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. 2025 Mar 1;10(3):67.
doi: 10.3390/tropicalmed10030067.

Syndemic Factors Associated with Zika Virus Infection Prevalence and Risk Factors in a Cohort of Women Living in Endemic Areas for Arboviruses in Northeast Brazil

Ligia Kerr  1 , Carlos Sanhueza-Sanzana  1 , Marto Leal  1 , Italo Aguiar  1 , Kasim Allel  2   3 , Moisés H Sandoval  4 , Cristiane Cunha Frota  5 , Marco Túlio Aguiar  1 , Adriano Ferreira Martins  1 , Livia Dias  1 , Rosa Livia Freitas de Almeida  1 , Francisco Herlânio Costa Carvalho  1 , Francisco Gustavo Silveira Correia  1 , Roberto da Justa Pires Neto  1 , Fernanda Montenegro Araújo  6 , Shirlene Telmos Silva de Lima  6 , Leda Maria Simões Mello  6 , Lucas de Lima Nogueira  5 , Terezinha do Menino Jesus Silva Leitão  1 , Maria da Glória Teixeira  7 , Jeni Stolow  8 , Guilherme Loureiro Werneck  9   10 , Ivo Castelo Branco Coelho  1 , Ronald Blanton  11 , Ana Zaira da Silva  1 , George W Rutherford  12 , Carl Kendall  1   8
Affiliations

Syndemic Factors Associated with Zika Virus Infection Prevalence and Risk Factors in a Cohort of Women Living in Endemic Areas for Arboviruses in Northeast Brazil

Ligia Kerr et al. Trop Med Infect Dis. .

Abstract

Background: We sought to explain the seroprevalence of Zika Virus (ZIKV) as a syndemic of socioeconomic, environmental, and health factors in a cohort of women living in Brazil.

Methods: This is a cohort study comprising 1498 women between 15 and 39 years of age followed up in two waves between February 2018 and August 2019. Two questionnaires addressed the arbovirus's socioeconomic, demographic, and behavioral aspects and participants' arbovirus infection history. Blood samples were collected to detect IgM and IgG for ZIKV, chikungunya virus (CHIKV), and dengue virus (DENV), and RT-PCR for ZIKV.

Results: The baseline prevalence for ZIKV was 43% (95%CI: 40.5, 45.6), increasing to 44.7% in the following period (95%CI: 42, 47.1). We found a prevalence of 44.1% among women having one syndemic factor, 49.9% for those having two, and 58% for women having three or more factors. Women reporting a single syndemic factor resulted in higher odds of acquiring ZIKV (OR = 1.6, 95%CI: 1.2-2.4). There were increased adjusted odds among women having two or three or more factors (OR = 2.1, 95%CI: 1.6-3.1; OR = 2.9, 95%CI: 2.0-4.3, respectively).

Conclusions: Tailored interventions targeting syndemic conditions, such as the co-circulation of urban arboviruses and poor living conditions, are crucial to improving the burden produced by ZIKV.

Keywords: Brazil; Zika virus infection; arboviruses; prevalence; syndemic; women’s health.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Theoretical framework of a hierarchical explanatory model for ZIKV infection in a cohort of women of reproductive age, Fortaleza, Brazil, 2018–2019. Notes: # ABEP Brazilian Association of Research Organizations. † Self-report of family history of arbovirus infection chikungunya virus, dengue virus, or Zika virus.
Figure 2
Figure 2
Algorithm for case definition of ZIKV infection according to laboratory results of the ZIF-cohort, Fortaleza, Brazil, 2018–2019. Notes: IgM or IgG anti-ZIKV, and anti-DENV, or RT-PCR anti-ZIKV and anti-DENV; N.B. 2nd wave tests produced fewer indeterminate results and women were reclassified according to the new lab results following the algorithm.
Figure 3
Figure 3
Predictive margins and marginal effect for syndemic factors of the prevalence of ZIKV infection according to laboratory results (following the algorithm for case definition in Figure 2), ZIF cohort, Fortaleza, Brazil, 2018–2019. Notes: OR (95%CI) = Odds Ratio (elementary complete or less education, water storage, and self-report of family history of arbovirus infections). Pr = marginal probability of multivariate logistic regression; Ref = reference category.
See this image and copyright information in PMC

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