Perceptions of Zika Virus Risk during 2016 Outbreak, Miami-Dade County, Florida, USA.

We conducted a survey on Zika virus perceptions and behaviors during the 2016 outbreak in Miami-Dade County, Florida, USA. Among women, Zika knowledge was associated with having a bachelor's degree. Among men, knowledge was associated with knowing someone at risk. Interventions during future outbreaks could be targeted by sex and education level.

Modeling the importation and local transmission of vector-borne diseases in Florida: The case of Zika outbreak in 2016.

Chikungunya, dengue, and Zika viruses are all transmitted by Aedes aegypti and Aedes albopictus mosquito species, had been imported to Florida and caused local outbreaks. We propose a deterministic model to study the importation and local transmission of these mosquito-borne diseases. The purpose is to model and mimic the importation of these viruses to Florida via travelers, local infections in domestic mosquitoes by imported travelers, and finally non-travel related transmissions to local humans by infected local mosquitoes. As a case study, the model will be used to simulate the accumulative Zika cases in Florida. Since the disease system is driven by a continuing input of infections from outside sources, orthodox analytic methods based on the calculation of the basic reproduction number are inadequate to describe and predict their behavior. Via steady-state analysis and sensitivity analysis, effective control and prevention measures for these mosquito-borne diseases are tested.

A novel method for mapping village-scale outdoor resting microhabitats of the primary African malaria vector, Anopheles gambiae.

BACKGROUND: Knowledge of Anopheles resting habitats is needed to advance outdoor malaria vector control. This study presents a technique to map locations of resting habitats using high-resolution satellite imagery (world view 2) and probabilistic Dempster-Shafer (D-S) modelling, focused on a rural village in southern Mali, West Africa where field sampling was conducted to determine outdoor habitat preferences of Anopheles gambiae, the main vector in the study area. METHODS: A combination of supervised and manual image classification was used to derive an accurate land-cover map from the satellite image that provided classes (i.e., photosynthetically active vegetation, water bodies, wetlands, and buildings) suitable for habitat assessment. Linear fuzzy functions were applied to the different image classes to scale resting habitat covariates into a common data range (0-1) with fuzzy breakpoints parameterized experimentally through comparison with mosquito outdoor resting data. Fuzzy layers were entered into a Dempster-Shafer (D-S) weight-of-evidence model that produced pixel-based probability of resting habitat locations. RESULTS: The D-S model provided a highly detailed suitability map of resting locations. The results indicated a significant difference (p < 0.001) between D-S values at locations positive for An. gambiae and a set of randomly sampled points. Further, a negative binomial regression indicated that although the D-S estimates did not predict abundance (p > 0.05) subsequent analysis suggested that the D-S modelling approach may provide a reasonable estimate locations of low-to-medium An. gambiae density. These results suggest that that D-S modelling performed well in identifying presence points and specifically resting habitats. CONCLUSION: The use of a D-S modelling framework for predicting the outdoor resting habitat locations provided novel information on this little-known aspect of anopheline ecology. The technique used here may be applied more broadly at different geographic scales using Google Earth, Landsat or other remotely-sensed imagery to assess the malaria vector resting habitats where outdoor control measures can reduce the burden of the disease in Africa and elsewhere.

A multi-criteria decision analysis approach to assessing malaria risk in northern South America.

BACKGROUND: Malaria control in South America has vastly improved in the past decade, leading to a decrease in the malaria burden. Despite the progress, large parts of the continent continue to be at risk of malaria transmission, especially in northern South America. The objectives of this study were to assess the risk of malaria transmission and vector exposure in northern South America using multi-criteria decision analysis. METHODS: The risk of malaria transmission and vector exposure in northern South America was assessed using multi-criteria decision analysis, in which expert opinions were taken on the key environmental and population risk factors. RESULTS: Results from our risk maps indicated areas of moderate-to-high risk along rivers in the Amazon basin, along the coasts of the Guianas, the Pacific coast of Colombia and northern Colombia, in parts of Peru and Bolivia and within the Brazilian Amazon. When validated with occurrence records for malaria, An. darlingi, An. albimanus and An. nuneztovari s.l., t-test results indicated that risk scores at occurrence locations were significantly higher (p < 0.0001) than a control group of geographically random points. CONCLUSION: In this study, we produced risk maps based on expert opinion on the spatial representation of risk of potential vector exposure and malaria transmission. The findings provide information to the public health decision maker/policy makers to give additional attention to the spatial planning of effective vector control measures. Therefore, as the region tackles the challenge of malaria elimination, prioritizing areas for interventions by using spatially accurate, high-resolution (1 km or less) risk maps may guide targeted control and help reduce the disease burden in the region.

Prospects and recommendations for risk mapping to improve strategies for effective malaria vector control interventions in Latin America.

With malaria control in Latin America firmly established in most countries and a growing number of these countries in the pre-elimination phase, malaria elimination appears feasible. A review of the literature indicates that malaria elimination in this region will be difficult without locally tailored strategies for vector control, which depend on more research on vector ecology, genetics and behavioural responses to environmental changes, such as those caused by land cover alterations, and human population movements. An essential way to bridge the knowledge gap and improve vector control is through risk mapping. Malaria risk maps based on statistical and knowledge-based modelling can elucidate the links between environmental factors and malaria vectors, explain interactions between environmental changes and vector dynamics, and provide a heuristic to demonstrate how the environment shapes malaria transmission. To increase the utility of risk mapping in guiding vector control activities, definitions of malaria risk for mapping purposes must be standardized. The maps must also possess appropriate scale and resolution in order to become essential tools in integrated vector management (IVM), so that planners can target areas in greatest need of control measures. Fully integrating risk mapping into vector control programmes will make interventions more evidence-based, making malaria elimination more attainable.

Linking land cover and species distribution models to project potential ranges of malaria vectors: an example using Anopheles arabiensis in Sudan and Upper Egypt.

BACKGROUND: Anopheles arabiensis is a particularly opportunistic feeder and efficient vector of Plasmodium falciparum in Africa and may invade areas outside its normal range, including areas separated by expanses of barren desert. The purpose of this paper is to demonstrate how spatial models can project future irrigated cropland and potential, new suitable habitat for vectors such as An. arabiensis. METHODS: Two different but complementary spatial models were linked to demonstrate their synergy for assessing re-invasion potential of An. arabiensis into Upper Egypt as a function of irrigated cropland expansion by 2050. The first model (The Land Change Modeler) was used to simulate changes in irrigated cropland using a Markov Chain approach, while the second model (MaxEnt) uses species occurrence points, land cover and other environmental layers to project probability of species presence. Two basic change scenarios were analysed, one involving a more conservative business-as-usual (BAU) assumption and second with a high probability of desert-to-cropland transition (Green Nile) to assess a broad range of potential outcomes by 2050. RESULTS: The results reveal a difference of 82,000 sq km in potential An. arabiensis range between the BAU and Green Nile scenarios. The BAU scenario revealed a highly fragmented set of small, potential habitat patches separated by relatively large distances (maximum distance = 64.02 km, mean = 12.72 km, SD = 9.92), while the Green Nile scenario produced a landscape characterized by large patches separated by relatively shorter gaps (maximum distance = 49.38, km, mean = 4.51 km, SD = 7.89) that may be bridged by the vector. CONCLUSIONS: This study provides a first demonstration of how land change and species distribution models may be linked to project potential changes in vector habitat distribution and invasion potential. While gaps between potential habitat patches remained large in the Green Nile scenario, the models reveal large areas of future habitat connectivity that may facilitate the re-invasion of An. arabiensis from Sudan into Upper Egypt. The methods used are broadly applicable to other land cover changes as they influence vector distribution, particularly those related to tropical deforestation and urbanization processes.

Near-present and future distribution of Anopheles albimanus in Mesoamerica and the Caribbean Basin modeled with climate and topographic data.

BACKGROUND: Anopheles albimanus is among the most important vectors of human malaria in Mesoamerica and the Caribbean Basin (M-C). Here, we use topographic data and 1950-2000 climate (near present), and future climate (2080) layers obtained from general circulation models (GCMs) to project the probability of the species' presence, p(s), using the species distribution model MaxEnt. RESULTS: The projected near-present distribution parameterized with 314 presence points related well to the known geographic distribution in the study region. Different model experiments suggest that the range of An. albimanus based on near-present climate surfaces covered at least 1.27 million km² in the M-C, although 2080 range was projected to decrease to 1.19 million km². Modeled p(s) was generally highest in Mesoamerica where many of the original specimens were collected. MaxEnt projected near-present maximum elevation at 1,937 m whereas 2080 maximum elevation was projected at 2,118 m. 2080 climate scenarios generally showed increased p(s) in Mesoamerica, although results varied for northern South America and no major range expansion into the mid-latitudes was projected by 2080. CONCLUSIONS: MaxEnt experiments with near present and future climate data suggest that An. albimanus is likely to invade high-altitude (>2,000 m) areas by 2080 and therefore place many more people at risk of malaria in the M-C region even though latitudinal range expansion may be limited.

Geographic profiling as a novel spatial tool for targeting infectious disease control.

BACKGROUND: Geographic profiling is a statistical tool originally developed in criminology to prioritise large lists of suspects in cases of serial crime. Here, we use two data sets--one historical and one modern--to show how it can be used to locate the sources of infectious disease. RESULTS: First, we re-analyse data from a classic epidemiological study, the 1854 London cholera outbreak. Using 321 disease sites as input, we evaluate the locations of 13 neighbourhood water pumps. The Broad Street pump--the outbreak's source--ranks first, situated in the top 0.2% of the geoprofile. We extend our study with an analysis of reported malaria cases in Cairo, Egypt, using 139 disease case locations to rank 59 mosquitogenic local water sources, seven of which tested positive for the vector Anopheles sergentii. Geographic profiling ranks six of these seven sites in positions 1-6, all in the top 2% of the geoprofile. In both analyses the method outperformed other measures of spatial central tendency. CONCLUSIONS: We suggest that geographic profiling could form a useful component of integrated control strategies relating to a wide variety of infectious diseases, since evidence-based targeting of interventions is more efficient, environmentally friendly and cost-effective than untargeted intervention.

Deforestation projections for carbon-rich peat swamp forests of Central Kalimantan, Indonesia.

We evaluated three spatially explicit land use and cover change (LUCC) models to project deforestation from 2005-2020 in the carbon-rich peat swamp forests (PSF) of Central Kalimantan, Indonesia. Such models are increasingly used to evaluate the impact of deforestation on carbon fluxes between the biosphere and the atmosphere. We considered both business-as-usual (BAU) and a forest protection scenario to evaluate each model's accuracy, sensitivity, and total projected deforestation and landscape-level fragmentation patterns. The three models, Dinamica EGO (DE), GEOMOD and the Land Change Modeler (LCM), projected similar total deforestation amounts by 2020 with a mean of 1.01 million ha (Mha) and standard deviation of 0.17 Mha. The inclusion of a 0.54 Mha strict protected area in the LCM simulations reduced projected loss to 0.77 Mha over 15 years. Calibrated parameterizations of the models using nearly identical input drivers produced very different landscape properties, as measured by the number of forest patches, mean patch area, contagion, and Euclidean nearest neighbor determined using Fragstats software. The average BAU outputs of the models suggests that Central Kalimantan may lose slightly less than half (45.1%) of its 2005 PSF by 2020 if measures are not taken to reduce deforestation there. The relatively small reduction of 0.24 Mha in deforestation found in the 0.54 Mha protection scenario suggests that these models can identify potential leakage effects in which deforestation is forced to occur elsewhere in response to a policy intervention.

Urbanization favors the proliferation of Aedes aegypti and Culex quinquefasciatus in urban areas of Miami-Dade County, Florida.

Urbanization processes are increasing globally. Anthropogenic alterations in the environment have profound effects on biodiversity. Decreased biodiversity due to biotic homogenization processes as a consequence of urbanization often result in increased levels of mosquito vector species and vector-borne pathogen transmission. Understanding how anthropogenic alterations in the environment will affect the abundance, richness, and composition of vector mosquito species is crucial for the implementation of effective and targeted mosquito control strategies. We hypothesized that anthropogenic alterations in the environment are responsible for increasing the abundance of mosquito species that are adapted to urban environments such as Aedes aegypti and Culex quinquefasciatus. Therefore, our objective was to survey mosquito relative abundance, richness, and community composition in Miami-Dade County, Florida, in areas with different levels of urbanization. We selected 24 areas, 16 remote areas comprised of natural and rural areas, and 8 urban areas comprised of residential and touristic areas in Miami-Dade County, Florida. Mosquitoes were collected weekly in each area for 24 h for 5 consecutive weeks from August to October 2020 using BG-Sentinel traps baited with dry ice. A total of 36,645 mosquitoes were collected, from which 34,048 were collected in the remote areas and 2,597 in the urban areas. Our results show a clear and well-defined pattern of abundance, richness, and community composition according to anthropogenic modifications in land use and land cover. The more urbanized a given area the fewer species were found and those were primary vectors of arboviruses, Ae. aegypti and Cx. quinquefasciatus.

Cemeteries in Miami-Dade County, Florida are important areas to be targeted in mosquito management and control efforts.

Definable habitats at the neighborhood level provide a wide range of favorable habitats with optimal conditions and environmental resources for mosquito survival. Problematic habitats for controlling mosquitoes in urban environments such as tire shops, bromeliad patches, and construction sites must be taken into consideration in the development of effective mosquito management and control in urban areas. Cemeteries are often located in highly urbanized areas serving as a haven for populations of vector mosquito species due to the availability of natural resources present in most cemeteries. Even though Miami-Dade County, Florida was the most affected area in the United States during the Zika virus outbreak in 2016 and is currently under a mosquito-borne illness alert after 14 confirmed locally transmitted dengue cases, the role of cemeteries in the proliferation of vector mosquitoes is unknown. Therefore, our objective was to use a cross-sectional experimental design to survey twelve cemeteries across Miami-Dade County to assess if vector mosquitoes in Miami can be found in these areas. Our results are indicating that vector mosquitoes are able to successfully exploit the resources available in the cemeteries. Culex quinquefasciatus was the most abundant species but it was neither as frequent nor present in its immature form as Aedes aegypti and Aedes albopictus. This study revealed that vector mosquitoes, such as Ae. aegypti, Ae. albopictus, and Cx. quinquefasciatus are successfully exploiting the resources available in these areas being able to thrive and reach high numbers. Mosquito control strategies should consider both long-term strategies, based on changing human behavior to reduce the availability of aquatic habitats for vector mosquitoes; as well as short-term strategies such as drilling holes or adding larvicide to the flower vases. Simple practices would greatly help improve the effectiveness of mosquito management and control in these problematic urban habitats.

Increase in Obesity Among Women of Reproductive Age in Zambia, 2002-2014.

Objective: To describe trends in obesity in Zambian women of reproductive age and to identify factors that may have contributed to changes in trends and nutrition outcomes. Materials and Methods: We obtained data on body mass index and individual factors of women from the Zambia Demographic and Health Survey for the period 2002 to 2014. From these data, we calculated descriptive statistics and examined the extent to which factors link to the odds of obesity over time. We also reviewed primary and secondary data sources, such as government documents, theses, and search engines to identify factors that may have contributed to trends and changes in nutrition outcomes. Results: The proportion of obesity doubled from 2002 (12.5%) to 2014 (22.3%). The odds were higher among educated, currently married and wealthy women, and it increased with age. Rural residence and working in agricultural-related jobs were linked to lower odds for obesity. This disparity varies by province. In addition, despite the presence of many nutrition policies and strategies, the increase in obesity occurred within the past two decades when urbanization and other factors (e.g., sedentary work, a proliferation of fast food restaurants, and advertisements) may have affected changes in nutrition outcomes for women. Conclusions: We identified increasing trends in obesity in women of reproductive age over time. The rapid urbanization and other factors that occurred in Zambia during this period are significant risk factors for obesity in Zambian women. The findings will be of interest to countries that are undergoing a nutrition transition.

A geographical sampling method for surveys of mosquito larvae in an urban area using high-resolution satellite imagery.

Entomological surveys in urban areas are often biased by selecting houses or locations with known high vector densities. A sampling strategy was developed for Puntarenas, Costa Rica, using high-resolution satellite imagery. Grids from the Advanced Spaceborne Thermal Emission and Reflection Radiometer and a QuickBird classified land cover map were used to determine the optimal final grid area for surveys. A random sample (10% of cells) was selected, and sample suitability was assessed by comparing the mean percentage of tree cover between sample and total cells. Sample cells were used to obtain entomological data from 581 locations: 26.3% of all locations positive for mosquito larvae were not households, they contained 29.5% of mosquito-positive habitats and 16% of Aedes aegypti pupae collected. Entomological indices for Ae. aegypti (pupae per person, Breteau index, container index, location index) were slightly lower when only household data were analyzed. High-resolution satellite imagery and geographical information systems appear useful for evaluating urban sites and randomly selecting locations for accurate entomological surveys.

Seasonal profiles of Aedes aegypti (Diptera: Culicidae) larval habitats in an urban area of Costa Rica with a history of mosquito control.

Dengue is the most important arboviral disease worldwide and the principal vector-borne disease in Costa Rica. Control of Aedes aegypti populations through source reduction is still considered the most effective way of prevention and control, although it has proven ineffective or unsustainable in many areas with a history of mosquito control. In this study, seasonal profiles and productivity of Aedes aegypti were analyzed in the city of Puntarenas, Costa Rica, where vector control has been practiced for more than ten years. Households contained more than 80% of larval habitats identified, although presence of habitats was more likely in other locations like lots and streets. In the wet season, habitats in the "other" category, like appliances, small manholes, and miscellaneous containers, were the most frequent habitats observed as well as the most common and productive habitats for Ae. aegypti. In the dry season, domestic animal drinking containers were very common, although concrete washtubs contained 79% of Ae. aegypti pupae collected. Individually, non-disposable habitats were as likely or more likely to contain mosquito larvae, and large containers were more likely to harbor mosquito larvae than the small ones only in the dry season. Considering various variables in the logistic regressions, predictors for Ae. aegypti in a habitat were habitat type (p < 0.001), setting (p = 0.043), and disposability (p = 0.022) in the wet season and habitat capacity in the dry season (p = 0.025). Overall, traditional Ae. aegypti larval indices and pupal indices in Puntarenas were high enough to allow viral transmission during the wet season. In spite of continued vector control, it has not been possible to reduce vector densities below threshold levels in Puntarenas, and the habitat profiles show that non-household locations, as well as non-disposable containers, should be targeted in addition to the standard control activities.

Spatial association between malaria vector species richness and malaria in Colombia.

Malaria transmission in Colombia is highly variable in space and time. Using a species distribution model, we mapped potential distribution of five vector species including Anopheles albimanus, Anopheles calderoni, Anopheles darlingi, Anopheles neivai, and Anopheles nuneztovari in five Departments of Colombia where malaria transmission remains problematic. We overlaid the range maps of the five species to reveal areas of sympatry and related per-pixel species richness to mean annual parasite index (API) for 2011-2014 mapped by municipality (n = 287). The relationship between mean number of vector species per municipality and API was evaluated using a Poisson regression, which revealed a highly significant relationship between species richness and API (p = 0 for Wald Chi-Square statistic). The results suggest that areas of relatively high transmission in Colombia typically contain higher number of vector species than areas with unstable transmission and that future elimination strategies should account for vector species richness.

Movement of Aedes aegypti following a sugar meal and its implication in the development of control strategies in Durán, Ecuador.

We evaluated how the presence of sugar sources impacted the distribution of Aedes aegypti in different habitats in Durán, Ecuador. Land cover and normalized difference vegetation index maps were used to guide a random point sampling routine to select study grids (30 m × 30 m) in low vegetation (LV) and high vegetation (HV). Five individual plants, at one home in the LV and HV grid, were treated with a different colored, non-attractive, 60% sucrose solution to determine mosquito feeding and movement. Sugar alone is not attractive to mosquitoes, so spraying vegetation with a dyed sugar solution can be used for visual determination of sugar feeding. Outdoor collections using BG sentinel traps and indoor collections using aspirators were conducted at the treatment home and with collection points at 20, 40, and 60 m surrounding the treatment home for three consecutive days. A total of 3,245 mosquitoes in two genera, Aedes and Culex, was collected. The proportion of stained Ae. aegypti females was 56.8% (510/898) and 0% for males. For Culex, 63.9% (248/388) females and 36.1% (140/388) males were collected stained. Aedes aegypti and Culex spp. were found up to 60 m stained in both LV and HV grids. Significantly more stained females Ae. aegypti were found inside homes compared to females and males of Culex spp. in both habitats. This study identifies that outdoor sugar feeding is a common behavior of Ae. aegypti and can be targeted as a control strategy in urban habitats in Latin America.

Irrigation in the arid regions of Tunisia impacts the abundance and apparent density of sand fly vectors of Leishmania infantum.

The distribution expansion of important human visceral leishmaniasis (HVL) and sporadic cutaneous leishmaniasis (SCL) vector species, Phlebotomus perfiliewi and P. perniciosus, throughout central Tunisia is a major public health concern. This study was designed to investigate if the expansion of irrigation influences the abundance of sand fly species potentially involved in the transmission of HVL and SCL located in arid bioclimatic regions. Geographic and remote sensing approaches were used to predict the density of visceral leishmaniasis vectors in Tunisia. Entomological investigations were performed in the governorate of Sidi Bouzid, located in the arid bioclimatic region of Tunisia. In 2012, sand flies were collected by CDC light traps located at nine irrigated and nine non-irrigated sites to determine species abundance. Eight species in two genera were collected. Among sand flies of the subgenus Larroussius, P. perfiliewi was the only species collected significantly more in irrigated areas. Trap data were then used to develop Poisson regression models to map the apparent density of important sand fly species as a function of different environmental covariates including climate and vegetation density. The density of P. perfiliewi is predicted to be moderately high in the arid regions. These results highlight that the abundance of P. perfiliewi is associated with the development of irrigated areas and suggests that the expansion of this species will continue to more arid areas of the country as irrigation sites continue to be developed in the region. The continued increase in irrigated areas in the Middle East and North Africa region deserves attention, as it is associated with the spread of L. infantum vector P. perfiliewi. Integrated vector management strategies targeting irrigation structures to reduce sand fly vector populations should be evaluated in light of these findings.

Predicting potential ranges of primary malaria vectors and malaria in northern South America based on projected changes in climate, land cover and human population.

BACKGROUND: Changes in land use and land cover (LULC) as well as climate are likely to affect the geographic distribution of malaria vectors and parasites in the coming decades. At present, malaria transmission is concentrated mainly in the Amazon basin where extensive agriculture, mining, and logging activities have resulted in changes to local and regional hydrology, massive loss of forest cover, and increased contact between malaria vectors and hosts. METHODS: Employing presence-only records, bioclimatic, topographic, hydrologic, LULC and human population data, we modeled the distribution of malaria and two of its dominant vectors, Anopheles darlingi, and Anopheles nuneztovari s.l. in northern South America using the species distribution modeling platform Maxent. RESULTS: Results from our land change modeling indicate that about 70,000 km(2) of forest land would be lost by 2050 and 78,000 km(2) by 2070 compared to 2010. The Maxent model predicted zones of relatively high habitat suitability for malaria and the vectors mainly within the Amazon and along coastlines. While areas with malaria are expected to decrease in line with current downward trends, both vectors are predicted to experience range expansions in the future. Elevation, annual precipitation and temperature were influential in all models both current and future. Human population mostly affected An. darlingi distribution while LULC changes influenced An. nuneztovari s.l. distribution. CONCLUSION: As the region tackles the challenge of malaria elimination, investigations such as this could be useful for planning and management purposes and aid in predicting and addressing potential impediments to elimination.

New baseline environmental assessment of mosquito ecology in northern Haiti during increased urbanization.

The catastrophic 2010 earthquake in Port-au-Prince, Haiti, led to the large-scale displacement of over 2.3 million people, resulting in rapid and unplanned urbanization in northern Haiti. This study evaluated the impact of this unplanned urbanization on mosquito ecology and vector-borne diseases by assessing land use and change patterns. Land-use classification and change detection were carried out on remotely sensed images of the area for 2010 and 2013. Change detection identified areas that went from agricultural, forest, or bare-land pre-earthquake to newly developed and urbanized areas post-earthquake. Areas to be sampled for mosquito larvae were subsequently identified. Mosquito collections comprised five genera and ten species, with the most abundant species being Culex quinquefasciatus 35% (304/876), Aedes albopictus 27% (238/876), and Aedes aegypti 20% (174/876). All three species were more prevalent in urbanized and newly urbanized areas. Anopheles albimanus, the predominate malaria vector, accounted for less than 1% (8/876) of the collection. A set of spectral indices derived from the recently launched Landsat 8 satellite was used as covariates in a species distribution model. The indices were used to produce probability surfaces maps depicting the likelihood of presence of the three most abundant species within 30 m pixels. Our findings suggest that the rapid urbanization following the 2010 earthquake has increased the amount of area with suitable habitats for urban mosquitoes, likely influencing mosquito ecology and posing a major risk of introducing and establishing emerging vector-borne diseases.

Social justice, climate change, and dengue.

Climate change should be viewed fundamentally as an issue of global justice. Understanding the complex interplay of climatic and socioeconomic trends is imperative to protect human health and lessen the burden of diseases such as dengue fever. Dengue fever is rapidly expanding globally. Temperature, rainfall, and frequency of natural disasters, as well as non-climatic trends involving population growth and migration, urbanization, and international trade and travel, are expected to increase the prevalence of mosquito breeding sites, mosquito survival, the speed of mosquito reproduction, the speed of viral incubation, the distribution of dengue virus and its vectors, human migration patterns towards urban areas, and displacement after natural disasters. The burden of dengue disproportionately affects the poor due to increased environmental risk and decreased health care. Mobilization of social institutions is needed to improve the structural inequalities of poverty that predispose the poor to increased dengue fever infection and worse outcomes. This paper reviews the link between dengue and climatic factors as a starting point to developing a comprehensive understanding of how climate change affects dengue risk and how institutions can address the issues of social justice and dengue outbreaks that increasingly affect vulnerable urban populations.