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      Analysis of the spatial distribution of cases of Zika virus infection and congenital Zika virus syndrome in a state in the southeastern region of Brazil: Sociodemographic factors and implications for public health

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          Abstract

          Objective

          To perform spatial distribution analysis of reported cases of Zika virus and congenital Zika syndrome (CZS) in the state of Espírito Santo, Brazil, by neighborhood, and relate the results to sociodemographic indicators and implications for the health process.

          Methods

          An ecological study using data from the 2016 National Notifiable Diseases Surveillance System, epidemiological records, and information on neighborhoods of families confirmed with CZS from qualitative field research.

          Results

          Sociodemographic indicators were analyzed in three distinct groups: general population with Zika virus, pregnant women with Zika virus, and cases of CZS visited. For the three groups, average literacy rates were 71.1%, 71.0%, and 68.3%; the average income per minimum wage was 1.4, 1.1, and 1.4; sanitary sewage coverage was 75.6%, 76.1%, and 71.4%; garbage coverage was 90.8%, 91.2%, and 89.2%; and water supply was 93.8%, 94.1% and 93.8%, respectively. Socioeconomic indicators showed no significant differences between groups, although they were above the national average. A nonsignificant variation of 68.3%–71.1% was seen in the average literacy level above 15 years of age.

          Conclusion

          Socioeconomic and demographic indicators of cases of Zika virus infection and CZS may indicate that the outbreak had different impacts according to class, social group, or gender, reflecting the persistence and social geography of inequality in Brazil.

          Abstract

          The sociodemographic profile of cases of Zika virus and congenital Zika virus syndrome reveals different impacts on social strata and reflects the social geography of inequality in Brazil.

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          Most cited references17

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          Zika virus: history of a newly emerging arbovirus.

          Zika virus was originally identified in a sentinel rhesus monkey in the Zika Forest of Uganda in 1947. The virus is a member of the family Flaviviridae, genus Flavivirus, and is transmitted to humans by Aedes species mosquitoes. The first report of Zika virus outside Africa and Asia was in 2007 when the virus was associated with a small outbreak in Yap State, part of the Federated States of Micronesia. Since then, Zika virus infections have been reported around the world, including in southeast Asia; French Polynesia and other islands in the Pacific Ocean; and parts of South, Central, and North America. Symptomatic infection in human beings normally results in a mild and self-limiting febrile disease, although recent reports have suggested a possible association with more serious sequelae such as Guillain-Barré syndrome, and microcephaly in newborn infants of mothers infected with Zika virus during pregnancy. In this Review, we summarise the history of Zika virus from its first detection to its current worldwide distribution.
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            Identification of Zika virus vectors and implications for control.

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              Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil

              Background Starting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015–2016), which is in Northeast Brazil, and its association with the living conditions in this city. Methods This was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of −2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions. Results During the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata. Conclusion This study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.
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                Author and article information

                Contributors
                paulassfreitas@gmail.com
                Journal
                Int J Gynaecol Obstet
                Int J Gynaecol Obstet
                10.1002/(ISSN)1879-3479
                IJGO
                International Journal of Gynaecology and Obstetrics
                John Wiley and Sons Inc. (Hoboken )
                0020-7292
                1879-3479
                23 January 2020
                January 2020
                : 148
                : Suppl 2 , Building opportunities during the Zika epidemic in the Americas: The case for strengthening research capacity ( doiID: 10.1002/ijgo.v148.s2 )
                : 61-69
                Affiliations
                [ 1 ] Laboratory of Epidemiology Federal University of Espírito Santo Vitória ES Brazil
                [ 2 ] Graduate Program in Collective Health Federal University of Espírito Santo Vitória ES Brazil
                [ 3 ] Departament of Geography Federal University of Espírito Santo Vitória ES Brazil
                [ 4 ] Department of Statistics Federal University of Espírito Santo Vitória ES Brazil
                [ 5 ] Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA USA
                Author notes
                [*] [* ] Correspondence

                Paula S.S. Freitas, Federal University of Espírito Santo.

                Email: paulassfreitas@ 123456gmail.com

                Article
                IJGO13049
                10.1002/ijgo.13049
                7065179
                31975398
                984f5426-9d4b-416b-914e-b177280bd3c6
                © 2020 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics

                This is an open access article distributed under the terms of the https://creativecommons.org/licenses/by/3.0/igo/legalcode which permits unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or the article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s URL.

                History
                Page count
                Figures: 4, Tables: 3, Pages: 9, Words: 6257
                Funding
                Funded by: HRP, TDR, WHO
                Categories
                Supplement Article
                Supplement Articles
                Custom metadata
                2.0
                January 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.7 mode:remove_FC converted:11.03.2020

                Obstetrics & Gynecology
                brazil,congenital zika virus syndrome,public health,spatial distribution,zika virus infection

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