Programmatic considerations and evidence gaps for chikungunya vaccine introduction in countries at risk of chikungunya outbreaks: Stakeholder analysis.

Chikungunya can have longstanding effects on health and quality of life. Alongside the recent approval of the world's first chikungunya vaccine by the US Food and Drug Administration in November 2023 and with new chikungunya vaccines in the pipeline, it is important to understand the perspectives of stakeholders before vaccine rollout. Our study aim is to identify key programmatic considerations and gaps in Evidence-to-Recommendation criteria for chikungunya vaccine introduction. We used purposive and snowball sampling to identify global, national, and subnational stakeholders from outbreak prone areas, including Latin America, Asia, and Africa. Semi-structured in-depth interviews were conducted and analysed using qualitative descriptive methods. We found that perspectives varied between tiers of stakeholders and geographies. Unknown disease burden, diagnostics, non-specific disease surveillance, undefined target populations for vaccination, and low disease prioritisation were critical challenges identified by stakeholders that need to be addressed to facilitate rolling out a chikungunya vaccine. Future investments should address these challenges to generate useful evidence for decision-making on new chikungunya vaccine introduction

Chikungunya seroprevalence, force of infection, and prevalence of chronic disability after infection in endemic and epidemic settings: a systematic review, meta-analysis, and modelling study.

BACKGROUND: Chikungunya is an arboviral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes with a growing global burden linked to climate change and globalisation. We aimed to estimate chikungunya seroprevalence, force of infection (FOI), and prevalence of related chronic disability and hospital admissions in endemic and epidemic settings. METHODS: In this systematic review, meta-analysis, and modelling study, we searched PubMed, Ovid, and Web of Science for articles published from database inception until Sept 26, 2022, for prospective and retrospective cross-sectional studies that addressed serological chikungunya virus infection in any geographical region, age group, and population subgroup and for longitudinal prospective and retrospective cohort studies with data on chronic chikungunya or hospital admissions in people with chikungunya. We did a systematic review of studies on chikungunya seroprevalence and fitted catalytic models to each survey to estimate location-specific FOI (ie, the rate at which susceptible individuals acquire chikungunya infection). We performed a meta-analysis to estimate the proportion of symptomatic patients with laboratory-confirmed chikungunya who had chronic chikungunya or were admitted to hospital following infection. We used a random-effects model to assess the relationship between chronic sequelae and follow-up length using linear regression. The systematic review protocol is registered online on PROSPERO, CRD42022363102. FINDINGS: We identified 60 studies with data on seroprevalence and chronic chikungunya symptoms done across 76 locations in 38 countries, and classified 17 (22%) of 76 locations as endemic settings and 59 (78%) as epidemic settings. The global long-term median annual FOI was 0·007 (95% uncertainty interval [UI] 0·003-0·010) and varied from 0·0001 (0·00004-0·0002) to 0·113 (0·07-0·20). The highest estimated median seroprevalence at age 10 years was in south Asia (8·0% [95% UI 6·5-9·6]), followed by Latin America and the Caribbean (7·8% [4·9-14·6]), whereas median seroprevalence was lowest in the Middle East (1·0% [0·5-1·9]). We estimated that 51% (95% CI 45-58) of people with laboratory-confirmed symptomatic chikungunya had chronic disability after infection and 4% (3-5) were admitted to hospital following infection. INTERPRETATION: We inferred subnational heterogeneity in long-term average annual FOI and transmission dynamics and identified both endemic and epidemic settings across different countries. Brazil, Ethiopia, Malaysia, and India included both endemic and epidemic settings. Long-term average annual FOI was higher in epidemic settings than endemic settings. However, long-term cumulative incidence of chikungunya can be similar between large outbreaks in epidemic settings with a high FOI and endemic settings with a relatively low FOI. FUNDING: International Vaccine Institute

High resolution atmospheric and oceanic modelling over Antarctica: a coupling interface to study sea-ice processes

Understanding the future evolution of the climate over Antarctica is crucial, as the continent holds the potential for a 3-meter rise in sea levels by 2300. However, the Antarctic climate is impacted by various processes and interactions, particularly at the ocean-atmosphere-sea ice interface, which are not fully implemented in Global Climate Models (GCMs). We are developing a high-resolution two-way coupling between the reginal climate model MARv3.13 and ocean/sea-ice model NEMO4.2/SI3 to study these processes, such as blowing snow over sea-ice, and their potential impact on future polar climate scenarios selected by the PolarRES consortium. We evaluated the standalone models' performance in simulating current climate conditions using various meteorological observations, satellite data, and ship observations. The results of this study are a first step to check the setup before moving to a fully coupled interface, and already show the importance of regional modelling to better resolve specific processes.&#160

Towards a high-resolution MAR-NEMO coupling to explore atmosphere-ocean-ice interactions in the Arctic

Arctic changes are at the center of climate concerns. Notably, recent Arctic warming drives rapid sea ice decline making the Arctic increasingly vulnerable. To better anticipate the consequences of this strong Arctic warming, it is crucial to better understand the driving processes responsible for large uncertainties in future climate projections. Interactions at the atmosphere-ocean-sea ice interface require particular attention. In this context, the PolarRES project aims at developing the coupled system MAR (atmosphere) - NEMO (ocean-sea ice) over the Arctic region at high spatial resolution (25 km). Such coupling will enable the climate community to access precise data at large scale. Since this coupling has never been applied to the Arctic, a proper model evaluation is required. Here standalone model simulations are compared against a newly compiled dataset including land station and buoys data. We find high correlations between the modeled and observed data. Our evaluation marks an important step in in the ongoing development of coupled models

Spatially heterogeneous effect of climate warming on the Arctic land ice

peer reviewedAbstract. Global warming has already substantially altered the Arctic cryosphere. Due to the Arctic warming amplification, the temperature is increasing more strongly, leading to pervasive changes in this area. Recent years were notably marked by melt records over the Greenland Ice Sheet, while other regions such as Svalbard seem to remain less influenced. This raises the question of the current state of the Greenland Ice Sheet and the various ice caps in the Arctic for which few studies are available. Here, we run the regional climate model (RCM) Modèle Atmosphérique Régional (MAR) at a resolution of 6 km over four different domains covering all Arctic land ice to produce a unified surface mass balance product from 1950 to the present day. We also compare our results to large-scale indices to better understand the heterogeneity of the evolutions across the Arctic and their links to recent climate change. We find a sharp decrease of surface mass balance (SMB) over the western Arctic (Canada and Greenland) in relationship with the atmospheric blocking situations that have become more frequent in summer, resulting in a 41 % increase of the melt rate since 1950. This increase is not seen over the Russian Arctic permanent ice areas, where melt rates have increased by only 3 % on average, illustrating a heterogeneity in the Arctic SMB response to global warming

La mort

Le sujet traité sous un angle résolument anthropologique, concerne l'Europe d'aujourd'hui : rituels funéraires des Tsiganes de Hongrie, photographies servant de médiation entre morts et vivants en Calabre, familiarisation des étudiants en médecine avec les cadavres, important taux de suicide chez les Vaqueiros des Asturies, autant d'études de cas sur les diverses façons de se représenter et d'affronter la mort

Vaccine value profile for Chikungunya

Chikungunya virus (CHIKV) a mosquito-borne alphavirus is the causative agent of Chikungunya (CHIK), a disease with low mortality but high acute and chronic morbidity resulting in a high overall burden of disease. After the acute disease phase, chronic disease including persistent arthralgia is very common, and can cause fatigue and pain that is severe enough to limit normal activities. On average, around 40% of people infected with CHIKV will develop chronic arthritis, which may last for months or years. Recommendations for protection from CHIKV focus on infection control through preventing mosquito proliferation. There is currently no licensed antiviral drug or vaccine against CHIKV. Therefore, one of the most important public health impacts of vaccination would be to decrease burden of disease and economic losses in areas impacted by the virus, and prevent or reduce chronic morbidity associated with CHIK. This benefit would particularly be seen in Low and Middle Income Countries (LMIC) and socio-economically deprived areas, as they are more likely to have more infections and more severe outcomes. This ‘Vaccine Value Profile’ (VVP) for CHIK is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of vaccines in the development pipeline and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships, and multi-lateral organizations. All contributors have extensive expertise on various elements of the CHIK VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information