Syndemic Factors Associated with Zika Virus Infection Prevalence and Risk Factors in a Cohort of Women Living in Endemic Areas for Arboviruses in Northeast Brazil
Kerr L., Sanhueza-Sanzana C., Leal M., Aguiar I., Allel K., Sandoval MH., Frota CC., Aguiar MT., Martins AF., Dias L., Almeida RLFD., Carvalho FHC., Correia FGS., Pires Neto RDJ., Araújo FM., Lima STSD., Mello LMS., Nogueira LDL., Leitão TDMJS., Teixeira MDG., Stolow J., Werneck GL., Coelho ICB., Blanton R., Silva AZD., Rutherford GW., Kendall C.
Background: We sought to explain the seroprevalence of Zika Virus (ZIKV) as a syndemic of socioeconomic, environmental, and health factors in a cohort of women living in Brazil. Methods: This is a cohort study comprising 1498 women between 15 and 39 years of age followed up in two waves between February 2018 and August 2019. Two questionnaires addressed the arbovirus’s socioeconomic, demographic, and behavioral aspects and participants’ arbovirus infection history. Blood samples were collected to detect IgM and IgG for ZIKV, chikungunya virus (CHIKV), and dengue virus (DENV), and RT-PCR for ZIKV. Results: The baseline prevalence for ZIKV was 43% (95%CI: 40.5, 45.6), increasing to 44.7% in the following period (95%CI: 42, 47.1). We found a prevalence of 44.1% among women having one syndemic factor, 49.9% for those having two, and 58% for women having three or more factors. Women reporting a single syndemic factor resulted in higher odds of acquiring ZIKV (OR = 1.6, 95%CI: 1.2–2.4). There were increased adjusted odds among women having two or three or more factors (OR = 2.1, 95%CI: 1.6–3.1; OR = 2.9, 95%CI: 2.0–4.3, respectively). Conclusions: Tailored interventions targeting syndemic conditions, such as the co-circulation of urban arboviruses and poor living conditions, are crucial to improving the burden produced by ZIKV.