Conditions of the household and peridomicile and severe dengue: a case-control study in Brazil.
BACKGROUND
The potential influence of high-vector-density environments where people are supposedly more exposed to mosquito bites may have a relation to the clinical severity of dengue fever, an association that has been poorly discussed in the literature.


OBJECTIVE
This study aimed at analyzing the association between anthropic environmental factors, particularly those related to the conditions of domicile and peridomicile, and the occurrence of severe dengue cases during the 2008 epidemic in the state of Rio de Janeiro.


METHODS
We conducted a retrospective case-control study with a sample of 88 severe patients aged 2-18. They were selected through chart review in four children's tertiary care centers. The 367 controls were neighbors of the cases, paired by age. Data were collected through interviews and systematic assessment of house conditions as well as peridomicile area conditions, and they were later analyzed by conditional logistic regression.


RESULTS
The presence of three or more high-volume capacity containers, which were without a lid or were inadequately sealed (water tanks, wells, cisterns, cement tanks, and pools), was significantly more frequent in households with severe cases when compared with households of controls (OR=1.6; CI 95%=1.36-20.01; p=0.015).


CONCLUSIONS
The presence of such larger reservoirs that could potentially produce more adult forms of the vector is consistent with a situation where people are more exposed to mosquito bites, and consequently are more prone to have multiple infections over a short period of time.


CONCLUSIONS
The emergence of severe dengue cases in a high-transmission context underpins the importance of constant vigilance and interventions in those types of reservoirs, which result from precarious household structures and irregular water supply services.
Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Gerusa
G
Gibson
Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Reinaldo
R
Souza-Santos
Laboratório de Transmissores de Hematozoários, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Nildimar Alves
NA
Honório
Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Antonio Guilherme
AG
Pacheco
Laboratório de Hanseníase, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Milton Ozório
MO
Moraes
Laboratório de Imunologia Viral, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Claire
C
Kubelka
Instituto de Pesquisas Clínicas Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Patrícia
P
Brasil
Programa de Computação Científica, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Oswaldo
O
Cruz
Programa de Computação Científica, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
Marilia Sá
MS
Carvalho
breeding sites; environmental health; premise conditions index; severe dengue