Fecundity and Fertility in the Presence of Zika

寨卡病毒存在下的生育力和生育力

• 批准号: 9374963
• 负责人: Marcos de Almeida Rangel
• 金额: $ 9.28万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-13 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9374963
• 关键词: Adult; Aedes; Affect; Americas; Area; Behavior; Behavior assessment; Behavioral Mechanisms; Biological; Birth; Birth Rate; Brazil; Characteristics; Climate; Communications Media; Communities; Contraceptive Agents; Country; Couples; Criminal Abortion; Culicidae; Data; Data Set; Delayed Childbearing; Dengue; Detection; Disadvantaged; Disease; Disease Outbreaks; Education; Epidemic; Family; Family Planning; Fertility; Fertility Rates; Fever; Government Agencies; Health; Health system; Healthcare Systems; Heterogeneity; Infant; Infant Health; Infection; Light; Literature; Low income; Maternal Health; Measures; Medical; Modeling; Monitor; Morale; Municipalities; Outcome; Pathogenesis; Pathway interactions; Pattern; Population; Population Dynamics; Pregnancy; Pregnancy Outcome; Pregnancy loss; Pregnant Women; Prevalence; Public Health; Records; Reproduction; Reproductive Health; Research; Resources; Risk; Sex Behavior; Single-Payer System; Socioeconomic Status; Source; Teratogenic effects; Termination of pregnancy; Testing; Ultrasonography; Uncertainty; United States; Virus; Woman; Zika Virus; base; behavioral response; chikungunya; cohort; data resource; health care service utilization; nervous system disorder; novel; prenatal; response; social media; socioeconomics; transmission process; trend; uptake; vector mosquito

Project Summary   In 2015, the Brazilian Health Ministry identified a Zika virus (ZIKV) outbreak in the northeastern region of the country. The outbreak has intensified and spread, reaching into 46 previously unaffected populations, including the southern United States. The epidemic is of special concern because Zika was found to cause severe neurological disorders among infants. Government agencies across the Americas have advised populations to take the epidemic into account when making family planning decisions, including specific appeals for fertility delay. Research on Zika has focused on transmission dynamics, disease pathogenesis, and teratogenic effects. We focus on an underexplored area of impact: population fertility. We build a detailed data set characterizing demographic patterns in Brazil from 2008-2018. Sources include natality files, records of interactions with the health care system, ecological data, and two types of media resources. Because we can identify pregnancies in progress, we provide the earliest possible estimates of fertility change driven by the epidemic. Our study has three aims: 1) To estimate the effect of Zika risk on population fertility; 2) To identify the magnitude of socioeconomic heterogeneity in fertility response to the epidemic; (3) To test for evidence of behavioral mechanisms through which a fertility response occurs. We estimate municipality-level pregnancy/fertility rates, and overlay those estimates on vulnerability to epidemic spread of Zika. We model two components of vulnerability: (a) transmission risk based on the suitability of each municipality's climate and topography for reproduction of the primary Zika mosquito vector (Aedes aegypti), and (b) depiction of infection risk using temporally-and spatially-referenced data from local and social media sources. Fertility rates calculated before the epidemic, and rates calculated in areas with minimal Aedes prevalence, provide an estimate of the expected temporal patterns within exposed areas in the absence of the epidemic. The difference between the observed and the expected patterns in fertility allow us to describe the direction, magnitude, and timing of the fertility response. Health-system data on long-acting contraceptives, prenatal practices, STIs, among others, allow us to detect evidence that fertility change is accompanied by related, behavioral responses to the epidemic. Our research provides early estimates of a major public health impact of Zika. It advances our understanding of how (and which) families shift fertility timing in response to reproductive health threats, shedding light on important patterns in population dynamics during and after epidemics.

项目摘要   2015年，巴西卫生部在东北地区确定了寨卡病毒（ZIKV）爆发 该国地区。爆发激烈而传播，以前伸入46 不受影响的人口，包括美国南部。流行病是特殊的 担心，因为发现寨卡病毒会导致婴儿严重的神经系统疾病。 美洲政府机构已建议人口将流行病带入 在做出计划生育决策时说明，包括生育延迟的具体表现。 Zika的研究重点是传播动态，疾病发病机理和 致化作用。我们专注于影响不足的影响力：人口生育能力。我们建造 一个详细的数据集，表征2008 - 2018年巴西的人口统计学模式。来源 包括自然文件，与医疗保健系统互动的记录，生态数据以及 两种类型的媒体资源。因为我们可以识别正在进行的怀孕，所以我们提供 最早可能通过流行病来估计生育能力变化。 我们的研究有三个目的：1）估计寨卡风险对种群生育的影响； 2）到 确定对流行病的生育能力反应中社会经济异质性的大小； （3） 测试出现生育力反应的行为机制的证据。我们 估计市政级别的妊娠/生育率，并覆盖脆弱性的估计 寨卡病毒的流行传播。我们对脆弱性的两个组成部分进行建模：（a）传输风险 基于每种文化的气候和地形对于再现的适用性 主要的Zika蚊子矢量（Aedes aegypti），（b）使用使用 来自本地和社交媒体来源的临时和空间引用的数据。生育率 在流行病之前计算出来，并在伊迪斯的流行率最小的地区计算的速率， 在不存在的情况下估算暴露区域内预期的临时模式 流行。观察到的生育能力和预期模式之间的差异允许 我们描述了生育能力的方向，大小和时机。健康系统数据 关于长效避孕药，产前实践，性传播感染等，允许我们检测到 生育变化伴随着对流行病的行为反应的证据。 我们的研究提供了对Zika的重大公共卫生影响的早期估计。它进步了 我们对（以及哪些）家庭如何转移生育时机以响应生殖时的理解 健康威胁，阐明了人口动态的重要模式 流行病。