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Disparities in Zika Virus Testing and Incidence Among Women of Reproductive Age—New York City, 2016

Lee, Christopher T. MD, MSc, MPH; Greene, Sharon K. PhD, MPH; Baumgartner, Jennifer MSPH; Fine, Anne MD
Journal of Public Health Management and Practice: Post Author Corrections: October 27, 2017
doi: 10.1097/PHH.0000000000000684
Research Full Report: PDF Only

Context:

The New York City Department of Health and Mental Hygiene (NYC DOHMH) performs surveillance for reportable diseases, including Zika virus (ZIKV) infection and disease, to inform public health responses. Incidence rates of other mosquito-borne diseases related to international travel are associated with census tract poverty level in NYC, suggesting that high poverty areas might be at higher risk for ZIKV infections.

Objectives:

We assessed ZIKV testing rates and incidence of travel-associated infection among reproductive age women in NYC to identify areas with high incidence and low testing rates and assess the effectiveness of public health interventions.

Design:

We analyzed geocoded ZIKV surveillance data collected by NYC DOHMH. Women aged 15 to 44 years tested during January-July 2016 (n = 4733) were assigned to census tracts, which we grouped by poverty level and quartile of the number of persons born in countries or territories with mosquito-borne ZIKV transmission as a proxy for risk of travel to these areas. We calculated crude ZIKV testing rates, incidence rates, and incidence rate ratios (IRRs).

Setting:

New York City.

Results:

Eight percent of patients (n = 376) tested had evidence of ZIKV infection. Cumulative incidence was higher both in areas with higher versus lower poverty levels (IRR = 2.4; 95% confidence interval [CI], 2.0-3.0) and in areas with the largest versus smallest populations of persons born in countries or territories with mosquito-borne ZIKV transmission (IRR = 11.3; 95% CI, 6.2-20.7). Initially, ZIKV testing rates were lowest in higher poverty areas with the largest populations of persons born in countries or territories with mosquito-borne ZIKV transmission (15/100 000), but following targeted interventions, testing rates were highest in these areas (80/100 000).

Conclusions:

Geocoded data enabled us to identify communities with low testing but high ZIKV incidence rates, intervene to promote testing and reduce barriers to testing, and measure changes in testing rates.

Correspondence: Anne Fine, MD, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, 42-09 28th St, CN 22A, Long Island City, NY 11101 (afine@health.nyc.gov).

This work was supported by US Centers for Disease Control and Prevention Cooperative Agreements for Epidemiology and Laboratory Capacity for Infectious Disease (ELC) grant number 5U50CK000407 and Public Health Emergency Preparedness (PHEP) grant number NU90TP000546. The authors thank staff in the New York City Department of Health and Mental Hygiene (NYC DOHMH) Bureau of Communicable Disease and Public Health Laboratory, staff who were activated for the Zika Response as part of the Surveillance and Epidemiology Branch of the NYC DOHMH Incident Command System, the NYC DOHMH Office of Vital Statistics, and partners at NYC Health + Hospitals.

The authors declare no conflicts of interest.

The findings and conclusions in this report are those of the authors, and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.