied scan statistics analysis to detect spatio-temporal clustering for each disease separately and for all three simultaneously. In general, clusters were not detected in the same locations and time periods, possibly due to competition between viruses for host resources, and change in behaviour of the human population (e.g. intensified vector-control activities in response to increasing cases of a particular arbovirus). Neighbourhoods with high populati...

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Section: Dengue Chikungunya and Zika Multivariate Clusterssupporting

confidence: 89%

Space-time clusters of dengue, chikungunya, and Zika cases in the city of Rio de Janeiro

Freitas

Cruz

Lowe

et al. 2019

Preprint

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“…These results, previous observations on dengue and CHIKV, observations in patient with chronic diseases, in pregnant women, and in persons renouncing to health care all suggest that social inequalities of health often affect the same populations with poorer living conditions and reduced access to care and prevention. [4,12] The present results emphasize that population approaches for a range of selected problems may be more pertinent than an array of PLOS NEGLECTED TROPICAL DISEASES vertical social programs in different populations. Indeed, many community approaches are presently funded as thematic (HIV prevention and testing, addictions.…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 69%

“…greater vector densities and transmission in these areas, whereas in rich neighborhoods populations were more likely to come from France and not be immunized thus being at risk for clinical disease [4].…”

Section: Introductionmentioning

confidence: 99%

ZIKA Virus infection in pregnant women in French Guiana: More precarious-more at risk

Hallet

Flamand²,

Rousset³

et al. 2020

PLoS Negl Trop Dis

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Background A recent study in French Guiana suggested that populations living in precarious neighborhoods were more at risk for Chikungunya CHIKV than those living in more privileged areas. The objective of the present study was to test the hypothesis that Zika virus (ZIKV) infection was more frequent in precarious pregnant women than in non-precarious pregnant women, as reflected by their health insurance status. Methods A multicentric cross-sectional study was conducted in Cayenne hospital including ZIKV pregnant women with serological or molecular proof of ZIKV during their pregnancy between January and December 2016. Health insurance information was recorded at delivery, which allowed separating women in: undocumented foreigners, precarious but with residence permit, and non-precarious. Results A total of 6654 women were included. Among them 1509 (22,7%) had confirmed ZIKV infection. Most women were precarious (2275/3439) but the proportion of precarious women was significantly greater in ZIKV-confirmed 728/906 (80.4%) than the ZIKV-negatives 1747/ 2533 (69.0%), p<0.0001. There were 1142 women classified as non-precarious, 1671 were precarious legal residents, and 1435 were precarious and undocumented. Precariousness and undocumented status were associated with a higher prevalence of ZIKV during pregnancy (adjusted prevalence ratio = 1.59 (95%CI = 1.29-1.97), p<0.0001), (adjusted prevalence ratio = 1.5 (95%CI = 1.2-1.8), p<0.0001), respectively.

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“…This theoretical framework was confirmed in Mayotte where social disparities in infection rate were primarily structured by housing conditions as well as cognitive representations of the disease, ‘legitimate images’ being found in rich urban settings, ‘folk theories’ being found in poor suburban settings [ 15 ]. Interestingly, the neighbourhood environment was found different between dengue (or Zika) and CHIKF-affected populations in French Guiana and Rio Janeiro, Brazil, where CHIKF tended to impact the most impoverished communities living in overcrowded areas, which may explain the higher basic reproductive number (R0) for CHIKV than for flaviviruses [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Individual and contextual risk factors for chikungunya virus infection: the SEROCHIK cross-sectional population-based study

Fred¹,

Fianu²,

Béral

et al. 2018

Epidemiol. Infect.

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The purpose of the study was to weigh the community burden of chikungunya determinants on Reunion island. Risk factors were investigated within a subset of 2101 adult persons from a population-based cross-sectional serosurvey, using Poisson regression models for dichotomous outcomes. Design-based risk ratios and population attributable fractions (PAF) were generated distinguishing individual and contextual (i.e. that affect individuals collectively) determinants. The disease burden attributable to contextual determinants was twice that of individual determinants (overall PAF value 89.5% vs. 44.1%). In a model regrouping both categories of determinants, the independent risk factors were by decreasing PAF values: an interaction term between the reporting of a chikungunya history in the neighbourhood and individual house (PAF 45.9%), a maximal temperature of the month preceding the infection higher than 28.5 °C (PAF 25.7%), a socio-economically disadvantaged neighbourhood (PAF 19.0%), altitude of dwelling (PAF 13.1%), cumulated rainfalls of the month preceding the infection higher than 65 mm (PAF 12.6%), occupational inactivity (PAF 11.6%), poor knowledge on chikungunya transmission (PAF 7.3%) and obesity/overweight (PAF 5.2%). Taken together, these covariates and their underlying causative factors uncovered 80.8% of chikungunya at population level. Our findings lend support to a major role of contextual risk factors in chikungunya virus outbreaks.

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Poverty and Arbovirus Outbreaks: When Chikungunya Virus Hits More Precarious Populations Than Dengue Virus in French Guiana

Cited by 37 publications

References 26 publications

Space-time clusters of dengue, chikungunya, and Zika cases in the city of Rio de Janeiro

Space-time clusters of dengue, chikungunya, and Zika cases in the city of Rio de Janeiro

ZIKA Virus infection in pregnant women in French Guiana: More precarious-more at risk

Individual and contextual risk factors for chikungunya virus infection: the SEROCHIK cross-sectional population-based study

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