a Department of Public Health, University of Copenhagen, Copenhagen , Denmark.
b Oswaldo Cruz Foundation, IAM-FIOCRUZ/PE , Recife , Brazil.
Glob Public Health. 2019 May;14(5):675-683. doi: 10.1080/17441692.2018.1532528. Epub 2018 Oct 9.
The health consequences of arbovirus infections such as dengue fever (DENV), Chikungunya (CHIKV) and Zika (ZIKV) has in recent years become a public health challenge, due to failure of prevention followed by increased incidence and pronounced social inequality in occurrence and consequences. This motivates a more systematic analysis of the potential mechanisms and pathways that generate these inequalities. We present in the paper a model that delineates five possible mechanisms driving the inequality of ZIKV and congenital Zika syndrome (CZS). They include differential exposure to bad housing and sanitary conditions, differential exposure to vector density and virus, differential vulnerability to the health effects of exposure to virus, differential intrauterine susceptibility to the teratogenic effects of ZIKV infection and differential social consequences of caring for a disabled child. For each mechanism, we present empirical evidence or need for more research as well as a discussion about policy implications.
近年来，登革热（DENV）、基孔肯雅热（CHIKV）和寨卡热（ZIKV）等虫媒病毒感染的健康后果已成为公共卫生挑战，原因是预防措施不力，随后发病率上升，且在发生和后果方面存在明显的社会不平等。这促使人们更系统地分析产生这些不平等的潜在机制和途径。本文提出了一个模型，该模型描绘了导致寨卡病毒和先天性寨卡综合征（CZS）不平等的五个可能机制。它们包括对不良住房和卫生条件的不同暴露、对媒介密度和病毒的不同暴露、对接触病毒的健康影响的不同脆弱性、对 ZIKV 感染致畸作用的不同宫内易感性以及对照顾残疾儿童的不同社会后果。对于每种机制，我们都提供了经验证据或需要进一步研究的内容，并讨论了政策含义。
