Population density, water supply, and the risk of dengue fever in Vietnam: cohort study and spatial analysis

Aedes aegypti, the major vector of dengue viruses, often breeds in water storage containers used by households without tap water supply, and occurs in high numbers even in dense urban areas. We analysed the interaction between human population density and lack of tap water as a cause of dengue fever...

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Bibliographic Details
Published in:PLoS medicine 2011-08, Vol.8 (8), p.e1001082-e1001082
Main Authors: Schmidt, Wolf-Peter, Suzuki, Motoi, Thiem, Vu Dinh, White, Richard G, Tsuzuki, Ataru, Yoshida, Lay-Myint, Yanai, Hideki, Haque, Ubydul, Tho, Le Huu, Anh, Dang Duc, Ariyoshi, Koya
Format: Article
Language:English
Subjects:
Adolescent
Aedes - growth & development
Aedes - virology
Animals
Biology
Child
Child, Preschool
Cohort Studies
Dengue
Dengue - diagnosis
Dengue - epidemiology
Dengue - prevention & control
Dengue - transmission
Dengue - virology
Dengue Virus - pathogenicity
Distribution
Female
Households
Humans
Insect Vectors - virology
Male
Medical research
Medicine
Models, Theoretical
Mosquito Control
Mosquitoes
Population Density
Risk Factors
Studies
Vietnam
Vietnam - epidemiology
Water Supply
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Summary:Aedes aegypti, the major vector of dengue viruses, often breeds in water storage containers used by households without tap water supply, and occurs in high numbers even in dense urban areas. We analysed the interaction between human population density and lack of tap water as a cause of dengue fever outbreaks with the aim of identifying geographic areas at highest risk. We conducted an individual-level cohort study in a population of 75,000 geo-referenced households in Vietnam over the course of two epidemics, on the basis of dengue hospital admissions (n = 3,013). We applied space-time scan statistics and mathematical models to confirm the findings. We identified a surprisingly narrow range of critical human population densities between around 3,000 to 7,000 people/km² prone to dengue outbreaks. In the study area, this population density was typical of villages and some peri-urban areas. Scan statistics showed that areas with a high population density or adequate water supply did not experience severe outbreaks. The risk of dengue was higher in rural than in urban areas, largely explained by lack of piped water supply, and in human population densities more often falling within the critical range. Mathematical modeling suggests that simple assumptions regarding area-level vector/host ratios may explain the occurrence of outbreaks. Rural areas may contribute at least as much to the dissemination of dengue fever as cities. Improving water supply and vector control in areas with a human population density critical for dengue transmission could increase the efficiency of control efforts. Please see later in the article for the Editors' Summary.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1001082