Mobility and non-household environments: understanding dengue transmission patterns in urban contexts.

Background: Households (HH) have been traditionally described as the main environments where people are at risk of dengue (and other arbovirus) infection. Mounting entomological evidence has suggested a larger role of environments other than HH in transmission. Recently, an agent-based model (ABM) estimated that over half of infections occur in non-household (NH) environments like workplaces, markets, and recreational sites. However, the importance of human and vector mobility and the configurations of urban spaces in mediating the effects of NH on dengue transmission remains understudied.

Methods: To improve our knowledge of the relevance of NH in transmission, we expanded an ABM calibrated from field data in Kenya to examine movement of people and vectors under different spatial configurations of buildings. In this model, we assessed the number of people traveling between HH and NH and their distance. Those were studied on three different urban configurations, on which the NH are spatially distributed either randomly (scattered), centered (in a single center), or clustered (in more than one cluster).

Results: Across simulations, the number of people moving is a major influential variable where higher levels of movement between HH and NH increases the number of cases. In addition, the number of cases is higher when NH are scattered. Intriguingly, the distance that people travel from HH to NH seems to have little effect on dengue burden; however, it affects the level of spatial clustering of cases.

Conclusions: These results highlight the importance of NH as a major spreader of infections between HH and NH environments supporting the relevance of NH in transmission and its interaction with human movement in driving dengue dynamics.