Seroprevalence, Incidence Estimates, and Environmental Risk Factors for Dengue, Chikungunya, and Zika Infection Amongst Children Living in Informal Urban Settlements in Indonesia and Fiji

Background: The burden of -transmitted viruses such as dengue, chikungunya, and Zika are increasing globally, fueled by urbanization and climate change, with some of the highest current rates of transmission in Asia. Local factors in the built environment have the potential to exacerbate or mitigate transmission.

Methods: In 24 informal urban settlements in Makassar, Indonesia and Suva, Fiji, we tested children under 5 years old for evidence of prior infection with dengue, chikungunya, and Zika viruses by IgG serology. We used a catalytic model using seroprevalence and mean age to estimate annual incidence of dengue in each country. We also conducted detailed questionnaires to evaluate environmental risk factors for a positive serology result. Dengue risk factors were evaluated for individual children by univariate and multivariable logistic regression accounting for settlement as a flxed effect. Trash and flooding were additionally evaluated as dengue risk factors at the settlement level by univariate linear regression.

Results: In Fiji and Indonesia respectively, 46% and 33% of children under 5 years old were seropositive for dengue, 3% and 3% for chikungunya, and 9% and 2% for Zika. In Indonesia, children living in a household where trash is routinely collected and removed were signiflcantly less likely to be dengue seropositive in both unadjusted and adjusted models [adjusted model: OR 0.3 (95% CI: 0.1-0.8)]. In Indonesia, settlements with a higher proportion of households reporting flooding also had lower dengue rates (slope = 0.44; p-value: <0.05).

Conclusions: Household trash collection and community flood management are important targets for interventions to mitigate the increasing risk of -transmitted viruses.