Abstract

BackgroundDengue 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.MethodologyAn 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.Principal findingsThe 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.ConclusionsThis 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.

Highlights

  • Dengue virus is a rapidly spreading mosquito-borne virus of global public health importance [1,2,3], causing extensive morbidity and economic loss in tropical and subtropical regions [2, 4, 5]

  • This study demonstrates a robust spatial association between dengue incidence rates and socioeconomic status across the different neighborhoods of the city of Noumea

  • From September 2008 to August 2009, New Caledonia suffered an epidemic with 8,586 reported dengue cases [22], initially caused by dengue serotype 1 (DENV1), until dengue serotype 4 (DENV4) started to co-circulate, causing the majority of reported cases [19]

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Summary

Introduction

Dengue virus is a rapidly spreading mosquito-borne virus of global public health importance [1,2,3], causing extensive morbidity and economic loss in tropical and subtropical regions [2, 4, 5]. Dengue is present in over 120 countries, and estimates suggest as many as 390 million infections per year worldwide, a quarter of which are symptomatic [6,7,8] Possible reasons for this rapid expansion include: climate change, population growth, urbanization, increased domestic and international travel, as well as disruption of health systems and vector control [1, 9,10,11].

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