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      Factores asociados con la incidencia de dengue en Costa Rica Translated title: Factors associated with incidence of dengue in Costa Rica

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          Abstract

          OBJETIVO: Determinar el grado de influencia de diferentes variables socioeconómicas, demográficas, geográficas y climáticas con respecto a la incidencia de dengue y dengue hemorrágico (D/DH) en Costa Rica durante el período 1999-2007. MÉTODOS: Se realizó un estudio epidemiológico de tipo correlacional, analizando la incidencia acumulada de D/DH desde 1999 a 2007 y su asociación con diferentes variables en los 81 cantones del país. La información se obtuvo de fuentes secundarias y las variables independientes usadas para el análisis se seleccionaron considerando su representatividad en cuanto a aspectos sociodemográficos, ambientales y de cobertura sanitaria que afectan a la epidemiología de D/DH. Estas variables se organizaron en cuatro grupos de indicadores: demográficos, socioeconómicos, de vivienda y climáticos y geográficos. Los datos se analizaron por medio de regresiones de Poisson simples y múltiples. RESULTADOS: Los cantones de Costa Rica con mayor incidencia de D/DH se localizaron principalmente cerca de las costas, coincidiendo con algunas de las variables estudiadas. La temperatura, la altitud y el índice de pobreza humana (IPH) fueron las variables más relevantes para explicar la incidencia de D/DH, en tanto que la temperatura fue la más significativa en los análisis múltiples. CONCLUSIONES: Los análisis permitieron relacionar una mayor incidencia de D/DH con cantones de menor altitud, mayor temperatura y un IPH elevado. Esta información es relevante como un primer paso para estratificar prioridades y optimizar acciones de prevención y control de esta enfermedad.

          Translated abstract

          OBJECTIVE: Determine the extent to which socioeconomic, demographic, geographic, and climate variables affected the incidence of dengue and dengue hemorrhagic fever (D/DH) in Costa Rica during the period 1999-2007. METHODS: A correlational epidemiologic study was conducted that analyzed the cumulative incidence of D/DH from 1999 to 2007 and its association with different variables in the country's 81 cantons. Information was obtained from secondary sources, and the independent variables used for the analysis were selected on the basis of their representativeness in terms of sociodemographic, environmental, and health coverage factors that affect the epidemiology of D/DH. These variables were divided into four groups of indicators: demographic, socioeconomic, housing, and climate and geographical. The data were analyzed by means of simple and multiple Poisson regressions. RESULTS: The Costa Rican cantons with a higher incidence of D/DH were located primarily near the coast, coinciding with some of the variables studied. Temperature, altitude, and the human poverty index were the most relevant variables in explaining the incidence of D/DH, while temperature was the most significant variable in the multiple analyses. CONCLUSIONS: The analyses made it possible to correlate a higher incidence of D/DH with lower-altitude cantons, higher temperature, and a high human poverty index ranking. This information is relevant as a first step toward prioritizing and optimizing actions for the prevention and control of this disease.

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          Dengue virus-mosquito interactions.

          The mosquito Aedes aegypti is more widely dispersed now than at any time in the past, placing billions of humans at risk of infection with one or more of the four dengue viruses. This review presents and discusses information on mosquito-dengue infection dynamics and describes the prominent role that temperature and rainfall play in controlling dengue viral transmission including discussions of the effect of interannual climate variations and the predicted effect of global warming. Complementary human determinants of dengue epidemiology include viremia titer, variation in viremic period, enhanced viremias, and threshold viremia. Topics covered include epidemiological phenomena such as traveling waves, the generation of genetic diversity of dengue viruses following virgin soil introductions and in hyperendemic settings, and evidence for and against viral virulence as a determinant of the severity of dengue infections. Also described is the crucial role of monotypic and heterotypic herd immunity in shaping dengue epidemic behavior.
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            Review of the factors modulating dengue transmission.

            G Kuno (1994)
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              Dengue--a re-emerging infectious disease in Singapore.

              Despite its well-established integrated nationwide Aedes mosquito control programme which incorporates source reduction, public health education and law enforcement, Singapore has not been spared from the regional resurgence of dengue. The disease incidence has been increasing from 9.3 per 100,000 in 1988 to 102.7 per 100,000 in 1996 at the time when the Aedes house index (HI) has dropped to around 1% from > 25% in the 1960s. Majority of the cases reported from 1990 to 1996 were dengue fever (DF); dengue haemorrhagic fever (DHF) constituted only 6.7%. The case-fatality rate was 0.1% with 13 (81.3%) of 16 serologically confirmed deaths above 19 years of age. The median age has shifted from 14 years in 1973 to 27 years in 1996. The proportion of primary infections also increased from about one-third in 1990 to nearly half in 1996. All four dengue serotypes have been detected from infected persons with dengue 2 predominating in 1990, 1991 and 1993, dengue 3 in 1992 and 1994 and dengue 1 in 1995 and 1996. The disease incidence was significantly correlated with Aedes aegypti HI and residents of compound houses had a significantly higher rate of infection as well as a higher morbidity rate compared with dwellers of high-rise public housing estates. Seroprevalence surveys confirmed the low level of dengue transmission. The immunity level of the general population has been declining with only 6.4% of children and young adults below 25 years of age possessing haemagglutination-inhibition antibody to dengue 2. It would appear that the successful vector control programme over the last two decades has brought about a paradoxical situation in that outbreaks tend to occur more frequently and with even greater intensity because of the low herd immunity of the population. Until the dengue vaccine is commercially available for mass immunisation of the population, community-based integrated control of Aedes aegypti remains the key to the prevention and control of DF/DHF.
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                Author and article information

                Journal
                rpsp
                Revista Panamericana de Salud Pública
                Rev Panam Salud Publica
                Organización Panamericana de la Salud (Washington, Washington, United States )
                1020-4989
                1680-5348
                April 2011
                : 29
                : 4
                : 234-242
                Affiliations
                [01] orgnameUniversidad de Costa Rica orgdiv1Facultad de Microbiología orgdiv2Departamento de Parasitología adriana.troyo@ 123456ucr.ac.cr
                [02] San José orgnameUniversidad de Costa Rica orgdiv1Centro Centroamericano de Población y Escuela de Estadística Costa Rica
                Article
                S1020-49892011000400004 S1020-4989(11)02900404
                10.1590/s1020-49892011000400004
                bf95cc25-d362-46fd-bbd3-de004eb29c13

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 23 November 2010
                : 23 April 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 44, Pages: 9
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                SciELO Public Health

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Artículos de Investigación Original

                Dengue,fiebre hemorrágica dengue,infecciones por arbovirus,incidencia,factores socioeconómicos,Costa Rica,dengue hemorrhagic fever,arbovirus infections,incidence,socioeconomic factors

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