José E. Hagan|Paula Moraga|Federico Costa|Nicolas Capian|Guilherme S. Ribeiro|Elsio A. Wunder|Ridalva Dias Martins Felzemburgh|Renato Barbosa Reis|Nívison Nery|Francisco S. Santana|Deborah Bittencourt Mothé Fraga|Balbino Lino dos Santos|Andréia C. Santos|Adriano Queiroz|Wagner de Souza Tassinari|Marília Sá Carvalho|Mitermayer Galvão dos Reis|Peter J. Diggle|Albert I. Ko
Spatiotemporal Determinants of Urban Leptospirosis Transmission: Four-Year Prospective Cohort Study of Slum Residents in Brazil
Yale University|Lancaster University|Yale University|Fundação Oswaldo Cruz|Ministry of Health|Universidade Federal da Bahia|Instituto de Saúde|Lancaster University|Universidade Federal da Bahia|Instituto de Saúde|Fundação Oswaldo Cruz|Ministry of Health|Yale University|Fundação Oswaldo Cruz|Ministry of Health|Fundação Oswaldo Cruz|Ministry of Health|Fundação Oswaldo Cruz|Ministry of Health|Fundação Oswaldo Cruz|Ministry of Health|Fundação Oswaldo Cruz|Ministry of Health|Fundação Oswaldo Cruz|Ministry of Health|Fundação Oswaldo Cruz|Ministry of Health|Fundação Oswaldo Cruz|Ministry of Health|Escola Nacional de Saúde Pública|Ministry of Health|Fundação Oswaldo Cruz|Escola Nacional de Saúde Pública|Ministry of Health|Fundação Oswaldo Cruz|Fundação Oswaldo Cruz|Ministry of Health|Lancaster University|Yale University|Fundação Oswaldo Cruz|Ministry of Health
background ratborne leptospirosis emerging zoonotic disease urban slum settlements adequate control measures challenge elucidating risk factors informing approaches prevention complex heterogeneous environment within slums vary fine spatial scales influence transmission bacterial agent methodologyprincipal findings performed prospective study 2003 slum residents city salvador brazil fouryear period 20032007 used spatiotemporal modelling approach delineate dynamics leptospiral transmission household interviews geographical information system surveys performed annually evaluate risk exposures environmental transmission sources completed annual serosurveys ascertain leptospiral infection based serological evidence among 1730 86 individuals completed least one year followup infection rate 354 95 ci 307406 per 1000 annual followup events male gender illiteracy age independently associated infection risk environmental risk factors included rat infestation 146 95 ci 100216 contact mud 157 95 ci 117217 lower household elevation 092 per 10m increase elevation 95 ci 082104 spatial distribution infection risk highly heterogeneous varied across small scales fixed effects spatiotemporal model accounted majority spatial variation risk significant residual component best explained spatial random effect although infection risk varied years spatial distribution risk associated fixed random effects vary temporally specific hotspots consistently higher transmission risk study years conclusionssignificance risk leptospiral infection urban slums determined large part structural features social environmental findings indicate topographic factors household elevation inadequate drainage increase risk promoting contact mud suggest soilwater interface serves environmental reservoir spillover transmission use spatiotemporal approach allowed identification geographic outliers unexplained risk patterns approach addition guiding targeted communitybased interventions identifying new hypotheses may general applicability towards addressing environmentallytransmitted diseases emerged complex urban slum settings