Please use this identifier to cite or link to this item: https://doi.org/10.1371/journal.pone.0201452
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dc.titleZika 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
dc.contributor.authorCampos M.C.
dc.contributor.authorDombrowski J.G.
dc.contributor.authorPhelan J.
dc.contributor.authorMarinho C.R.F.
dc.contributor.authorHibberd M.
dc.contributor.authorClark T.G.
dc.contributor.authorCampino S.
dc.date.accessioned2019-11-01T08:12:52Z
dc.date.available2019-11-01T08:12:52Z
dc.date.issued2018
dc.identifier.citationCampos 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
dc.identifier.issn19326203
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/161216
dc.description.abstractZika 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.
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceUnpaywall 20191101
dc.subjectAedes aegypti
dc.subjectArticle
dc.subjectBrazil
dc.subjectchikungunya
dc.subjectdata base
dc.subjectenvironmental factor
dc.subjecthigh risk population
dc.subjecthuman
dc.subjectincidence
dc.subjectmicrocephaly
dc.subjectnonhuman
dc.subjectregister
dc.subjectrisk factor
dc.subjectsocial status
dc.subjectsolid waste management
dc.subjectvirus transmission
dc.subjectwater supply
dc.subjectZika fever
dc.subjectZika virus
dc.subjectAedes
dc.subjectanimal
dc.subjectecosystem
dc.subjectfactual database
dc.subjectfemale
dc.subjectgrowth, development and aging
dc.subjectinfant
dc.subjectlarva
dc.subjectmale
dc.subjectmicrocephaly
dc.subjectnewborn
dc.subjectpoverty
dc.subjecttransmission
dc.subjectZika fever
dc.subjectZika virus
dc.subjectAedes
dc.subjectAnimals
dc.subjectBrazil
dc.subjectDatabases, Factual
dc.subjectEcosystem
dc.subjectFemale
dc.subjectHumans
dc.subjectIncidence
dc.subjectInfant
dc.subjectInfant, Newborn
dc.subjectLarva
dc.subjectMale
dc.subjectMicrocephaly
dc.subjectPoverty
dc.subjectZika Virus
dc.subjectZika Virus Infection
dc.typeArticle
dc.contributor.departmentDEPT OF MICROBIOLOGY & IMMUNOLOGY
dc.description.doi10.1371/journal.pone.0201452
dc.description.sourcetitlePLoS ONE
dc.description.volume13
dc.description.issue8
dc.description.pagee0201452
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