Associations Between Environmental and Sociodemographic Data and Hepatitis‐A Transmission in Pará State (Brazil)

摘要

Hepatitis‐A is a waterborne infectious disease transmitted by the eponymous hepatitis‐A virus (HAV). Due to the disease's sociodemographic and environmental characteristics, this study applied public census and remote sensing data to assess risk factors for hepatitis‐A transmission. Municipality‐level data were obtained for the state of Pará, Brazil. Generalized linear and nonlinear models were evaluated as alternative predictors for hepatitis‐A transmission in Pará. The Histogram Gradient Boost (HGB) regression model was deemed the best choice ( R M S E = 2.36, and higher R 2 ?=?0.95) among the tested models. Partial dependence analysis and permutation feature importance analysis were used to investigate the partial dependence and the relative importance values of the independent variables in the disease transmission prediction model. Results indicated a complex relationship between the disease transmission and the sociodemographic and environmental characteristics of the study area. Population size, lack of sanitation, urban clustering, year of notification, insufficient public vaccination programs, household proximity to open‐air dumpsites and storm‐drains, and lack of access to healthcare facilities and hospitals were sociodemographic parameters related to HAV transmission. Turbidity and precipitation were the environmental parameters closest related to disease transmission. Based on HGB model, a hepatitis‐A risk map was built for Pará state. The obtained risk map can be thought of as an auxiliary tool for public health strategies. This study reinforces the need to incorporate remote sensing data in epidemiological modelling and surveillance plans for the development of early prevention strategies for hepatitis‐A. Plain Language Summary Hepatitis‐A is a waterborne infectious disease and accounts for ～70,000 deaths per year around the world. The disease's transmission is intimately dependent on sanitary, social, cultural and environmental conditions. Therefore, this study applied public census and environmental remote sensing data to assess risk factors related to hepatitis‐A transmission. Municipality‐level data were obtained for the state of Pará, Brazil. We analyzed the models' results and verified that the disease transmission has a complex relationship with the sociodemographic and environmental characteristics of the study area. Population size, lack of sanitation, urban clustering, year of notification, insufficient public vaccination programs, household proximity to open‐air dumpsites and storm‐drains, and lack of access to healthcare facilities and hospitals are sociodemographic parameters related to HAV transmission. The overall turbidity of the municipalities' waterbodies and the monthly accumulated precipitation were the environmental parameters closest related to disease transmission. Our results also depicted higher transmission rates for hepatitis‐A in the northern municipalities of the study area. Our results can be thought of as auxiliary tools for public health strategies and policy making. This study reinforces the need to incorporate environmental data in epidemiological modelling and surveillance plans for the development of early prevention strategies for waterborne diseases. Key Points Hepatitis‐A is a waterborne infectious disease responsible for ～70,000 deaths per year around the world In this work, sociodemographic and environmental factors were related to hepatitis‐A transmission by applying census and remote sensing data This research stresses the need to incorporate remote sensing data to epidemiological modelling for prevention and surveillance plans