Dengue Outbreak Response During COVID-19 Pandemic, Key Largo, Florida, USA, 2020

We report a dengue outbreak in Key Largo, Florida, USA, from February through August 2020, during the COVID-19 pandemic. Successful community engagement resulted in 61% of case-patients self-reporting. We also describe COVID-19 pandemic effects on the dengue outbreak investigation and the need to increase clinician awareness of dengue testing recommendations

J Travel Med

BackgroundDengue is a leading cause of febrile illness among international travelers. We aimed to describe the epidemiology and clinical characteristics of imported dengue in returning travelers evaluated at GeoSentinel sites from 2007\u20132022.MethodsWe retrieved GeoSentinel records of dengue among travelers residing in non-endemic countries. We considered dengue confirmed when diagnosed by a positive DENV-specific RT-PCR, positive NS-1 antigen, and/or anti-DENV IgG seroconversion, and probable when diagnosed by single anti-DENV IgM or high titer anti-DENV IgG detection. Severe dengue was defined as evidence of clinically significant plasma leakage or bleeding, organ failure, or shock, according to the 2009 WHO guidance. Complicated dengue was defined as either severe dengue or dengue with presence of any warning sign. Analyses were descriptive.ResultsThis analysis included 5,958 travelers with confirmed (n=4,859; 81.6%) or probable (n=1,099; 18.4%) dengue. The median age was 33 years (range: <1\u201391); 3,007 (50.5%) travelers were female. The median travel duration was 21 days (interquartile range [IQR]: 15\u201332). The median time between illness onset and GeoSentinel site visit was 7 days (IQR: 4\u201315). The most frequent reasons for travel were tourism (67.3%), visiting friends or relatives (12.2%), and business (11.0%). The most frequent regions of acquisition were Southeast Asia (50.4%), South-Central Asia (14.9%), the Caribbean (10.9%), and South America (9.2%). Ninety-five (1.6%) travelers had complicated dengue, of whom 27 (0.5%) had severe dengue, and one died. Of 2,710 travelers with data available, 724 (26.7%) were hospitalized. The largest number of cases (n=835) was reported in 2019.ConclusionsA broad range of international travelers should be aware of the risk of acquiring dengue and receive appropriate pretravel counselling regarding preventive measures. Prospective cohort studies are needed to further elucidate dengue risk by destination and over time, as well as severe outcomes and prolonged morbidity (long-dengue) due to travel-related dengue.GeoSentinel Foundation/ISTM/Public Health Agency of Canada/U01 CK000632/CK/NCEZID CDC HHSUnited States/US Centers for Disease Control and Prevention/1 U01CK000632-01-00/International Society of Travel Medicine

BIG DATA APPLICATIONS AND CHALLENGES IN GISCIENCE (CASE STUDIES: NATURAL DISASTER AND PUBLIC HEALTH CRISIS MANAGEMENT)

This dissertation examines the application and significance of user-generated big data in Geographic Information Science (GIScience), with a focus on managing natural disasters and public health crises. It explores the role of social media data in understanding human-environment interactions and in informing disaster management and public health strategies. A scalable computational framework will be developed to model extensive unstructured geotagged data from social media, facilitating systematic spatiotemporal data analysis.The research investigates how individuals and communities respond to high-impact events like natural disasters and public health emergencies, employing both qualitative and quantitative methods. In particular, it assesses the impact of socio-economic-demographic characteristics and the digital divide on social media engagement during such crises. In addressing the opioid crisis, the dissertation delves into the spatial dynamics of opioid overdose deaths, utilizing Multiscale Geographically Weighted Regression to discern local versus broader-scale determinants. This analysis foregrounds the necessity for targeted public health responses and the importance of localized data in crafting effective interventions, especially within communities that are ethnically diverse and economically disparate. Using Hurricane Irma as a case study, this dissertation analyzes social media activity in Florida in September 2017, leveraging Multiscale Geographically Weighted Regression to explore spatial variations in social media discourse, its correlation with damage severity, and the disproportionate impact on racialized communities. It integrates social media data analysis with political-ecological perspectives and spatial analytical techniques to reveal structural inequalities and political power differentials. The dissertation also tackles the dissemination of false information during the COVID-19 pandemic, examining Twitter activity in the United States from April to July 2020. It identifies misinformation patterns, their origins, and their association with the pandemic\u27s incidence rates. Discourse analysis pinpoints tweets that downplay the pandemic\u27s severity or spread disinformation, while spatial modeling investigates the relationship between social media discourse and disease spread. By concentrating on the experiences of racialized communities, this research aims to highlight and address the environmental and social injustices they face. It contributes empirical and methodological insights into effective policy formulation, with an emphasis on equitable responses to public health emergencies and natural disasters. This dissertation not only provides a nuanced understanding of crisis responses but also advances GIScience research by incorporating social media data into both traditional and critical analytical frameworks

Chapter 15: Human Health

Climate change has profound negative effects on human health. Climate-related extreme events that impact the US population include floods, droughts, wildfires, extreme temperatures, and storms. All are expected to increase in frequency, intensity, and extent (KM 2.2). Health risks from a changing climate include higher rates of heat-related morbidity and mortality; increases in the geographic range of some infectious diseases; greater exposure to poor air quality; increases in some adverse pregnancy outcomes; higher rates of pulmonary, neurological, and cardiovascular diseases; and worsening mental health. These risks affect all US residents but have disproportionate repercussions for under-resourced and overburdened communities and individuals, such as pregnant people, communities of color, children, people with disabilities, people experiencing homelessness, people with chronic diseases, and older adults. Structural racism and discrimination against groups that have been marginalized play a direct role in health inequities and are public health crises.8 Existing and projected human health impacts of climate change affect populations that are already experiencing an unprecedented decline in life expectancy due to environmental, social, political, and economic conditions that determine community health and well-being. Creating climate-resilient health systems, implementing adaptation measures, and mitigating greenhouse gas (GHG) emissions can protect human health

Evaluación de la aplicación de insecticidas comerciales residuales, para el control de Aedes aegypti en Yucatán

Se llevaron a cabo dos experimentos: i) de laboratorio con el uso de cinco sustratos: concreto, madera, malla mosquitera, loza y tela y ii) de campo simulado en seis viviendas experimentales; para evaluar la bioeficacia de dos insecticidas residuales en aerosol disponibles para el público: H24 Poder Fulminante Ultra Eficaz y Baygón Ultra Verde. Para el experimento en laboratorio, cada insecticida se probó contra mosquitos hembra adultas de Aedes aegypti criados en laboratorio, rociando cada sustrato según lo indicado en la etiqueta del fabricante. Se realizaron bioensayos con cuatro conos (un ensayo y tres réplicas, con 10 mosquitos cada uno) recomendados por la OMS. Para el experimento en campo simulado, se adecuaron dos habitaciones: una utilizada como tratamiento con rociado con insecticida residual y otra como control sin rociar con sitios de reposo para mosquitos. El insecticida fue rociado en los sitios destinados: armario, buró, cama, cortinas y paredes. Se liberaron 100 mosquitos, se dejaron por 24 horas y se recolectaron al día siguiente. Todos los mosquitos luego de cada experimento se transfirieron a vasos de papel limpios. Cada experimento se repitió cada semana hasta que las mortalidades fueron de ≤50% que fue cuando se interrumpieron. Los dos aerosoles indujeron mortalidad completa durante al menos las primeras dos semanas en ambas cepas de mosquitos en los sustratos rociados. Los resultados en las viviendas experimentales demuestran que no hubo diferencias significativas durante las tres primeras semanas del estudio, es decir, que se colectó el número máximo de mosquitos muertos en cada casa experimental. Sin embargo, fue a partir de la semana tres cuando se presenta una diferencia en la que hubo una reducción en la mortalidad de los adultos de Ae. aegypti que representa una pérdida de la eficacia del insecticida. Los resultados demuestran que es necesario implementar nuevas medidas de control de Ae. Aegypti, con una racionalización en el uso de insecticidas y un mejor control matando mosquitos durante más tiempo con solo rociar determinadas aéreas de las viviendas. De igual manera se reporta que los insecticidas son efectivos si se utilizan según las especificaciones del fabricante. Abstract Two experiments were carried out: i) laboratory with the use of five substrates: concrete, wood, mosquito net, crockery and cloth and ii) simulated field in six experimental dwellings; to evaluate the bioefficacy of two residual aerosol insecticides available to the public: H24 Ultra Effective Fulminating Power and Baygon Ultra Green. For the laboratory experiment, each insecticide was tested against adult female Aedes aegypti mosquitoes reared in the laboratory, spraying each substrate as indicated on the manufacturer's label. Bioassays were carried out with four cones (one trial and three replicates, with 10 mosquitoes each) recommended by WHO. For the simulated field experiment, two rooms were adapted: one used as treatment with residual insecticide spraying and another as a control without spraying with rest sites for mosquitoes. The insecticide was sprayed at the intended sites: wardrobe, bureau, bed, curtains and walls. 100 mosquitoes were released, left for 24 hours and collected the next day. All mosquitoes after each experiment were transferred to clean paper cups. Each experiment was repeated every week until the mortalities were ≤50%, which was when they were interrupted. The two aerosols induced complete mortality for at least the first two weeks in both strains of mosquitoes on the sprayed substrates. The results in the experimental dwellings show that there were no significant differences during the first three weeks of the study, that is, that the maximum number of dead mosquitoes was collected in each experimental house. However, it was from week three when there is a difference in which there was a reduction in the mortality of adults of Ae. aegypti which represents a loss of the effectiveness of the insecticide. The results show that it is necessary to implement new Ae. Aegypti, with a rationalization in the use of insecticides and better control by killing mosquitoes for a longer time just by spraying certain areas of the houses. In the same way it is reported that insecticides are effective if they are used according to the manufacturer'sspecifications

Force Majeure and Hardship in the Age of Corona

Source info: McGill Journal of Dispute Resolution, Forthcomin

Arboviruses in Mammals in the Neotropics: A Systematic Review to Strengthen Epidemiological Monitoring Strategies and Conservation Medicine.

peer reviewedArthropod-borne viruses (arboviruses) are a diverse group of ribonucleic acid (RNA) viruses, with the exception of African swine fever virus, that are transmitted by hematophagous arthropods to a vertebrate host. They are the important cause of many diseases due to their ability to spread in different environments and their diversity of vectors. Currently, there is no information on the geographical distribution of the diseases because the routes of transmission and the mammals (wild or domestic) that act as potential hosts are poorly documented or unknown. We conducted a systematic review from 1967 to 2021 to identify the diversity of arboviruses, the areas, and taxonomic groups that have been monitored, the prevalence of positive records, and the associated risk factors. We identified forty-three arboviruses in nine mammalian orders distributed in eleven countries. In Brazil, the order primates harbor the highest number of arbovirus records. The three most recorded arboviruses were Venezuelan equine encephalitis, Saint Louis encephalitis and West Nile virus. Serum is the most used sample to obtain arbovirus records. Deforestation is identified as the main risk factor for arbovirus transmission between different species and environments (an odds ratio of 1.46 with a 95% confidence interval: 1.34-1.59). The results show an increase in the sampling effort over the years in the neotropical region. Despite the importance of arboviruses for public health, little is known about the interaction of arboviruses, their hosts, and vectors, as some countries and mammalian orders have not yet been monitored. Long-term and constant monitoring allows focusing research on the analysis of the interrelationships and characteristics of each component animal, human, and their environment to understand the dynamics of the diseases and guide epidemiological surveillance and vector control programs. The biodiversity of the Neotropics should be considered to support epidemiological monitoring strategies

The use of mobile applications for tracking and monitoring COVID19 cases and their contribution to pandemic surveillance and control. Systematic review

Traballo Fin de Grao en Medicina. Curso 2020-2021Complementando diferentes estrategias de control y mientras los programas de vacunación surgían efecto muchos países buscaron apoyar el rastreo de contactos COVID-19 con el uso de aplicaciones digitales. La principal función de estas es el registro automático del tiempo de interacción entre sus usuarios para la detección de contactos de riesgo y acelerar el diagnostico de nuevas infecciones. El uso de estas aplicaciones genera controversias, principalmente por cuestiones de privacidad y seguridad, y la posible vulneración de la legislación de protección de datos de cada país. Nuestro objetivo es revisar la evidencia disponible sobre las aplicaciones de rastreo de contactos; en esta revisión analizamos específicamente los países que las han implementado, sus características y la posible efectividad en el control de la pandemia. Realizamos una revisión sistematizada de estudios observacionales o de modelado matemático publicados en español e inglés indexados en Pubmed y Cochrane sobre estas aplicaciones. Tras la evaluación de calidad, sintetizamos la información por países en cuanto finalidad, tecnología, gestión de datos, fecha de distribución, nivel de adopción y su posible influencia en el control pandémico. Se analizan 54 publicaciones que hacen referencia a 83 aplicaciones de rastreo digital de 62 países, de ellas 35 usan un sistema de rastreo por proximidad, 16 por geolocalización, 17 por geolocalización y proximidad, siendo una minoría las que usan otros sistemas, principalmente en Asia. Parece que, para que sean útiles por si mismas, deben ser adoptadas por al menos el 60-80% de la población, aunque con cifras del 20-25% reducen la transmisibilidad si se aplican simultáneamente con otras medidas de salud publica. Pese al potencial beneficio que aportan en el control de la pandemia su adopción en occidente ha sido limitada, de ahí que se deban idear medidas para vencer resistencias, interconectar servicios y demostrar su utilidad en los nuevos escenariosdiferentes estratexias de control e mentres os programas de vacinación estaban entrando en vigor, moitos países intentaron apoiar o rastrexo de contactos COVID-19 co uso de aplicacións dixitais. A súa función principal é rexistrar automaticamente o tempo de interacción entre os seus usuarios para detectar contactos de risco e acelerar o diagnóstico de novas infeccións. O uso destas aplicacións xera controversias, principalmente por problemas de privacidade e seguridade, e a posible violación da lexislación de protección de datos de cada país. O noso obxectivo é revisar a evidencia dispoñible sobre as aplicacións de rastrexo de contactos; Nesta revisión, analizamos especificamente os países que as implementaron, as súas características e a súa posible eficacia no control da pandemia. Realizamos unha revisión sistemática de estudos de modelos observacionais ou matemáticos publicados en español e inglés indexados en Pubmed e Cochrane sobre estas aplicacións. Despois da avaliación da calidade, sintetizamos a información por países sobre propósito, tecnoloxía, xestión de datos, data de distribución, nivel de adopción e a súa posible influencia no control da pandemia. Analízanse 54 publicacións que fan referencia a 83 aplicacións de rastrexo dixital de 62 países, das cales 35 utilizan un sistema de rastrexo de proximidade, 16 por xeolocalización, 17 por xeolocalización e proximidade, sendo unha minoría as que utilizan outros sistemas como códigos QR, principalmente en Asia. Parece que, para seren útiles por si mesmas, deben ser adoptados polo menos polo 60-80% da poboación, aínda que con cifras do 20 ao 25% reducen a transmisibilidade se se aplican simultaneamente con outras medidas de saúde pública. A pesar do potencial beneficio que proporcionan no control da pandemia, a súa adopción en Occidente foi limitada, polo que hai que idear medidas para superar a resistencia, interconectar servizos e demostrar a súa utilidade en novos escenariosMany countries sought to support COVID-19 contact tracing with the use of digital applications as a supplement for different control strategies and while vaccination programmes are emerging. The main function of these is the automatic recording of interaction time between users to detect risk contacts and accelerate the diagnosis of new infections. The use of these applications generates controversy, mainly due to privacy and security issues, and the possible violation of data protection legislation in each country. Our objective is to review the evidence about contact tracing applications; in this review we specifically analyse the countries that have implemented them, their characteristics and their possible effectiveness in controlling the pandemic. We conducted a systematised review of observational or mathematical modelling studies published in English and Spanish and indexed in Pubmed and Cochrane. After quality assessment, we synthesised the information by country in terms of purpose, technology, data management, date of distribution, level of adoption and their potential influence on pandemic control. We analysed 54 publications referring to 83 digital tracking applications from 62 countries, of which 35 use a proximity tracking system, 16 use geolocation, 17 use geolocation and proximity, and a minority use other systems like QR codes, mainly in Asia. It appears that, to be useful on their own, they need to be adopted by at least 60-80% of the population, although levels of 20-25% reduce transmissibility if applied simultaneously with other public health measures. Despite their potential benefit in pandemic control, their adoption in Western countries has been limited, hence interventions must be devised to overcome resistance, link services and demonstrate their usefulness in new epidemiologic scenari

Epidemiological conditions to support dengue vaccine introduction in Asia using data from traditional and novel sources

Dengue, an Aedes mosquito-borne flavivirus, is the most common vector-borne viral infection worldwide. Infections result in around 100 million (95% credible interval: 67 - 136 million) clinical episodes and 10.5 million (95% uncertainty intervals: 4.1 – 22.7 million) hospitalizations annually, mostly within the Asia Pacific region. There are four closely related viral serotypes, all of which cause severe disease. First infections are often mild/asymptomatic but subsequent infections with heterologous serotypes more frequently result in severe episodes and hospitalisations. National surveillance systems are not designed to estimate the full disease burden and the value of preventive measures is therefore poorly defined. In 2014 the first dengue vaccine, CYD-TDV, was licensed having demonstrated significant efficacy against all four serotypes in study participants aged 2 – 16 years. Subsequent analyses after 5 years’ follow-up revealed a more complex vaccine profile with superior protection in individuals seropositive for dengue, but an elevated risk of hospitalized dengue in seronegative vaccine recipients. Population-level benefit-risk is therefore dependent on epidemiological criteria and WHO recommends its use only under certain conditions or following confirmation of individual serostatus. This thesis describes a body of epidemiological research designed to improve understanding of these conditions. Studies were intended to fill important knowledge gaps identified following discussions with local vaccine policymakers and experts. My role, working within a multidisciplinary team, was to understand identified gaps and develop and implement a corresponding research agenda to fill them. I designed and contributed to protocols, provided oversight to their implementation working with local research teams, analysed and interpreted the resulting data and drafted the manuscripts included in this thesis which were published between 2016 and 2020. These studies used different methods: we analysed existing data sources to improve estimates of symptomatic dengue disease burden; measured age-stratified dengue seroprevalence in children in India and Indonesia; estimated force-of-infection (the annual rate at which seronegative individuals acquire infection) as an indicator of endemicity in seven Asian countries; and conducted a prospective surveillance study to plan future dengue vaccine effectiveness research. After refining these methods for dengue, we extended them to Japanese encephalitis, another mosquito-borne flavivirus. Using data derived from active case ascertainment from the placebo arm of a paediatric clinical trial, wherein parents were contacted weekly and reminded to report to study sites in case of febrile illness in their children, we identified a crude dengue attack rate of 4.6%/year. Only 29% of these events were clinically diagnosed as dengue by study investigators, indicating that most symptomatic disease fails to satisfy existing case definitions. This active case ascertainment captured a greater proportion of symptomatic dengue than national passive surveillance systems. The ratio between these two rates (“expansion factor”) can be used to estimate the full disease burden from passive surveillance reports and we calculated factors ranging from 0.5 – 31.7, depending on country and case definition. Large seroprevalence surveys in India and Indonesia confirmed very high rates of paediatric infection: by the age of 10 years, 73% of children in India and 79% in Indonesia had been infected at least once. We also identified serological evidence for circulation of multiple dengue serotypes in both countries. We used these and other serological data to estimate force-of-infection which varied widely between countries from 1.7% (Singapore) to 24.1% (the Philippines), with significant heterogeneity within countries. The force of infection of Japanese encephalitis was much lower (varying from 0.8% in Malaysia to 5.2% in Vietnam) but this demonstration of transmission in urban areas was an important finding in areas where Japanese encephalitis vaccination is not routine. After conducting a hospital-based surveillance study to plan future dengue vaccine effectiveness studies in Malaysia, we concluded that test-negative case control studies are not feasible due to small numbers of test-negative controls; and that case control studies for dengue vaccines could be significantly biased by underlying differences between cases and controls. In summary, these studies demonstrated intense but heterogeneous dengue transmission across multiple Asia-pacific countries. These levels of transmission are broadly compatible with recommendations for dengue vaccine introduction at the national level but, due to heterogeneity in endemicity, more local approaches would likely be needed before implementation of mass vaccination programmes