Keshab Rijal,

MPH,
Yonsei University of Health System

Title of the Project:

Investigation of the association between socio economic and demographic factors
and Dengue fever infection in the Coastal part of Mexico.
1. Introduction and Literature Survey:
1.1. Background:

Dengue causes the greatest human disease burden of any arbovirus, with an
estimated 10,000 deaths1 and 100million symptomatic infections per year in over
125 countries1. Roughly half of the global population currently lives in areas that are
environmentally suitable for dengue transmission. Dengue is transmitted to humans
by Aedes species mosquitoes, which thrive in tropical and sub-tropical urban centres
around the globe. In combination with these global trends, rising temperatures
attributed to climate change have increased concerns that dengue will intensify in
already endemic areas through faster viral amplification, increased vector survival,
reproduction and biting rate, ultimately leading to longer transmission seasons and a
greater number of human infections, more of which are expected to be severe.
Increasing temperatures may further exacerbate this situation by enabling greater
spread and transmission in low-risk or currently dengue-free parts of Asia, Europe,
North America and Australia. [1]
Dengue is a mosquito-borne viral infection that has spread throughout the tropical
world over the past 60 years and now affects over half the world’s population. The
geographical range of dengue is expected to further expand due to ongoing global
phenomena including climate change and urbanization. We applied statistical
mapping techniques to the most extensive database of case locations to date to
predict global environmental suitability for the virus as of 2015. We then made use
of climate, population and socioeconomic projections for the years 2020, 2050 and
2080 to project future changes in virus suitability and human population at risk. This
study is the first to consider the spread of Aedes mosquito vectors to project dengue
suitability. Our projections provide a key missing piece of evidence for the changing
global threat of vector-borne disease and will help decision-makers worldwide to
better prepare for and respond to future changes in dengue risk. [1]

With a significant increase in incidence in the past decades, dengue has become one
of the most prevalent infectious diseases and a major health concern in the tropical
and subtropical regions of earth, including more than 100 countries in Southeast
Asia, Africa, North and South America, and the western Pacific regions. Dengue
virus (DENV) is estimated to cause 390 million infections annually, and 3.6 billion
people are at risk of DENV infection. The incidence of dengue has increased 7-fold
between 1990 and 2013, with 8.9 billion dollars of global economic burden of
dengue in 2013. [2]

1.2. Literature Review:

One of the most intriguing relationships found in the various study was the regular increase
in illness attack rates with increasing age. In previous studies of epidemics in Puerto Rico
and Jamaica during the 1960s and in the Fiji Islands in 1975," a different age pattern was
found. In these epidemics there was a rise in dengue illness rates up to age 25, but then these
rates leveled off and fell considerably in older age groups. In an epidemic investigation in a
Pacific Island,n the illness patterns by age were similar to those we observed whereas the
infection rates were very high in all age groups from 5 to 25 years. This implies that the
illness rate given infection (ie pathogeniciry) rose in progressively older age groups in this
age range. This conclusion depends upon the assumption made in this Pacific Island study
that individuals in this age range had not suffered dengue infections except during the
epidemic. This assumption may be in error. In a previous study in Mexico during the current
pandemic, infection rates determined serologically rose regularly through the fifth decade of
life.u Pathogenicity also rose slightly through the fourth decade of life. In a study in
Thailand, seroconversion rates from negative to positive rose regularly with age.g [3]
In summary, the age-specific illness patterns rise in all studies in the first three decades of
life and this rise has been associated with both increasing infection rates and increasing
pathogenicity. A decrease in illness attack rates is seen in some studies in the older age
groups but not in others. Perhaps this pattern reflects residual immunity from previous
epidemics in older individuals in certain areas but not in others.[3]
The protective effects we observed from screens and mosquito netting could be important in
controlling the transmission of dengue in situations where eradication of the mosquito is not
attempted; it would be useful, however, to know why these effects were not observed in all
three cities before basing control measures to them. The fact that we observed very strong
socioeconomic relationships in all three cities and that these effects were not explained by
any of the other variables we measured implies that other important risk factors related to
personal behavior probably exist and these might be exploited in control efforts.[3]

Our observations give some impetus to the implementation of an intensive

surveillance and perifocal control strategy, but there are important observations
lacking on which to base control strategies, such as what are the probabilities of
transmission outside of perifocal control areas and what means might be employed to
decrease the probability of transmission other than intensive mosquito control
efforts. The presence of a disease causing very low mortality, even though it causes
extensive morbidity, is not likely to motivate health officials in developing countries
to undertake the studies needed to make the necessary observations for efficient
disease control. But Mexico has already been extensively invaded with type 1
dengue just as Cuba had been before it experienced hemorrhagic dengue. The
observation by Thai investigators that more than 20% of type 2 infections following
type 1 infections are associated with a severe illness requiring hospitalization and
with a high mortality rate14 should be more than enough to motivate additional
epidemic investigations like those reported here which can further specify the risk
factors and transmission patterns of dengue.[3]

The WHO recommended method used for estimating the region wise burden
considers number of cases and death and population structure in a region for
calculating a comprehensive burden estimate. We emphasize the use of DALYs
instead of simple incidence or death for better understanding of burden of the
disease. Mostly, geographic distribution of burden estimates has been limited to
incidence and prevalence rates. Proposed method of estimating burden per region
considers disease severity, death and duration, providing robust estimates.
Discrepancies identified between standard incidence map and DALY maps reflects
mapping the burden of the disease can be used to more efficiently identify at-risk
districts for health preparedness to save lives and economic loss [48]. Increased risk
association with dengue burden was seen in the year 2014 and 2016 compared to
2013 is because of higher mortality reported in these years compared to 2015. To the
best of our knowledge, this is the first study that attempted to quantify the
spatiotemporal heterogeneity in the burden of dengue using time-series historical
notification data in India. [4]

1.3. Objective of the Project:

The objective of the project is to investigate the association between socio economic
and demographic factors and Dengue fever infection in the Coastal part of Mexico.
2. Method of Data Analysis:
2.1 Data analysis strategy:
This project is designed to investigate association between the socio economic and
demographic factors and Dengue fever infection in the Coastal part of Mexico. The
coastal part is considered as high risk area for vector borne diseases including
malaria, dengue etc. Various social economic and geographical data were collected
including age, socio economic status, sector of the residence in the city and existence
of saving account on the bank. The presence or absence of dengue fever infection
was also examined. In order to search the answer of main research questions, logistic
regression analysis will be done.

2.2. Statistical Method:

Variables for Analysis:
The main independent or intervening variables for this project will be age, socio
economic status, sector of the residence in the city and existence of saving account
on the bank.
The dependent or outcome variable in the project will be presence or absence of dengue
fever infection.
Statistical Method:
The data analys is for this study will include both descriptive and inferential statistics.
Descriptive statistics will be computed for independent variables (age, socio economic
status, sector of the residence ), and for the dependant variable (presence or absence of
dengue fever infection). Descriptive analys is will include the proportion of each
category of variables.
Logistic regression analysis will be done to examine the association between
independent and dependant variables. The analysis w ill be analyzed is there any
difference in disease status by socioeconomic status and age. Later the geographic
distribution of the disease also will be examined.
Testing Hypothesis:
The hypotheses in the study will be tested at the 0.05 level of s ignificance. All the
analyses will be conducted us ing Statistical Packages for Social Science (SPSS 20)
software.
H0: There is negative relation between socio economic status and dengue fever
infection.
H1: There is no relation between socio economic status and dengue fever infection.

2.3. Data analyzing procedure in Detail:

Correlations between independent variables and dependent variables w ill be calculated.
The logistic regressions will be used for the modeling since there are more than one
categorical dependent variables and a single categorical independent variable .
3. Expected Result:
There will be a negative association between socio economic status and the dengue
fever infection; lower the socio economic condition there will be higher the dengue
infection and vice verse.
4. References Used:

1. The current and future global distribution and population at risk of

dengue, Jane P. Messina et al. (2019).
2. Re-emergence of dengue virus serotype-3 infections in Gabon in 2016–
2017, and evidence for the risk of repeated dengue virus infections
Haruka Abe (2019).
3. Dengue Epidemics on the Pacific Coast of Mexico, HECTOR GOMEZ
DAMES' etal, International Journal of Epidemiology (1988).
4. A Short Report on Distribution of and associated factors for dengue
burden in the state of Odisha, India during 2010–2016, Subhashisa Swain
et al, (2019).
5. Applied Linear Statistical Models, Michael H. Kutner, Christopher J.
Nachtsheim, John Neter, William Li, McGraw-Hill!Irwin, USA.Fifth
Edition(2005).