20 Years Spatial-Temporal Analysis of Dengue Fever and Hemorrhagic Fever in Mexico.

BACKGROUND AND AIM: Dengue Fever (DF) is a human vector-borne disease and a major public health problem worldwide. In Mexico, DF and Dengue Hemorrhagic Fever (DHF) cases have increased in recent years. The aim of this study was to identify variations in the spatial distribution of DF and DHF cases over time using space-time statistical analysis and geographic information systems. METHODS: Official data of DF and DHF cases were obtained in 32 states from 1995-2015. Space-time scan statistics were used to determine the space-time clusters of DF and DHF cases nationwide, and a geographic information system was used to display the location of clusters. RESULTS: A total of 885,748 DF cases was registered of which 13.4% (n = 119,174) correspond to DHF in the 32 states from 1995-2015. The most likely cluster of DF (relative risk = 25.5) contained the states of Jalisco, Colima, and Nayarit, on the Pacific coast in 2009, and the most likely cluster of DHF (relative risk = 8.5) was in the states of Chiapas, Tabasco, Campeche, Oaxaca, Veracruz, Quintana Roo, Yucatán, Puebla, Morelos, and Guerrero principally on the Gulf coast over 2006-2015. CONCLUSION: The geographic distribution of DF and DHF cases has increased in recent years and cases are significantly clustered in two coastal areas (Pacific and Gulf of Mexico). This provides the basis for further investigation of risk factors as well as interventions in specific areas.

Comparative analysis of two alternative models for epidemiological surveillance in the Mexican Malaria Control Program.

The current surveillance model used by the Malaria Control Program in a Mexican state was analyzed using a systematic evaluation of the model ("PAATI" programs, actions, activities, tasks and inputs) through a diagrammatic evaluation of all the components in the process. The actions, activities tasks and inputs of this surveillance model (based on active and passive malaria case detection using tick blood smears examination), as well as those of an innovative alternative model (based on passive malaria case detection using immunodiagnostic strips, with an overall sensitivity of 93.3% and specificity of 99.5%) were identified and evaluated. It was documented that although the same actions are carried out in both models, many more activities are necessary with more tasks and inputs (traditional: 19 activities and 55 tasks, alternative: 13 activities and 32 tasks) in the current one. Adjusting to a population of 10,000 inhabitants, 1000 prospective cases and 2 years of surveillance, the cost of diagnosing and treating one malaria case was of 8.97 US dollars in this model and of 6.34 US dollars in the alternative one.