2009 Summer Institute on Climate Information for Public Health

As the world’s attention is increasingly focused on the effects of climate change, it is essential to better understand the role that climate plays in community health and disease. Equally important is the need for decisive, coordinated interaction between climate experts and health workers to decide how best to respond to the variations in climate that in part drive the burden of disease in communities of developing countries. The 2009 Summer Institute on Climate Information for Public Health (SI 09) was designed to engage professionals who play a key role in the operational decision-making for climate-sensitive diseases in identifying and evaluating appropriate use of climate information. The International Research Institute for Climate and Society (IRI) designed and implemented the second annual Summer Institute (SI), in partnership with the Center for International Earth Science Information Network (CIESIN) and the Mailman School of Public Health (MSPH) at Columbia University. The IRI is a premier global research and capacity-building institution focused on the use of climate information in key areas of development. It is a collaborating centre with the World Health Organization–Pan-American Health Organization (WHO–PAHO) on climate-sensitive diseases. The IRI, CIESIN, and MSPH are partner institutions of The Earth Institute at Columbia University. Together these institutes combine extensive experience in en- vironmental health, population mapping and modeling with climate prediction and the study of climate variability and change. SI 09 was held at Columbia University’s Lamont-Doherty Campus in Palisades, New York, between June 1st and June 12th, 2009. A panel discussion was held at the MSPH on June 3rd, 2009

Curriculum for Best Practices

Public health professionals, field epidemiologists, health management workers and health policymakers are increasingly concerned about the potential impact that climate can have on public health. Climate not only determines the spatial and seasonal distribution of many public health events, such as infectious diseases, but also is a key determinant of inter-annual variability in disease incidence, including epidemics and medium-term trends. However, many public health professionals are not yet aware of the ways in which climate information can help them manage the impacts of climate on their disease surveillance and control activities, as well as program implementation and evaluation. Similarly, climate scientists are not aware of how they can contribute to the information needs of the public health sector. Despite the challenges inherent to the multidisciplinary nature of the field of climate and public health, interdisciplinary work and dialogue is necessary to bridge this gap. Public health is a broad effort organized by society to protect, promote and restore the people’s health. It is the combination of sciences, skills and beliefs directed to the maintenance and improvement of health through collective or social actions. Many significant contributions to public health stem from activities outside the formal health sector (e.g., water resources management and food security). In this context, climate researchers should be considered a part of the public health community. Protecting public health from the vagaries of climate will requires new working relationships between the public health sector and the providers of climate data and information. It will also demand a wide variety of strategies and must occur at multiple levels. One of these strategies is to increase the public health community’s capacity to understand, use, and demand the appropriate climate information to mitigate the public health impacts of climate. However, good information is not enough. The public health community must also be able to distinguish between different kinds of data to determine what is relevant, at what time and space scale, to their population. Consider, for instance, the many ways that temperature affects human health. Rising average temperatures are predicted to increase the incidence and duration of heat waves, which are known to be a major hazard to particular segments of the population including those with heart problems, respiratory diseases such as asthma, the elderly, the very young, and the homeless. Rising temperatures may also increase the incidence of infectious diseases and contribute to air quality problems. Determining which of these issues are most pressing will require public health professionals to interpret various kinds of information and that is why it is so important to train them. It is also important the courses are tailored to the local context and resources, for developed and developing countries have different abilities to cope with stresses from the climate

International Research Institute for Climate and Society

Now that the world’s attention is focused on climate variability and climate change adaptation, it is essential, not only for public health communities, but also for planners in central government, to understand the role climate plays in driving disease burden and impacting economic growth. Public health emerges as the final common pathway for all impacts of climate variability and climate change on individuals as well as societies. As a contribution to this process, The International Research Institute for Climate and Society (IRI), in partnership with the Center for International Earth Science Information Network (CIESIN) and the Mailman School of Public Health (MSPH) at Columbia University initiated this two-week course in 2008. Building on the response of our 2008 - 2009 alumni, and a great demand from the climate and health community the 2010 Summer Institute on Climate Information for Public Health (SI10) was designed to engage professionals who play a key role in the operational decision-making for climate-sensitive diseases in identifying and evaluating appropriate use of climate information. SI10 was held at Columbia University’s Lamont-Doherty Campus in Palisades, New York, between May 17th and May 28th, 2010

Africa needs climate data to fight disease

Climate variability and change are a major concern for public health in Africa. The livelihoods of hundreds of millions of people there are dependent on rain-fed agriculture and seasonal water resources. Poor rural communities also suffer from under-nutrition and bear the greatest burden of infectious diseases and natural disasters while having the least access to public-health services. Many of Africa’s most important cities are on the coast and at risk of sea level rise. Without adequate infrastructure they are vulnerable to poor sanitation during floods and shortages of drinking water and loss of hydroelectric power during droughts. Rising temperatures, air pollutants and dust threaten to increase heat stress and respiratory disease

4th MERIT Technical Meeting: Synthesis Report. November 18-20, 2010

Background As established in 2007 and lead by the World Health organization (WHO), the Meningitis Environmental Risk Information Technologies (MERIT) project is a collaborative initiative between the public health, environmental and research communities. MERIT partners work to combine environmental and social, economic and demographic information with public health data to strengthen decisionmaking and preparedness for epidemic meningococcal meningitis in Africa. Conducting such an effort is increasingly important, as both the on-going introduction of the new conjugate vaccine against Neisseria Meningitidis serogroup A (Men A) and some environmental and climate changes are expected to shape the dynamics of meningococcal meningitis in the African Meningitis Belt. Organization and Sponsorship Every year since its implementation, the MERIT Steering Committee1 holds an international technical meeting that enables member of the MERIT Community to review the status and achievements of MERIT based on the recommendations of the previous technical meetings, and to plan the way forward. The 4th MERIT Technical Meeting was organized by the MERIT Steering Committee in partnership with the Ethiopian Climate and Health Working Group (CHWG)/AntiMalaria Association (AMA) , November 19-20, 2010. Hosted for the second time by the CHWG/AMA at the United Nations Economic Commission for Africa (UNECA) compound at the United Nations (UN) Conference Centre, in Addis Ababa, Ethiopia, the meeting was sponsored by the European Commission Joint Research Centre (JRC), Google.org, the Group on Earth Observations (GEO), the Health and Climate Foundation (HCF) and the Spanish Ministry of Foreign Affairs and Cooperation. Outcomes Following opening addresses by the Federal Ministry of Health (FMoH) of Ethiopia and the WHO Representative in Ethiopia, 73 participants from the public health, environmental and social sciences communities, involved through a wide range of international and national institutions, attended the meeting. Through presentations, discussions and working group sessions, they addressed the ways to ensure the public health relevance of MERIT activities in the context of the changing epidemiology and nature of the Meningitis Belt region in Africa, identified potential new partnerships and opportunities with regards to investigating the role of environmental, social, epidemiological and biological risk factors on meningitis epidemics in Africa. Efforts further focused on the ways to develop an operational decision support tool which will help inform reactive vaccination strategies in districts in epidemic as well as preventive strategies in line with the introduction of the new conjugate Men A vaccine, through (but not limited to) the near real-time monitoring of the next meningitis epidemic season. The means to develop, to advance and to support country-led MERIT activities were also discussed, with emphasis on Ethiopia and Nigeria

Quantifying model evidence for yellow fever transmission routes in Africa

Yellow fever is a vector-borne disease endemic in tropical regions of Africa, where 90% of the global burden occurs, and Latin America. It is notoriously under-reported with uncertainty arising from a complex transmission cycle including a sylvatic reservoir and non-specific symptom set. Resulting estimates of burden, particularly in Africa, are highly uncertain. We examine two established models of yellow fever transmission within a Bayesian model averaging framework in order to assess the relative evidence for each model’s assumptions and to highlight possible data gaps. Our models assume contrasting scenarios of the yellow fever transmission cycle in Africa. The first takes the force of infection in each province to be static across the observation period; this is synonymous with a constant infection pressure from the sylvatic reservoir. The second model assumes the majority of transmission results from the urban cycle; in this case, the force of infection is dynamic and defined through a fixed value of R0 in each province. Both models are coupled to a generalised linear model of yellow fever occurrence which uses environmental covariates to allow us to estimate transmission intensity in areas where data is sparse. We compare these contrasting descriptions of transmission through a Bayesian framework and trans-dimensional Markov chain Monte Carlo sampling in order to assess each model’s evidence given the range of uncertainty in parameter values. The resulting estimates allow us to produce Bayesian model averaged predictions of yellow fever burden across the African endemic region. We find strong support for the static force of infection model which suggests a higher proportion of yellow fever transmission occurs as a result of infection from an external source such as the sylvatic reservoir. However, the model comparison highlights key data gaps in serological surveys across the African endemic region. As such, conclusions concerning the most prevalent transmission routes for yellow fever will be limited by the sparsity of data which is particularly evident in the areas with highest predicted transmission intensity. Our model and estimation approach provides a robust framework for model comparison and predicting yellow fever burden in Africa. However, key data gaps increase uncertainty surrounding estimates of model parameters and evidence. As more mathematical models are developed to address new research questions, it is increasingly important to compare them with established modelling approaches to highlight uncertainty in structures and data

The effect of climate change on yellow fever disease burden in Africa

Yellow Fever (YF) is an arbovirus endemic in tropical regions of South America and Africa and it is estimated to cause 78,000 deaths a year in Africa alone. Climate change may have substantial effects on the transmission of YF and we present the first analysis of the potential impact on disease burden. We extend an existing model of YF transmission to account for rainfall and a temperature suitability index and project transmission intensity across the African endemic region in the context of four climate change scenarios. We use these transmission projections to assess the change in burden in 2050 and 2070. We find disease burden changes heterogeneously across the region. In the least severe scenario, we find a 93.0%[95%CI(92.7, 93.2%)] chance that annual deaths will increase in 2050. This change in epidemiology will complicate future control efforts. Thus, we may need to consider the effect of changing climatic variables on future intervention strategies

POLICI: A web application for visualising and extracting yellow fever vaccination coverage in Africa

Recent yellow fever (YF) outbreaks have highlighted the increasing global risk of urban spread of the disease. In context of recurrent vaccine shortages, preventive vaccination activities require accurate estimates of existing population-level immunity. We present POLICI (POpulation-Level Immunization Coverage – Imperial), an interactive online tool for visualising and extracting YF vaccination coverage estimates in Africa. We calculated single year age-disaggregated sub-national population-level vaccination coverage for 1950–2050 across the African endemic zone by collating vaccination information and inputting it into a demographic model. This was then implemented on an open interactive web platform. POLICI interactively displays age-disaggregated, population-level vaccination coverages at the first subnational administrative level, through numerous downloadable and customisable visualisations. POLICI is available at https://polici.shinyapps.io/yellow_fever_africa/. POLICI offers an accessible platform for relevant stakeholders in global health to access and explore vaccination coverages. These estimates have already been used to inform the WHO strategy to Eliminate Yellow fever Epidemics (EYE)

Response thresholds for epidemic meningitis in sub-Saharan Africa following the introduction of MenAfriVac®.

BACKGROUND: Since 2010, countries in the African meningitis belt have been introducing a new serogroup A meningococcal conjugate vaccine (MenAfriVac(®)) through mass campaigns. With the subsequent decline in meningitis due to Neisseria meningitidis serogroup A (NmA) and relative increase in meningitis due to other serogroups, mainly N. meningitidis serogroup W (NmW), the World Health Organisation (WHO) initiated a review of the incidence thresholds that guide response to meningitis epidemics in the African meningitis belt. METHODS: Meningitis surveillance data from African meningitis belt countries from 2002 to 2013 were used to construct a single NmW dataset. The performance of different weekly attack rates, used as thresholds to initiate vaccination response, on preventing further cases was estimated. The cumulative seasonal attack rate used to define an epidemic was also varied. RESULTS: Considerable variation in effect at different thresholds was observed. In predicting epidemics defined as a seasonal cumulative incidence of 100/10(5) population, an epidemic threshold of 10 cases/10(5) population/week performed well. Based on this same epidemic threshold, with a 6 week interval between crossing the epidemic threshold and population protection from a meningococcal vaccination campaign, an estimated 17 cases per event would be prevented by vaccination. Lowering the threshold increased the number of cases per event potentially prevented, as did shortening the response interval. If the interval was shortened to 4 weeks at the threshold of 10/10(5), the number of cases prevented would increase to 54 per event. CONCLUSIONS: Accelerating time to vaccination could prevent more cases per event than lowering the threshold. Once the meningitis epidemic threshold is crossed, it is of critical importance that vaccination campaigns, where appropriate, are initiated rapidly