BIOLOGY Buzz | December 2021

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Introduction to the One Health Framework

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Analysis on the One Health Components in the Slums of Metro Manila

The Incorporation of One Health Framework to Crafted Policies

and Initiatives

iology B uzz B VO L 1 | I S S UE 1

ONE HEALTH FRAMEWORK AND THE HEALTH ISSUES IN THE SLUMS OF METRO MANILA

De c e m b e r 2021

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Table of Contents

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A Letter From the Team

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Introduction to the One Health Framework

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Challenges Encountered in Slum Areas

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Analysis on the One Health Components in the Slums of Metro Manila

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The Spread of Zoonotic Diseases Among the Slums of Metro Manila

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The Incorporation of One Health Framework to Crafted Policies and Initiatives

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Meet the Biology Buzz Team

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References

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A Letter From the Team W

ith all the pressing events prevailing in this generation, it is of utmost importance that we prioritize our overall health today more than ever.

Our team is more than glad to present to you this year’s issue of Biology Buzz, which is a newsletter that would provide you with a glimpse into the One Health Framework – a health concept that discusses the unifying characteristics and interdisciplinary relationship within human, environmental, and animal health.

More importantly, we would delve deep upon the concerning health issues that our fellow Filipino people are battling through while they are spending their lives in the slums of Metro Manila.

The city, being one of the most densely populated areas in the country, exhibits

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an alarmin g growt h an d s prea d o f diseases among different places; and this is why it is significant to address the health situation with an approach that interrelates all contributing factors affecting it.

Fou n d in s ide are s u pple me nt ary sets of information about the essence of discussing these health issues with regard to the reputable framework. May you find the learning journey as efficiently informative and mind-awakening as our team did.

Stay well!

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THE BIOLOGY BUZZ TEAM Chloe Villafuerte, Gabrielle Lavitoria, Kaye Sarcaoga, Gabrielle Beltran

BIOLOGY BUZZ

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Introduction to the One Health Framework

O

ne Health Framework refers to the intrinsic interdependence of human health to animal health and environmental health. Introduced in the early 2000s, the concept has been established and enacted by the World Organization for Animal Health (formerly known as the Office International des Epizooties) as a cross-discipline, collaborative, and multisectoral global approach with the principal purpose of understanding risks for human and animal health, as well as the ecosystem health (Office International des Epizooties 2021).

The idea behind One Health Framework may have been known for more than a century, but its relevance and applicability to existing communities have increased in recent years due to the emergence of multiple factors that altered patterns of interaction among humans, animals, plants, and the environment.

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Environmental Health

Human population has been rapidly escalating over the past years, which led to the continuous expansion of residential areas into new geographic locations allowing close contact with wild and domestic animals. Exposure to these animals and their environments enables diseases to actively progress from one host to another, i.e., humans.

Multiple anthropogenic activities, e.g., intensive agricultural practices, deforestation, urban development, industrial procedures, have agitated environmental conditions and habitats, resulting in the development and steady proliferation of zoonotic diseases.

When we protect one, we protect all.

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- Centers for Disease Control and Prevention (2018)

1. Gives a Deeper Understanding of Infectious Disease Ecology. Re-emerging and emerging zoonotic diseases in animals and humans can be traced through the relationships of animals and its surrounding environment.

2. Supports Global Health Security. Adequate and in-depth knowledge involving the host, pathogens, and the environment can address probable health threats revolving on zoonotic diseases, vector-borne diseases, food safety and security, antimicrobial resistance, environmental contamination (Centers for Disease Control and Prevention 2018) and so forth. Gathered ​​ data and analysis can contribute to the prevention of infectious diseases, early detection, and treatment procedures.

3. Serve as a Declarative Call for Action. Supporting evidence of the One Health Approach utilized in addressing zoonotic diseases can persuade governments, non-government organizations, and, most notably, citizens to actively participate in executing relevant programs.

BIOLOGY BUZZ

ONE HEALTH Human Health

Animal Health

DID YOU KNOW? November 3 is One Health Day. The 3rd of November, 2021 marks the sixth annual One Health Day.

Every individual serves an important role, including you! Communicating, coordinating, and actively collaborating enables us to have the greatest influence on enhancing and sustaining the health for our fellow people, animals, and our shared environment.

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Challenges Encountered in Slum Areas T

he rapid rate of urbanization entailed the continuous prevalence of slum areas or informal settlements. Highly populated residential areas comprised of densely-packed substandard housing units have been widespread nowadays, as majority of impoverished people have resorted to dwell in such living parameters due to the lack of adequate funds for suitable housing.

In 2010, over 4.0 million people or approximately 37% of the population within Metro Manila, the country’s principal city, lived in slums. In fact, Manila is home to roughly onetenth of the country’s total slum residents, with Tondo being one of the most densely inhabited areas having 80,000 people per square kilometer.

As of 2018, there are over 526 slum communities dispersed across Metro Manila’s cities and municipalities, which houses 2.5 million people in either unoccupied public or private lands typically found along rivers, garbage dumps, train lines, industrial operations as well as beneath bridges (Quigley 2018)

HUMAN 1. H i g h R a t e s o f I l l n e s s e s . D i s e a s e s proliferate swiftly due to close proximity of residences, high population density, and insufficient suitable toilets.

2. Malnutrition. Rate of malnutrition among children is three times greater in slums than in non-slum communities, as the majority of the children resort to scavenging for food in garbage (Brown 2019).

3. I n c r e a s e d C h i l d M o r t a l i t y . T h e Department of Health reported that the child mortality rate is three times higher in slum areas compared to non-slum areas (Brown 2019).

ANIMAL 1. Proliferation of Destructive Insects and Other Organisms. Stagnant waste materials, water, and other contaminants emit a foul smell, which attracts disturbing insects and vermin.

2. Unsafe Practice of Livestock Agriculture.

Slums can be home to various livestocks, such as pigs, chickens, and goats, which usually roam around freely leading to the transmission of possible diseases, traffic accidents, and environmental contamination (Correa and Grace 2014).

ENVIRONMENT 1. Pollution — Air, Water, Land, Noise. 66% of slum residents resort to open pits or waterways to dispose of human waste due to the lack of hygiene facilities in the area (Brown 2019).

2. Urban Flooding. Lack of proper waste management, poor drainage system maintenance, and deficit infrastructures have led to flooding accompanied by mud even under normal rains (Ballesteros 2010).

3. Congestion. Overcrowded environment is absolutely apparent given the land scarcity and immense population.

4. Pr o n e t o N a t u r a l a n d M a n - m a d e D i s a s t e r s . Th e i n h e re n t c o n g e s t e d environment puts residents at a heightened risk of fire, earthquakes,typhoons, and other environmental pressures.

OTHER NOTABLE PROBLEMS 1. Prevalence of Violence. Monitoring and controlling crimes remain to be prominent difficulties due tightly braided routes and few signages, making it difficult for emergency and law enforcement vehicles to navigate through the area. Social disorganization also contributes to the alarming cases of illicit activities, e.g., theft, substance abuse, human trafficking, ect.

2. Perpetuation of the Cycle of Poverty.

Nearly all residents of slum areas, i.e. workers and students, are often vulnerable to exploitation and marginalization due to the absence of a formal address.

3. Susceptible to Evictions. Urban slum dwellers tend to be at higher risk of constant and unforeseen displacements at any given time, given the absence of secure land rights.

BIOLOGY BUZZ

Analysis on the One in the Slums of HUMAN HEALTH

Photo credit: https://www.worldbank.org/content/dam/photos/780x439/2021/jun-1/ph-nutrition2020-ezra-acayan.jpg

The congested and unsanitary living situation of the people in urban slum areas expose its inhabitants to numerous health risks. Malnutrition is rampant among children living in these highly populated communities such that its rate is three times higher than non-slum settlements (Brown 2019). This has been a persisting problem in the Philippines, and poverty is seen as one of the major causes wherein 42.4% of children from poverty-stricken households are stunted (Mbuya et al. 2021). In relation to malnutrition, anemia is also a result of inadequate access to nutritious foods especially those that are iron-rich. A study conducted by Asian Development Bank revealed that 50% of the children living in slums are anemic from a low-iron diet. Cases of diarrheal diseases are twice higher due to high exposure to clogged sewers and polluted surroundings.

The U.S. Agency for International Development (USAID) reports 80 percent of the children from eight months to 15 years having at least two species of intestinal parasites from foraging for food in garbage.

Incidence rates of tuberculosis are of greater degree in these places given the crowded living conditions that result in faster transmission of the said disease (Noykhovich et al. 2018). Zoonotic diseases are also prevalent in the slums because of the appearance of several breeding sites of animal vectors – in the next pages, some would be discussed in detail. Overall, children in urban slums are twice as likely to die before reaching the age of 5 (Acosta 2015) and the child mortality rate is three times higher than non-slum areas. One of the reasons for this escalating case of deaths is the lack of access to national health programs and medical facilities.

ANIMAL

Photo credit: https://images.squarespace-cd 8e31/1467744251332-4LMYN8XNLFDFYMHKKDE3

The highly polluted urban com contributors to the worsening he and aquatic animals. Improper especially in the surrounding wa countless parasites such as round and tapeworms (Blue Cross 2021 as hosts, buta also other animal slums are one of the most comm the unhealthy living conditions i experience animal cruelty, endu develop diseases such as rabie Humane Society n.d.). Poor water q dumping of solid or human waste area damages the ecosystem in th River which runs through Metro water in the city, but it cannot sus waste releases gasses and takes waste products and household g water given the lack of access to revealed a score of 6 for Pasig Ri both bad marks compared to th (Atienza 2018). The numbers st settlers are huge land and water animals and the biodiversity.

BIOLOG

Health Components f Metro Manila HEALTH

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mmunities in Metro Manila are also ealth condition of some terrestrial waste disposal in these areas, aterways, helps in the spread of dworms, hookworms, whipworms 1), that do not only seek humans ls as well. For instance, dogs in mon stray animals that suffer from in the said settlements. Most are ure the shabby pavements, and es and skin diseases (Michigan quality caused by the irresponsible es in the sewers or rivers near the he aquatic environment. The Pasig Manila is an important body of stain life anymore since the pile of up oxygen. Furthermore, factory garbage are both thrown into the facilities. The index of one study iver, 16 for Manila Bay, which are he highest possible score of 100 trengthen the fact that informal polluters that affect the health of

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ENVIRONMENTAL HEALTH

Photo credit: https://smokymountainsmanila.files.wordpress.com/2014/05/37_1959slums-aufmuelldeponie-smoky-mountain-manila-huetten1.jpg?w=640

Another aspect that is severely affected by urbanization is the environment due to the accumulation of multifarious detrimental anthropogenic activities. Residents in these areas live in poorly structured shelters which makes them more susceptible to the destructive effects of natural disasters such as typhoons, and earthquakes. The materials used in their houses could block disposal systems resulting in more extreme flooding. Pollution is the chief aftermath of the widespread proliferation of slums in Metro Manila that includes negligence in proper solid waste disposal, contamination of nearby bodies of water, and air pollution.

Residents from the district produce a total of 8,400 to 8,600 tons of garbage in total each day which is equivalent to 25% of the national waste generation (Regmi 2018). Most, if not all, informal settlers resort to throwing human waste in open holes or rivers due to unavailability of proper sanitation facilities like toilets.

Inappropriate throwing of garbage results in countless deleterious effects that touch human health as well. For instance, the Smokey Mountain found in Tondo, Manila was once a fishing village in the 1960s but is now known as a heavily polluted area and an uncontrolled dump site (EJOLT 2020). Domains like this bring about serious environmental consequences such as global warming, soil contamination, and groundwater depletion.

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The Spread of Zoonotic Diseases Among the Slums of Metro Manila MALARIA

LEPTOSPIROSIS

alaria is a parasitic disease that spreads through a bite of an infected mosquito.

While many falsely believe that it is caused by a virus or bacteria, malaria is actually caused by Plasmodium, a multicellular parasite that spends a part of its life cycle in the red blood cells of its human host. Female mosquitoes that bite humans with the parasite infestation then get infected and spread the disease to other humans. Manifestations of malaria, moreover, include headache, diarrhea, vomiting, and jaundice among the others.

eptospirosis is a blood infection caused by a bacteria known as Leptospira interrogans. It is an infectious disease among animals and humans that is often spread through exposure to urine of the infected animals. The bacteria enters animals’ and humans’ skin through cuts or abrasions. Humans infected with the disease may experience chronic, episodic headache, renal failure, respiratory distress, and hemorrhage, while manifestations in animals include depression, lack of appetite, reproductive problems, and vomiting among the others.

Additionally, common animal transmitters include domesticated dogs, rodents, and other farm animals such as pigs and cattles.

The disease has long ago been common among squatter settlements of Metro Manila. It occurs mostly in tropical and poor communities where there is little to no access to environmental sanitation. In fact, the European Alliance Against Malaria assessed that malaria is often known to be the “epidemic of the poor”. This could be highly linked to the fact that there is a lack of preventive measures, medical treatment, and access to sanitation among these settlements.

While the National Center for Biotechnology Information (NCBI) identified leptospirosis as the most common zoonotic infection in the world, urban slum dwellers in Metro Manila experience high prevalence of the said infection due to poor water sanitation and exposure to flooded areas where there is high infestation of Leptospira. In fact, the Department of Health (DOH) declared a surge of leptospirosis way back 2012 whereas numerous cases and deaths were reported in Metro Manila alone.

This resulted from heavy flooding in the urban areas.

DENGUE

ZIKA VIRUS

engue is a mosquito-borne viral disease typically found in tropical and subtropical countries, which occurs primarily in urban settlements. The disease is caused by four distinct but associated serotypes, collectively known as the Dengue viruses (DENV). Female mosquitoes of the species Aedes aegypti and Aedes albopictus are the virus’ principal carriers, which are maintained by two transmission cycles: (1) mosquitos transmit the virus among non-human primates and (2) mosquitos transmit the virus among humans. There are a multitude of symptoms associated with Dengue, including fever, vomiting, nausea, rashes, aches, and pains, which usually last 2-7 days depending on the severity of the infection (Agrupis et al. 2019).

nother zoonotic disease which arises from urban areas is the Zika virus, which is primarily transmitted by the Aedes aegypti mosquito (World Health Organization 2018). Due to the condensed population, poor sanitation and water quality are prevalent in the slums of Metro Manila and these become the spawning grounds of the said vector. Symptoms of this virus include fever, rash, conjunctivitis, muscle and joint pain, malaise or headache which last for around 2-7 days. However, the most concerning aspect of this disease is the accompanying spread of what is considered as the “largest epidemic ever of a congenital complication” (Snyder et al. 2017) called microcephaly, or the stoppage of brain development in babies during pregnancy resulting in a smaller head size than normal (CDC 2020). Zika virus remains a disease of the urban poor because crowding in these communities makes residents vulnerable to a faster rate of spread of the disease. According to the statistics of the Department of Health (Bureau of Quarantine 2017), the National Capital Region held the highest percentage of the total number of Zika cases in the Philippines amounting to 35% (20 of 57 cases). In the same report, Dr. Rosell-Ubial stated that cleanliness continues to be the main prevention for the emergence of mosquito-borne diseases, and the increasing number of slum areas in the metro could be the major cause of the rapid escalation of Aedes mosquito reproduction.

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There have been multiple dengue outbreaks in the Philippines, specifically in highly urbanized cities such as Metro Manila. Last November 2021, the Department of Health observed a clustering of dengue cases in some areas of Metro Manila, e.g.

Tondo; however, this year’s cases and mortality rates have greatly fluctuated compared to the past years (Gonzales 2021). Urban slum residents are highly susceptible to the disease, due to the lack of an efficient mosquito surveillance system, contaminated environment, poor hygiene facilities, and poor solid waste management.

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The Incorporation of One Health Framework to Crafted Policies and Initiatives W

hy is it important to incorporate the One Health Framework in coming up with policies and initiatives that will help combat the worsening health situation in Metro Manila’s squatter settlements?

Several health policies have been implemented to address the deteriorating overall health situation among squatter settlements in Metro Manila. These initiatives, however, do not seem adequate and sufficient to successfully eradicate this health dilemma as there are critical factors that the local government continues to fail to consider.

Addressing the health issues within slums of Metro Manila should incorporate the concepts involved in the One Health Framework. This is for significant reasons that: 1. One Health encourages public health intervention of medical practitioners in animal, human, and environmental health - As the human population within squatter settlements in Metro Manila is rapidly increasing, human-to-animal contacts are expanding at the same time.

Poverty also influences these people’s lack of access to environmental sanitation which in turn fuels the spread of vectorborne and other zoonotic diseases that contribute adverse effects to all the lives involved.

- The involvement of policymakers and human health practitioners alone would not efficiently resolve the issue for a reason that this is not the sole concern that we should focus on. The environment these people dwell in and the animals they come in contact with vastly affect the quality of health in the poor urban areas.

- From this circumstance we can also assess that the neglected health situation lies upon contributing factors that include all human, environmental, and animal health. This is the main reason why the cooperation of medical professionals in these three health domains is highly essential. Doctors, nurses, epidemiologists, veterinarians, agricultural staff, wildlife experts, and ecologists are only few of the health practitioners that should all collaborate together in order to create a successful public health intervention and initiative that will hopefully attend to the health needs of our people.

2. The Integration of One Health Framework would highlight a collaborative approach towards addressing the congestion in urban Manila.

- As emphasized in this newsletter, human, animal and environmental health are tightly interrelated with one another hence, it is not enough to tackle the problem of Metro Manila slums by a sole organization. Instead, the central government should adopt a cross-sectoral solution wherein agencies such as the Department of Health (DOH) may spearhead the discussion about the health risks of densely-packed settlements.

Together with the Department of Science and Technology, they could design projects that would alleviate the problem of pollution and study the possible emergence of novel zoonotic diseases in the area. Meanwhile, the Department of Public Works and Highways (DPWH) and Metro Manila Development Authority (MMDA) could work handin-hand to lay out some propositions with regards to urban development plans, alternative housing for informal settlers, waste disposal, flood and sewer control.

- Local government units in the region shall convene to discuss probable long-term solutions to this problem. However, it is important to note the background of the people living in the squatter settlements and create an approach that would not provoke fear and panic. Providing options and educating them in a medium they would understand will promote a healthy conversation between the people and the authorities. The One Health Framework does not stop within the working body of the government, but it must also be explicated to the inhabitants comprehensively so that they would be aware about the goal of the projects to be implemented.

BIOLOGY BUZZ

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Meet the Biology Buzz Team What inspired you to create this issue of the Biology Buzz?

CHLOE MARGALAUX VILLAFUERTE If there’s anything, I’d say my keen interest in the field of Biology is the first thing that motivated me towards the creation of this newsletter issue. I’ve always found the One Health Framework truly a collaborative concept that represents the boundless disciplines of Biology, and interrelating it with the health issues rampant among Metro Manila slum settlements would definitely help provide our society with substantial information that will in turn spark awareness and call for action.

Thank you so much for reading Biology Buzz. May we all continue pursuing initiatives that promote the overall well-being of bio!

GABRIELLE LAVITORIA Ever since I was a kid, I have always known that I had the heart of an advocate.

Time helped me discover my passion for science, specifically my admiration for life on Earth, which fueled my ambition to become a medical doctor and also an agent of change. It is my honor to write a few pieces in this year's issue of the Biology Buzz for I got a chance to share some insights that are heavily related to what I want to fight for —an accessible and affordable healthcare system for all.

The worsening problem of slums in Metro Manila is close to my heart because this is my hometown, and I am a firsthand witness of the struggles that are rooted from poverty in the urban settlements. I am also glad to have discussed the concept of One Health Framework which, I think, must be amplified in our country and be considered as an outline in addressing these kinds of problems.

Thank you for continuously supporting the Biology Buzz. This is Elle, reminding you to always stay curious and bio-bservant!

KAYE CARMEL SARCAOGA

Biology Buzz

Biology Buzz

Some people say that biology is solely memorization and it is not challenging enough compared to Chemistry or Physics or Math; but, personally, the subject is truly beyond the walls of one’s memorization skills! As I learned more about Biology, I discovered a wide array of relevant and timely concepts, which are applicable to various aspects including human, animal, and environmental health.

In particular, I encountered the versatile idea behind the One Health Framework and, indeed, it added a different perspective on how we can improve the overall quality of all life on Earth. Being a part of Biology Buzz was definitely an eyeopener experience, as I got to explore more about the challenging life in the slums of Metro Manila.

We hope you all learned and enjoyed the first edition of Biology Buzz! Thank you!

PATRICIA GABRIELLE BELTRAN Being exposed to different organizations and advocacies, I learned how to love even the smallest of things and care for all components of life. Additionally, my passion for graphic design was truly the reason why I got excited to start this newsletter. Combining both is just pure elation!

I hope this issue of Biology Buzz is both an eye-opener and an eye candy for you, our readers. I hope you learned something about the One Health Framework and the condition of the slums in our country.

Thanks for reading!

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Agrupis KA, Ylade M, Aldaba J, Lopez, AL, Deen J. 2019. Trends in dengue research in the Philippines: A systematic review. National Center for Biotechnology Information. [accessed 10 Dec 2021].

Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6483330/ Atienza LW. 2018. Under the murky depths: What’s in the Pasig River? FlipScience - Top Philippine science news and features for the inquisitive Filipino. [accessed 2021 Dec 14]. Available from: https://www.flipscience.ph/news/features-news/features/whats-inthe-pasig-river/.

Ballesteros MM. 2010. Linking poverty and the environment: Evidence from slums in Philippine cities. Philippine Institute for Development Studies. [accessed 10 Dec 2021]. Available from: https://dirp3. pids.gov.ph/ris/dps/pidsdps1033.pdf

Blue Cross. 2021. Intestinal Worms in Dogs. Blue Cross. [accessed 2021 Dec 14]. Available from: https://www.bluecross.org.uk/petadvice/intestinal-worms-dogs#:~:text=There%20are%20four%20 common%20types.

Brown Z. 2019. 10 Facts About Slums in Manila. The Borgen Project. [accessed 2021 Dec 14]. Available from: https://borgenproject. org/10-facts-about-slums-in-manila/.

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CDC. 2020. Facts about Microcephaly | Birth Defects | NCBDDD | CDC. Centers for Disease Control and Prevention. [accessed 2021 Dec 13]. Available from: https://www.cdc.gov/ncbddd/ birthdefects/microcephaly.html#:~:text=Microcephaly%20is%20 a%20condition%20where.

Centers for Disease Control and Prevention. 2021. Malaria. U. S. Department of Health and Human Services. [accessed 10 Dec 2021]. Available from: https://www.cdc.gov/malaria/about/faqs. html Centers for Disease Control and Prevention. 2018. One health basics. [accessed 11 Dec 2021]. Retrieved December 10, 2021. Available from: https://www.cdc.gov/onehealth/basics/index.html.

Correa MT, Grace D. 2014. Slum Livestock Agriculture. National Center for Biotechnology Information. [accessed 11 Dec 2021]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152485/

Department of Health Staff. 2012. The surge of leptospirosis.

Department of Health. [accessed 10 Dec 2021]. Available from: https://doh.gov.ph/node/1497 EJOLT. 2020. Smokey mountain and Payatas dumpsites, Manila, Philippines | EJAtlas. Environmental Justice Atlas. [accessed 2021 Dec 14]. Available from: https://ejatlas.org/conflict/smokeymountain-philippines.

European Alliance Against Malaria. 2007. Malaria and poverty. Malaria Consortium. [accessed 10 Dec 2021]. Available from: https:// www.malariaconsortium.org/userfiles/file/Past%20events/ factsheet2%20-%20malaria%20and%20poverty.pdf

Gonzales, C. (2021, November 25). DOH sees clustering of dengue cases in some parts of PH. Inquirer. [accessed 11 Dec 2021].

Available from: https://newsinfo.inquirer.net/1511046/doh-seesclustering-of-dengue-cases-in-some-parts-of-ph Mbuya NVN, Demombynes G, Piza SFA, Adona AJV. 2021.

Undernutrition in the Philippines. doi:10.1596/978-1-4648-1701-4. [accessed 2021 Dec 14]. https://www.worldbank.org/en/country/ philippines/publication/-key-findings-undernutrition-in-thephilippines.

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Office International des Epizooties. 2021. One health. [accessed 10 Dec 2021]. Available from: https://www.oie.int/en/what-we-do/ global-initiatives/one-health/ Quigley, A. 2018. 10 important and little-known facts about poverty in Manila. The Borgen Project. [accessed 10 Dec 2021]. Available from: https://borgenproject.org/tag/slums-in-manila/ Regmi RK. 2018. Urbanization and Related Environmental Issues of Metro Manila. Journal of Advanced College of Engineering and Management. 3:79. doi:10.3126/jacem.v3i0.18906. [accessed 2021 Dec 14]. Available from: https://www.nepjol.info/index.php/ JACEM/article/view/18906/15439.

Snyder RE, Boone CE, Cardoso CAA, Aguiar-Alves F, Neves FPG, Riley LW. 2017. Zika: A scourge in urban slums. Wunder E, editor. PLOS Neglected Tropical Diseases. 11(3):e0005287. doi:10.1371/ journal.pntd.0005287. [accessed 2021 Nov 9]. Available from: https://sci-hub.se/http://dx.doi.org/10.1371/journal. pntd.0005287.

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