The social and spatial ecology of dengue presence and burden during an outbreak in Guayaquil, Ecuador, 2012
Dengue fever, a mosquito-borne viral disease, is an ongoing public health problem in Ecuador and throughout the tropics, yet we have a limited understanding of the disease transmission dynamics in these regions. The objective of this study was to characterize the spatial dynamics and social-ecological risk factors associated with a recent dengue outbreak in Guayaquil, Ecuador. We examined georeferenced dengue cases (n = 4,248) and block-level census data variables to identify potential social-ecological variables associated with the presence and burden of dengue fever in Guayaquil in 2012. We applied LISA and Morans I tests to analyze hotspots of dengue cases and used multimodel selection in R computing language to identify covariates associated with dengue incidence at the census zone level. Significant hotspots of dengue transmission were found near the North Central and Southern portions of Guayaquil. Significant risk factors for presence of dengue included poor housing conditions (e.g., poor condition of ceiling, floors, and walls), access to paved roads, and receipt of remittances. Counterintuitive positive correlations with dengue presence were observed with several municipal services such as garbage collection and access to piped water. Risk factors for the increased burden of dengue included poor housing conditions, garbage collection, receipt of remittances, and sharing a property with more than one household. Social factors such as education and household demographics were negatively correlated with increased dengue burden. Our findings elucidate underlying differences with dengue presence and burden and indicate the potential to develop dengue vulnerability and risk maps to inform disease prevention and control - information that is also relevant for emerging epidemics of chikungunya and zika.\n\nHighlightsO_LIIn 2012, Guayaquil, Ecuador had a large outbreak of dengue cases\nC_LIO_LIDengue case presence and burden exhibited spatial heterogeneity at the census block level\nC_LIO_LISocial-ecological drivers of case presence and burden differed in this outbreak, highlighting the need to model both types of epidemiological data\nC_LIO_LIAccess to municipal resources such as garbage collection and piped water had counterintuitive relationships with dengue presence, but poor housing, garbage collection and remittances correlated to dengue burden.\nC_LIO_LIOur findings inform risk mapping and vector control and surveillance allocation, relevant to this and other concurrent emergent epidemics such as chikungunya and zika\nC_LI