UNIVERSITY OF CALIFORNIA SAN DIEGO SAN DIEGO STATE UNIVERSITY Risk factors and surveillance for arboviruses and their vectors in Guatemala and Puerto Rico A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Public Health (Epidemiology) by Zachary Joseph Madewell Committee in Charge: University of California San Diego Professor Kimberly C. Brouwer, Chair Professor Cinnamon S. Bloss Professor Richard S. Garfein Professor Stephen H. Waterman San Diego State University Professor Stephanie K. Brodine Professor Thomas E. Novotny 2020 Copyright Zachary Joseph Madewell, 2020 All rights reserved The Dissertation of Zachary Joseph Madewell is approved, and it is acceptable in quality and form for publication on microfilm and electronically: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Chair University of California San Diego San Diego State University 2020 iii EPIGRAPH Mosquito or Man? Dr. Rubert Boyce iv TABLE OF CONTENTS Signature page ............................................................................................................................................ iii Epigraph ..................................................................................................................................................... iv Table of contents ......................................................................................................................................... v List of acronyms ........................................................................................................................................ vii List of figures ............................................................................................................................................ viii List of tables................................................................................................................................................ ix Acknowledgements .................................................................................................................................... xi Vita ............................................................................................................................................................ xiii Abstract of the dissertation .................................................................................................................... xvii CHAPTER 1: Introduction ........................................................................................................................ 1 CHAPTER 2: Inverse association between dengue, chikungunya, and Zika virus infection and indicators of household air pollution in Santa Rosa, Guatemala: a case-control study ..................... 41 Abstract ................................................................................................................................................... 42 Introduction ............................................................................................................................................. 44 Methods ................................................................................................................................................... 46 Results ..................................................................................................................................................... 51 Discussion ............................................................................................................................................... 52 References ............................................................................................................................................... 57 CHAPTER 3: Comparing vector and human surveillance strategies to detect arbovirus transmission: a simulation study for Zika virus detection in Puerto Rico .......................................... 68 Abstract ................................................................................................................................................... 69 Introduction ............................................................................................................................................. 70 Methods ................................................................................................................................................... 71 Results ..................................................................................................................................................... 76 Discussion ............................................................................................................................................... 78 References ............................................................................................................................................... 82 CHAPTER 4: Associations between household environmental and immature mosquito abundance in Quetzaltenango, Guatemala ................................................................................................................ 91 Abstract ................................................................................................................................................... 92 Introduction ............................................................................................................................................. 94 Methods ................................................................................................................................................... 95 Results ................................................................................................................................................... 100 Discussion ............................................................................................................................................. 101 v References ............................................................................................................................................. 107 CHAPTER 5: Discussion and Conclusions ........................................................................................... 119 Appendix .................................................................................................................................................. 128 vi LIST OF ACRONYMS AFI Acute febrile illnesses AOR Adjusted odds ratio CDC Centers for Disease Control and Prevention CHIKV Chikungunya virus CI Confidence interval DENV Dengue virus ELISA Enzyme-linked immunosorbent assay HAP Household air pollution IQR Interquartile range MSPAS Ministerio de Salud Pública y Asistencia Social OR Odds ratio PCA Principal components analysis PPV Positive predictive value PRDH Puerto Rico Department of Health RT-PCR Reverse transcription polymerase chain reaction SAGO Sentinel autocidal gravid ovitraps SD Standard deviation SE Standard error SES Socioeconomic status UI Uncertainty interval UVG Universidad del Valle de Guatemala VICo Vigilancia Integrada Colaborativa WNV West Nile virus ZIKV Zika virus vii LIST OF FIGURES Figure 1.1: Eco-Bio-Social Conceptual Framework ................................................................................... 38 Figure 1.2: Epidemiological Triad .............................................................................................................. 39 Figure 1.3: Transmission cycles of Zika virus ............................................................................................ 40 Figure 2.1: Cuilapa National Hospital and Nueva Santa Rosa Health Center, Santa Rosa Department, Guatemala ................................................................................................................................................... 63 Figure 3.1: The total number of Zika virus infections detected and probability of detecting local transmission of Zika virus by testing Aedes aegypti females collected from CDC sentinel autocidal gravid ovitraps (SAGO) and emergency department patients with two or more Zika virus symptoms ................ 85 Figure 3.2: Expected number of tests for vector and human surveillance strategies .................................. 86 Figure 3.3: Relationship between the number of simulated Zika virus positive mosquito pools and human infections, and estimated incidence rate of human infections ..................................................................... 87 Figure 3.4: Time series relationship between the actual number of positive mosquito pools and human cases in Caguas, Puerto Rico, and estimated incidence rate of human infections ...................................... 88 Figure 4.1: Coatepeque and Génova, Quetzaltenango Department, Guatemala ....................................... 114 Figure 4.2: Cubic splines of associations between environmental capital and total number of larvae and pupae per household, Coatepeque and Génova, Guatemala, 2017 ........................................................... 115 Figure S.1: Positive predictive value of testing mosquito pools for Zika virus and emergency department patients with two or more Zika virus symptoms ......................................................................................