Preventing the next Aedes-borne arboviral disease epidemic

Dengue, chikungunya and Zika are infectious diseases transmitted to humans by Aedes species mosquitoes (mainly Aedes aegypti). These arboviruses caused outbreaks in several countries belonging to Africa, America, Asia, the Caribbean, and the Pacific. Besides all recommendations of the World Health Organization (WHO), and novel mosquito control strategies that have been developed, countries are still struggling with preventing and controlling the transmission of Aedes-borne infectious diseases (ABIDs). To overcome the difficulties in ABID control interventions, first, the challenges with regards to Aedes control at the macro-level (health system), meso-level (community), and the micro-level (individuals) of that specific country need to be determined. Therefore, this dissertation's overall aim is to investigate the context and concepts shaping the health system, community and individual prevention and control interventions/ behaviour for ABIDs in Curaçao. We have combined different research methodologies (qualitative and quantitative) and disciplines (e.g., epidemiology, entomology, microbiology, and social and environmental sciences) to study the above-mentioned research topics. Different theoretical frameworks and concepts were used to understand the intricate relationship between macro (health system), meso (social groups) and micro-level (individuals) vis-à-vis ABIDs prevention and control. All studies presented in this thesis provide readers with the information to understand the challenges of Aedes control in Curaçao holistically. Our results highlight the relevance of risk communication, cultural schemas, and heuristics in disease control. This information is useful to policymakers and others concerned with the prevention and control of ABIDs

Vector control strategies in Brazil: a qualitative investigation into community knowledge, attitudes and perceptions following the 2015-2016 Zika virus epidemic.

OBJECTIVE: The World Health Organization declared a Public Health Emergency of International Concern following the rapid emergence of neonatal microcephaly in Brazil during the 2015-2016 Zika virus (ZIKV) epidemic. In response, a national campaign sought to control Aedes mosquito populations and reduce ZIKV transmission. Achieving adherence to vector control or mosquito-bite reduction behaviours, including the use of topical mosquito repellents, is challenging. Coproduction of research at the community level is needed to understand and mitigate social determinants of lower engagement with Aedes preventive measures, particularly within disempowered groups. DESIGN: In 2017, the Zika Preparedness Latin America Network (ZikaPLAN) conducted a qualitative study to understand individual and community level experiences of ZIKV and other mosquito-borne disease outbreaks. Presented here is a thematic analysis of 33 transcripts from community focus groups and semistructured interviews, applying the Health Belief Model (HBM) to elaborate knowledge, attitudes and perceptions of ZIKV and vector control strategies. PARTICIPANTS: 120 purposively sampled adults of approximate reproductive age (18-45); 103 women participated in focus groups and 17 men in semistructured interviews. SETTING: Two sociopolitically and epidemiologically distinct cities in Brazil: Jundiaí (57 km north of São Paolo) and Salvador (Bahia state capital). RESULTS: Four key and 12 major themes emerged from the analysis: (1) knowledge and cues to action; (2) attitudes and normative beliefs (perceived threat, barriers, benefits and self-efficacy); (3) behaviour change (household prevention and community participation); and (4) community preferences for novel repellent tools, vector control strategies and ZIKV messaging. CONCLUSIONS: Common barriers to repellent adherence were accessibility, appearance and effectiveness. A strong case is made for the transferability of the HBM to inform epidemic preparedness for mosquito-borne disease outbreaks at the community level. Nationally, a health campaign targeting men is recommended, in addition to local mobilisation of funding to strengthen surveillance, risk communication and community engagement

CIN: Internationalization Strategies of the Insecticide Paint Artilin 3A Mate

In a globalized world, where information cross countries’ boarders, companies seek new markets and challenges, in order for others to have broader knowledge about the firm and to increase profits by going international. Enterprises must be aware that despite the profit and knowledge increase, there are other factors to be taken into account like the individuals, environment, laws and regulations, resources and strategies on the host country when they want to go international. CIN is a good example of an internationalized company, created in Portugal in 1962, already settled in 31 countries and having different markets such as decoration, industrial and accessories. Nowadays, CIN is developing internationalization strategies to launch in its existing markets a new product called Artilin 3A Mate, an insecticide paint that has a research, innovation and development element to which 11 percent of the human resources of the company are affected. The main objective of this case study is to understand how such a specific product can enter in different markets, either for aesthetic reasons or in order to combat vector-borne diseases. It is also expected to demonstrate how this product launch may be, in pedagogical terms, an example of a company that is betting on the development of a functional high-performance paints (anti-mites, anti-insects and resistant to fungi) that comes up in a context against illnesses like dengue, malaria and zika, distributing it among the markets they are already in.Num mundo globalizado, a informação atravessa as fronteiras dos países, as empresas procuram novos mercados e desafios, de modo a que outros adquiram um maior conhecimento sobre a empresa e receitas aumentem com a perspectiva de se internacionalizarem. As empresas têm de estar conscientes de que para além do aumento de receitas e conhecimento, existem outros factores a ter em consideração tal como os indivíduos, o ambiente envolvente, as leis e normas, recursos e estratégias no país anfitrião para o qual a empresa se pretende internacionalizar. A CIN é um bom exemplo de uma empresa que se internacionalizou com sucesso. Criada em Portugal em 1962, está actualmente instalada em 31 países abrangendo diferentes tipos de mercado como os da decoração, industrial e dos acessórios. Nos dias de hoje, a CIN está a desenvolver estratégias de internacionalização para lançar nos mercados existentes um novo produto com a designação de Artilin 3A Mate, uma tinta insecticida que decorre de uma extensa actividade de pesquisa, inovação e desenvolvimento à qual estão afectos 11 porcento dos recursos humanos da empresa. O objectivo principal deste estudo de caso é compreender como um produto tão específico poderá entrar em diferentes mercados, tanto por razões estéticas como pelo combate a doenças transmissíveis por insectos. Espera-se também demonstrar como o lançamento deste produto, em termos pedagógicos, pode constituir um exemplo estratégico de uma empresa que está a apostar numa tinta de alta performance (anti - ácaros, anti-insectos e resistentes a fungos) no que toca ao combate de doenças como o dengue, malária e zika, distribuindo-a nos mercados onde já se encontra instalada

A Social and Ecological Approach to Mosquito Species Distribution Across Land Use in Bangor, Maine

Mosquitoes are ubiquitous pests and infectious disease vectors. However, not all mosquito species bite humans, or are competent pathogen vectors between bloodmeal hosts. Along with climatic variables like temperature and rainfall, mosquito species distribution is determined by aquatic habitat availability for juvenile mosquito development, and terrestrial habitat and host availability for adult mosquitoes. There is variation in the preferred aquatic habitat for gravid female oviposition and subsequent larval development. Some mosquito species’ oviposition and development are associated with ephemeral water sources (e.g., floodplains), others prefer more permanent water sources (e.g., bogs or vernal pools). Other mosquitoes have evolved to occupy small, artificial water containers (e.g., buckets, tires) that are associated with human-dominated areas. These environmental factors are impacted by human processes like agriculture and urbanization and affect human exposure to mosquitoes and mosquito-borne diseases (MBD). Human exposure is also affected by mosquito control (e.g., spraying pesticides, emptying water containers) or personal protective behaviors (e.g., using mosquito repellent, wearing protective clothing). This interaction of human and environmental factors that affect mosquito habitat allows us to approach this system using a social-ecological systems (SES) framework. Social-ecological approaches call for the components within a system and the relationships between them to be examined from an integrated perspective including cultural, political, economic and ecological viewpoints across spatial scales. The One Health framework is an SES which considers the health of animals, humans and the environment as interconnected and dependent on one another. The ecology of vector-borne diseases, and mosquito ecology specifically, are relevant topics for application of the One Health model due to the interactions of human and environmental variables. In this thesis, mosquito species distribution was examined at 40 sites across an urban to rural gradient and recreational parks in Bangor, Maine to understand how mosquito distribution is affected by land use in this region. Additionally, a Knowledge, Attitudes and Practices survey was distributed among participants at the 30 residential study sites to understand factors that affect engagement in mosquito control and personal protective behaviors. A mosquito habitat assessment was conducted at each participant’s property to integrate the analysis of social and ecological variables. Results show that mosquito abundance was significantly different across land use categories. Mosquito abundance was highest in recreational parks and rural residential areas. Among residential categories, rural sites had the most nuisance species mosquitoes, and the least vector species mosquitoes. Urban residential sites had the lowest mosquito abundance, but highest vector species abundance. Participant knowledge level was not associated with the amount of aquatic habitat suitable for larval mosquitoes, and participants were likely report mosquitoes as a nuisance on their properties, but unlikely to engage in control practices. These results indicate a possible mismatch between mosquito exposure, mosquito perceptions and engagement in control behaviors, which warrants further study. This thesis adds to a limited body of literature which examine mosquitoes from a social and ecological perspective in the United States, and this integrated perspective is important for understanding, protecting and improving public health issues related to mosquitoes

Public health messages on arboviruses transmitted by Aedes aegypti in Brazil.

BACKGROUND: The outbreak of Zika virus in Brazil in 2015 followed the arrival of chikungunya in 2014 and a long history of dengue circulation. Vital to the response to these outbreaks of mosquito-borne pathogens has been the dissemination of public health messages, including those promoted through risk communication posters. This study explores the content of a sample of posters circulated in Brazil towards the end of the Zika epidemic in 2017 and analyses their potential effectiveness in inducing behaviour change. METHODS: A content analysis was performed on 37 posters produced in Brazil to address outbreaks of mosquito-borne pathogens. The six variables of the Health Belief Model were used to assess the potential effectiveness of the posters to induce behaviour change. RESULTS: Three overarching key messages emerged from the posters. These included (i) the arboviruses and their outcomes, (ii) a battle against the mosquito, and (iii) a responsibility to protect and prevent. Among the six variables utilised through the Health Belief Model, cues to action were most commonly featured, whilst the perceived benefits of engaging in behaviours to prevent arbovirus transmission were the least commonly featured. CONCLUSIONS: The posters largely focused on mosquito-borne transmission and the need to eliminate breeding sites, and neglected the risk of the sexual and congenital transmission of Zika and the importance of alternative preventive actions. This, we argue, may have limited the potential effectiveness of these posters to induce behaviour change

Public responses to infectious diseases outbreaks: the role of emotions

BACKGROUND: Infectious disease outbreaks account for significant global costs in human lives, social implications, and financial burden. It is considered possible to minimise the consequences of catastrophic viral outbreaks through advance preparation and effective communication. To prepare effectively, it is important to understand the political, social, economic and cultural factors that impact on the epidemic spread and shape human responses and action. Despite the capacity of human emotions to influence all these issues, they have been largely neglected in public health. AIM: To ascertain if there are emotional determinants impacting population responses to infectious diseases outbreaks and understand how such emotions are influenced by the social and wider determinants related to the local context where outbreaks emerge. METHODS: A systematic review that explores the differences in public responses by emotion, infection, outcome and region, and five in-depth case studies of infectious diseases outbreaks at a national level to understand how responses are shaped by the local and global context of the time. FINDINGS: There are emotional determinants that influence public responses to epidemics and pandemics and impact on the uptake of interventions. To improve the effectiveness of public health communications in the face of emerging outbreaks, certain important messages emerged in my research, including the need to disrupt the power dynamics of “top-down” communications, build trust between global and local actors (as well as with governments), and harness the potential role of traditional media and social media for good and connection. Which emotions are evoked through public health communications is also important, as fear and panic were shown to be counterproductive in promoting uptake of interventions, but worry and empathy emerged as key motivators for action. CONCLUSIONS: Both in the context of the COVID-19 pandemic and for future emerging infectious diseases outbreaks, emotions need to be considered in crisis communications

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

While it is well known that socioeconomic markers are associated with a higher risk of arbovirus infections, research on the relationship between socioeconomic factors and congenital Zika syndrome (CZS) remains limited. This study investigates the relationship between socioeconomic risk markers and live births with CZS in Brazil. We conducted a population-based study using data from all registered live births in Brazil (Live Births Information System) linked with the Public Health Event Record from 1 January 2015 to 31 December 2018. We used logistic regression models to estimate the OR and 95% CIs of CZS based on a three-level framework. In an analysis of 11 366 686 live births, of which 3353 had CZS, we observed that live births of self-identified black or mixed race/brown mothers (1.72 (95% CI 1.47 to 2.01) and 1.37 (95% CI 1.24 to 1.51)) were associated with a higher odds of CZS. Live births from single women compared with married women and those from women with less than 12 years of education compared with those with more than 12 years of education also had higher odds of CZS. In addition, live births following fewer prenatal care appointments had increased odds of CZS in the nationwide data. However, in the analyses conducted in the Northeast region (where the microcephaly epidemic started before the link with Zika virus was established and before preventive measures were known or disseminated), no statistical association was found between the number of prenatal care appointments and the odds of CZS. This study shows that live births of the most socially vulnerable women in Brazil had the greatest odds of CZS. This disproportionate distribution of risk places an even greater burden on already socioeconomically disadvantaged groups, and the lifelong disabilities caused by this syndrome may reinforce existing social and health inequalities

Current Perspectives on Viral Disease Outbreaks

The COVID-19 pandemic has reminded the world that infectious diseases are still important. The last 40 years have experienced the emergence of new or resurging viral diseases such as AIDS, ebola, MERS, SARS, Zika, and others. These diseases display diverse epidemiologies ranging from sexual transmission to vector-borne transmission (or both, in the case of Zika). This book provides an overview of recent developments in the detection, monitoring, treatment, and control of several viral diseases that have caused recent epidemics or pandemics

Current Topics in Neglected Tropical Diseases

Neglected tropical diseases (NTDs) is a diverse group of communicable diseases that prevail in tropical and subtropical conditions in 149 countries. NTDs affect more than one billion people and cost developing economies billions of dollars every year. According to the World Health Organization (WHO), NTDs mainly affect populations living in poverty, without adequate sanitation, and in close contact with infectious vectors, domestic animals, and livestock. Migration, as well as climate change and variability, are key factors in NTD prevalence. Therefore, NTDs deserve more study. Recently, viruses transmitted by vectors (arboviruses) that affect not only people living in the tropics, but also travelers and migrating populations, have been causing epidemics. Examples of these viruses include Dengue, Chikungunya, Zika, Mayaro, and encephalitis viruses. These viruses emerge and reemerge in multiple regions of the world, as occurred in the Americas recently (2013-2017) with Chikungunya and Zika. This book aims to update the significant epidemiological and clinical research of NTDs in many aspects with a multinational perspective