ArticlePLoS neglected tropical diseases2022
Dengue, Zika, and Chikungunya viral circulation and hospitalization rates in Brazil from 2014 to 2019: An ecological study.
Article in PLoS neglected tropical diseases, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 16 citations in OpenAlex.
- Epidemiological and molecular analysis of the Chikungunya virus outbreak in the state of Rondônia.Infection · 2026Review
- Dengue, chikungunya and Zika virus surveillance in blood donors in Brazil, 2019-2021.Vox sanguinis · 2026Article
- Beyond the metropolises: the decentralization of chikungunya to non-metropolitan areas across Brazil.Cadernos de saude publica · 2026Article
- Bussuquara Virus: A Neglected Orthoflavivirus with Broad Distribution Across Central and South America and the Caribbean.Viruses · 2025Review
- Sex-specific public health data: analyzing the arboviral impact on women in Brazil.Revista de saude publica · 2025Article
- The risk and risk factors of chikungunya virus infection and rheumatological sequelae in a cohort of U.S. Military Health System beneficiaries: Implications for the vaccine era.PLoS neglected tropical diseases · 2024Article
- Long chikungunya? An overview to immunopathology of persistent arthralgia.World journal of virology · 2024Review
- [Dengue lethality and inequalities in the Region of the Americas between 2014 and 2023Letalidade da dengue e desigualdades na Região das Américas entre 2014 e 2023].Revista panamericana de salud publica = Pan American journal of public health · 2024Article
- Risk of adverse pregnancy and infant outcomes associated with prenatal Zika virus infection: a post-epidemic cohort in Central-West Brazil.Scientific reports · 2023Article
- Democratizing Public Health: Participatory Policymaking Institutions, Mosquito Control, and Zika in the Americas.Tropical medicine and infectious disease · 2023Article
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Authors and funding
12 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn addition to their direct pathogenic effects, arthropod-borne (arboviruses) have been hypothesized to indirectly contribute to hospitalizations and death through decompensation of pre-existing comorbidities. Using nationwide data routinely collected from 1 January 2014 to 31 December 2019 in Brazil, we investigated whether local increases in arbovirus notifications were associated with excess hospitalization.
methodsWe estimated the relative risks for the association between municipality- and state-level increases in arboviral case notifications and age-standardized hospitalization rates (i.e., classified as direct or indirect based on ICD-10 codes) using Bayesian multilevel models with random effects accounting for temporal and geographic correlations. For municipality-level analyses, we excluded municipalities with <200 notifications of a given arbovirus and further adjusted the models for the local Gini Index, Human Development Index, and Family Healthcare Strategy (Estratégia de Saúde da Família) coverage. Models for dengue, Zika, and chikungunya were performed separately.
resultsFrom 2014 to 2019, Brazil registered 7,566,330 confirmed dengue cases, 159,029 confirmed ZIKV cases, and 433,887 confirmed CHIKV cases. Dengue notifications have an endemic and seasonal pattern, with cases present in 5334 of the 5570 (95.8%) Brazilian municipalities and most (69.5%) registered between February and May. Chikungunya notifications followed a similar seasonal pattern to DENV but with a smaller incidence and were restricted to 4390 (78.8%) municipalities. ZIKV was only notified in 2581 (46.3%) municipalities. Increases in dengue and chikungunya notifications were associated with small increases in age-standardized arbovirus-related hospitalizations, but no consistent association was found with all-cause or other specific indirect causes of hospitalization. Zika was associated to increases in hospitalizations by neurological diseases.
conclusionsAlthough we found no clear association between increased incidence of the three arboviruses and excess risks of all-cause or indirect hospitalizations at the municipality- and state-levels, follow-up investigations at the individual-level are warranted to define any potential role of acute arbovirus infection in exacerbating risks of hospitalization from underlying conditions.
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