title: Socioeconomic factors and vulnerability to outbreaks of leptospirosis in Nicaragua.
abstract: Leptospirosis is an epidemic-prone zoonotic disease that occurs worldwide, with more than 500,000 human cases reported annually. It is influenced by environmental and socioeconomic factors that affect the occurrence of outbreaks and the incidence of the disease. Critical areas and potential drivers for leptospirosis outbreaks have been identified in Nicaragua, where several conditions converge and create an appropriate scenario for the development of leptospirosis. The objectives of this study were to explore possible socioeconomic variables related to leptospirosis critical areas and to construct and validate a vulnerability index based on municipal socioeconomic indicators. Municipalities with lower socioeconomic status (greater unsatisfied basic needs for quality of the household and for sanitary services, and higher extreme poverty and illiteracy rates) were identified with the highest leptospirosis rates. The municipalities with highest local vulnerability index should be the priority for intervention. A distinction between risk given by environmental factors and vulnerability to risk given by socioeconomic conditions was shown as important, which also applies to the "causes of outbreaks" and "causes of cases".
authors.affiliation: University of Medical Sciences of Habana, Havana Atherosclerosis Research and Reference Center, Policlínico 19 de Abril, Tulipán y Panorama, Nuevo Velado, Plaza de la Revolución, La Habana 10600, Cuba. jbacallao@infomed.sld.cu.
authors.forename: Jorge
authors.initials: J
authors.lastname: Bacallao
authors.affiliation: Pan American Health Organization, Department of Communicable Diseases and Health Analysis, 525 23rd. St. NW, Washington, DC 20037, USA. schneidc@paho.org.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Schneider
authors.affiliation: Pan American Health Organization, Department of Communicable Diseases and Health Analysis, 525 23rd. St. NW, Washington, DC 20037, USA. najerapa@paho.org.
authors.forename: Patricia
authors.initials: P
authors.lastname: Najera
authors.affiliation: Pan American Health Organization, Department of Communicable Diseases and Health Analysis, 525 23rd. St. NW, Washington, DC 20037, USA. aldighsy@paho.org.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Aldighieri
authors.affiliation: Pan American Health Organization Nicaragua, P.O. Box 1309, Managua, Nicaragua. sotoa@nic.ops-oms.org.
authors.forename: Aida
authors.initials: A
authors.lastname: Soto
authors.affiliation: Pan American Health Organization Nicaragua, P.O. Box 1309, Managua, Nicaragua. marquinw@nic.ops-oms.org.
authors.forename: Wilmer
authors.initials: W
authors.lastname: Marquiño
authors.affiliation: Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, P.O. Box 107, Managua, Postal Sector 15AB, Nicaragua. carlossaen@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sáenz
authors.affiliation: Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, P.O. Box 107, Managua, Postal Sector 15AB, Nicaragua. zoonosis@minsa.gob.ni.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Jiménez
authors.affiliation: Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, P.O. Box 107, Managua, Postal Sector 15AB, Nicaragua. ggmavellan@yahoo.com.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Moreno
authors.affiliation: Ministry of Health of Nicaragua, Costado Oeste Colonia Primero de Mayo, P.O. Box 107, Managua, Postal Sector 15AB, Nicaragua. ve1s67-chi@minsa.gob.ni.
authors.forename: Octavio
authors.initials: O
authors.lastname: Chávez
authors.affiliation: Pan American Health Organization, Department of Communicable Diseases and Health Analysis, 525 23rd. St. NW, Washington, DC 20037, USA. deisegalan@gmail.com.
authors.forename: Deise I
authors.initials: DI
authors.lastname: Galan
authors.affiliation: Pan American Health Organization, Department of Communicable Diseases and Health Analysis, 525 23rd. St. NW, Washington, DC 20037, USA. espinalm@paho.org.
authors.forename: Marcos A
authors.initials: MA
authors.lastname: Espinal
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D007922:Leptospirosis / Q000453:epidemiology*; D009527:Nicaragua / Q000453:epidemiology; D012959:Socioeconomic Factors