{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T19:04:50Z","timestamp":1773687890624,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R01HD091257"],"award-info":[{"award-number":["R01HD091257"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011967","name":"Columbia Population Research Center","doi-asserted-by":"publisher","award":["P2CH042849"],"award-info":[{"award-number":["P2CH042849"]}],"id":[{"id":"10.13039\/100011967","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011967","name":"Columbia Population Research Center","doi-asserted-by":"publisher","award":["T32HD007081"],"award-info":[{"award-number":["T32HD007081"]}],"id":[{"id":"10.13039\/100011967","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008562","name":"University of Texas at Austin","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008562","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Northeast Brazil has the world's highest rate of Zika-related microcephaly. However, Zika case counts cannot accurately describe burden because mandatory reporting was only established when the epidemic was declining in the region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To advance the study of the Zika epidemic, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters for Aedes-borne diseases (2014\u20132017) and for microcephaly (2015\u20132017), separately. Municipalities were classified according to a proposed gradient of Zika burden during the epidemic, based on the combination of cluster status in each analysis and considering the strength of the evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 26 Aedes-borne diseases clusters (11 high-risk) and 5 microcephaly clusters (3 high-risk) in Pernambuco. According to the proposed Zika burden gradient, our results indicate that the northeast of Pernambuco and the Sert\u00e3o region were hit hardest by the Zika epidemic. The first is the most populous area of Pernambuco, while the second has one of the highest rates of social and economic inequality in Brazil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We successfully identified possible hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/trstmh\/trac099","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T12:57:54Z","timestamp":1665579474000},"page":"189-196","source":"Crossref","is-referenced-by-count":3,"title":["Identifying hidden Zika hotspots in Pernambuco, Brazil: a spatial analysis"],"prefix":"10.1093","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9012-9382","authenticated-orcid":false,"given":"La\u00eds Picinini","family":"Freitas","sequence":"first","affiliation":[{"name":"Population Research Center, University of Texas at Austin , Austin, Texas 78712-1699 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Lowe","sequence":"additional","affiliation":[{"name":"Department of Earth Sciences, Barcelona Supercomputing Center (BSC) , Barcelona 08034 , Spain"},{"name":"Catalan Institution for Research and Advanced Studies (ICREA) , Barcelona , Spain"},{"name":"Centre on Climate Change & Planetary Health and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine , London WC1E 7HT , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew E","family":"Koepp","sequence":"additional","affiliation":[{"name":"Population Research Center, University of Texas at Austin , Austin, Texas 78712-1699 , USA"},{"name":"Department of Human Development and Family Sciences, University of Texas at Austin , Austin, Texas 78712 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra Valongueiro","family":"Alves","sequence":"additional","affiliation":[{"name":"Post-graduation Program of Public Health, Centro de Ci\u00eancias M\u00e9dicas, Universidade Federal de Pernambuco , Recife, Pernambuco 50670-901 , Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly","family":"Dondero","sequence":"additional","affiliation":[{"name":"Department of Sociology, American University , Washington , D.C. 20016-8072, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Let\u00edcia J","family":"Marteleto","sequence":"additional","affiliation":[{"name":"Population Research Center, University of Texas at Austin , Austin, Texas 78712-1699 , USA"},{"name":"Department of Sociology, University of Texas at Austin , Austin, Texas 78712 , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"issue":"1","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"96","DOI":"10.3390\/ijerph15010096","article-title":"The Zika virus epidemic in Brazil: from discovery to future implications","volume":"15","author":"Lowe","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"10097","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/S0140-6736(17)31368-5","article-title":"Infection-related microcephaly after the 2015 and 2016 Zika virus outbreaks in Brazil: a surveillance-based analysis","volume":"390","author":"de Oliveira","year":"2017","journal-title":"Lancet North Am Ed"},{"issue":"9","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"675","DOI":"10.2471\/BLT.16.171082","article-title":"Zika: the origin and spread of a mosquito-borne virus","volume":"94","author":"Kindhauser","year":"2016","journal-title":"Bull World Health Organ"},{"issue":"1","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3390\/v13010012","article-title":"New insights on the Zika virus arrival in the americas and spatiotemporal reconstruction of the epidemic dynamics in Brazil","volume":"13","author":"Costa","year":"2020","journal-title":"Viruses"},{"issue":"7658","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1038\/nature22401","article-title":"Establishment and cryptic transmission of Zika virus in Brazil and the Americas","volume":"546","author":"Faria","year":"2017","journal-title":"Nature"},{"issue":"11","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"e0006055","DOI":"10.1371\/journal.pntd.0006055","article-title":"Zika virus displacement by a chikungunya outbreak in Recife, Brazil","volume":"11","author":"Magalhaes","year":"2017","journal-title":"PLoS NeglTrop Dis"},{"issue":"3","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"e1002755","DOI":"10.1371\/journal.pmed.1002755","article-title":"The association between Zika virus infection and microcephaly in Brazil 2015\u20132017: an observational analysis of over 4 million births","volume":"16","author":"Brady","year":"2019","journal-title":"PLoS Med"},{"issue":"10097","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/S0140-6736(17)31478-2","article-title":"Risk of Zika-related microcephaly: stable or variable?","volume":"390","author":"Rodrigues","year":"2017","journal-title":"Lancet North Am Ed"},{"issue":"3","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/S1473-3099(17)30697-7","article-title":"Zika virus and microcephaly: Where do we go from here?","volume":"18","author":"Costa","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"5","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1038\/s41564-019-0376-y","article-title":"Past and future spread of the arbovirus vectors Aedes aegypti and Aedes albopictus","volume":"4","author":"Kraemer","year":"2019","journal-title":"Nature Microbiology"},{"issue":"9","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.3201\/eid2409.170361","article-title":"Symptomatic dengue during pregnancy and congenital neurologic malformations","volume":"24","author":"Paix\u00e3o","year":"2018","journal-title":"Emerg Infect Dis"},{"issue":"5","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1590\/0037-8682-0245-2016","article-title":"Zika in Pernambuco: rewriting the first outbreak","volume":"49","author":"de Brito","year":"2016","journal-title":"Rev Soc Bras Med Trop"},{"issue":"6","key":"2023030119483607200_","article-title":"Monitoramento integrado de altera\u00e7\u00f5es no crescimento e desenvolvimento relacionadas \u00e0 infec\u00e7\u00e3o pelo v\u00edrus Zika e outras etiologias infecciosas, at\u00e9 a Semana Epidemiol\u00f3gica 52 de 2017","volume":"49","author":"Minist\u00e9rio da Sa\u00fade do Brasil","year":"2018","journal-title":"Boletim Epidemiol\u00f3gico"},{"key":"2023030119483607200_","volume-title":"Panorama - IBGE - Cidades - Pernambuco","author":"IBGE"},{"key":"2023030119483607200_","volume-title":"Panorama - IBGE - Cidades - Recife","author":"IBGE"},{"issue":"26","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"124","DOI":"10.31406\/relap2020.v14.i1.n26.6","article-title":"Proje\u00e7\u00f5es populacionais por sexo e idade para pequenas \u00e1reas no Brasil","volume":"14","author":"Freire FHM de","year":"2019","journal-title":"Revista Latinoamericana de Poblaci\u00f3n"},{"issue":"43","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the Tidyverse","volume":"4","author":"Wickham","year":"2019","journal-title":"J Open Source Software"},{"key":"2023030119483607200_","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-24277-4","volume-title":"ggplot2: Elegant Graphics for Data Analysis","author":"Wickham","year":"2016"},{"key":"2023030119483607200_","volume-title":"R","author":"The R Foundation for Statistical Computing","year":"2020"},{"issue":"6","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1080\/03610929708831995","article-title":"A spatial scan statistic","volume":"26","author":"Kulldorff","year":"1997","journal-title":"Commun Stat Theory Methods"},{"key":"2023030119483607200_","doi-asserted-by":"crossref","DOI":"10.32614\/CRAN.package.rsatscan","article-title":"rsatscan: tools, classes, and methods for interfacing with satscan stand-alone software","author":"Kleinman","year":"2015"},{"key":"2023030119483607200_","author":"Freitas","year":"2022","journal-title":"laispfreitas\/PE_satscan [Internet]"},{"key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12889-018-5039-z","article-title":"Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil","volume":"18","author":"de Souza","year":"2018","journal-title":"BMC Public Health"},{"issue":"30","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/S0968-8080(07)30326-1","article-title":"Maternal mortality in Pernambuco, Brazil: What has changed in ten years?","volume":"15","author":"Alves","year":"2007","journal-title":"Reprod Health Matters"},{"issue":"2","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1590\/S1519-38292011000200005","article-title":"Desigualdades sociodemogr\u00e1ficas e causas de morte em menores de cinco anos no Estado de Pernambuco","volume":"11","author":"Murakami","year":"2011","journal-title":"Rev Bras Saude Mater Infant"},{"issue":"3","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/S1473-3099(17)30727-2","article-title":"Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study","volume":"18","author":"de Ara\u00fajo","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1038\/s41598-020-58407-7","article-title":"Association of past dengue fever epidemics with the risk of Zika microcephaly at the population level in Brazil","volume":"10","author":"Carvalho","year":"2020","journal-title":"Sci Rep"},{"issue":"3","key":"2023030119483607200_","doi-asserted-by":"crossref","first-page":"700","DOI":"10.3390\/ijerph17030700","article-title":"Spatiotemporal analysis of the population risk of congenital microcephaly in Pernambuco State, Brazil","volume":"17","author":"Alexander","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2023030119483607200_","volume-title":"WHO Coronavirus Disease (COVID-19) Dashboard","author":"WHO","year":"2021"},{"key":"2023030119483607200_","volume-title":"CDC updates, expands list of people at risk of severe COVID-19 illness","author":"CDC","year":"2020"}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/117\/3\/189\/49376793\/trac099.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/trstmh\/article-pdf\/117\/3\/189\/49376793\/trac099.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,5]],"date-time":"2024-10-05T13:47:19Z","timestamp":1728136039000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/117\/3\/189\/6795156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,3]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,11,3]]},"published-print":{"date-parts":[[2023,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trac099","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.03.15.21253657","asserted-by":"object"}]},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"value":"0035-9203","type":"print"},{"value":"1878-3503","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3]]},"published":{"date-parts":[[2022,11,3]]}}}