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Objective: To estimate the occurrence of self-reported chikungunya relapse and identify associated factors. Materials and Methods: A cross-sectional study in December 2015 included 1305 homes in ei...

Background In the Mexican state of Guerrero, some households place fish in water storage containers to prevent the development of mosquito larvae. Studies have shown that larvivorous fish reduce larva count in household water containers, but there is a lack of evidence about whether the use of fish is associated with a reduction in dengue virus infection. We used data from the follow up survey of the Camino Verde cluster randomised controlled trial of community mobilisation to reduce dengue risk to study this association. Methods The survey in 2012, among 90 clusters in the three coastal regions of Guerrero State, included a questionnaire to 10,864 households about socio-demographic factors and self-reported cases of dengue illness in the previous year. Paired saliva samples provided serological evidence of recent dengue infection among 4856 children aged 3–9 years. An entomological survey in the same households looked for larvae and pupae of Aedes aegypti and recorded presence of fish and temephos in water containers. We examined associations with the two outcomes of recent dengue infection and reported dengue illness in bivariate analysis and then multivariate analysis using generalized linear mixed modelling. Results Some 17% (1730/10,111) of households had fish in their water containers. The presence of fish was associated with lower levels of recent dengue virus infection in children aged 3–9 years (OR 0.64; 95% CI 0.45–0.91), as was living in a rural area (OR 0.57; 95% CI 0.45–0.71), and being aged 3–5 years (OR 0.65; 95% CI 0.51–0.83). Factors associated with lower likelihood of self-reported dengue illness were: the presence of fish (OR 0.79; 95% CI 0.64–0.97), and living in a rural area (OR 0.74; 95% CI 0.65–0.84). Factors associated with higher likelihood of self-reported dengue illness were: higher education level of the household head (OR 1.28; 95% CI 1.07–1.52), living in a household with five people or less (OR 1.33; 95% CI 1.16–1.52) and household use of insecticide anti-mosquito products (OR 1.68; 95% CI 1.47–1.92). Conclusions Our study suggests that fish in water containers may reduce the risk of dengue virus infection and dengue illness. This could be a useful part of interventions to control the Aedes aegypti vector.

Community mobilisation for prevention requires engagement with and buy in from those communities. In the Mexico state of Guerrero, unprecedented social violence related to the narcotics trade has eroded most community structures. A recent randomised controlled trial in 90 coastal communities achieved sufficient mobilisation to reduce conventional vector density indicators, self-reported dengue illness and serologically proved dengue virus infection. The Camino Verde intervention was a participatory research protocol promoting local discussion of baseline evidence and co-design of vector control solutions. Training of facilitators emphasised community authorship rather than trying to convince communities to do specific activities. Several discussion groups in each intervention community generated a loose and evolving prevention plan. Facilitators trained brigadistas, the first wave of whom received a small monthly stipend. Increasing numbers of volunteers joined the effort without pay. All communities opted to work with schoolchildren and for house-to-house visits by brigadistas. Children joined the neighbourhood vector control movements where security conditions permitted. After 6 months, a peer evaluation involved brigadista visits between intervention communities to review and to share progress. Although most communities had no active social institutions at the outset, local action planning using survey data provided a starting point for community authorship. Well-known in their own communities, brigadistas faced little security risk compared with the facilitators who visited the communities, or with governmental programmes. We believe the training focus on evidence-based dialogue and a plural community ownership through multiple design groups were key to success under challenging security conditions. ISRCTN27581154 .

Vaccination is a key current prophylactic measure for occupational risk of hepatitis B virus (HBV) infection. This study measures HBV vaccination coverage among health personnel in a Mexican hospital, and identifies factors associated with completion of the vaccination schedule.A cross-sectional study in workers of the Acapulco General Hospital, Mexico. Interviews documented vaccination history against HBV, number of doses received, and date of vaccination. Health workers with complete vaccination were considered those with at least three doses of vaccine received at intervals of two months between first and second doses, and six months to a year in the third dose.Some 52% of workers (436/834) reported at least one vaccination during their professional life and only 5.5% (46/834) completed the HBV vaccination schedule. Factors associated with completion were academic degree, perception of infection risk at work, and knowledge of vaccine efficacy and the need for a complete schedule.In line with hospitals in other studies, few hospital workers were fully vaccinated. Evidence from this study can inform efforts to increase HBV vaccination coverage.