Spatiotemporal Analysis of the Population Risk of Congenital Microcephaly in Pernambuco State, Brazil

Alexander, Neal; Souza, Wayner Vieira de; Rodrigues, Laura C.; Braga, Cynthia; Sá, André Luiz Alves de; Bezerra, Luciana Caroline Albuquerque; Martelli, Celina Maria Turchi

doi:10.3390/ijerph17030700

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…The hotspot for microcephaly and/or CNS alterations associated with congenital infection cases identified in this study (2017–2018) were not detected in the national-level kernel analysis that also used the RESP database [ 23 ]. Consistent with our study findings, a spatial–temporal analysis of the microcephaly outbreak in Pernambuco state (2015), in the Northeast region of Brazil, also showed a high concentration of cases in the metropolitan area of the capital, followed by the expansion of microcephaly cases to municipalities with smaller populations, far from the initial epicentre [ 68 ]. The present spatial analysis contributes to existing research by identifying other areas of risk for the occurrence of microcephaly, in addition to the metropolitan areas of the capital and its surroundings.…”

Section: Discussionsupporting

confidence: 87%

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

et al. 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 sociodemographic/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 Notifiable Diseases (ZIKV cases) and the Public Health Event Registry (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* statistics) 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 confirmed. 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 identified 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 determinant 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 identified in the post-epidemic hotspots.

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Section: Discussionsupporting

confidence: 87%

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

et al. 2021

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“…The two high-risk microcephaly clusters were identified on opposite sides in the state, in the northeast – including parts of the Metropolitan Region of Recife, Mata and Agreste – and in a more western part of the Sertão region. A recent study estimated the spatiotemporal distribution of microcephaly in Pernambuco using a conditional autoregressive model and found high microcephaly prevalences also in the middle portion of the state [28]. In addition to having used a different methodology, the authors used data from a different source, the Registro de Evento de Saúde Pública [Public Health Event Registry] (RESP) system, explaining the differences in the results.…”

Section: Discussionmentioning

confidence: 99%

Identifying hidden Zika hotspots in Pernambuco, Brazil: A spatial analysis

Freitas

Lowe

et al. 2021

Preprint

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Northeast Brazil has the world's highest rate of Zika-related microcephaly. Yet, in this hard-hit region, traditional case counts of Zika cannot accurately describe Zika risk. Reporting of Zika cases only became mandatory after its association with microcephaly in neonates, when the Zika epidemic was already declining in the region. To advance the study of the Brazilian Zika epidemic and its impacts, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used the Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters and combined the results to identify the municipalities most affected by the Zika epidemic. Municipalities were classified as hotspots if they were part of any high-risk cluster, and classified according to a gradient of Zika burden during the epidemic, considering the strength of the evidence. In Pernambuco, officials confirmed 123,934 dengue cases, 167 Zika cases, and 32,983 chikungunya cases between 2014-2017, and 800 microcephaly cases between 2015-2017. We identified 26 Aedes-borne diseases clusters (11 high-risk), and 5 microcephaly cases clusters (3 high-risk). Combining the results, sixty-three out of 184 municipalities were identified as hotspots for Zika. The northeast of Pernambuco and the Sertão region were hit hardest by the Zika epidemic. The first is the most populous area, while the second has one of the highest rates of social and economic inequality in Brazil. The identification of Sertão as a Zika hotspot was only possible because the clusters results were combined. The under-reporting of acute infectious diseases is expected to be higher in poor areas. Therefore, using only Aedes-borne data does not correctly identify the high-risk areas. We successfully identified hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.

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Identifying hidden Zika hotspots in Pernambuco, Brazil: a spatial analysis

Freitas

Lowe

Koepp

et al. 2022

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Northeast Brazil has the world's highest rate of Zika-related microcephaly. However, Zika case counts cannot accurately describe burden because mandatory reporting was only established when the epidemic was declining in the region. Methods To advance the study of the Zika epidemic, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters for Aedes-borne diseases (2014–2017) and for microcephaly (2015–2017), separately. Municipalities were classified according to a proposed gradient of Zika burden during the epidemic, based on the combination of cluster status in each analysis and considering the strength of the evidence. Results We identified 26 Aedes-borne diseases clusters (11 high-risk) and 5 microcephaly clusters (3 high-risk) in Pernambuco. According to the proposed Zika burden gradient, our results indicate that the northeast of Pernambuco and the Sertão region were hit hardest by the Zika epidemic. The first is the most populous area of Pernambuco, while the second has one of the highest rates of social and economic inequality in Brazil. Conclusion We successfully identified possible hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.

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Spatiotemporal Analysis of the Population Risk of Congenital Microcephaly in Pernambuco State, Brazil

Cited by 4 publications

References 24 publications

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

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

Identifying hidden Zika hotspots in Pernambuco, Brazil: A spatial analysis

Identifying hidden Zika hotspots in Pernambuco, Brazil: a spatial analysis

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