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Social Stressors, Arboviral Infection, and Immune Dysregulation in the Coastal Lowland Region of Ecuador: A Mixed Methods Approach in Ecological Perspective

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  • 1 Clinical and Translational Sciences Institute, University of Rochester School of Medicine, Rochester, New York;
  • | 2 InterAmerican Institute for Global Change Research (IAI), Directorate, Montevideo, Uruguay;
  • | 3 State University of New York Upstate Medical University, Department of Medicine, Syracuse, New York;
  • | 4 State University of New York Upstate Medical University, Institute for Global Health and Translational Science, Syracuse, New York;
  • | 5 Department of Microbiology & Immunology, State University of New York – Upstate Medical University, Syracuse, New York;
  • | 6 Department of Geography, University of Florida, Gainesville, Florida;
  • | 7 Department of Chemistry, State University of New York College at Oswego, New York;
  • | 8 Department of Public Health, Syracuse University, Syracuse, New York;
  • | 9 Universidad Técnica de Machala, Medicine, Machala, El Oro, Ecuador;
  • | 10 Aab Cardiovascular Research Institute, University of Rochester School of Medicine, Rochester, New York;
  • | 11 Department of Medicine, University of Rochester School of Medicine, Rochester, New York;
  • | 12 Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York

ABSTRACT.

Aedes aegypti, the mosquito that transmits arboviral diseases such as dengue (DENV), chikungunya (CHIKV), and Zika viruses (ZIKV), is present in tropical and subtropical regions of the world. Individuals at risk of mosquito-borne disease (MBD) in the urban tropics face daily challenges linked to their socio-environment conditions, such as poor infrastructure, poverty, crowding, and limited access to adequate healthcare. These daily demands induce chronic stress events and dysregulated immune responses. We sought to investigate the role of socio-ecologic risk factors in distress symptoms and their impact on biological responses to MBD in Machala, Ecuador. Between 2017 and 2019, individuals (≥ 18 years) with suspected arbovirus illness (DENV, ZIKV, and CHIKV) from sentinel clinics were enrolled (index cases, N = 28). Cluster investigations of the index case households and people from four houses within a 200-m radius of index home (associate cases, N = 144) were conducted (total N = 172). Hair samples were collected to measure hair cortisol concentration (HCC) as a stress biomarker. Blood samples were collected to measure serum cytokines concentrations of IL-10, IL-8, TNF-α, and TGF-β. Univariate analyses were used to determine the association of socio-health metrics related to perceived stress scores (PSS), HCC, and immune responses. We found that housing conditions influence PSS and HCC levels in individuals at risk of MBD. Inflammatory cytokine distribution was associated with the restorative phase of immune responses in individuals with low-moderate HCC. These data suggest that cortisol may dampen pro-inflammatory responses and influence activation of the restorative phase of immune responses to arboviral infections.

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Author Notes

Address corresponding to Denisse Vega Ocasio, Clinical and Translational Sciences Institute, University of Rochester School of Medicine, Rochester, NY 14652. E-mail: dvegaoc@emory.edu

Financial support: At the time this work was completed, Dr. Vega Ocasio was a trainee in the University of Rochester’s Translational Biomedical Science PhD Program, which is supported by Grant 2TL1TR002000-05 from the National Center for Advancing Translational Sciences, National Institutes of Health. Dr. Vega Ocasio was additionally supported by funds from BWF1014095 from the Burroughs Wellcome Fund. The surveillance study was supported by SUNY Upstate Medical University and Clinical Research Management (CRM). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of this manuscript.

Disclaimer: We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Authors’ addresses: Denisse Vega Ocasio, Clinical and Translational Sciences Institute, University of Rochester School of Medicine, Rochester, NY, E-mail: dvegaoc@emory.edu. Anna M. Stewart-Ibarra, Inter-American Institute for Global Change Research, Directorate Montevideo, Uruguay, State University of New York Upstate Medical University, Department of Medicine, Syracuse, NY, and State University of New York Upstate Medical University, Institute for Global Health and Translational Science, Syracuse, NY, E-mail: astewart@dir.iai.int. Rachel Sippy, State University of New York Upstate Medical University, Department of Microbiology and Immunology, Syracuse, NY, and University of Florida, Department of Medical Geography, Gainesville, FL, E-mail: sippyr@upstate.edu. Kestutis G. Bendinskas, State University of New York at Oswego College Stores, Department of Chemistry, Oswego, NY, E-mail: kestutis.bendinskas@gmail.com. Brooks B. Gump, Syracuse University, Department of Public Health, Syracuse, NY, E-mail: bbgump@syr.edu. Cinthya Cueva-Aponte, State University of New York Upstate Medical University, Institute Center for Global Health and Translational Science, Syracuse, NY, E-mail: cin_ka10@hotmail.com. Efrain Beltrán Ayala, Universidad Tecnica de Machala, Medicine, Machala, El Oro, ecuador, E-mail: felixbeltran57@hotmail.com. Craig N. Morrell, University of Rochester School of Medicine and Dentistry, Aab Cardiovascular Research Institute, Rochester, NY, and University of Rochester School of Medicine and Dentistry, Department of Medicine, Rochester, NY, E-mail: craig_morrell@urmc.rochester.edu. Timothy D. Dye, University of Rochester School of Medicine and Dentistry, Department of Obstetrics and Gynecology, Rochester, NY, E-mail: tim_dye@urmc.rochester.edu.

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