Presentation on theme: "Health Vulnerability Index (HVI)"— Presentation transcript:
1 Health Vulnerability Index (HVI) FEDERAL UNIVERSITY OF MINAS GERAISVETERINARY SCHOOLDEPARTMENT OF PREVENTIVE VETERINARY MEDICINEBelo Horizonte, BrazilHealth Vulnerability Index (HVI)and its association with Dengue fever in BrazilMisael Enrique Oviedo Pastrana1*; Rachel Lage Brito2; Rafael Romero Nicolino1;Camila Stefanie Fonseca de Oliveira1; João Paulo Amaral Haddad3.1PhD student in Veterinary Science / Epidemiology , Preventive Veterinary Departament,Federal University of Minas Gerais, Belo Horizonte, Brazil.2Municipality of Pedro Leopoldo, Minas Gerais, Brazil..3Preventive Veterinary Departament, Federal University of Minas Gerais, Belo Horizonte, Brazil.*Corresponding author:
2 Dengue Virus It is an arbovirus, flavivirus genus Transmitted by mosquitoesThere are 4 serotypes (Den-1, 2,3,4)Co-circulation of these serotypes in theWestern Hemisphere, has been observedin recent years, 2006–2010.Clinical presentation:ColdDengue fever (DF)Dengue hemorrhagic fever (DHF)Dengue shock syndrome (DSS)DeathPan American Health OrganizationIn Laughlin et al 2012.Perera and Kuhn, 2008
3 Distribution of global dengue risk Determination of risk status based on combined reports from WHO, the United States Centers for Disease Control and Prevention, Gideon online, ProMED, DengueMap, Eurosurveillance and published literature (Simmons CP et al, 2012).WHO, 2012
4 Average number of dengue and severe dengue cases reported to WHO annually in 1955–2007 and number of cases reported in recent years, 2008–2010WHO, 2012
5 Average number of dengue cases in 30 most highly endemic countries/territories as reported to WHO, 2004–2010WHO, 2012
6 Dengue FeverIn Brazil, the Zoonoses Control Centers are the institution responsible for the management of the dengue.Aedes aegyptiIs the most common epidemic vector in America;It can be easily identified;But, this is also the main transmitting agent of the urban yellow fever.
7 Are among the most important reemerging infectious diseases globally Health ImpactAre among the most important reemerging infectious diseases globally50 – 100million annual infections500,000 cases of DHF/DSS20,000 – 25,000 deathsCause public alarm and stress in the public health control systemsLaughlin et al 2012.
8 Social/health factors (30%) Health Vulnerability Index (HVI)HVI is an official indicator .Was created with the purpose of revealing inequalities between the epidemiological profiles of different social groups .It’s composed of five variables:HVIHVI has been used in epidemiological studies characterizing and correlating population groups with the distribution of diseases.Association between the HVI and dengue could identify sites for action priority, facilitating decision-making in the execution of more efficient actions to controlling.Sanitation (20%)Housing (10%)Income (20%)Education (20%)Social/health factors (30%)GEEPI, 2003; Araújo, 2011; Barbosa, 2011
9 Methods Selecting a municipality. Pedro Leopoldo (PL), located in the Metropolitan Region of Belo Horizonte, state of Minas Gerais, Brazil.The unit of analysis was the census sector.Sixty-nine census tracts were evaluated in PL.PL has a population of 54,596 inhabitants
10 Geographical location of cases MethodsDengue cases were identified and spatially located using a GPS.The evaluation was from 2009 to 2011.The incidence rates were determined for the 69 census sectorsInstability problems were identified by:Errors in the identification of individuals.Underreporting of casesSmall population sizes of some census tracts.Geographical location of cases
11 Methods Instability corrections: with support of Bayesian statistics, using the local empirical Bayes estimator.Comparison between the original incidence rates and Bayesian rates.Kernel density, global autocorrelation (Moran’s I) and local autocorrelation (Anselin Local Moran’s I) were used to understand the distribution of dengue and their association with HVI.Were used: TerraView 4.2 (National Institute for Space Research -INPE, Brazil) and ArcGIS 9.3 (ESRI, USA)
12 ResultsCases, population and number of census tracts analyzed in the different districts of the municipality of Pedro Leopoldo, state of Minas Gerais, Brazil.DistrictsNº. of analyzedsectorsPopulation200920102011Total of casesNo. of CasesPedro Leopoldo3222768565152159Dr. Lund7569812131035Fidalgo3253514Lagoa de Santo Antônio24218082811Vera Cruz2Total6954596819775253
13 ResultsComparisons between the distributions of original incidence and Bayesian incidence, in the year 2009 (A) 2010 (B) and 2011 (C).AIn the original rates were selected the census tracts with values in the 2nd , 3rd , 4th and 5th quantileCould be observed how these same points were revalued by the Bayesian method, passing some other quantiles and reducing the instability.The Local Empirical Bayes Estimator allowed the generation of new corrected incidence ratesThe Bayesian distribution was the most appropriate and probable.BC
14 ResultsKernel density allowed estimating the intensity for the spatial distribution of the HVI and Bayesian incidence rates.Spatial distribution of the HVI (A).Conglomerate with high HVI are identified in the north of the municipality. In contrast, these area had the lowest incidence rates.Spatial distribution of the Bayesian incidence rates (B,C, and D).The distribution of Bayesian incidence rates showed similarity in the three years.Clusters of high incidence in the centralarea were identified.
16 ResultsLocal autocorrelation allowed to Identify clusters in the spatial distribution of the HVI and Bayesian incidence rates.Spatial distribution of the HVI (A).HVI clusters:Cluster, type HH, was identified in the north.Clusters, types LL, were identified in the central part of the city.Spatial distribution of the Bayesian incidence rates (B,C, and D).Incidence clusters.Cluster, type HH was identified for each year in the central area.The incongruity between HVI and Bayesian incidence rates demonstrated that HVI is not a good indicator to estimate the risk of dengue in the city of Pedro Leopoldo.
17 ConclusionsThe Local Empirical Bayes Estimator proved to be an important tool for generating new rates corrected and smoothed.The application of kernel density and local spatial autocorrelation correctly identified the areas of greatest health risk.However, this vulnerability does not reflect the site where the highest incidence rate and raw number of cases of dengue occur.HVI is not an efficient indicator to be adopted for the control and identification of risk areas for dengue in the municipality of Pedro Leopoldo.New hypotheses have to be considered.
18 ReferencesAraujo, V.E.M. Analysis of spatio-temporal distribution of visceral leishmaniosis and clinical-epidemiological profile of the cases and deaths, Belo Horizonte, Minas Gerais. Doctoral thesis. ICB/UFMG, p., il.Barbosa, AD, Characterization and spatial distribution of scorpion stings in Belo Horizonte, Minas Gerais, 2005 to Master's Dissertation. EV/UFMG, p., il.World Health Organization ,2012.Global strategy for dengue prevention and controlGEEPI - Epidemiology and Information Office. Health Vulnerability Index. Municipal Government of Belo Horizonte. 2003, 10 p.Laughlin CA; Morens DM;Cassetti MC; 1 Costero-Saint AD; San Martin JL; Whitehead SS; Fauci AS. Dengue Research Opportunities in the Americas. The Journal of Infectious Diseases 2012;206:1121–7.Perera R, Kuhn RJ. Structural proteomics of dengue virus. Curr Opin Microbiol, (4): 369–377.