Elsevier

Travel Medicine and Infectious Disease

Volume 18, July–August 2017, Pages 57-66
Travel Medicine and Infectious Disease

Original article
Mapping the ecoepidemiology of Zika virus infection in urban and rural areas of Pereira, Risaralda, Colombia, 2015–2016: Implications for public health and travel medicine

https://doi.org/10.1016/j.tmaid.2017.05.004Get rights and content

Abstract

Objective

Geographical information systems (GIS) have been demonstrated earlier to be of great use to inform public health action against vector-borne infectious diseases.

Methods

Using surveillance data on the ongoing ZIKV outbreak from Pereira, Colombia (2015–2016), we estimated incidence rates (cases/100,000 population), and developed maps correlating with the ecoepidemiology of the area.

Results

Up to October 8, 2016, 439 cases of ZIKV were reported in Pereira (93 cases/100,000 pop.), with highest rates in the South-West area. At the corregiments (sub-municipalities) of Pereira, Caimalito presented the highest rate. An urban area, Cuba, has 169 cases/100,000 pop., with a low economical level and the highest Aedic index (9.1%). Entomological indexes were associated with ZIKV incidence at simple and multiple non-linear regressions (r2 > 0.25; p < 0.05).

Conclusions

Combining entomological, environmental, human population density, travel patterns and case data of vector-borne infections, such as ZIKV, leads to a valuable tool that can be used to pinpoint hotspots also for infections such as dengue, chikungunya and malaria. Such a tool is key to planning mosquito control and the prevention of mosquito-borne diseases in local populations. Such data also enable microepidemiology and the prediction of risk for travelers who visit specific areas in a destination country.

Introduction

Zika virus (ZIKV) has caused epidemics during 2015–2017 in different countries of the Americas, with more than 50 countries/territories affected in this region, from 148 globally affected in any form (including imported cases) [1], [2]. After Brazil, probably Colombia is the second most affected country in the region [3], [4], [5], with over 100,000 cases having been reported from this Northern South American country, reflecting overall incidence rates above 150 cases/100,000 [3]. However, as previously demonstrated; when detailed analyses, at primary, secondary and tertiary territory levels are conducted, incidence rates found tend to be highly variable, and higher [3], [6], [7], [8].

Early-developed ZIKV epidemiological maps for Colombia using geographical information systems (GIS) at high incidence departments, such as La Guajira [8] and Sucre [7] (Caribbean region), Tolima [6] and Valle del Cauca [3] (Central and Western region), Santander and Norte de Santander (Northeastern area) were published, but these did not include ecoepidemiological analyses that would allow to a better understand the pattern of temporo-spatial distribution of ZIKV infection in these newly-endemic areas. This has been shown to be significant in other vector-borne and arboviral diseases, such as dengue [9], [10], [11], [12], where multiple studies have documented the influence of climate variables on its epidemiology, including reports from Colombia [9], [10], [11], [12]. Even more, there is a clear need from public health authorities to develop and use GIS-based maps not just for ZIKV, but also for dengue and chikungunya, which are co-circulating in Pereira, in Risaralda, as well Colombia and Latin America at the same time, even co-infecting [1], [13], [14].

ZIKV and other arboviral diseases could be associated with multiple factors including changes in environmental and social conditions that may influence their epidemiology [15], [16], [17], [18]. Up to date, there is a lack of studies assessing eco-epidemiological factors that would be related to ZIKV in Latin America, including Colombia, during ongoing epidemics [19].

Eco-epidemiological information is of utmost importance, which should include the availability of risk maps to address recommendations related to prioritize interventions as well for identification of areas of risk by visitors or people returning from visiting specific places [8], [11], [20], [21]. Linked to educational programs and other interventional measures [10], [20], [21], [22], [23], eco-epidemiological data should be considered in an integrated and systematic approach for ZIKV and other arboviral diseases control by national and local health authorities, as well at the community level in order to reduce and mitigate the disease impact.

In the current study, we set out to obtain estimates of ZIKV infection incidence rates in the municipality of Pereira, the capital of Risaralda department and the major city of the Coffee-Triangle region of Colombia; which included the development of GIS-based maps for disease, as well as its ecosystems, rainfall, economical classification as well as entomological indicators, among other ecoepidemiological aspects, in 2015–2016.

Section snippets

Methods

Scientific publications using GIS for development of epidemiological maps in ZIKV in Latin America are still lacking [6], [7], [8], [20], [24]. Pereira is the major city of the Coffee-Triangle region, which includes three departments (first administrative territory level) and 53 municipalities (second administrative territory level). This is the capital of Risaralda (957,250 habitants in 2016), a department surrounded by six other western departments (Antioquia, Caldas, Tolima, Quindio, Valle

Results

Up to October 8, 2016, 439 cases of ZIKV were reported in Pereira (33.85% of Risaralda department), for cumulated rates of 93/100,000 (Table 1). Of the total number of cases, 50 (11.4%) were laboratory confirmed by RT-PCR.

From the total number of cases, 77.7% occurred in the urban area, with a global incidence rate of 85.5 cases/100,000 (Table 1) (Fig. 1), and 94.1/100,000 in the rural area (1.1 times higher). Rates differed from 0 to 460/100,000 (Caimalito, rural, 7.3% of the municipality

Discussion

Colombia has reported a total of 104,724 cases of ZIKV infection during 2015–2016 (up to October 15, 2016), 8826 (8.4%) of them confirmed by RT-PCR [27], [28]. From the total, 1298 have been from Risaralda (1.24%) and 439 from Pereira city. Although the Ministry of Health, through its National Institute of Health, have declared the end of the epidemic phase in the country (during epidemiological 28th, July 16, 2016), certainly ZIKV has become endemic with stable transmission in most of its

Ethical approval

Not required.

Funding

Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia. This study is part of the project “Desarrollo de Mapas Epidemiológicos a través de Sistemas de Información Geográfica para la Caracterización Geográfica de Enfermedades Infecciosas y Tropicales en el Eje Cafetero de Colombia” (Code 5-15-5 [2015–2017]), Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia.

Author contributions

Study design: AJRM, Data collection: PR, JT, CAO, Data analysis: AJRM, COLR, PR, JT, Writing: All authors. All authors contributed to, and approved the final version submitted.

Data availability

Raw data for is available and will be provided on request.

Grant information

This study was funded by the Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia (Code 5-15-5 [2015–2017]). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of interest

The authors have no conflict of interest to disclose.

Acknowledgments

To Yuan Lian (USA) and Bao Cai (USA), for their critical review and English improvement of the manuscript. This manuscript has been previously presented in part at the XVIII Pan-American Congress of Infectious Diseases (Pan-American Association of Infectious Diseases, API), Panama City, Panama, May 2017 (Poster H-16). The Faculty of Health Sciences and Vice-Rectorship of Research of the Universidad Tecnologica de Pereira, the Colombian Association of Infectious Diseases (ACIN) (Coffee-Triangle

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