Age and socio-economic status affect dengue and COVID-19 incidence: spatio-temporal analysis of the 2020 syndemic in Buenos Aires City.

In early 2020, Argentina experienced the worst dengue outbreak in its history, concomitant with first-to-date increasing COVID-19 cases. Dengue epidemics in temperate Argentina have already been described as spatially heterogeneous; in the previous 2016 outbreak, transmission occurred 7.3 times more frequently in slums compared to the rest of Buenos Aires City (CABA). These informal settlements have deficient sanitary conditions, precarious housing and high incidence of social vulnerabilities. The purpose of this work was to study the spatio-temporal patterns of the 2020 dengue epidemic in CABA in relation to socio-economic living conditions of its inhabitants and its interaction with the onset of COVID-19. The study considered the period between Jan 1st and May 30th 2020. Dengue and COVID-19 databases were obtained from the National Health Surveillance System; each record was anonymized and geo-localized. The city was divided according to census tracts and grouped in four socio-economic strata: slums, high, mid and low residential. An aligned-rank transform ANOVA was performed to test for differences in the incidence of dengue and COVID-19, and age at death due to COVID-19, among socio-economic strata, four age categories and their interaction. The incidence by cluster was calculated with a distance matrix up to 600 m from the centroid. Spatial joint dengue and COVID-19 risk was estimated by multiplying the nominal risk for each disease, defined from 1 (low) to 5 (high) according to their quantiles. During the study period, 7,175 dengue cases were registered in CABA (incidence rate 23.3 cases per 10,000 inh), 29.2% of which occurred in slums. During the same period, 8,809 cases of COVID-19 were registered (28.6 cases per 10,000 inh); over half (51.4%) occurred in slums, where the median age of cases (29 years old) was lower than in residential areas (42 years old). The mean age of the deceased was 58 years old in slums compared to 79 years old outside. The percentage of deaths in patients under 60 years old was 56% in slums compared to 8% in the rest of the city. The incidence of both diseases was higher in slums than in residential areas for most age categories. Spatial patterns were heterogeneous: dengue presented higher incidence values in the southern sector of the city and the west, and low values in highly urbanized quarters, whereas COVID-19 presented higher values in the east, south, high populated areas and slums. The lowest joint risk clusters were located mainly in high residential areas, whereas high joint risk was observed mainly in the south, some western clusters, the historical part of the city and center north. The social epidemiological perspective of dengue and COVID-19 differed, given that socio environmental heterogeneity influenced the burden of both viruses in a different manner. Despite the overwhelming effect of the COVID-19 pandemic, health care towards other diseases, especially in territories with pre-existing vulnerabilities, should not be unattended.

Peridomestic natural breeding sites of Nyssomyia whitmani (Antunes and Coutinho) in an endemic area of tegumentary leishmaniasis in northeastern Argentina.

The scarce information about breeding sites of phlebotomines limits our understanding of the epidemiology of tegumentary leishmaniasis. Identifying the breeding sites and seasons of immature stages of these vectors is essential to propose prevention and control strategies different from those targeting the adult stage. Here we identified the rural breeding environments of immature stages of Ny. whitmani, vector species of Leishmania braziliensis in the north of Misiones province, Argentina; then we determined and compared the environmental and structural characteristics of those sites. We also identified the season of greatest emergence and its relationship with adult abundance. During a first collection period, between 28 and 48 emergence traps were set continuously for 16 months in six environments of the farm peridomicile and domicile: below house, chicken shed, experimental chicken shed, forest edge, pigsty and under fruit tree. Traps were checked and rotated every 40 nights. A total of 146 newly emerged individuals were collected (93.8% of them were Ny. whitmani), totaling an effort of 23,040 emergence trap-nights. The most productive environments were chicken shed and below house, and the greatest emergence was recorded in spring and summer. During a second collection period, emergence traps and light traps for adult capture were placed in the chicken shed and below house environments of eight farms. Emergence traps were active continuously during spring, summer, and early autumn. Environmental and structural characteristics of each environment were recorded. A total of 84 newly emerged phlebotomines (92.9% Ny. whitmani; 72,144 emergence trap-nights) and 13,993 adult phlebotomines (147 light trap-nights) were recorded in the chicken shed and below house environments. A positive correlation was also observed between trap success of newly emerged phlebotomines and of adults after 120 days. A high spatial variability was observed in the emergence of Ny. whitmani, with the number of newly emerged individuals being highest in soils of chicken sheds with the highest number of chickens and closest to forest edge. Moreover, below house was found to be as important as chicken sheds as breeding sites of Ny. whitmani. Management of the number of chickens in sheds, soil moisture and pH, and the decision of where to localize the chicken sheds in relation to the houses and the forest edge, might contribute to reduce the risk of human vector exposure and transmission of Leishmania.

Update on the distribution of Aedes albopictus (Diptera: Culicidae) in Misiones, Argentina.

The Asian tiger mosquito ( Aedes albopictus, Diptera: Culicidae) has spread rapidly in the last 30 years from its native region in Southeast Asia. In Argentina, studies on its potential distribution suggest that this species could be found in temperate zones of the province of Buenos Aires. However, since its initial detection in 1998 Ae. albopictus is bounded to the subtropical province of Misiones. To evaluate the presence and abundance of Ae. albopictus in the Northeast of Argentina, we preliminarily evaluated the presence of this vector by analyzing its presence in tires of 20 cities belonging to the province of Misiones and four cities in Northern Corrientes, and then performed an evaluation of the vector in the towns where the vector was detected. Aedes albopictus was present only in two cities of Misiones: Eldorado and Colonia Aurora. Aedes aegypti and Ae . albopictus accounted for 86% of the individuals collected in the domiciles of both towns. In Colonia Aurora both species were in similar abundances suggesting a co-dominance. The present study extends the austral distribution of Ae. albopictus in Argentina to the city of Colonia Aurora where the highest abundance recorded in Argentina was detected. Nevertheless, the reasons of its bounded distribution in the region are not known.

Identificación de los escenarios epidemiológicos de la enfermedad de Chagas en áreas de nulo riesgo de transmisión vectorial de Trypanosoma cruzi / Identification of the epidemiological scenarios of the disease of Chagas in areas with no risk of vector transmission of Trypanosoma cruzi

La enfermedad de Chagas congénita se refiere a la transmisión de Trypanosoma cruzi de una generación a la siguiente, incluyendo la transmisión prenatal, perinatal y posnatal. Constituye la primera forma de aparición de nuevos casos en nuestro país y es la única forma de transmisión que puede ocurrir en todas las provincias de Argentina, donde se estima que el 4% de las mujeres embarazadas están infectadas. Este estudio tuvo como objetivo conocer la situación epidemiológica de la infección connatal de la enfermedad de Chagas en las zonas de nulo riesgo de transmisión vectorial (Buenos Aires, Chubut, Santa Cruz y Tierra del Fuego). Así como identificar los saberes y prácticas del personal de salud en relación al diagnóstico de Chagas en personas embarazadas y su descendencia, con el fin de identificar nuevos escenarios epidemiológicos y compartir estrategias para detectar niños y niñas tempranamente y permitirles el acceso oportuno al tratamiento en estas áreas del país. En relación a la nueva coyuntura transitada desde el 2019 al 2021 inclusive, se planificó el desarrollo de una encuesta vía web al personal sanitario de las provincias en estudio y, de modo complementario, realizar entrevistas a distancia a los actores esenciales en sus niveles de atención (3 niveles de atención sanitaria y los dos niveles de gestión nacional y provincial). De los resultados de las encuestas y las entrevistas, se desprende la necesidad de avanzar en una capacitación, la misma se estructuró con modalidad de taller, para abordar las dificultades que surgieron en las instancias previas e introducir conceptos y visiones que permitan realizar un abordaje integral del Chagas congénito/connatal. Esta actividad final se desarrollará en el mes de septiembre de 2021, por lo cual los resultados no podrán ser presentados en este informe. Este proyecto llegó a poner de manifiesto ciertas deficiencias en la formación de los profesionales, y principalmente la postergación del Chagas en los sistemas, implicando la descoordinación y desconocimientos entre niveles de responsabilidades, la falta de recursos así como el desconocimiento y/o desinterés. Si bien estas cuestiones son conocidas en la práctica, mediante el trabajo realizado en este proyecto se visibilizaron estas cuestiones, que son claramente relevantes para que los circuitos de atención y cuidado funcionen y tengan una actitud pro-activa, actitud necesaria al tratarse la transmisión vertical de Chagas

Presence of Lutzomyia longipalpis and Nyssomyia whitmani in Entre Rios, Argentina.

The objective of this study was to evaluate the presence of Lutzomyia longipalpis in the Argentine city of Concordia, in the province of Entre Rios, without record of this species despite previous samplings, but with canine cases of visceral leishmaniasis and Lu. longipalpis reports both, from Northern Argentine localities and from the city of Salto, Uruguay, located just across the river and the international border. This study confirms the presence of Lu. longipalpis and Nyssomyia whitmani, related to the risk of visceral and tegumentary leishmaniasis, respectively, in Concordia-Entre Rios. The presence of Lu. longipalpis confirms the ongoing dispersal along the Uruguay river basin. The presence of these species in the study area alerts about the risk of transmission of Leishmania spp.

Environmental suitability for Lutzomyia longipalpis in a subtropical city with a recently established visceral leishmaniasis transmission cycle, Argentina

BACKGROUND Visceral leishmaniasis (VL) is an endemic disease in northeastern Argentina including the Corrientes province, where the presence of the vector and canine cases of VL were recently confirmed in December 2008. OBJECTIVES The objective of this study was to assess the modelling of micro- and macro-habitat variables to evaluate the urban environmental suitability for the spatial distribution of Lutzomyia longipalpis presence and abundance in an urban scenario. METHODS Sampling of 45 sites distributed throughout Corrientes city (Argentina) was carried out using REDILA-BL minilight traps in December 2013. The sampled specimens were identified according to methods described by Galati (2003). The analysis of variables derived from the processing of satellite images (macro-habitat variables) and from the entomological sampling and surveys (micro-habitat variables) was performed using the statistical software R. Three generalised linear models were constructed composed of micro- and macro-habitat variables to explain the spatial distribution of the abundance of Lu. longipalpis and one composed of micro-habitat variables to explain the occurrence of the vector. FINDINGS A total of 609 phlebotominae belonging to five species were collected, of which 56% were Lu. longipalpis. In addition, the presence of Nyssomyia neivai and Migonemya migonei, which are vectors of tegumentary leishmaniasis, were also documented and represented 34.81% and 6.74% of the collections, respectively. The explanatory variable normalised difference vegetation index (NDVI) described the abundance distribution, whereas the presence of farmyard animals was important for explaining both the abundance and the occurrence of the vector. MAIN CONCLUSIONS The results contribute to the identification of variables that can be used to establish priority areas for entomological surveillance and provide an efficient transfer tool for the control and prevention of vector-borne diseases.

Environmental suitability for Lutzomyia longipalpis in a subtropical city with a recently established visceral leishmaniasis transmission cycle, Argentina.

BACKGROUND: Visceral leishmaniasis (VL) is an endemic disease in northeastern Argentina including the Corrientes province, where the presence of the vector and canine cases of VL were recently confirmed in December 2008. OBJECTIVES: The objective of this study was to assess the modelling of micro- and macro-habitat variables to evaluate the urban environmental suitability for the spatial distribution of Lutzomyia longipalpis presence and abundance in an urban scenario. METHODS: Sampling of 45 sites distributed throughout Corrientes city (Argentina) was carried out using REDILA-BL minilight traps in December 2013. The sampled specimens were identified according to methods described by Galati (2003). The analysis of variables derived from the processing of satellite images (macro-habitat variables) and from the entomological sampling and surveys (micro-habitat variables) was performed using the statistical software R. Three generalised linear models were constructed composed of micro- and macro-habitat variables to explain the spatial distribution of the abundance of Lu. longipalpis and one composed of micro-habitat variables to explain the occurrence of the vector. FINDINGS: A total of 609 phlebotominae belonging to five species were collected, of which 56% were Lu. longipalpis. In addition, the presence of Nyssomyia neivai and Migonemya migonei, which are vectors of tegumentary leishmaniasis, were also documented and represented 34.81% and 6.74% of the collections, respectively. The explanatory variable normalised difference vegetation index (NDVI) described the abundance distribution, whereas the presence of farmyard animals was important for explaining both the abundance and the occurrence of the vector. MAIN CONCLUSIONS: The results contribute to the identification of variables that can be used to establish priority areas for entomological surveillance and provide an efficient transfer tool for the control and prevention of vector-borne diseases.

Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination.

BACKGROUND: Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES: We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS: Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS: We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS: Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.

Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination

BACKGROUND Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.

Lutzomyia longipalpis Presence and Abundance Distribution at Different Micro-spatial Scales in an Urban Scenario.

The principal objective of this study was to assess a modeling approach to Lu. longipalpis distribution in an urban scenario, discriminating micro-scale landscape variables at microhabitat and macrohabitat scales and the presence from the abundance of the vector. For this objective, we studied vectors and domestic reservoirs and evaluated different environmental variables simultaneously, so we constructed a set of 13 models to account for micro-habitats, macro-habitats and mixed-habitats. We captured a total of 853 sandflies, of which 98.35% were Lu. longipalpis. We sampled a total of 197 dogs; 177 of which were associated with households where insects were sampled. Positive rK39 dogs represented 16.75% of the total, of which 47% were asymptomatic. Distance to the border of the city and high to medium density vegetation cover ended to be the explanatory variables, all positive, for the presence of sandflies in the city. All variables in the abundance model ended to be explanatory, trees around the trap, distance to the stream and its quadratic, being the last one the only one with negative coefficient indicating that the maximum abundance was associated with medium values of distance to the stream. The spatial distribution of dogs infected with L. infantum showed a heterogeneous pattern throughout the city; however, we could not confirm an association of the distribution with the variables assessed. In relation to Lu. longipalpis distribution, the strategy to discriminate the micro-spatial scales at which the environmental variables were recorded allowed us to associate presence with macrohabitat variables and abundance with microhabitat and macrohabitat variables. Based on the variables associated with Lu. longipalpis, the model will be validated in other cities and environmental surveillance, and control interventions will be proposed and evaluated in the microscale level and integrated with socio-cultural approaches and programmatic and village (mesoscale) strategies.