title: Determination of clusters and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitória, Brazil.
abstract: Dengue occurrence is partially influenced by the immune status of the population. Consequently, the introduction of a new Dengue virus serotype can trigger explosive epidemics in susceptible populations. The determination of clusters in this scenario can help to identify hotspots and understand the disease dispersion regardless of the influence of the population herd immunity. The present study evaluated the pattern and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitória, Espírito Santo state, Brazil. Data on 18,861 dengue cases reported in Vitória from September 2012 to June 2013 were included in the study. The analysis of spatial variation in temporal trend was performed to detect clusters that were compared by their respective relative risk, house index, population density, and income in an ecological study. Overall, 11 clusters were detected. The time trend increase of dengue incidence in the overall study population was 636%. The five clusters that showed a lower time trend increase than the overall population presented a higher incidence in the beginning of the epidemic and, compared to the six clusters with higher time trend increase, they presented higher relative risk for their inhabitants to acquire dengue infection (P-value = 0.02) and a lower income (P-value <0.01). House index and population density did not differ between the clusters. Early increase of dengue incidence and higher relative risk for acquiring dengue infection were favored in low-income areas. Preventive actions and improvement of infrastructure in low-income areas should be prioritized in order to diminish the magnitude of dengue dispersion after the introduction of a new serotype.
authors.affiliation: Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.
authors.forename: Creuza Rachel
authors.identifier: http://orcid.org/0000-0003-0182-7969
authors.initials: CR
authors.lastname: Vicente
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Herbinger
authors.affiliation: Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil.
authors.forename: Crispim
authors.initials: C
authors.lastname: Cerutti Junior
authors.affiliation: Institute of Tropical Medicine, LIM-52 (LIMHC), University of São Paulo, São Paulo, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Malta Romano
authors.affiliation: Coordination of Epidemiological Surveillance, Department of Health, Vitória, Brazil.
authors.forename: Aline
authors.initials: A
authors.lastname: de Souza Areias Cabidelle
authors.affiliation: Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.|Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Fröschl
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016000:Cluster Analysis; D003715:Dengue / Q000196:embryology / Q000453:epidemiology*; D006801:Humans