Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0201452
Title: Zika might not be acting alone: Using an ecological study approach to investigate potential co-acting risk factors for an unusual pattern of microcephaly in Brazil
Authors: Campos M.C.
Dombrowski J.G.
Phelan J.
Marinho C.R.F.
Hibberd M. 
Clark T.G.
Campino S.
Keywords: Aedes aegypti
Article
Brazil
chikungunya
data base
environmental factor
high risk population
human
incidence
microcephaly
nonhuman
register
risk factor
social status
solid waste management
virus transmission
water supply
Zika fever
Zika virus
Aedes
animal
ecosystem
factual database
female
growth, development and aging
infant
larva
male
microcephaly
newborn
poverty
transmission
Zika fever
Zika virus
Aedes
Animals
Brazil
Databases, Factual
Ecosystem
Female
Humans
Incidence
Infant
Infant, Newborn
Larva
Male
Microcephaly
Poverty
Zika Virus
Zika Virus Infection
Issue Date: 2018
Citation: Campos M.C., Dombrowski J.G., Phelan J., Marinho C.R.F., Hibberd M., Clark T.G., Campino S. (2018). Zika might not be acting alone: Using an ecological study approach to investigate potential co-acting risk factors for an unusual pattern of microcephaly in Brazil. PLoS ONE 13 (8) : e0201452. ScholarBank@NUS Repository. https://doi.org/10.1371/journal.pone.0201452
Rights: Attribution 4.0 International
Abstract: Zika virus infections can cause a range of neurologic disorders including congenital microcephaly. However, while Zika infections have been notified across all regions in Brazil, there has been an unusual number of congenital microcephaly case notifications concentrated in the Northeast of the country. To address this observation, we investigated epidemiological data (2014-2016) on arbovirus co-distribution, environmental and socio-economic factors for each region in Brazil. Data on arbovirus reported cases and microcephaly were collected from several Brazilian Ministry of Health databases for each Federal unit. These were complemented by environmental management, social economic and Aedes aegypti infestation index data, extracted from multiple databases. Spatial time "ecological" analysis on the number of arboviruses transmitted by Aedes mosquitoes in Brazil show that the distribution of dengue and Zika was widespread in the whole country, with higher incidence in the West- Central region. However, reported chikungunya cases were higher in the Northeast, the region also with the highest number of microcephaly cases registered. Social economic factors (human development index and poverty index) and environmental management (water supply/storage and solid waste management) pointed the Northeast as the less wealthy region. The Northeast is also the region with the highest risk of Aedes aegypti house infestation due to the man-made larval habitats. In summary, the results of our ecological analysis support the hypothesis that the unusual distribution of microcephaly might not be due to Zika infection alone and could be accentuated by poverty and previous or co-infection with other pathogens. Our study reinforces the link between poverty and the risk of disease and the need to understand the effect on pathogenesis of sequential exposure to arboviruses and co-viral infections. Comprehensive large-scale cohort studies are required to corroborate our findings. We recommend that the list of infectious diseases screened, particularly during pregnancy, be regularly updated to include and effectively differentiate all viruses from ongoing outbreaks. Copyright © 2018 Campos et al.
Source Title: PLoS ONE
URI: https://scholarbank.nus.edu.sg/handle/10635/161216
ISSN: 19326203
DOI: 10.1371/journal.pone.0201452
Rights: Attribution 4.0 International
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