Inverse association between dengue, chikungunya, and Zika virus infection and indicators of household air pollution in Santa Rosa, Guatemala: A case-control study, 2011-2018

• Published in: PloS one 2020-06, Vol.15 (6), p.e0234399
• Main Authors: Madewell, Zachary J, López, María Reneé, Espinosa-Bode, Andrés, Brouwer, Kimberly C, Sánchez, César G, McCracken, John P
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aedes - virology; Air pollution; Air Pollution, Indoor - analysis; Animals; Aquatic insects; Arbovirus diseases; Biology and Life Sciences; Biomass; Biomass energy; Burning; Campylobacter; Case studies; Case-Control Studies; Chikungunya Fever - epidemiology; Chikungunya virus; Child; Clean fuels; Cooking; Demographics; Demography; Dengue; Dengue - epidemiology; Dengue fever; Diarrhea; Disease; E coli; Engineering and Technology; Environmental health; Epidemics; Etiology; Exposure; Family Characteristics; Female; Fever; Fires; Fuelwood; Global health; Guatemala - epidemiology; Guillain-Barre syndrome; Health aspects; Health problems; Health risks; Health surveillance; Hospitals; Households; Humans; Illnesses; Independent variables; Indoor air pollution; Infections; Infectious diseases; Insect control; Insect Repellents - analysis; Logistic Models; Male; Medicine and Health Sciences; Minority & ethnic groups; Mosquito Vectors - virology; Mosquitoes; Observations; Outdoor air quality; People and places; Physical Sciences; Population density; Public health; Regression analysis; Regression models; Repellents; Retrospective Studies; Risk Factors; Rotavirus; Salmonella; Signs and symptoms; Smoke; Smoke - analysis; Socioeconomics; Studies; Vector-borne diseases; Viruses; Wood; Young Adult; Zika virus; Zika Virus Infection - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0234399

Dengue, chikungunya, and Zika viruses are increasingly important public health problems. Burning vegetation, leaves, and other plant products have been shown to be effective mosquito repellents for their vector, Aedes spp., but there has been scant research on whether firewood cooking smoke in households influences mosquito populations or mosquito-borne diseases. About 2.9 billion people worldwide use biomass fuel for household cooking and heating, resulting in an estimated 1.6 million deaths annually from household air pollution (HAP)-related diseases. Global health agencies now encourage households to transition from biomass to clean fuels, but it is unclear whether such interventions may actually increase risk for mosquito-borne diseases. This retrospective case-control study evaluated associations between arboviral infections and cooking with firewood in Santa Rosa, Guatemala. Vigilancia Integrada Comunitaria (VICo) was a prospective public health surveillance system for bacterial, parasitic, and viral causes of diarrheal, neurological, respiratory, and febrile illnesses in hospitals and clinics in the department of Santa Rosa, Guatemala. Enrolled VICo in-patients and out-patients during 2011-2018 were interviewed using standardized questionnaires on demographics and household characteristics. Blood and stool specimens were collected and tested to identify the etiologies presenting symptoms. Cases were defined as laboratory-positive for dengue, chikungunya, or Zika virus infections. Controls were laboratory-positive for bacterial and viral diarrheal illnesses (e.g., Salmonella, Shigella, Campylobacter, Escherichia coli, rotavirus, norovirus, sapovirus, or astrovirus). Cooking with firewood, kitchen location, stove type, and firewood cooking frequency were the independent exposure variables. Logistic regression models were used to analyze unadjusted and adjusted associations between arboviral infections and exposures of interest. There were 311 arboviral cases and 1,239 diarrheal controls. Arboviral infections were inversely associated with cooking with firewood in the main house (AOR: 0.22; 95% CI: 0.08-0.57), cooking with firewood on an open hearth (AOR: 0.50; 95% CI: 0.33-0.78), and cooking with firewood ≥5 times per week (AOR: 0.54; 95% CI: 0.36-0.81), adjusting for age, sex, ethnicity, socioeconomic status index, number of people per household, community population density, community elevation, recruitment location, season, and admission year. Seve