Zika virus infection and microcephaly: spatial analysis and socio-environmental determinants in a region of high Aedes aegypti infestation in the central-west region of Brazil
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2021
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Background: More than 5 years after the Zika virus (ZIKV) epidemic, Zika infection remains a major concern in
regions with high Aedes infestation. The objectives of this study were (i) to identify clusters of ZIKV infection and
microcephaly, and/or central nervous system (CNS) alterations associated with congenital infection during the
epidemic peak in 2016 and subsequently, in 2017 and 2018; (ii) to measure the non-spatial correlation between ZIKV
infection and microcephaly and/or CNS alterations associated with congenital infection; and (iii) to analyse the soci odemographic/economic, health, and environmental determinants associated with the incidence of ZIKV in a region
of high infestation by Aedes aegypti in the Central-West Region of Brazil.
Methods: This ecological study analysed 246 municipalities in the state of Goiás (6.9 million inhabitants). The data
were obtained from the Information System for Notifable Diseases (ZIKV cases) and the Public Health Event Regis try (microcephaly and/or CNS alterations associated with congenital infection). Incidence rates and prevalence of
ZIKA infection were smoothed by an empirical Bayesian estimator (LEbayes), producing the local empirical Bayesian
rate (LEBR). In the spatial analysis, ZIKV infection and microcephaly cases were georeferenced by the municipality of
residence for 2016 and grouped for 2017 and 2018. Global Moran’s I and the Hot Spot Analysis tool (Getis-Ord Gi* sta tistics) were used to analyse the spatial autocorrelation and clusters of ZIKV infection and microcephaly, respectively. A
generalised linear model from the Poisson family was used to assess the association between ecological determinants
and the smoothing incidence rate of ZIKV infection.
Results: A total of 9892 cases of acute ZIKV infection and 121 cases of microcephaly were confrmed. The mean LEBR
of the ZIKV infection in the 246 municipalities was 22.3 cases/100,000 inhabitants in 2016, and 10.3 cases/100,000
inhabitants in 2017 and 2018. The LEBR of the prevalence rate of microcephaly and/or CNS alterations associated with
congenital infection was 7 cases/10,000 live births in 2016 and 2 cases/10,000 live births during 2017–2018. Hotspots
of ZIKV infection and microcephaly cases were identifed in the capital and neighbouring municipalities in 2016, with
new clusters in the following years. In a multiple regression Poisson analysis, ZIKV infection was associated with higher population density, the incidence of dengue, Aedes larvae infestation index, and average rainfall. The important deter minant of ZIKV infection incidence reduction was the increase in households attended by endemic disease control
agents.
Conclusions: Our analyses were able to capture, in a more granular way, aspects that make it possible to inform
public managers of the sentinel areas identifed in the post-epidemic hotspots.
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Zika virus, Arbovirus, Socioeconomic status, Microcephaly, Public health, Spatial analysis, Brazil
Citação
NUNES, Patrícia Silva et al. Zika virus infection and microcephaly: spatial analysis and socio-environmental determinants in a region of high Aedes aegypti infestation in the central-west region of Brazil. BMC Infectious Diseases, London, v. 21, e1107, 2021. DOI: 10.1186/s12879-021-06805-1. Disponível em: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06805-1. Acesso em: 18 fev. 2025.