Dengue fever is a major public health problem in many tropical regions of the world. It is a vector-borne disease, transmitted most often by the mosquito Aedes aegypti. According to the WHO, the prevalence of dengue is highest in tropical areas of Asia and the Americas, with 50-100 million estimated cases of dengue fever and 250,000-500,000 cases of dengue hemorrhagic fever occurring annually worldwide as explosive outbreaks in urban areas.
In Brazil, three dengue virus serotypes (DENV) have been introduced in the past three decades. In 2007-2008, a dengue fever epidemic in Rio de Janeiro led to 240 deaths registered (100 deaths due to dengue hemorrhagic fever and 140 due to other dengue-related complications). This populous city presents highly favorable conditions for transmission of dengue. Dengue surveillance and control in large urban areas with high levels of dengue transmission pose important challenges. Therefore, consistent knowledge of the dynamics of this disease that integrates epidemiological and entomological data is essential.
Human movement is a key factor of dengue virus inflow in Rio de Janeiro, Brazil. The results published in a new paper, based on data from a severe epidemic in 2007-2008, contribute to new understanding on the dynamics of dengue fever in the second largest city in Brazil. This research combines data on dengue fever seroprevalence, recent dengue infection, and vector density in three neighborhoods of Rio de Janeiro: an urban, a suburban, and a slum area. Serological surveys were conducted before and during the epidemic period. Entomological surveys consisted of weekly collections of A. aegypti eggs and adults from traps. This integrated entomological-serological survey showed evidence of silent transmission even during a severe epidemic. No association was observed between household infestation index and risk of dengue infection in these areas, raising new questions about where transmission occurs – in the household, at work or elsewhere. When combined, the neighborhood-specific seroprevalence maps correlated significantly higher risk with areas of intense people traffic. These results add to previous epidemiological studies of dengue virus infections and contribute to the understanding of A. aegypti habits. The conclusions may provide a basis for new studies that could further identify the higher seroprevalence risk areas and help to develop and implement dengue-control programs.
Spatial Evaluation and Modeling of Dengue Seroprevalence and Vector Density in Rio de Janeiro, Brazil. PLoS Negl Trop Dis 3(11): e545. doi:10.1371/journal.pntd.0000545
Rio de Janeiro, Brazil, experienced a severe dengue fever epidemic in 2008. This was the worst epidemic ever, characterized by a sharp increase in case-fatality rate, mainly among younger individuals. A combination of factors, such as climate, mosquito abundance, buildup of the susceptible population, or viral evolution, could explain the severity of this epidemic. The main objective of this study is to model the spatial patterns of dengue seroprevalence in three neighborhoods with different socioeconomic profiles in Rio de Janeiro. As blood sampling coincided with the peak of dengue transmission, we were also able to identify recent dengue infections and visually relate them to Aedes aegypti spatial distribution abundance. We analyzed individual and spatial factors associated with seroprevalence using Generalized Additive Model (GAM). Three neighborhoods were investigated: a central urban neighborhood, and two isolated areas characterized as a slum and a suburban area. Weekly mosquito collections started in September 2006 and continued until March 2008. In each study area, 40 adult traps and 40 egg traps were installed in a random sample of premises, and two infestation indexes calculated: mean adult density and mean egg density. Sera from individuals living in the three neighborhoods were collected before the 2008 epidemic (July through November 2007) and during the epidemic (February through April 2008). Sera were tested for DENV-reactive IgM, IgG, Nested RT-PCR, and Real Time RT-PCR. From the before– after epidemics paired data, we described seroprevalence, recent dengue infections (asymptomatic or not), and seroconversion. Recent dengue infection varied from 1.3% to 14.1% among study areas. The highest IgM seropositivity occurred in the slum, where mosquito abundance was the lowest, but household conditions were the best for promoting contact between hosts and vectors. By fitting spatial GAM we found dengue seroprevalence hotspots located at the entrances of the two isolated communities, which are commercial activity areas with high human movement. No association between recent dengue infection and household’s high mosquito abundance was observed in this sample. This study contributes to better understanding the dynamics of dengue in Rio de Janeiro by assessing the relationship between dengue seroprevalence, recent dengue infection, and vector density. In conclusion, the variation in spatial seroprevalence patterns inside the neighborhoods, with significantly higher risk patches close to the areas with large human movement, suggests that humans may be responsible for virus inflow to small neighborhoods in Rio de Janeiro. Surveillance guidelines should be further discussed, considering these findings, particularly the spatial patterns for both human and mosquito populations.