Prevention and control of Aedes transmitted infections in the post-pandemic scenario of COVID-19: challenges and opportunities for the region of the Americas

Spatio-Temporal Cluster Detection of Dengue, Chikungunya, and Zika Viruses' Infection in Rio de Janeiro State from 2010 to 2019

Dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) virus infections are widespread throughout the Rio de Janeiro state. The co-circulation of these emergent arboviruses constitutes a serious public health problem, resulting in outbreaks that can spatially and temporally overlap. Environmental conditions favor the presence, maintenance, and expansion of Aedes aegypti, the primary vector of these urban arboviruses. This study assessed the detection of clusters of urban arboviruses in the Rio de Janeiro state from 2010 to 2019. Notified cases of dengue, chikungunya, and Zika were grouped by year according to the onset of symptoms and their municipality of residence. The study period recorded the highest number of dengue epidemics in the state along with the simultaneous circulation of chikungunya and Zika viruses. The analyzes showed that the central municipalities of the metropolitan regions were associated with higher risk areas. Central municipalities in metropolitan regions were the first most likely clusters for dengue and Zika, and the second most likely cluster for chikungunya. Furthermore, the northwest and north regions were comprised clusters with the highest relative risk for the three arboviruses, underscoring the impact of these arboviruses in less densely populated regions of Brazil. The identification of high-risk areas over time highlights the need for effective control measures, targeted prevention and control interventions for these urban arboviral diseases.

Dengue and COVID-19 Co-Circulation in the Peruvian Amazon: A Population-Based Study

The COVID-19 pandemic affected the main Amazon cities dramatically, with Iquitos City reporting the highest seroprevalence of anti-SARS-CoV-2 antibodies during the first COVID-19 wave worldwide. This phenomenon raised many questions about the possibility of a co-circulation of dengue and COVID-19 and its consequences. We carried out a population-based cohort study in Iquitos, Peru. We obtained a venous blood sample from a subset of 326 adults from the Iquitos COVID-19 cohort (August 13-18, 2020) to estimate the seroprevalence of anti-dengue virus (DENV) and anti-SARS-CoV-2 antibodies. We tested each serum sample for anti-DENV IgG (serotypes 1, 2, 3, and 4) and SARS-CoV-2 antibodies anti-spike IgG and IgM by ELISA. We estimated an anti-SARS-CoV-2 seroprevalence of 78.0% (95% CI, 73.0-82.0) and an anti-DENV seroprevalence of 88.0% (95% CI, 84.0-91.6), signifying a high seroprevalence of both diseases during the first wave of COVID-19 transmission in the city. The San Juan District had a lower anti-DENV antibody seroprevalence than the Belen District (prevalence ratio, 0.90; 95% CI, 0.82-0.98). However, we did not observe these differences in anti-SARS-CoV-2 antibody seroprevalence. Iquitos City presented one of the highest seroprevalence rates of anti-DENV and anti-SARS-CoV-2 antibodies worldwide, but with no correlation between their antibody levels.

The Impact of COVID-19 Pandemic on Arthropod-Related Diseases

Background

The Covid-19 pandemic that caused by the infection with the novel Coronavirus SARS-CoV-2 has revealed individual and global vulnerabilities all over the world. Many countries that had been struggled with arthropod-borne diseases (VBDs) are now embroiled in another challenge caused by COVID-19 pandemic. The situation that poses major obstacles 1) by misdiagnosis 2) delay in early and appropriate treatment of VBDs 3) difficulties in applying regular strategy for vector control and prevention methods and finally 4) irregularity in financing supports. Given the possible scenario of syndemics, it is important to plan integrated and combined measurement with the maximum participation of the people and health authorities. Here, the impact of COVID-19 pandemic on some major arthropod-related diseases will be discussed.

Methods

To access the collective data all related databases such as Science direct, PubMed, Elsevier, Google scholar, as well WHO web page were searched with key words "arthropoda-related diseases, COVID-19 with the name of each individual disease".

Results

The results showed that the management, control, and treatment of most important arthropod-related diseases could be delayed due to COVID-19 pandemic.

Conclusion

Dealing with COVID-19, it is crucial to consider the other main killers such as malaria, dengue fever, etc. more especially in vulnerable populations by greater political, financial and global commitment. Continued surveillance will be essential to monitor for any possible changes.

Percepção da população sobre a atuação das autoridades e das comunidades no controle das arboviroses

RESUMO O controle ambiental para a prevenção das arboviroses depende tanto de ações dos poderes públicos quanto do envolvimento das comunidades. A presente pesquisa analisou a percepção de 385 pessoas em 17 municípios das 5 regiões do País sobre a atuação das autoridades e da própria comunidade em relação ao controle e à prevenção da dengue. Independentemente da região, os participantes reconheceram que ações como saneamento básico, coleta regular de lixo, fiscalização de terrenos baldios e domicílios fechados têm sido frequentemente negligenciadas pelas autoridades. A responsabilização da comunidade, na figura do vizinho que não cumpre as medidas de controle, também foi percepção dominante, chamando a atenção a ausência de qualquer reconhecimento sobre como condições sociais desfavoráveis influenciam nas dificuldades para a realização dos procedimentos preventivos. Reflete-se ainda acerca dos prejuízos que a pandemia de Covid-19 tem causado às práticas preventivas e seus possíveis impactos futuros.

Perception of the population on the role of authorities and communities in controlling arboviruses

ABSTRACT The environmental control for prevention of arboviruses depends both on the actions of public authorities and the involvement of communities. The present study analyzed the perception of 385 citizens of 17 municipalities from the 5 regions of Brazil regarding the actions of the authorities and the community itself in relation to the control and prevention of dengue. The participants acknowledged that actions such as basic sanitation, regular waste collection, inspection of vacant lots and closed homes have often been neglected by the authorities. There was a tendency to hold the community accountable, through the example of neighbors who do not carry out prevention procedures. It was also noteworthy the silencing around unfavorable social conditions that can hinder the implementation of prevention procedures. We also reflected on the damage that the COVID-19 pandemic has caused to preventive practices and its possible future impacts.

[COVID-19 as a syndemic: a theoretical model and foundations for a comprehensive approach in health]

This essay aims to present and discuss the theoretical framework for the COVID-19 syndemic. The first part presents the foundations and principles of syndemic theory. For the purposes of this essay, syndemic was defined as a process of synergic interaction between two or more diseases, in which the effects are mutually enhanced. We discussed the three principal typologies of syndemic interaction: mutually causal epidemics; epidemics interacting synergically; and serial causal epidemics. In the second part, COVID-19 is analyzed as a syndemic resulting from the interaction between various groups of diseases and the socioeconomic context. The theoretical model considered the interaction between COVID-19 and chronic noncommunicable diseases, infectious and parasitic diseases, and mental health problems. The essay addressed how social iniquities and conditions of vulnerability act at various levels to increase the effect of COVID-19 and other pandemics. The last section discusses the need for comprehensive, multisector, and integrated responses to COVID-19. A model for intervention was presented that involves the patient care and socioeconomic dimensions. In the sphere of patient care, the authors defend the structuring of strong and responsive health systems, accessible to the entire population. The economic and social dimension addressed the issue of reclaiming the ideals of solidarity, the health promotion strategy, and emphasis on social determinants of health. In conclusion, the lessons learned from the syndemic approach to COVID-19 call on government and society to develop policies that link clinical, sanitary, socioeconomic, and environmental interventions.

Pandemic-associated mobility restrictions could cause increases in dengue virus transmission

BACKGROUND

The COVID-19 pandemic has induced unprecedented reductions in human mobility and social contacts throughout the world. Because dengue virus (DENV) transmission is strongly driven by human mobility, behavioral changes associated with the pandemic have been hypothesized to impact dengue incidence. By discouraging human contact, COVID-19 control measures have also disrupted dengue vector control interventions, the most effective of which require entry into homes. We sought to investigate how and why dengue incidence could differ under a lockdown scenario with a proportion of the population sheltered at home.

METHODOLOGY & PRINCIPAL FINDINGS

We used an agent-based model with a realistic treatment of human mobility and vector control. We found that a lockdown in which 70% of the population sheltered at home and which occurred in a season when a new serotype invaded could lead to a small average increase in cumulative DENV infections of up to 10%, depending on the time of year lockdown occurred. Lockdown had a more pronounced effect on the spatial distribution of DENV infections, with higher incidence under lockdown in regions with higher mosquito abundance. Transmission was also more focused in homes following lockdown. The proportion of people infected in their own home rose from 54% under normal conditions to 66% under lockdown, and the household secondary attack rate rose from 0.109 to 0.128, a 17% increase. When we considered that lockdown measures could disrupt regular, city-wide vector control campaigns, the increase in incidence was more pronounced than with lockdown alone, especially if lockdown occurred at the optimal time for vector control.

CONCLUSIONS & SIGNIFICANCE

Our results indicate that an unintended outcome of lockdown measures may be to adversely alter the epidemiology of dengue. This observation has important implications for an improved understanding of dengue epidemiology and effective application of dengue vector control. When coordinating public health responses during a syndemic, it is important to monitor multiple infections and understand that an intervention against one disease may exacerbate another.

Field Effectiveness of Drones to Identify Potential Aedes aegypti Breeding Sites in Household Environments from Tapachula, a Dengue-Endemic City in Southern Mexico

Aedes aegypti control programs require more sensitive tools in order to survey domestic and peridomestic larval habitats for dengue and other arbovirus prevention areas. As a consequence of the COVID-19 pandemic, field technicians have faced a new occupational hazard during their work activities in dengue surveillance and control. Safer strategies to monitor larval populations, in addition to minimum householder contact, are undoubtedly urgently needed. Drones can be part of the solution in urban and rural areas that are dengue-endemic. Throughout this study, the proportion of larvae breeding sites found in the roofs and backyards of houses were assessed using drone images. Concurrently, the traditional ground field technician's surveillance was utilized to sample the same house groups. The results were analyzed in order to compare the effectiveness of both field surveillance approaches. Aerial images of 216 houses from El Vergel village in Tapachula, Chiapas, Mexico, at a height of 30 m, were obtained using a drone. Each household was sampled indoors and outdoors by vector control personnel targeting all the containers that potentially served as Aedes aegypti breeding sites. The main results were that the drone could find 1 container per 2.8 found by ground surveillance; however, containers that were inaccessible by technicians in roofs and backyards, such as plastic buckets and tubs, disposable plastic containers and flowerpots were more often detected by drones than traditional ground surveillance. This new technological approach would undoubtedly improve the surveillance of Aedes aegypti in household environments, and better vector control activities would therefore be achieved in dengue-endemic countries.

Comparison of viral load between saliva and nasopharyngeal swabs for SARS-CoV2: the role of days of symptoms onset on diagnosis

BACKGROUND

Coronavirus disease 2019 (COVID-19) is highly infectious causing millions of deaths worldwide. Nasopharyngeal swabs are the primary sample of choice for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), thus, to decrease the exposure to potentially infected samples through the collection is a key point to reduce the risk of infection in healthcare workers.

OBJECTIVES

This study aimed to evaluate the sensitivity and viral load of saliva specimens by days of symptoms onset comparing to nasopharyngeal swabs in subjects with mild symptoms.

METHODS

Saliva and nasopharyngeal swabs samples were collected from São Paulo Hospital workers presenting mild symptoms, such as fever, cough, sore throat, rhinorrhea, myalgia, headaches, anosmia, ageusia, and fatigue. To understand the positivity and viral load, reverse transcription-polymerase chain reaction (RT-PCR) was performed.

FINDINGS

Saliva specimens presented a sensitivity of 98.6% compared to nasopharyngeal swabs. Overall, saliva showed lower viral load compared to nasopharyngeal swabs, regarding days of symptoms onset on diagnosis, the first four days had significant changes in viral load and no significant difference was reported in the days five to nine.

MAIN CONCLUSIONS

Although RT-PCR of saliva has presented a lower viral load compared to nasopharyngeal swabs, saliva specimens are a potential and reliable candidate for COVID-19 diagnosis through RT-PCR.

Impact of concurrent epidemics of dengue, chikungunya, zika, and COVID-19

INTRODUCTION:

This study evaluated the epidemiological implications of arbovirus infections and coronavirus disease (COVID-19) co-occurrences in Espírito Santo, Brazil.

METHODS:

This ecological study of dengue, chikungunya, zika, and COVID-19 was performed from January 1 to July 31, 2020.

RESULTS:

Espírito Santo registered 44,614, 8,092, 3,138, and 91,483 cases of dengue, chikungunya, zika, and COVID-19, respectively (January-July, 2020). In the 27 and four municipalities with a high incidence of dengue and chikungunya, respectively, the incidence of COVID-19 was 647.0-3,721.7 and 1,787.2-3,403.0 cases per 100,000 inhabitants, respectively.

CONCLUSIONS:

Espírito Santo experienced an overlap of epidemics, especially in urban areas.

The adoption of the One Health approach to improve surveillance of venomous animal injury, vector-borne and zoonotic diseases in Foz do Iguaçu, Brazil

Public health institutions with sectorized structure and low integration among field teams, old-fashioned practices such as paper-based storage system, and poorly qualified health agents have limited ability to conduct accurate surveillance and design effective timely interventions. Herein, we describe the steps taken by the Zoonosis Control Center of Foz do Iguaçu (CCZ-Foz) in the last 23 years to move from an archaic and sectorized structure to a modern and timely surveillance program embracing zoonotic diseases, venomous animal injuries, and vector-borne diseases epidemiology under the One Health approach. The full implementation of the One Health approach was based on 5 axes: (1) merging sectorized field teams; (2) adoption of digital solutions; (3) health agents empowerment and permanent capacitation; (4) social mobilization; and (5) active surveys. By doing so, notifications related to zoonotic diseases and venomous animals increased 10 and 21 times, respectively, with no impairment on arbovirus surveillance (major concern in the city). Open sources database (PostgreSQL) and software (QGis) are daily updated and create real-time maps to support timely decisions. The adoption of One Health approach increased preparedness for endemic diseases and reemerging and emerging threats such as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).