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It is with great interest that I read the original research by Lobkowicz et al, ascertaining that coinfections do not strongly influence clinical manifestations of uncomplicated ZIKV infections . With this interesting finding in mind, it is important to remember that Neglected Tropical Diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioural and physical environment . More than 70% of countries and territories affected by NTDs are low-income and low and middle income countries . Thus, there are extreme inequalities with regards to disease distribution. People are affected by NTDs because of an array of social determinants. It is plausible that these social determinants may allow for coinfections of Zika (ZIKV), dengue virus (DENV) and chikungunya (CHIKV).
Social Determinants of Health (SDH) are the conditions in which individuals are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life . SDH encompass socioeconomic factors, environmental factors and biological factors. These factors play a fundamental role in the proliferation of vector-borne diseases such as ZIKV, DENV and CHIKV. The relationship between the vector and SDH is complex, yet it is extremely important to recognise in order to evaluate the impact of socioeconomic factors on infectious diseases.
There are major ineq...
There are major inequalities with regards to disease distribution. The relationship between Gross Domestic Product (GDP) and health is a starting point for examination of inequalities in the global health context. High income countries tend to have greater GDPs, which often means nations have better health systems and social services.
The distribution of ZIKV infection is unevenly spread across the globe . The weight of Zika Virus Disease falls on the poor for different reasons. In tropical urban areas, those from a low socioeconomic income group are not able to manage the cost of air-conditioning, window screens, or insect repellent . With no piped water and poor sanitation, they are compelled to store water in containers, giving perfect conditions to the expansion of mosquitoes .
The combination of ZIKV, DENV and CHIKV coinfections obfuscates the public health problem in various populations where complications due to poverty, poor basic sanitation and poor vector control persist. Further work is needed to elucidate the importance of the interactions between socio-environmental factors and transmission of ZIKV, DENV and CHIKV. The importance of SDH when understanding the risk factors that potentiate NTDs spread, is crucial for public health academics, health ministers and governments, as any interventions must consider ecological, biological and social factors.
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3. WHO. Social determinants of health [Internet]. World Health Organization. 2020 [cited 10 May 2020]. Available from: https://www.who.int/social_determinants/en/
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