Identifying urban hotspots of dengue, chikungunya, and Zika transmission in Mexico to support risk stratification efforts: a spatial analysis

• Type of Material: Article
• Authors: Audrey Lenhart, Emory University; Felipe Dzul-Manzanilla, Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE); Fabián Correa-Morales, Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE); Azael Che-Mendoza, Universidad Autonoma de Yucatan, Merida; Jorge Palacio-Vargas, Servicios de Salud de Yucatan; Gustavo Sánchez-Tejeda, Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE); Jesus F González-Roldan, Sociedad Mexicana de Salud Publica; Hugo López-Gatell, Subsecretaria de Prevencion y Promocion de la Salud; Adriana E Flores-Suárez, Universidad Autónoma de Nuevo Leon; Hector Gómez-Dantes, National Institute of Public Health, Cuernavaca, Mexico; Giovanini E Coelho, Department of Communicable Diseases and Environmental Determinants of Health, Washington DC; Haroldo S da Silva Bezerra, Emory University; Norma Pavia-Ruz, Centro de Investigaciones Regionales Hideyo Noguchi, Universidad Autonoma de Yucatan; Audrey Lenhart, Centers for Disease Control and Prevention; Pablo Manrique-Saide, Emory University; Gonzalo Vazquez Prokopec, Emory University
• Language: English
• Date: 2021-05-05
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/S2542-5196(21)00030-9
• Title of Journal or Parent Work: Lancet Planetary Health
• Volume: 5
• Issue: 5
• Start Page: e277
• End Page: e285
• Grant/Funding Information: Research funding was provided by an Interagency Agreement between USAID and the US Centers for Disease Control and Prevention (CDC: OADS BAA 2016-N-17844; principal investigator [PI] GMV-P), by the Canadian Institutes of Health Research and International Development Research Centre (Preventing Zika disease with novel vector control approaches; project 108412; PI PM-S) by Fondo Mixto CONACyT (Mexico)-Gobierno del Estado de Yucatan (project YUC-2017-03-01-556; PI PM-S). GMV-P was supported by a US National Institutes of Health / National Institute of Allergy and Infectious Diseases programme project (U01AI148069) and Emory University (Emory Global Health Institute seed funds). The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the US CDC or USAID. The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the CDC, USAID, PAHO.
• Keywords: Zika transmission; urban; arboviral diseases dengue
• Research Categories: Environmental Sciences

Abstract

Background Effective Aedes aegypti control is limited, in part, by the difficulty in achieving sufficient intervention coverage. To maximise the effect of vector control, areas with persistently high numbers of Aedes-borne disease cases could be identified and prioritised for preventive interventions. We aimed to identify persistent Aedes-borne disease hotspots in cities across southern Mexico. Methods In this spatial analysis, geocoded cases of dengue, chikungunya, and Zika from nine endemic Mexican cities were aggregated at the census-tract level. We included cities that were located in southern Mexico (the arbovirus endemic region of Mexico), with a high burden of dengue cases (ie, more than 5000 cases reported during a 10-year period), and listed as high priority for the Mexican dengue control and prevention programme. The Getis-Ord Gi*(d) statistic was applied to yearly slices of the dataset to identify spatial hotspots of each disease in each city. We used Kendall's W coefficient to quantify the agreement in the distribution of each virus. Findings 128 507 dengue, 4752 chikungunya and 25 755 Zika clinical cases were reported between Jan 1, 2008, and Dec 31, 2016. All cities showed evidence of transmission heterogeneity, with a mean of 17·6% (SD 4·7) of their total area identified as persistent disease hotspots. Hotspots accounted for 25·6% (SD 9·7; range 12·8–43·0) of the population and 32·1% (10·5; 19·6–50·5) of all Aedes-borne disease cases reported. We found an overlap between hotspots of 61·7% for dengue and Zika and 53·3% for dengue and chikungunya. Dengue hotspots in 2008–16 were significantly associated with dengue hotspots detected during 2017–20 in five of the nine cities. Heads of vector control confirmed hotspot areas as problem zones for arbovirus transmission. Interpretation This study provides evidence of the overlap of Aedes-borne diseases within geographical hotspots and a methodological framework for the stratification of arbovirus transmission risk within urban areas, which can guide the implementation of surveillance and vector control.