Spatial diffusion of Zika fever epidemics in the Municipality of Salvador-Bahia, Brazil, in 2015-2016: does Zika fever have the same spread pattern as Dengue and Chikungunya fever epidemics?

Abstract INTRODUCTION The recent emergence and rapid spread of Zika and Chikungunya fevers in Brazil, occurring simultaneously to a Dengue fever epidemic, together represent major challenges to public health authorities. This study aimed to identify and compare the 2015-2016 spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia. METHODS We used two study designs comprising a cross-sectional-to-point pattern and an ecological analysis of lattice data. Residential addresses involving notified cases were geocoded. We used four spatial diffusion analysis techniques: (i) visual inspection of the sequential kernel and choropleth map, (ii) spatial correlogram analysis, (iii) spatial local autocorrelation (LISA) changes analysis and, (iv) nearest neighbor index (NNI) modeling. RESULTS Kernel and choropleth maps indicated that arboviruses spread to neighboring areas near the first reported cases and occupied these new areas, suggesting a diffusion expansion pattern. A greater case density occurred in central and western areas. In 2015 and 2016, the NNI best-fit model had an S-curve compatible with an expansion pattern for Zika (R2 = 0.94; 0.95), Chikungunya (R2 = 0.99; 0.98) and Dengue (R2 = 0.93; 0.99) epidemics, respectively. Spatial correlograms indicated a decline in spatial lag autocorrelations for the three diseases (expansion pattern). Significant LISA changes suggested different diffusion patterns, although a small number of changes were detected. CONCLUSIONS These findings indicate diffusion expansion, a unique spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia, namely. Knowing how and where arboviruses spread in Salvador-Bahia can help improve subsequent specific epidemic control interventions.