Determinants of short-term movement in a developing region and implications for disease transmission.

Background: Human mobility is important for infectious disease spread. However, little is known about how travel varies by demographic groups and how this heterogeneity influences infectious disease risk. Methods: We analyzed ten years of survey data from 15 communities in a remote but rapidly changing region in rural Ecuador where road development in the past 15-20 years has dramatically changed travel. We identify determinants of travel and incorporate them into an infection transmission model. Results: Individuals living in communities more remote at baseline had lower travel rates compared with less remote villages (adjusted odds ratio [OR]=0.51, 95% CI 0.38, 0.67). Our model predicts that less remote villages are, therefore, at increased disease risk. Though road building and travel increased for all communities, this risk differential remained over 10 years of observation. Our transmission model also suggests that travelers and non-travelers have different roles in disease transmission. Adults travel more than children (adjusted OR=1.73, 95% CI 1.30, 2.31) and therefore disseminate infection from population centers to rural communities. Children are more likely than adults to be infected locally (attributable fraction=0.24 and 0.09, respectively) and were indirectly affected by adult travel patterns. Conclusions: These results reinforce the importance of large population centers for regional transmission and show that children and adults may play different roles in disease spread. Changing transportation infrastructure and subsequent economic and social transitions are occurring worldwide, potentially causing increased regional risk of disease. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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