| 1. |
- Ramadona, Aditya L., 1982-
(författare)
-
Spatiotemporal prediction of arbovirus outbreak risk : the role of weather and population mobility
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Arboviruses such as dengue and chikungunya have been a significant public health burden globally for several decades. In Indonesia, all four dengue serotypes are circulating. Considering that Indonesian children are exposed to dengue early in life, and secondary infection is more likely to cause severe dengue, the population of Indonesia is confronting a high potential risk of severe dengue. Severe complications such as hemorrhage can develop and lead to fatal outcomes. There exists no specific treatment for dengue infection, but symptomatic treatment can be effective to prevent deaths. Consequently, vector control has become a critical component for controlling dengue transmission, but it is currently often triggered as a reactive response to observed outbreak clusters. Based on disease surveillance, it thus remains challenging to implement vector control efficiently to prevent outbreaks. While meteorological conditions have shown to be predictive of dengue incidence over space and time, it has rarely been used to predict outbreaks at a fine-scale intra-urban level. Further, as the propagation of dengue outbreaks and the introduction of viruses has been found to be associated with human mobility, predictive models combining meteorological conditions with granular mobility data hold promise to provide more predictive models. The objectives in this thesis were to 1) describe the influence of temperature, rainfall, and past dengue cases, and population mobility on dengue risk; 2) develop and validate spatiotemporal models of dengue outbreak risk at fine-scale at the intra-urban level; 3) to utilize new data to assess the emergence and spread of chikungunya in an outbreak situation.Methods: Initially, multivariate time series regression models were established to analyze the risk of dengue corresponding to monthly mean temperature, cumulative rainfall, and past dengue case. Following that, we investigated the potential use of geotagged social media data as a proxy of population mobility to estimate the effect of dengue virus importation pressure in urban villages. Subsequently, we employed distributed lag non-linear models with a Spatiotemporal Bayesian hierarchical model framework to determine the exposure-lag-response association between the risk of dengue and meteorological data while allowing the spatial covariance to be informed by mobility flows. Finally, we validated the selected best-fitted model by its predictive ability using an unseen dataset to mimic an actual situation of an early warning system in use.Results: We found that an optimal combination of meteorology and autoregressive lag terms of past dengue cases was predictive of dengue incidence and the occurrence of dengue epidemics. Subsequently, when we integrated mobility data our results suggested that population mobility was an essential driver of the spread of dengue within cities when combined with information on the local circulation of the dengue virus. The geotagged Twitter data was found to provide important information on presumably local population mobility patterns which were predictive and can improve our understanding of the direction and the risk of spread.Conclusions: A spatiotemporal prediction model was developed that predicted a prognosis of dengueat fine spatial and temporal resolution. Subsequently, such a prognosis can be used as the foundation for developing an early warning system to more effectively deploy vector control prior to the establishment of local outbreak clusters. These findings have implications for targeting dengue control activities at the intraurban villages level, especially in the light of ever increasing population growth, mobility and climate change.
|
|
| 2. |
- Farooq, Zia, 1986-
(författare)
-
Navigating epidemics : by leveraging data science and data-driven modelling
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ours is an era of global change—including climate change, land-use change, urbanization, increased mobility of humans, species and goods, and environmental shifts. Concurrently, we are witnessing a tangible increase in the rate of (re)emerging infectious diseases, mostly driven by global change factors. This complex landscape of infectious diseases necessitates strategies underpinned by computational tools such as data-driven models to enhance our understanding, response, and predictions of potential epidemics.In this thesis, I leveraged data science algorithms and developed data-driven models that extend beyond specific pathogens, providing insights to prepare for future epidemics, with a focus on Europe. I delved into three temporal contexts: 1) retrospective analyses to understand the contribution of global change factors—specifically climate change and human mobility—fuelling the disease outbreaks and expansion (papers I & IV), 2) develop model to improve disease severity estimation during an outbreak for immediate response (paper III), and 3) future disease transmission risk trajectories under various projected scenarios of global change (paper II)—each playing a crucial role in proactive public health planning and response.In paper I, we assessed the predictive ability and the influence of eco-climatic factors on West Nile virus (WNV)—a pathogen with multiple hosts and mosqutio-vectors, and of public health concern in Europe. Utilizing an advanced machine learning classifier XGBoost, trained on a diverse dataset encompassing eco-climatic, sociodemographic predictors to the WNV presence/absence data, the model accurately predicted the WNV risk a season ahead. Furthermore, by employing an explainable AI algorithm, we uncovered both local and European-level drivers of WNV transmission. Higher temperatures in summer and spring, along with drier winters, were pivotal in the escalated frequency of WNV outbreaks in Europe from 2010 to 2019.In paper II, we projected the WNV risk under climate change and socioeconomics scenarios by integrating augmenting the outputs of climate ensemble into machine learning algorithms. We projected transmission risk trends and maps at local, national, regional and European scale. We predicted a three to five fold increase in WNV transmission risk during the next few decades (2040-60) compared 2000-2020 under extreme climate change scenarios. The proportion of diseasereported European land areas could increase from 15% to 23-30%, putting 161 to 244 million people at risk. Western Europe remains at largest relative risk of WNV increase under all scenarios, and Northern Europe under extreme scenarios. With the current rate of spread and in the absence of intervention or vaccines the virus will have sustained suitability even under low carbon emission scenarios in currently endemic European regions.In paper III, we developed a method to quantify an important epidemiological parameter-case fatality ratio (CFR)— commonly used measure to assess the disease severity during novel outbreaks. In our model, we accounted for the time lags between the reporting of a cases and that of the case fatalities and the probability distribution of time lags and derived the CFR and distribution parameters using an optimization algorithm. The method provided more accurate CFR estimations earlier than the widely used estimators under various simulation scenarios. The method also performed well on empirical COVID-19 data from 34 countries. In paper IV, we modelled annual dengue importations in Europe and the United States driven by human mobility and climate. Travel rates were modelled using a radiation model based on population density, geographic distance, and travel volumes. Dengue viraemic travellers were computed considering local mosquito bite risk, travel-associated bite probability, and visit duration. A dynamic vector life-stage model quantified the climatic suitability of transmissionpermissive local areas. Dengue importations linearly increased in Europe and the U.S. from 2015-2019, rising by 588% and 390%, respectively, compared to 1996-2000 estimates, driven by increased travel volumes (373%) and dengue incidence rates (30%) from endemic countries. Transmission seasons lengthened by 53% and 15% in Europe and the U.S., respectively, indicating increasingly permissive climates for local outbreaks. These findings apply to other diseases such as chikungunya, Zika, and yellow fever, sharing common intermediate host vectors, namely Aedes mosquitoes.This thesis highlights Europe's increasing vulnerability to infectious diseases due to global change factors, putting millions at risk. It emphasizes the significance of advanced modelling and innovative data streams in anticipating epidemic risks. Developing digital early warning systems to track disease drivers and taking urgent climate change mitigation and adaptation measures are crucial to anticipate and reduce future epidemic risks. The outcomes of this research can be used to develop technology-driven decision support tools to aid public health authorities and policymakers in making evidence-based decisions during and inter-epidemic periods.
|
|
| 3. |
- Liyanage, Prasad, 1975-
(författare)
-
The Influence of Climate and Public Health Interventions on Aedes Vectors and Dengue in Sri Lanka
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Dengue, a viral infection transmitted by Aedes mosquitos, flourishes in urban tropical environments by a complex process. Interactions among susceptible humans, dengue viruses, and Aedes mosquitoes determine dengue transmission patterns, and these interactions are modified by driving factors related to weather, the environment, and human behaviour, including mobility. Understanding the drivers of dengue and evaluating the effectiveness and costeffectiveness of existing vector control policies are vital to developing evidence-based and timely interventions.Methods: The exposure-lag-response associations between weather variables, Aedes vector indices and dengue at each sub-district Medical Officer of Health (MOH) divisions in Kalutara district, Sri Lanka, were estimated using distributed lag non-linear models. These estimates were meta-analyzed to obtain the average estimates for the district, while exploring the heterogeneities among MOH divisions. Non-linear extension to the interrupted time series analysis was used to evaluate the impact of nation wide mobility restrictions implemented during COVID-19 pandemic on dengue risk at each district, at different age groups in the western province and at the climate zones in Sir Lanka. The effects of the vector control interventions implemented through the civil military cooporation (CIMIC) on dengue were estimated at Panadura MOH division of Kalutara district using interrupted time series analysis while adjusting for potential confounders. The costeffectiveness of the CIMIC intervention was evaluated using a decision analytical modelling framework.Results: We found that El Niño, rainfall, temperature and Aedes larval indices were associated with each other, and dengue, at lag intervals expanding from one to six months. The nation wide mobility restriction was associated with a statistically significant reduction in dengue risk in all climate zones in Sri Lanka. The highest impact was observed among the children age less than 19 years. We found that the CIMIC intervention reduced dengue risk by 50% and was cost-effectivein a defined area.Conclusion: The manifestation of dengue is preceded by the biologically plausible latencies of increasing Aedes larvae and the onset of weather events in Kalutara district. When augmented with location-specific information of vector activities, one to six months lead time from the onset of weather events enables public health authorities to set up short, intermediate, and long-term goals for vector control interventions. The observed significant reduction in dengue risk following the national lockdown in Sri Lanka further highlighted the importance of vector control at public places and schools. The findings of these studies suggest that communities affected by dengue can benefit from investments in vector control if interventions are implemented rigorously and coordinated well across sectors. The methodological framework we developed in this doctoral thesis will contribute to the understanding of the local determinants of dengue and the developmentof early warning systems blended with effective and cost-effective vector control interventions in Sri Lanka and beyond.
|
|
| 4. |
- Kriit, Hedi Katre, 1990-
(författare)
-
Improved health economic assessments of sustainable transport solutions in urban environments
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Part of the European Strategy to achieve climate neutrality in the transport sector is to increase the proportion of electric vehicles (EVs) and active commuting. Health co-benefits from reduced air pollution and increased active commuting are assumed to follow; however, all dimensions of expected health effects are not quantified nor valued monetarily. Current state-of-the art health impact assessments (HIAs) of air pollution assume immediate change in health with exposure; however, the time-window of importance for health outcomes is unknown. Moreover, the currently applied risk estimate of sick leaves in relation to air pollution is poorly generalizable due to outdated exposure assessment and subjective data on outcome. The overall aim of this thesis is to assess the health economic effects of sustainable urban transport solutions and improve the epidemiological knowledge base of air pollution effects. Methods: The health effects of increased active commuting and the resulting change in air pollution exposure were valued monetarily from a health care perspective, and a cost-effectiveness analysis of investment in bicycle infrastructure was conducted. A health economic assessment from a societal perspective was also conducted for an increased proportion of EVs in the vehicle fleet, considering a change in both exhaust and non-exhaust particles. The exposure-lag response between air pollution and risk for ischemic heart disease (IHD) and stroke was assessed in a multi-cohort study using distributed lag-nonlinear models (DLNMs). A case cross-over study design was applied to estimate the odds of sick leaves in relation to short-term PM2.5 exposure, and production losses were valued using the human capital method. Results: Investing in bicycle infrastructure to enable increased active commuting was estimated to be cost-effective from a health care perspective. An increased proportion of EVs was estimated to decrease population-weighted PM2.5 concentrations without the use of studded winter tires, but was estimated to increase with the current use of studded winter tires in Stockholm Sweden. For a 0-50% use of studded winter tires the health economic costs ranged between €20 and €122 million (M). An independent effect of PM2.5 on sick leaves was estimated to correspond to €2M per year in productivity loss for the population of Stockholm municipality. Exposure time windows closer in time and local sources of air pollution were suggested to be of greater importance for incident IHD and stroke.Conclusions: This thesis has demonstrated the health economic potential in policies seeking to transform the transport sector towards sustainability. Investment in the transport sector could lead to decreased morbidity and decreased monetary burden in the health care sector. Non-exhaust particles should be considered in order to fully assess the health economic effects of EVs. Moreover, the risk estimate of sick leaves in relation to air pollution exposure could be included in international HIAs.
|
|
| 5. |
- Näslund, Ulf, et al.
(författare)
-
Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) : a pragmatic, open-label, randomised controlled trial
- 2019
-
Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 393:10167, s. 133-142
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.
|
|
| 6. |
- Altmejd, Adam, et al.
(författare)
-
Nowcasting COVID-19 statistics reported with delay : A case-study of Sweden and the UK
- 2023
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:4
-
Tidskriftsartikel (refereegranskat)abstract
- The COVID-19 pandemic has demonstrated the importance of unbiased, real-time statistics of trends in disease events in order to achieve an effective response. Because of reporting delays, real-time statistics frequently underestimate the total number of infections, hospitalizations and deaths. When studied by event date, such delays also risk creating an illusion of a downward trend. Here, we describe a statistical methodology for predicting true daily quantities and their uncertainty, estimated using historical reporting delays. The methodology takes into account the observed distribution pattern of the lag. It is derived from the "removal method"-a well-established estimation framework in the field of ecology.
|
|
| 7. |
- Armando, Chaibo Jose, et al.
(författare)
-
Climate variability, socio-economic conditions and vulnerability to malaria infections in Mozambique 2016–2018 : a spatial temporal analysis
- 2023
-
Ingår i: Frontiers in Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Temperature, precipitation, relative humidity (RH), and Normalized Different Vegetation Index (NDVI), influence malaria transmission dynamics. However, an understanding of interactions between socioeconomic indicators, environmental factors and malaria incidence can help design interventions to alleviate the high burden of malaria infections on vulnerable populations. Our study thus aimed to investigate the socioeconomic and climatological factors influencing spatial and temporal variability of malaria infections in Mozambique.Methods: We used monthly malaria cases from 2016 to 2018 at the district level. We developed an hierarchical spatial–temporal model in a Bayesian framework. Monthly malaria cases were assumed to follow a negative binomial distribution. We used integrated nested Laplace approximation (INLA) in R for Bayesian inference and distributed lag nonlinear modeling (DLNM) framework to explore exposure-response relationships between climate variables and risk of malaria infection in Mozambique, while adjusting for socioeconomic factors.Results: A total of 19,948,295 malaria cases were reported between 2016 and 2018 in Mozambique. Malaria risk increased with higher monthly mean temperatures between 20 and 29°C, at mean temperature of 25°C, the risk of malaria was 3.45 times higher (RR 3.45 [95%CI: 2.37–5.03]). Malaria risk was greatest for NDVI above 0.22. The risk of malaria was 1.34 times higher (1.34 [1.01–1.79]) at monthly RH of 55%. Malaria risk reduced by 26.1%, for total monthly precipitation of 480 mm (0.739 [95%CI: 0.61–0.90]) at lag 2 months, while for lower total monthly precipitation of 10 mm, the risk of malaria was 1.87 times higher (1.87 [1.30–2.69]). After adjusting for climate variables, having lower level of education significantly increased malaria risk (1.034 [1.014–1.054]) and having electricity (0.979 [0.967–0.992]) and sharing toilet facilities (0.957 [0.924–0.991]) significantly reduced malaria risk.Conclusion: Our current study identified lag patterns and association between climate variables and malaria incidence in Mozambique. Extremes in climate variables were associated with an increased risk of malaria transmission, peaks in transmission were varied. Our findings provide insights for designing early warning, prevention, and control strategies to minimize seasonal malaria surges and associated infections in Mozambique a region where Malaria causes substantial burden from illness and deaths.
|
|
| 8. |
- Armando, Chaibo Jose, et al.
(författare)
-
Spatial-temporal analysis of climate and socioeconomic conditions on cholera incidence in Mozambique from 2000 to 2018 : an ecological longitudinal retrospective study
- 2024
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 14:8
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study aims to assess both socioeconomic and climatic factors of cholera morbidity in Mozambique considering both spatial and temporal dimensions.DESIGN: An ecological longitudinal retrospective study using monthly provincial cholera cases from Mozambican Ministry of Health between 2000 and 2018. The cholera cases were linked to socioeconomic data from Mozambique Demographic and Health Surveys conducted in the period 2000-2018 and climatic data; relative humidity (RH), mean temperature, precipitation and Normalised Difference Vegetation Index (NDVI). A negative binomial regression model in a Bayesian framework was used to model cholera incidence while adjusting for the spatiotemporal covariance, lagged effect of environmental factors and the socioeconomic indicators.SETTING: Eleven provinces in Mozambique.RESULTS: Over the 19-year period, a total of 153 941 cholera cases were notified to the surveillance system in Mozambique. Risk of cholera increased with higher monthly mean temperatures above 24°C in comparison to the reference mean temperature of 23°C. At mean temperature of 19°C, cholera risk was higher at a lag of 5-6 months. At a shorter lag of 1 month, precipitation of 223.3 mm resulted in an 57% increase in cholera risk (relative risk, RR 1.57 (95% CI 1.06 to 2.31)). Cholera risk was greatest at 3 lag months with monthly NDVI of 0.137 (RR 1.220 (95% CI 1.042 to 1.430)), compared with the reference value of 0.2. At an RH of 54%, cholera RR was increased by 62% (RR 1.620 (95% CI 1.124 to 2.342)) at a lag of 4 months. We found that ownership of radio RR 0.29, (95% CI 0.109 to 0.776) and mobile phones RR 0.262 (95% CI 0.097 to 0.711) were significantly associated with low cholera risk.CONCLUSION: The derived lagged patterns can provide appropriate lead times in a climate-driven cholera early warning system that could contribute to the prevention and management of outbreaks.
|
|
| 9. |
- Bowman, Leigh, et al.
(författare)
-
A comparison of Zika and dengue outbreaks using national surveillance data in the Dominican Republic
- 2018
-
Ingår i: PLoS Neglected Tropical Diseases. - : Public Library Science. - 1935-2727 .- 1935-2735. ; 12:11
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Aedes-borne arboviruses continue to precipitate epidemics worldwide. In Dominican Republic, the appearance of Zika virus cases that closely followed a large dengue epidemic provided an opportunity to study the different transmission drivers behind these two flaviviruses. Retrospective datasets were used to collect information on the populations at risk and descriptive statistics were used to describe the outbreaks on a national scale.METHODOLOGY/ PRINCIPAL FINDINGS: Expectedly, box plots showed that 75% of dengue was reported in those aged <20 years while Zika infections were more widely dispersed among the population. Dengue attack rates were marginally higher among males at 25.9 per 10,000 population vs. 21.5 per 10,000 population for females. Zika infections appeared to be highly clustered among females (73.8% (95% CI 72.6%, 75.0%; p<0.05)); age-adjusted Zika attack rates among females were 7.64 per 10,000 population compared with 2.72 per 10,000 population among males. R0 calculations stratified by sex also showed a significantly higher metric among females: 1.84 (1.82, 1.87; p<0.05) when compared to males at 1.72 (1.69, 1.75; p<0.05). However, GBS attack rates stratified by sex revealed slightly higher risk in males vs. females, at 0.62 and 0.57 per 10,000 population respectively.CONCLUSIONS/ SIGNIFICANCE: Evidence suggests little impact of existing dengue immunity on reported attack rates of Zika at the population level. Confounding of R0 and incident risk calculations by sex-specific over-reporting can alter the reliability of epidemiological metrics, which could be addressed using associated proxy syndromes or conditions to explore seemingly sex-skewed incidence. The findings indicate that community awareness campaigns, through influencing short-term health seeking behaviour, remain the most plausible mechanism behind increased reporting among women of reproductive age, although biological susceptibility cannot yet be ruled out. Media campaigns and screening are therefore recommended for women of reproductive age during Zika outbreaks. Future research should focus on clinical Zika outcomes among dengue seropositive individuals.
|
|
| 10. |
- Brännström, Åke, 1975-, et al.
(författare)
-
A Method for Estimating the Number of Infections From the Reported Number of Deaths
- 2022
-
Ingår i: Frontiers in Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- At the outset of an epidemic, available case data typically underestimate the total number of infections due to insufficient testing, potentially hampering public responses. Here, we present a method for statistically estimating the true number of cases with confidence intervals from the reported number of deaths and estimates of the infection fatality ratio; assuming that the time from infection to death follows a known distribution. While the method is applicable to any epidemic with a significant mortality rate, we exemplify the method by applying it to COVID-19. Our findings indicate that the number of unreported COVID-19 infections in March 2020 was likely to be at least one order of magnitude higher than the reported cases, with the degree of underestimation among the countries considered being particularly high in the United Kingdom.
|
|
| 11. |
- Colon-Gonzalez, J. Felipe, et al.
(författare)
-
Projecting the risk of mosquito-borne diseases in a warmer and more populated world : a multi-model, multi-scenario intercomparison modelling study
- 2021
-
Ingår i: The Lancet Planetary Health. - : Elsevier. - 2542-5196. ; 5:7, s. E404-E414
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Mosquito-borne diseases are expanding their range, and re-emerging in areas where they had subsided for decades. The extent to which climate change influences the transmission suitability and population at risk of mosquito-borne diseases across different altitudes and population densities has not been investigated. The aim of this study was to quantify the extent to which climate change will influence the length of the transmission season and estimate the population at risk of mosquito-borne diseases in the future, given different population densities across an altitudinal gradient.Methods: Using a multi-model multi-scenario framework, we estimated changes in the length of the transmission season and global population at risk of malaria and dengue for different altitudes and population densities for the period 1951-99. We generated projections from six mosquito-borne disease models, driven by four global circulation models, using four representative concentration pathways, and three shared socioeconomic pathways.Findings: We show that malaria suitability will increase by 1·6 additional months (mean 0·5, SE 0·03) in tropical highlands in the African region, the Eastern Mediterranean region, and the region of the Americas. Dengue suitability will increase in lowlands in the Western Pacific region and the Eastern Mediterranean region by 4·0 additional months (mean 1·7, SE 0·2). Increases in the climatic suitability of both diseases will be greater in rural areas than in urban areas. The epidemic belt for both diseases will expand towards temperate areas. The population at risk of both diseases might increase by up to 4·7 additional billion people by 2070 relative to 1970-99, particularly in lowlands and urban areas.Interpretation: Rising global mean temperature will increase the climatic suitability of both diseases particularly in already endemic areas. The predicted expansion towards higher altitudes and temperate regions suggests that outbreaks can occur in areas where people might be immunologically naive and public health systems unprepared. The population at risk of malaria and dengue will be higher in densely populated urban areas in the WHO African region, South-East Asia region, and the region of the Americas, although we did not account for urban-heat island effects, which can further alter the risk of disease transmission.
|
|
| 12. |
- DiSera, Laurel, et al.
(författare)
-
The Mosquito, the Virus, the Climate : An Unforeseen Réunion in 2018
- 2020
-
Ingår i: GeoHealth. - : John Wiley & Sons. - 2471-1403. ; 4:8
-
Tidskriftsartikel (refereegranskat)abstract
- The 2018 outbreak of dengue in the French overseas department of Réunion was unprecedented in size and spread across the island. This research focuses on the cause of the outbreak, asserting that climate played a large role in the proliferation of the Aedes albopictus mosquitoes, which transmitted the disease, and led to the dengue outbreak in early 2018. A stage‐structured model was run using observed temperature and rainfall data to simulate the life cycle and abundance of the Ae. albopictus mosquito. Further, the model was forced with bias‐corrected subseasonal forecasts to determine if the event could have been forecast up to 4 weeks in advance. With unseasonably warm temperatures remaining above 25°C, along with large tropical‐cyclone‐related rainfall events accumulating 10–15 mm per event, the modeled Ae. albopictus mosquito abundance did not decrease during the second half of 2017, contrary to the normal behavior, likely contributing to the large dengue outbreak in early 2018. Although subseasonal forecasts of rainfall for the December–January period in Réunion are skillful up to 4 weeks in advance, the outbreak could only have been forecast 2 weeks in advance, which along with seasonal forecast information could have provided enough time to enhance preparedness measures. Our research demonstrates the potential of using state‐of‐the‐art subseasonal climate forecasts to produce actionable subseasonal dengue predictions. To the best of the authors' knowledge, this is the first time subseasonal forecasts have been used this way.
|
|
| 13. |
- Doum, Dyna, et al.
(författare)
-
Dengue Seroprevalence and Seroconversion in Urban and Rural Populations in Northeastern Thailand and Southern Laos
- 2020
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:23
-
Tidskriftsartikel (refereegranskat)abstract
- Dengue is the most rapidly spreading mosquito-borne viral disease in the world. The detection of clinical cases enables us to measure the incidence of dengue infection, whereas serological surveys give insights into the prevalence of infection. This study aimed to determine dengue seroprevalence and seroconversion rates in northeastern Thailand and southern Laos and to assess any association of mosquito control methods and socioeconomic factors with dengue virus (DENV) infection. Cross-sectional seroprevalence surveys were performed in May and November 2019 on the same individuals. Blood samples were collected from one adult and one child, when possible, in each of 720 randomly selected households from two urban and two rural sites in both northeastern Thailand and southern Laos. IgG antibodies against DENV were detected in serum using a commercial enzyme-linked immunosorbent assay (ELISA) kit. Overall, 1071 individuals participated in the study. The seroprevalence rate was high (91.5%) across all 8 study sites. Only age and province were associated with seroprevalence rates. There were 33 seroconversions during the period from May to November, of which seven reported fever. More than half of the seroconversions occurred in the rural areas and in Laos. Dengue seroconversion was significantly associated with young age (<15 years old), female gender, province, and duration of living in the current residence. No socioeconomic factors or mosquito control methods were found to be associated with seroprevalence or seroconversion. Notably, however, the province with most seroconversions had lower diurnal temperature ranges than elsewhere. In conclusion, our study has highlighted the homogeneity of dengue exposure across a wide range of settings and most notably those from rural and urban areas. Dengue can no longer be considered to be solely an urban disease nor necessarily one linked to poverty.
|
|
| 14. |
- Farooq, Zia, et al.
(författare)
-
Artificial intelligence to predict West Nile virus outbreaks with eco-climatic drivers
- 2022
-
Ingår i: The Lancet Regional Health - Europe. - : Elsevier BV. - 2666-7762. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In Europe, the frequency, intensity, and geographic range of West Nile virus (WNV)-outbreaks have increased over the past decade, with a 7.2-fold increase in 2018 compared to 2017, and a markedly expanded geographic area compared to 2010. The reasons for this increase and range expansion remain largely unknown due to the complexity of the transmission pathways and underlying disease drivers. In a first, we use advanced artificial intelligence to disentangle the contribution of eco-climatic drivers to WNV-outbreaks across Europe using decade-long (2010-2019) data at high spatial resolution. Methods: We use a high-performance machine learning classifier, XGBoost (eXtreme gradient boosting) combined with state-of-the-art XAI (eXplainable artificial intelligence) methodology to describe the predictive ability and contribution of different drivers of the emergence and transmission of WNV-outbreaks in Europe, respectively. Findings: Our model, trained on 2010-2017 data achieved an AUC (area under the receiver operating characteristic curve) score of 0.97 and 0.93 when tested with 2018 and 2019 data, respectively, showing a high discriminatory power to classify a WNV-endemic area. Overall, positive summer/spring temperatures anomalies, lower water availability index (NDWI), and drier winter conditions were found to be the main determinants of WNV-outbreaks across Europe. The climate trends of the preceding year in combination with eco-climatic predictors of the first half of the year provided a robust predictive ability of the entire transmission season ahead of time. For the extraordinary 2018 outbreak year, relatively higher spring temperatures and the abundance of Culex mosquitoes were the strongest predictors, in addition to past climatic trends. Interpretation: Our AI-based framework can be deployed to trigger rapid and timely alerts for active surveillance and vector control measures in order to intercept an imminent WNV-outbreak in Europe. Funding: The work was partially funded by the Swedish Research Council FORMAS for the project ARBOPREVENT (grant agreement 2018-05973).
|
|
| 15. |
|
|
| 16. |
- Farooq, Zia, et al.
(författare)
-
European projections of West Nile virus transmission under climate change scenarios
- 2023
-
Ingår i: One Health. - : Elsevier. - 2352-7714. ; 16
-
Tidskriftsartikel (refereegranskat)abstract
- West Nile virus (WNV), a mosquito-borne zoonosis, has emerged as a disease of public health concern in Europe. Recent outbreaks have been attributed to suitable climatic conditions for its vectors favoring transmission. However, to date, projections of the risk for WNV expansion under climate change scenarios is lacking. Here, we estimate the WNV-outbreaks risk for a set of climate change and socioeconomic scenarios. We delineate the potential risk-areas and estimate the growth in the population at risk (PAR). We used supervised machine learning classifier, XGBoost, to estimate the WNV-outbreak risk using an ensemble climate model and multi-scenario approach. The model was trained by collating climatic, socioeconomic, and reported WNV-infections data (2010−22) and the out-of-sample results (1950–2009, 2023–99) were validated using a novel Confidence-Based Performance Estimation (CBPE) method. Projections of area specific outbreak risk trends, and corresponding population at risk were estimated and compared across scenarios. Our results show up to 5-fold increase in West Nile virus (WNV) risk for 2040-60 in Europe, depending on geographical region and climate scenario, compared to 2000-20. The proportion of disease-reported European land areas could increase from 15% to 23-30%, putting 161 to 244 million people at risk. Across scenarios, Western Europe appears to be facing the largest increase in the outbreak risk of WNV. The increase in the risk is not linear but undergoes periods of sharp changes governed by climatic thresholds associated with ideal conditions for WNV vectors. The increased risk will require a targeted public health response to manage the expansion of WNV with climate change in Europe.
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
- Hollowell, Thomas, et al.
(författare)
-
Public health determinants of child malaria mortality : a surveillance study within Siaya County, Western Kenya
- 2023
-
Ingår i: Malaria Journal. - : BioMed Central (BMC). - 1475-2875. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Malaria deaths among children have been declining worldwide during the last two decades. Despite preventive, epidemiologic and therapy-development work, mortality rate decline has stagnated in western Kenya resulting in persistently high child malaria morbidity and mortality. The aim of this study was to identify public health determinants influencing the high burden of malaria deaths among children in this region.Methods: A total of 221,929 children, 111,488 females and 110,441 males, under the age of 5 years were enrolled in the Kenya Medical Research Institute/Center for Disease Control Health and Demographic Surveillance System (KEMRI/CDC HDSS) study area in Siaya County during the period 2003–2013. Cause of death was determined by use of verbal autopsy. Age-specific mortality rates were computed, and cox proportional hazard regression was used to model time to malaria death controlling for the socio-demographic factors. A variety of demographic, social and epidemiologic factors were examined.Results: In total 8,696 (3.9%) children died during the study period. Malaria was the most prevalent cause of death and constituted 33.2% of all causes of death, followed by acute respiratory infections (26.7%) and HIV/AIDS related deaths (18.6%). There was a marked decrease in overall mortality rate from 2003 to 2013, except for a spike in the rates in 2008. The hazard of death differed between age groups with the youngest having the highest hazard of death HR 6.07 (95% CI 5.10–7.22). Overall, the risk attenuated with age and mortality risks were limited beyond 4 years of age. Longer distance to healthcare HR of 1.44 (95% CI 1.29–1.60), l ow maternal education HR 3.91 (95% CI 1.86–8.22), and low socioeconomic status HR 1.44 (95% CI 1.26–1.64) were all significantly associated with increased hazard of malaria death among children.Conclusions: While child mortality due to malaria in the study area in Western Kenya, has been decreasing, a final step toward significant risk reduction is yet to be accomplished. This study highlights residual proximal determinants of risk which can further inform preventive actions.
|
|
| 20. |
- Iftekhar, Emil Nafis, et al.
(författare)
-
A look into the future of the COVID-19 pandemic in Europe : an expert consultation
- 2021
-
Ingår i: The Lancet Regional Health. - : Elsevier. - 2666-7762. ; 8
-
Tidskriftsartikel (refereegranskat)abstract
- How will the coronavirus disease 2019 (COVID-19) pandemic develop in the coming months and years? Based on an expert survey, we examine key aspects that are likely to influence the COVID-19 pandemic in Europe. The challenges and developments will strongly depend on the progress of national and global vaccination programs, the emergence and spread of variants of concern (VOCs), and public responses to non-pharmaceutical interventions (NPIs). In the short term, many people remain unvaccinated, VOCs continue to emerge and spread, and mobility and population mixing are expected to increase. Therefore, lifting restrictions too much and too early risk another damaging wave. This challenge remains despite the reduced opportunities for transmission given vaccination progress and reduced indoor mixing in summer 2021. In autumn 2021, increased indoor activity might accelerate the spread again, whilst a necessary reintroduction of NPIs might be too slow. The incidence may strongly rise again, possibly filling intensive care units, if vaccination levels are not high enough. A moderate, adaptive level of NPIs will thus remain necessary. These epidemiological aspects combined with economic, social, and health-related consequences provide a more holistic perspective on the future of the COVID-19 pandemic.
|
|
| 21. |
- Ingole, Vijendra, et al.
(författare)
-
Socioenvironmental factors associated with heat and cold-related mortality in Vadu HDSS, western India : a population-based case-crossover study
- 2017
-
Ingår i: International journal of biometeorology. - : Springer. - 0020-7128 .- 1432-1254. ; 61:10, s. 1797-1804
-
Tidskriftsartikel (refereegranskat)abstract
- Ambient temperatures (heat and cold) are associated with mortality, but limited research is available about groups most vulnerable to these effects in rural populations. We estimated the effects of heat and cold on daily mortality among different sociodemographic groups in the Vadu HDSS area, western India. We studied all deaths in the Vadu HDSS area during 2004-2013. A conditional logistic regression model in a case-crossover design was used. Separate analyses were carried out for summer and winter season. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for total mortality and population subgroups. Temperature above a threshold of 31 A degrees C was associated with total mortality (OR 1.48, CI = 1.05-2.09) per 1 A degrees C increase in daily mean temperature. Odds ratios were higher among females (OR 1.93; CI = 1.07-3.47), those with low education (OR 1.65; CI = 1.00-2.75), those owing larger agricultural land (OR 2.18; CI = 0.99-4.79), and farmers (OR 1.70; CI = 1.02-2.81). In winter, per 1 A degrees C decrease in mean temperature, OR for total mortality was 1.06 (CI = 1.00-1.12) in lag 0-13 days. High risk of cold-related mortality was observed among people occupied in housework (OR = 1.09; CI = 1.00-1.19). Our study suggests that both heat and cold have an impact on mortality particularly heat, but also, to a smaller degree, cold have an impact. The effects may differ partly by sex, education, and occupation. These findings might have important policy implications in preventing heat and cold effects on particularly vulnerable groups of the rural populations in low and middle-income countries with hot semi-arid climate.
|
|
| 22. |
- Karlsson, Oskar, et al.
(författare)
-
The human exposome and health in the Anthropocene
- 2021
-
Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 50:2, s. 378-389
-
Tidskriftsartikel (refereegranskat)
|
|
| 23. |
- Kien, Tran Mai, et al.
(författare)
-
Climate Services For Infectious Disease Control: A Nexus Between Public Health Preparedness and Sustainable Development, Lessons Learned From Long-Term Multi Site Time Series Analysis of Dengue Fever in Vietnam
- 2016
-
Ingår i: International conference on public health: Accelerating the achievement of sustainable development goals for the improvement and equitable distribution of population health. ; , s. 83-84
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Climate Services provide valuable information for making actionable, data-driven decisions to protect public health in a myriad of manners. There is mounting global evidence of the looming threat climate change poses to human health, including the variability and intensity of infectious disease outbreaks in Vietnam and other low-resource and developing areas. In light of the Sustainable Development Goals, lessons learned from time-series analysis may inform public health preparedness strategies for sustainable urban development in terms of dengue epidemiology, surveillance, control, and early warnings.Subjects and Methods: Nearly 40 years of spatial and temporal (times-series) dataset of meteorological records, including rainfall, temperature, and humidity (among others) which can be predictors of dengue were assembled for all provinces of Vietnam and associated with case data reported to General Department of Preventive Medicine, Ministry of Health of Vietnam during the same period. Time series of climate and disease variables was analyzed for trends and changing patterns of those variables over time. The time-series statistical analysis methods sought to identify spatial (when possible) and temporal trends, seasonality, cyclical patterns of disease, and to discover anomalous outbreak events, which departed from expected epidemiological patterns and corresponding meteorological phenomena, such as El Nino Southern Oscillation (ENSO).Results: Analysis yielded largely conserved finding with other locations in South East Asia for larger Outbreak years and events such as ENSO. Seasonality, trend, and cycle in many provinces were persistent throughout the dataset, indicating strong potential for Climate Services to be used in dengue early warnings.Conclusion: Even public health practitioners, having adequate tools for dengue control available must plan and budget vector control and patient treatment efforts well in advance of large scale dengue epidemics to curb such events overall morbidity and mortality. Similarly, urban and sustainable development in Vietnam might benefit from evidence linking climate change, and ill-health events spatially and temporally in future planning. Long term analysis of dengue case data and meteorological records, provided a cases study evidence for emerging opportunities that on how refined climate services could contribute to protection of public health.
|
|
| 24. |
- Kim, Sooyoung, et al.
(författare)
-
A systematic review of the evidence on the effectiveness and cost-effectiveness of mass screen-and-treat interventions for Malaria control
- 2021
-
Ingår i: American Journal of Tropical Medicine and Hygiene. - : American Society of Tropical Medicine and Hygiene. - 0002-9637 .- 1476-1645. ; 105:6, s. 1722-1731
-
Forskningsöversikt (refereegranskat)abstract
- Malaria elimination and eradication efforts have stalled globally. Further, asymptomatic infections as silent transmission reservoirs are considered a major challenge to malaria elimination efforts. There is increased interest in a mass screen-and-treat (MSAT) strategy as an alternative to mass drug administration to reduce malaria burden and transmission in endemic settings. This study systematically synthesized the existing evidence on MSAT, from both epidemiological and economic perspectives. Searches were conducted on six databases (PubMed, EMBASE, CINALH, Web of Science, Global Health, and Google Scholar) between October and December 2020. Only experimental and quasi-experimental studies assessing the effectiveness and/or cost-effectiveness of MSAT in reducing malaria prevalence or incidence were included. Of the 2,424 citation hits, 14 studies based on 11 intervention trials were eligible. Eight trials were conducted in sub-Saharan Africa and three trials in Asia. While five trials targeted the community as a whole, pregnant women were targeted in five trials, and school children in one trial. Transmission setting, frequency, and timing of MSAT rounds, and measured outcomes varied across studies. The pooled effect size of MSAT in reducing malaria incidence and prevalence was marginal and statistically nonsignificant. Only one study conducted an economic evaluation of the intervention and found it to be cost-effective when compared with the standard of care of no MSAT. We concluded that the evidence for implementing MSAT as part of a routine malaria control program is growing but limited. More research is necessary on its short- and longer-term impacts on clinical malaria and malaria transmission and its economic value.
|
|
| 25. |
- Landrigan, Philip J., et al.
(författare)
-
Human Health and Ocean Pollution
- 2020
-
Ingår i: Annals of Global Health. - : Ubiquity Press. - 2214-9996. ; 86:1
-
Forskningsöversikt (refereegranskat)abstract
- Background: Pollution - unwanted waste released to air, water, and land by human activity - is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood.Goals: (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health.Methods: Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention.Environmental Findings: Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources - coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths.Ecosystem Findings: Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks.Human Health Findings: Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children's risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals - phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste - can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South - environmental injustice on a planetary scale.Conclusions: Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth's resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted. Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored. Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries.Recommendations: World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health. Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress. Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries. Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas.
|
|
