Fecundity and Fertility in the Presence of Zika

项目摘要 -- 2015年，巴西卫生部发现东北部爆发寨卡病毒(ZIKV) 该国家的地区。疫情加剧并蔓延，此前已达到46起 未受影响的人口，包括美国南部。这场流行病是特殊的。 令人担忧的是，寨卡病毒被发现会导致婴儿出现严重的神经疾病。 美洲各地的政府机构建议人们将疫情带到 在作出计划生育决定时考虑到这一点，包括特别呼吁推迟生育。 寨卡病毒的研究主要集中在传播动力学、疾病发病机制和 致畸作用。我们把重点放在一个未被开发的影响领域：人口生育率。我们建造 一组详细的数据集，描述了2008-2018年巴西的人口结构。消息来源 包括出生档案、与医疗保健系统相互作用的记录、生态数据和 两种类型的媒体资源。因为我们可以识别正在进行的怀孕，所以我们提供 对疫情导致的生育率变化的可能最早估计。 我们的研究有三个目的：1)估计寨卡病毒风险对人口生育的影响；2) 确定生育率应对疫情的社会经济异质性程度；(3) 以测试发生生育反应的行为机制的证据。我们 估计市政一级的怀孕率/生育率，并覆盖这些关于脆弱性的估计 寨卡病毒的流行蔓延。我们对脆弱性的两个组成部分进行了建模：(A)传播风险 根据每个直辖市的气候和地形是否适合繁殖 主要寨卡病毒媒介(埃及伊蚊)，以及(B)使用 来自本地和社交媒体来源的时间和空间参考数据。生育率 在疫情爆发前计算，在伊蚊流行率最低的地区计算， 提供暴露区域内预期时间模式的估计值 这场流行病。观察到的和预期的生育率模式之间的差异允许 描述生育反应的方向、大小和时间。健康状况-系统数据 关于长效避孕药、产前做法、性传播感染等，使我们能够检测到 有证据表明，生育率的变化伴随着对疫情的相关行为反应。 我们的研究对寨卡病毒对公众健康的重大影响提供了初步估计。它进步了 我们对家庭如何(以及哪些)改变生育时机以应对生育的理解 健康威胁，揭示了人口动态中和之后的重要模式 流行病。

Project Summary   In 2015, the Brazilian Health Ministry identified a Zika virus (ZIKV) outbreak in the northeastern region of the country. The outbreak has intensified and spread, reaching into 46 previously unaffected populations, including the southern United States. The epidemic is of special concern because Zika was found to cause severe neurological disorders among infants. Government agencies across the Americas have advised populations to take the epidemic into account when making family planning decisions, including specific appeals for fertility delay. Research on Zika has focused on transmission dynamics, disease pathogenesis, and teratogenic effects. We focus on an underexplored area of impact: population fertility. We build a detailed data set characterizing demographic patterns in Brazil from 2008-2018. Sources include natality files, records of interactions with the health care system, ecological data, and two types of media resources. Because we can identify pregnancies in progress, we provide the earliest possible estimates of fertility change driven by the epidemic. Our study has three aims: 1) To estimate the effect of Zika risk on population fertility; 2) To identify the magnitude of socioeconomic heterogeneity in fertility response to the epidemic; (3) To test for evidence of behavioral mechanisms through which a fertility response occurs. We estimate municipality-level pregnancy/fertility rates, and overlay those estimates on vulnerability to epidemic spread of Zika. We model two components of vulnerability: (a) transmission risk based on the suitability of each municipality's climate and topography for reproduction of the primary Zika mosquito vector (Aedes aegypti), and (b) depiction of infection risk using temporally-and spatially-referenced data from local and social media sources. Fertility rates calculated before the epidemic, and rates calculated in areas with minimal Aedes prevalence, provide an estimate of the expected temporal patterns within exposed areas in the absence of the epidemic. The difference between the observed and the expected patterns in fertility allow us to describe the direction, magnitude, and timing of the fertility response. Health-system data on long-acting contraceptives, prenatal practices, STIs, among others, allow us to detect evidence that fertility change is accompanied by related, behavioral responses to the epidemic. Our research provides early estimates of a major public health impact of Zika. It advances our understanding of how (and which) families shift fertility timing in response to reproductive health threats, shedding light on important patterns in population dynamics during and after epidemics.