Barrera R, Delgado N, Jiménez M, Villalobos I, Romero I
Laboratorio de Biología de Vectores, Instituto de Zoología Tropical, Facultad de Ciencias, Universidad Central de Venezuela, Apdo 47058, Caracas 1041-A, Venezuela.
Rev Panam Salud Publica. 2000 Oct;8(4):225-33. doi: 10.1590/s1020-49892000000900001.
Any effort to control dengue hemorrhagic fever (DHF) faces a number of challenges. Among these are the great environmental heterogeneity of homes and neighborhoods in urban centers where the primary dengue vector, Aedes aegypti, breeds, as well as shortages of resources and of personnel trained in mosquito control. Adequate epidemiological surveillance could serve as a basis to begin to stratify urban communities and identify the areas in them where control efforts should be focused. In this study we stratified Maracay, Venezuela, a city with hyperendemic dengue hemorrhagic fever, using a geographic information system and analyzing the persistence, incidence, and prevalence of dengue, by means of clinical diagnoses reported from 1993 through 1998. Maracay has around one million inhabitants living in some 349 neighborhoods in the six communities that make up the greater Maracay metropolitan area. During that 1993-1998 period the Maracay area reported 10,576 cases of dengue, 2,593 cases of DHF, and 8 deaths. The incidence of DHF was related to the incidence of dengue, the number of inhabitants in an area, and population density. The spatial pattern of dengue incidence was stable over the years that were studied, and significant, positive relationships were found between pairs of years and the incidence of dengue by neighborhood. The persistence of dengue was related directly to monthly incidence by neighborhood. These spatial patterns helped to divide the city into three strata: 68 neighborhoods without apparent dengue, 226 neighborhoods with low persistence and prevalence, and 55 neighborhoods with high persistence and prevalence. We recommend giving the highest priority for control efforts to these 55 neighborhoods, which make up just 35% of the Maracay urban area but had 70% of all the reported dengue cases.
控制登革出血热（DHF）的任何努力都面临着诸多挑战。其中包括城市中心家庭和社区环境差异极大，主要登革热媒介埃及伊蚊在这些地方繁殖，以及资源短缺和缺乏蚊虫控制方面的专业人员。充分的流行病学监测可作为对城市社区进行分层并确定控制工作重点区域的基础。在本研究中，我们利用地理信息系统对委内瑞拉马拉开波市进行分层，该市登革出血热高度流行，通过分析1993年至1998年报告的临床诊断数据，研究登革热的持续性、发病率和患病率。马拉开波市约有100万居民，分布在构成大马拉凯都会区的6个社区的约349个街区。在1993 - 1998年期间，马拉开波地区报告了10576例登革热病例、2593例登革出血热病例和8例死亡。登革出血热的发病率与登革热发病率、某地区居民数量以及人口密度有关。在研究的几年中，登革热发病率的空间模式保持稳定，并且发现不同年份之间以及各街区登革热发病率之间存在显著的正相关关系。登革热的持续性与各街区的月发病率直接相关。这些空间模式有助于将城市分为三个层次：68个无明显登革热的街区、226个持续性和患病率较低的街区以及55个持续性和患病率较高的街区。我们建议将控制工作的最高优先级给予这55个街区，它们仅占马拉开波市区的35%，却报告了所有登革热病例的70%。
