Zellweger Raphaël M, Cano Jorge, Mangeas Morgan, Taglioni François, Mercier Alizé, Despinoy Marc, Menkès Christophe E, Dupont-Rouzeyrol Myrielle, Nikolay Birgit, Teurlai Magali
Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Epidemiology of Infectious Diseases Expertise and Research Unit, Institut Pasteur in New Caledonia, Institut Pasteur International Network, Nouméa, New Caledonia.
PLoS Negl Trop Dis. 2017 Apr 3;11(4):e0005471. doi: 10.1371/journal.pntd.0005471. eCollection 2017 Apr.
Dengue is a mosquito-borne virus that causes extensive morbidity and economic loss in many tropical and subtropical regions of the world. Often present in cities, dengue virus is rapidly spreading due to urbanization, climate change and increased human movements. Dengue cases are often heterogeneously distributed throughout cities, suggesting that small-scale determinants influence dengue urban transmission. A better understanding of these determinants is crucial to efficiently target prevention measures such as vector control and education. The aim of this study was to determine which socioeconomic and environmental determinants were associated with dengue incidence in an urban setting in the Pacific.
An ecological study was performed using data summarized by neighborhood (i.e. the neighborhood is the unit of analysis) from two dengue epidemics (2008-2009 and 2012-2013) in the city of Nouméa, the capital of New Caledonia. Spatial patterns and hotspots of dengue transmission were assessed using global and local Moran's I statistics. Multivariable negative binomial regression models were used to investigate the association between dengue incidence and various socioeconomic and environmental factors throughout the city.
The 2008-2009 epidemic was spatially structured, with clusters of high and low incidence neighborhoods. In 2012-2013, dengue incidence rates were more homogeneous throughout the city. In all models tested, higher dengue incidence rates were consistently associated with lower socioeconomic status (higher unemployment, lower revenue or higher percentage of population born in the Pacific, which are interrelated). A higher percentage of apartments was associated with lower dengue incidence rates during both epidemics in all models but one. A link between vegetation coverage and dengue incidence rates was also detected, but the link varied depending on the model used.
This study demonstrates a robust spatial association between dengue incidence rates and socioeconomic status across the different neighborhoods of the city of Nouméa. Our findings provide useful information to guide policy and help target dengue prevention efforts where they are needed most.
登革热是一种由蚊子传播的病毒，在世界许多热带和亚热带地区造成广泛的发病率和经济损失。登革热病毒通常存在于城市中，由于城市化、气候变化和人类流动增加，其传播速度正在加快。登革热病例在城市中往往分布不均，这表明小规模的决定因素会影响登革热在城市中的传播。更好地了解这些决定因素对于有效地实施诸如病媒控制和教育等预防措施至关重要。本研究的目的是确定在太平洋地区的一个城市环境中，哪些社会经济和环境决定因素与登革热发病率相关。
采用新喀里多尼亚首府努美阿市两次登革热疫情（2008 - 2009年和2012 - 2013年）按社区汇总的数据进行生态研究（即社区为分析单位）。使用全局和局部莫兰指数统计评估登革热传播的空间模式和热点。多变量负二项回归模型用于研究整个城市登革热发病率与各种社会经济和环境因素之间的关联。
2008 - 2009年的疫情在空间上具有结构性，存在高发病率和低发病率社区的集群。2012 - 2013年，整个城市的登革热发病率更为均匀。在所有测试模型中，较高的登革热发病率始终与较低的社会经济地位相关（较高的失业率、较低的收入或较高比例的出生在太平洋地区的人口，这些因素相互关联）。在所有模型（除一个模型外）中，较高比例的公寓与两次疫情期间较低的登革热发病率相关。还检测到植被覆盖与登革热发病率之间的联系，但该联系因所使用的模型而异。
本研究表明，努美阿市不同社区的登革热发病率与社会经济地位之间存在强烈的空间关联。我们的研究结果为指导政策提供了有用信息，并有助于在最需要的地方开展登革热预防工作。
