Cláudia Torres Codeço

Endemic and epidemic dynamics of cholera: the role of the aquatic reservoir

BackgroundIn the last decades, attention to cholera epidemiology increased, as cholera epidemics became a worldwide health problem. Detailed investigation of V. cholerae interactions with its host and with other organisms in the environment suggests that cholera dynamics is much more complex than previously thought. Here, I formulate a mathematical model of cholera epidemiology that incorporates an environmental reservoir of V. cholerae. The objective is to explore the role of the aquatic reservoir on the persistence of endemic cholera as well as to define minimum conditions for the development of epidemic and endemic cholera.ResultsThe reproduction rate of cholera in a community is defined by the product of social and environmental factors. The importance of the aquatic reservoir depends on the sanitary conditions of the community. Seasonal variations of contact rates force a cyclical pattern of cholera outbreaks, as observed in some cholera-endemic communities.ConclusionsFurther development on cholera modeling requires a better understanding of V. cholerae ecology and epidemiology. We need estimates of the prevalence of V. cholerae infection in endemic populations as well as a better description of the relationship between dose and virulence.

Spatial Evaluation and Modeling of Dengue Seroprevalence and Vector Density in Rio de Janeiro, Brazil

Background Rio de Janeiro, Brazil, experienced a severe dengue fever epidemic in 2008. This was the worst epidemic ever, characterized by a sharp increase in case-fatality rate, mainly among younger individuals. A combination of factors, such as climate, mosquito abundance, buildup of the susceptible population, or viral evolution, could explain the severity of this epidemic. The main objective of this study is to model the spatial patterns of dengue seroprevalence in three neighborhoods with different socioeconomic profiles in Rio de Janeiro. As blood sampling coincided with the peak of dengue transmission, we were also able to identify recent dengue infections and visually relate them to Aedes aegypti spatial distribution abundance. We analyzed individual and spatial factors associated with seroprevalence using Generalized Additive Model (GAM). Methodology/Principal Findings Three neighborhoods were investigated: a central urban neighborhood, and two isolated areas characterized as a slum and a suburban area. Weekly mosquito collections started in September 2006 and continued until March 2008. In each study area, 40 adult traps and 40 egg traps were installed in a random sample of premises, and two infestation indexes calculated: mean adult density and mean egg density. Sera from individuals living in the three neighborhoods were collected before the 2008 epidemic (July through November 2007) and during the epidemic (February through April 2008). Sera were tested for DENV-reactive IgM, IgG, Nested RT-PCR, and Real Time RT-PCR. From the before–after epidemics paired data, we described seroprevalence, recent dengue infections (asymptomatic or not), and seroconversion. Recent dengue infection varied from 1.3% to 14.1% among study areas. The highest IgM seropositivity occurred in the slum, where mosquito abundance was the lowest, but household conditions were the best for promoting contact between hosts and vectors. By fitting spatial GAM we found dengue seroprevalence hotspots located at the entrances of the two isolated communities, which are commercial activity areas with high human movement. No association between recent dengue infection and households high mosquito abundance was observed in this sample. Conclusions/Significance This study contributes to better understanding the dynamics of dengue in Rio de Janeiro by assessing the relationship between dengue seroprevalence, recent dengue infection, and vector density. In conclusion, the variation in spatial seroprevalence patterns inside the neighborhoods, with significantly higher risk patches close to the areas with large human movement, suggests that humans may be responsible for virus inflow to small neighborhoods in Rio de Janeiro. Surveillance guidelines should be further discussed, considering these findings, particularly the spatial patterns for both human and mosquito populations.

Uncertainties regarding dengue modeling in Rio de Janeiro, Brazil

Dengue fever is currently the most important arthropod-borne viral disease in Brazil. Mathematical modeling of disease dynamics is a very useful tool for the evaluation of control measures. To be used in decision-making, however, a mathematical model must be carefully parameterized and validated with epidemiological and entomological data. In this work, we developed a simple dengue model to answer three questions: (i) which parameters are worth pursuing in the field in order to develop a dengue transmission model for Brazilian cities; (ii) how vector density spatial heterogeneity influences control efforts; (iii) with a degree of uncertainty, what is the invasion potential of dengue virus type 4 (DEN-4) in Rio de Janeiro city. Our model consists of an expression for the basic reproductive number (R0) that incorporates vector density spatial heterogeneity. To deal with the uncertainty regarding parameter values, we parameterized the model using a priori probability density functions covering a range of plausible values for each parameter. Using the Latin Hypercube Sampling procedure, values for the parameters were generated. We conclude that, even in the presence of vector spatial heterogeneity, the two most important entomological parameters to be estimated in the field are the mortality rate and the extrinsic incubation period. The spatial heterogeneity of the vector population increases the risk of epidemics and makes the control strategies more complex. At last, we conclude that Rio de Janeiro is at risk of a DEN-4 invasion. Finally, we stress the point that epidemiologists, mathematicians, and entomologists need to interact more to find better approaches to the measuring and interpretation of the transmission dynamics of arthropod-borne diseases.

Body size-associated survival and dispersal rates of Aedes aegypti in Rio de Janeiro

Abstract The daily survival rate of Aedes aegypti (L) (Diptera: Culicidae) is one of the most important parameters in mathematical models of dengue transmission. In this report, we evaluate the effect of adult body size on the survival and dispersal rates of male and female Ae. aegypti, the primary dengue vector in Brazil. Independent of larval diet (i.e. size), the daily survival rate of females recaptured in the field was greater than that of males (smaller: t = 5.617; d.f. = 15; P < 0.05; larger: t = 4.241; d.f. = 16; P < 0.05). Larger males lived longer than smaller males (t = 2.2893; d.f. = 7; P < 0.05), but no size effect was observed for females (t =– 0.086; d.f. = 19; P= 0.932). The daily survival rate of smaller females was similar to that of larger females (0.712 and 0.730, respectively, as calculated by an exponential model, and 0.743 and 0.779, respectively, calculated by a non‐linear model), and they dispersed further than larger females (mean distances travelled were 78.8 m and 40.9 m, respectively; t =− 10.22; d.f. = 323; P < 0.05). Adult body size did not influence male dispersal distances (t = 0.904; d.f. = 206; P= 0.367). Given our evidence that smaller females appear to have similar lifespans and evidence from other studies that they bite more frequently during a single gonotrophic cycle than larger females, our results suggest that smaller females have a higher vectorial capacity.

Temporal Distribution of Aedes aegypti in Different Districts of Rio De Janeiro, Brazil, Measured by Two Types of Traps

ABSTRACT Dengue dynamics in Rio de Janeiro, Brazil, as in many dengue-endemic regions of the world, is seasonal, with peaks during the wet-hot months. This temporal pattern is generally attributed to the dynamics of its mosquito vector Aedes aegypti (L.). The objectives of this study were to characterize the temporal pattern of Ae. aegypti population dynamics in three neighborhoods of Rio de Janeiro and its association with local meteorological variables; and to compare positivity and density indices obtained with ovitraps and MosquiTraps. The three neighborhoods are distinct in vegetation coverage, sanitation, water supply, and urbanization. Mosquito sampling was carried out weekly, from September 2006 to March 2008, a period during which large dengue epidemics occurred in the city. Our results show peaks of oviposition in early summer 2007 and late summer 2008, detected by both traps. The ovitrap provided a more sensitive index than MosquiTrap. The MosquiTrap detection threshold showed high variation among areas, corresponding to a mean egg density of ≈25–52 eggs per ovitrap. Both temperature and rainfall were significantly related to Ae. aegypti indices at a short (1 wk) time lag. Our results suggest that mean weekly temperature above 22–24°C is strongly associated with high Ae. aegypti abundance and consequently with an increased risk of dengue transmission. Understanding the effects of meteorological variables on Ae. aegypti population dynamics will help to target control measures at the times when vector populations are greatest, contributing to the development of climate-based control and surveillance measures for dengue fever in a hyperendemic area.

Movement of Dengue Vectors Between the Human Modified Environment and an Urban Forest in Rio de Janeiro

Abstract The movement of Aedes aegypti (L.) and Aedes albopictus (Skuse) females between sylvatic and urban environments was investigated by marking, releasing, and recapturing adults and by identifying rubidium (Rb)-marked eggs of females that were released after taking a bloodmeal containing RbCl. When released in the forest, Ae. albopictus females flew as far as 1,000 m and reached houses within 1 wk. When Ae. albopictus were released close to houses, most females were recaptured near the release point, and Rb-marked eggs were found 1,000 m away in the forest only once, 35 d after the release. These differing patterns of movement may suggest a preference of Ae. albopictus for the human-modified environment. Ae. aegypti, however, showed low tendency to disperse into the forest. The capacity of Ae. albopictus females to disperse from a sylvatic into a human-modified environment suggests that this species may play a role in the dissemination of forest-restricted pathogens, such as yellow fever virus.

Higher incidence of Zika in adult women than adult men in Rio de Janeiro suggests a significant contribution of sexual transmission from men to women

OBJECTIVES The recent emergence of Zika in Brazil and its association with an increased rate of congenital malformations has raised concerns over its impact on the birth rate in the country. Using data on the incidence of Zika in 2015-2016 and dengue in 2013 and 2015-2016 for the city of Rio de Janeiro (population 6.4 million), a massive increase of Zika in women compared to men was documented. METHODS The age-adjusted incidence was compared between men and women. A negative binomial Poisson generalized linear model was fitted to the Zika incidence data to determine the significance of sexual transmission statistically. RESULTS Even after correcting for the bias due to the systematic testing of pregnant women for Zika, there were found to be 90% more registered cases per 100000 women than men in the sexually active age group (15-65 years); this was not the case for age groups <15 years and >65 years. Assuming that infected men transmit the disease to women in their semen, but that the converse is not true, some extra incidence in women is to be expected. An alternate hypothesis would be that women visit doctors more often than men. To test this, the incidence of dengue fever was compared in men and women in 2015 and in 2013 (before Zika reached Rio de Janeiro): in both years, women were 30% more likely to be reported with dengue. CONCLUSION Women in the sexually active age group are far more likely to get Zika than men (+90% increase); sexual transmission is the most probable cause. Women in the 15-65 years age group are also 30% more likely to be reported with dengue than men, which is probably due to women being more careful with their health.

Análise de sobrevivência: teoria e aplicações em saúde

O objetivo apoiar o desenvolvimento metodologico em analise de dados longitudinais, atraves da aplicacao, teste e disseminacao de metodos estatisticos inovadores no contexto da saude, particularmente os voltados para a analise de sobrevida

A Bayesian Framework for Parameter Estimation in Dynamical Models

Mathematical models in biology are powerful tools for the study and exploration of complex dynamics. Nevertheless, bringing theoretical results to an agreement with experimental observations involves acknowledging a great deal of uncertainty intrinsic to our theoretical representation of a real system. Proper handling of such uncertainties is key to the successful usage of models to predict experimental or field observations. This problem has been addressed over the years by many tools for model calibration and parameter estimation. In this article we present a general framework for uncertainty analysis and parameter estimation that is designed to handle uncertainties associated with the modeling of dynamic biological systems while remaining agnostic as to the type of model used. We apply the framework to fit an SIR-like influenza transmission model to 7 years of incidence data in three European countries: Belgium, the Netherlands and Portugal.

Dynamic modeling of vaccinating behavior as a function of individual beliefs.

Individual perception of vaccine safety is an important factor in determining a persons adherence to a vaccination program and its consequences for disease control. This perception, or belief, about the safety of a given vaccine is not a static parameter but a variable subject to environmental influence. To complicate matters, perception of risk (or safety) does not correspond to actual risk. In this paper we propose a way to include the dynamics of such beliefs into a realistic epidemiological model, yielding a more complete depiction of the mechanisms underlying the unraveling of vaccination campaigns. The methodology proposed is based on Bayesian inference and can be extended to model more complex belief systems associated with decision models. We found the method is able to produce behaviors which approximate what has been observed in real vaccine and disease scare situations. The framework presented comprises a set of useful tools for an adequate quantitative representation of a common yet complex public-health issue. These tools include representation of beliefs as Bayesian probabilities, usage of logarithmic pooling to combine probability distributions representing opinions, and usage of natural conjugate priors to efficiently compute the Bayesian posterior. This approach allowed a comprehensive treatment of the uncertainty regarding vaccination behavior in a realistic epidemiological model.