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.

项目概要   2015年，巴西卫生部确认东北部爆发寨卡病毒（ZIKV）疫情 该国疫情加剧并蔓延，此前已蔓延至46个地区。 未受影响的人群，包括美国南部，这种流行病具有特殊性。 之所以令人担忧，是因为寨卡病毒被发现会导致婴儿严重的神经系统疾病。 美洲各地的政府机构都建议人们认真对待这一流行病 在做出计划生育决定时考虑这一因素，包括延迟生育的具体呼吁。 寨卡病毒的研究重点是传播动力学、疾病发病机制和 我们关注一个尚未充分研究的影响领域：人口生育率。 描述 2008 年至 2018 年巴西人口模式的详细数据集。 包括出生档案、与医疗保健系统互动的记录、生态数据以及 因为我们可以识别正在进行的怀孕，所以我们提供两种类型的媒体资源。 对流行病驱动的生育率变化的最早估计。 我们的研究有三个目的：1）估计寨卡风险对人口生育率的影响； 确定生育率对流行病反应的社会经济异质性程度（3） 测试生育反应发生的行为机制的证据。 估计市级怀孕/生育率，并将这些估计叠加到脆弱性上 针对寨卡病毒的流行病传播，我们对脆弱性的两个组成部分进行了建模：(a) 传播风险。 根据每个城市的气候和地形是否适合繁殖 主要寨卡蚊媒（埃及伊蚊），以及 (b) 使用以下方法表示感染风险 来自本地和社交媒体来源的时间和空间参考数据。 流行前，以及在计算出的伊蚊流行率最低的地区计算的比率， 提供在没有条件的情况下暴露区域内预期时间模式的估计 观察到的生育率模式与预期的生育率模式之间存在差异。 我们来描述卫生系统数据的方向、幅度和时间。 关于长效避孕药具、产前实践、性传播感染等的信息，使我们能够发现 有证据表明，生育率的变化伴随着对流行病的相关行为反应。 我们的研究提供了寨卡病毒主要公共卫生影响的早期估计。 我们对家庭如何（以及哪些）根据生育情况改变生育时间的理解 健康威胁，揭示期间和之后人口动态的重要模式 流行病。