House-to-house human movement drives dengue virus transmission

• Type of Material: Article
• Authors: Steven T. Stoddard, University of California, Davis; Brett M. Forshey, Hospital Centro Medico Naval; Amy C. Morrison, University of California, Davis; Valerie A. Paz-Soldan, Tulane University; Gonzalo Vazquez Prokopec, Emory University; Helvio Astete, Hospital Centro Medico Naval; Robert C. Reiner, Jr., University of California, Davis; Stalin Vilcarromero, Hospital Centro Medico Naval; John P. Elder, San Diego State University; Eric S. Halsey, Hospital Centro Medico Naval; Tadeusz J. Kochel, Hospital Centro Medico Naval; Uriel Kitron, Emory University; Thomas W. Scott, University of California, Davis
• Language: English
• Date: 2013-15-01
• Publisher: National Academy of Sciences
• Publication Version: Final Published Version
• Copyright Statement: © 2013 National Academy of Sciences.
• Final Published Version (URL): http://www.pnas.org/content/110/3/994
• Title of Journal or Parent Work: Proceedings of the National Academy of Sciences
• ISSN: 1091-6490
• Volume: 110
• Issue: 3
• Start Page: 994
• End Page: 999
• Grant/Funding Information: This work is supported by National Institutes of Health Grant R01 AI069341-01 (to T.W.S.), US Department of Defense Global Emerging Infections Systems Research Program Work Unit No. 847705.82000.25GB.B0016 (http://www.afrims.org/geis.html), and Military Infectious Disease Research Program Work Unit No. 6000 RAD1.S.B0302.
• Keywords: emerging infections; infectious disease; arthropod-borne virus; disease ecology; spatial epidemiology
• Research Categories: Health Sciences, Epidemiology; Environmental Sciences

Abstract

Dengue is a mosquito-borne disease of growing global health importance. Prevention efforts focus on mosquito control, with limited success. New insights into the spatiotemporal drivers of dengue dynamics are needed to design improved disease-prevention strategies. Given the restricted range of movement of the primary mosquito vector, Aedes aegypti, local human movements may be an important driver of dengue virus (DENV) amplification and spread. Using contact-site cluster investigations in a case-control design, we demonstrate that, at an individual level, risk for human infection is defined by visits to places where contact with infected mosquitoes is likely, independent of distance from the home. Our data indicate that house-to-house human movements underlie spatial patterns of DENV incidence, causing marked heterogeneity in transmission rates. At a collective level, transmission appears to be shaped by social connections because routine movements among the same places, such as the homes of family and friends, are often similar for the infected individual and their contacts. Thus, routine, house-to-house human movements do play a key role in spread of this vector-borne pathogen at fine spatial scales. This finding has important implications for dengue prevention, challenging the appropriateness of current approaches to vector control. We argue that reexamination of existing paradigms regarding the spatiotemporal dynamics of DENV and other vector-borne pathogens, especially the importance of human movement, will lead to improvements in disease prevention.