Mass Gatherings and Diarrheal Disease Transmission Among Rural Communities in Coastal Ecuador.
Mass gatherings exacerbate infectious disease risks by creating crowded, high-contact conditions and straining the capacity of local infrastructure. While mass gatherings have been extensively studied in the context of epidemic disease transmission, the role of gatherings in incidence of high-burden, endemic infections has not been previously studied. Here, we examine diarrheal incidence among 17 communities in Esmeraldas, Ecuador, in relation to recurrent gatherings characterized using ethnographic data collected during and after the epidemiologic surveillance period (2004-2007). Using distributed-lag generalized estimating equations, adjusted for seasonality, trend, and heavy rainfall events, we found significant increases in diarrhea risk in host villages, peaking 2 weeks after an event's conclusion (incidence rate ratio, 1.21; confidence interval, adjusted for false coverage rate of ≤0.05: 1.02, 1.43). Stratified analysis revealed heightened risks associated with events where crowding and travel were most likely (2-week-lag incidence rate ratio, 1.51; confidence interval, adjusted for false coverage rate of ≤0.05: 1.09, 2.10). Our findings suggest that community-scale mass gatherings might play an important role in endemic diarrheal disease transmission and could be an important focus for interventions to improve community health in low-resource settings.
['Collender|Philip A|PA|', 'Morris|Christa|C|', 'Glenn-Finer|Rose|R|', 'Acevedo|Andrés|A|', 'Chang|Howard H|HH|', 'Trostle|James A|JA|', 'Eisenberg|Joseph N S|JNS|', 'Remais|Justin V|JV|']
D015986:Confounding Factors, Epidemiologic D003441:Crowding D003967:Diarrhea D004196:Disease Outbreaks D004484:Ecuador D062665:Epidemiological Monitoring D005260:Female D006801:Humans D015994:Incidence D008297:Male D015233:Models, Statistical D012307:Risk Factors D012424:Rural Population D014195:Travel
mass gatherings diarrheal disease crowding travel environmental determinants social dynamics