Disease ecology, biodiversity, and the latitudinal gradient in income

Modeling the synergistic interplay between malaria dynamics and economic growth

The mosquito-borne disease (malaria) imposes significant challenges on human health, healthcare systems, and economic growth/productivity in many countries. This study develops and analyzes a model to understand the interplay between malaria dynamics, economic growth, and transient events. It uncovers varied effects of malaria and economic parameters on model outcomes, highlighting the interdependence of the reproduction number (R0) on both malaria and economic factors, and a reciprocal relationship where malaria diminishes economic productivity, while higher economic output is associated with reduced malaria prevalence. This emphasizes the intricate interplay between malaria dynamics and socio-economic factors. The study offers insights into malaria control and underscores the significance of optimizing external aid allocation, especially favoring an even distribution strategy, with the most significant reduction observed in an equal monthly distribution strategy compared to longer distribution intervals. Furthermore, the study shows that controlling malaria in high mosquito biting areas with limited aid, low technology, inadequate treatment, or low economic investment is challenging. The model exhibits a backward bifurcation implying that sustainability of control and mitigation measures is essential even when R0 is slightly less than one. Additionally, there is a parameter regime for which long transients are feasible. Long transients are critical for predicting the behavior of dynamic systems and identifying factors influencing transitions; they reveal reservoirs of infection, vital for disease control. Policy recommendations for effective malaria control from the study include prioritizing sustained control measures, optimizing external aid allocation, and reducing mosquito biting.

The Hidden Hand of Asymptomatic Infection Hinders Control of Neglected Tropical Diseases: A Modeling Analysis

BACKGROUND

Neglected tropical diseases are responsible for considerable morbidity and mortality in low-income populations. International efforts have reduced their global burden, but transmission is persistent and case-finding-based interventions rarely target asymptomatic individuals.

METHODS

We develop a generic mathematical modeling framework for analyzing the dynamics of visceral leishmaniasis in the Indian sub-continent (VL), gambiense sleeping sickness (gHAT), and Chagas disease and use it to assess the possible contribution of asymptomatics who later develop disease (pre-symptomatics) and those who do not (non-symptomatics) to the maintenance of infection. Plausible interventions, including active screening, vector control, and reduced time to detection, are simulated for the three diseases.

RESULTS

We found that the high asymptomatic contribution to transmission for Chagas and gHAT and the apparently high basic reproductive number of VL may undermine long-term control. However, the ability to treat some asymptomatics for Chagas and gHAT should make them more controllable, albeit over relatively long time periods due to the slow dynamics of these diseases. For VL, the toxicity of available therapeutics means the asymptomatic population cannot currently be treated, but combining treatment of symptomatics and vector control could yield a quick reduction in transmission.

CONCLUSIONS

Despite the uncertainty in natural history, it appears there is already a relatively good toolbox of interventions to eliminate gHAT, and it is likely that Chagas will need improvements to diagnostics and their use to better target pre-symptomatics. The situation for VL is less clear, and model predictions could be improved by additional empirical data. However, interventions may have to improve to successfully eliminate this disease.

Impacts of Deforestation on Childhood Malaria Depend on Wealth and Vector Biology

Ecosystem change can profoundly affect human well-being and health, including through changes in exposure to vector-borne diseases. Deforestation has increased human exposure to mosquito vectors and malaria risk in Africa, but there is little understanding of how socioeconomic and ecological factors influence the relationship between deforestation and malaria risk. We examined these interrelationships in six sub-Saharan African countries using demographic and health survey data linked to remotely sensed environmental variables for 11,746 children under 5 years old. We found that the relationship between deforestation and malaria prevalence varies by wealth levels. Deforestation is associated with increased malaria prevalence in the poorest households, but there was not significantly increased malaria prevalence in the richest households, suggesting that deforestation has disproportionate negative health impacts on the poor. In poorer households, malaria prevalence was 27%-33% larger for one standard deviation increase in deforestation across urban and rural populations. Deforestation is also associated with increased malaria prevalence in regions where Anopheles gambiae and Anopheles funestus are dominant vectors, but not in areas of Anopheles arabiensis. These findings indicate that deforestation is an important driver of malaria risk among the world's most vulnerable children, and its impact depends critically on often-overlooked social and biological factors. An in-depth understanding of the links between ecosystems and human health is crucial in designing conservation policies that benefit people and the environment.

Mosquito (Diptera: Culicidae) populations in contrasting areas of the western regions of Burkina Faso: species diversity, abundance and their implications for pathogen transmission

BACKGROUND

Mosquitoes (Diptera: Culicidae) can have a significant negative impact on human health. The urbanization of natural environments and their conversion for agricultural use, as well as human population growth, may affect mosquito populations and increase the risk of emerging or re-emerging mosquito-borne diseases. We report on the variety and number of adult mosquitoes found in four environments with varying degrees of human impact (rural, urban, rice fields, and forest) located in a savannah zone of West Africa.

METHODS

Mosquitoes were collected from two regions (Hauts-Bassins and Sud-Ouest) of Burkina Faso during five periods between August 2019 and June 2021. Sampling sites were grouped according to environment. Mosquitoes were collected using BG-Sentinel traps and double net traps, and Prokopack Aspirators. Statistical analyses were performed using R software version 4.1.2. Logistic regression, using generalised mixed linear models, was used to test the effect of environment on mosquito abundance and diversity. Alpha diversity analysis was also performed, using the vegan package.

RESULTS

A total of 10,625 adult mosquitoes were collected, belonging to 33 species and five genera: Culex, Aedes, Anopheles, Mansonia, and Ficalbia. The most dominant species were Culex quinquefasciatus, Anopheles gambiae sensu lato and Aedes aegypti. Alpha diversity was similar in the two regions. Habitat had a significant effect on mosquito species richness, the Shannon index and the Simpson index. The rural environment had the highest species richness (n = 28) followed by the forest environment (n = 24). The highest number of mosquitoes (4977/10,625) was collected in the urban environment.

CONCLUSIONS

The species composition of the mosquito populations depended on the type of environment, with fewer species in environments with a high human impact such as urban areas and rice fields. Due to the diversity and abundance of the mosquito vectors, the human populations of all of the environments examined are considered to be at potential risk of mosquito-borne diseases.

Neighbours and relatives: accounting for spatial distribution when testing causal hypotheses in cultural evolution

Many important and interesting hypotheses about cultural evolution are evaluated using cross-cultural correlations: if knowing one particular feature of a culture (e.g. environmental conditions such as temperature, humidity or parasite load) allows you to predict other features (e.g. language features, religious beliefs, cuisine), it is often interpreted as indicating a causal link between the two (e.g. hotter climates carry greater disease risk, which encourages belief in supernatural forces and favours the use of antimicrobial ingredients in food preparation; dry climates make the production of distinct tones more difficult). However, testing such hypotheses from cross-cultural comparisons requires us to take proximity of cultures into account: nearby cultures share many aspects of their environment and are more likely to be similar in many culturally inherited traits. This can generate indirect associations between environment and culture which could be misinterpreted as signals of a direct causal link. Evaluating examples of cross-cultural correlations from the literature, we show that significant correlations interpreted as causal relationships can often be explained as a result of similarity between neighbouring cultures. We discuss some strategies for sorting the explanatory wheat from the co-varying chaff, distinguishing incidental correlations from causal relationships.

Identifying the regional drivers of influenza-like illness in Nova Scotia, Canada, with dominance analysis

The spread of viral pathogens is inherently a spatial process. While the temporal aspects of viral spread at the epidemiological level have been increasingly well characterized, the spatial aspects of viral spread are still understudied due to a striking absence of theoretical expectations of how spatial dynamics may impact the temporal dynamics of viral populations. Characterizing the spatial transmission and understanding the factors driving it are important for anticipating local timing of disease incidence and for guiding more informed control strategies. Using a unique data set from Nova Scotia, Canada, the objective of this study is to apply a new novel method that recovers a spatial network of the influenza-like viral spread where the regions in their dominance are identified and ranked. We, then, focus on identifying regional predictors of those dominant regions. Our analysis uncovers 18 key regional drivers among 112 regions, each distinguished by unique community-level vulnerability factors such as demographic and economic characteristics. These findings offer valuable insights for implementing targeted public health interventions and allocating resources effectively.

Why did doctrinal religions first appear in the Northern Subtropical Zone?

Doctrinal religions that involve recognised gods, more formal theologies, moral codes, dedicated religious spaces and professional priesthoods emerged in two phases during the Neolithic. Almost all of these appeared in a narrow latitudinal band (the northern Subtropical Zone). I suggest that these developments were the result of a need to facilitate community bonding in response to scalar stresses that developed as community sizes increased dramatically beyond those typical of hunter-gatherer societies. Conditions for population growth (as indexed by rainfall patterns and the difference between pathogen load and the length of the growing season) were uniquely optimised in this zone, creating an environment of ecological release in which populations could grow unusually rapidly. The relationship between latitude, religion and language in contemporary societies suggests that the peculiar characteristics of the northern (but not the southern) Subtropical Zone were especially favourable for the evolution of large scale religions as a way of enforcing community cohesion.

Soil zinc deficiency and child stunting: Evidence from Nepal

We examine the negative child health impacts of soil zinc (Zn) deficiency in Nepal. Soil Zn deficiency limits both crop yields and the Zn concentration in food crops, leading many to speculate that it underlies human Zn deficiency and child stunting, globally and particularly in South Asia. We find strong evidence that soil Zn deficiency does have a causal impact on child stunting in Nepal's Tarai region, the breadbasket of the country. Using causal bounds, we find that a 1 part per million increase in plant-available soil Zn - achievable with application of Zn-enriched fertilizer - decreases child stunting by between 1 and 7.5 percentage points. Multiple statistical sensitivity tests indicate that this relationship is unlikely to be manufactured by omitted, relevant variables.

Ecological and socioeconomic factors associated with the human burden of environmentally mediated pathogens: a global analysis

BACKGROUND

Billions of people living in poverty are at risk of environmentally mediated infectious diseases-that is, pathogens with environmental reservoirs that affect disease persistence and control and where environmental control of pathogens can reduce human risk. The complex ecology of these diseases creates a global health problem not easily solved with medical treatment alone.

METHODS

We quantified the current global disease burden caused by environmentally mediated infectious diseases and used a structural equation model to explore environmental and socioeconomic factors associated with the human burden of environmentally mediated pathogens across all countries.

FINDINGS

We found that around 80% (455 of 560) of WHO-tracked pathogen species known to infect humans are environmentally mediated, causing about 40% (129 488 of 359 341 disability-adjusted life years) of contemporary infectious disease burden (global loss of 130 million years of healthy life annually). The majority of this environmentally mediated disease burden occurs in tropical countries, and the poorest countries carry the highest burdens across all latitudes. We found weak associations between disease burden and biodiversity or agricultural land use at the global scale. In contrast, the proportion of people with rural poor livelihoods in a country was a strong proximate indicator of environmentally mediated infectious disease burden. Political stability and wealth were associated with improved sanitation, better health care, and lower proportions of rural poverty, indirectly resulting in lower burdens of environmentally mediated infections. Rarely, environmentally mediated pathogens can evolve into global pandemics (eg, HIV, COVID-19) affecting even the wealthiest communities.

INTERPRETATION

The high and uneven burden of environmentally mediated infections highlights the need for innovative social and ecological interventions to complement biomedical advances in the pursuit of global health and sustainability goals.

FUNDING

Bill & Melinda Gates Foundation, National Institutes of Health, National Science Foundation, Alfred P. Sloan Foundation, National Institute for Mathematical and Biological Synthesis, Stanford University, and the US Defense Advanced Research Projects Agency.

Estimation of Ebola’s spillover infection exposure in Sierra Leone based on sociodemographic and economic factors

Zoonotic diseases spread through pathogens-infected animal carriers. In the case of Ebola Virus Disease (EVD), evidence supports that the main carriers are fruit bats and non-human primates. Further, EVD spread is a multi-factorial problem that depends on sociodemographic and economic (SDE) factors. Here we inquire into this phenomenon and aim at determining, quantitatively, the Ebola spillover infection exposure map and try to link it to SDE factors. To that end, we designed and conducted a survey in Sierra Leone and implement a pipeline to analyze data using regression and machine learning techniques. Our methodology is able (1) to identify the features that are best predictors of an individual’s tendency to partake in behaviors that can expose them to Ebola infection, (2) to develop a predictive model about the spillover risk statistics that can be calibrated for different regions and future times, and (3) to compute a spillover exposure map for Sierra Leone. Our results and conclusions are relevant to identify the regions in Sierra Leone at risk of EVD spillover and, consequently, to design and implement policies for an effective deployment of resources (e.g., drug supplies) and other preventative measures (e.g., educational campaigns).

The costs and benefits of primary prevention of zoonotic pandemics

The lives lost and economic costs of viral zoonotic pandemics have steadily increased over the past century. Prominent policymakers have promoted plans that argue the best ways to address future pandemic catastrophes should entail, "detecting and containing emerging zoonotic threats." In other words, we should take actions only after humans get sick. We sharply disagree. Humans have extensive contact with wildlife known to harbor vast numbers of viruses, many of which have not yet spilled into humans. We compute the annualized damages from emerging viral zoonoses. We explore three practical actions to minimize the impact of future pandemics: better surveillance of pathogen spillover and development of global databases of virus genomics and serology, better management of wildlife trade, and substantial reduction of deforestation. We find that these primary pandemic prevention actions cost less than 1/20th the value of lives lost each year to emerging viral zoonoses and have substantial cobenefits.

Disparity in socio-economic status explains the pattern of self-medication of antibiotics in India: understanding from game-theoretic perspective

The emergence of antimicrobial resistance has raised great concern for public health in many lower-income countries including India. Socio-economic determinants like poverty, health expenditure and awareness accelerate this emergence by influencing individuals' attitudes and healthcare practices such as self-medication. This self-medication practice is highly prevalent in many countries, where antibiotics are available without prescriptions. Thus, complex dynamics of drug- resistance driven by economy, human behaviour, and disease epidemiology poses a serious threat to the community, which has been less emphasized in prior studies. Here, we formulate a game-theoretic model of human choices in self-medication integrating economic growth and disease transmission processes. We show that this adaptive behaviour emerges spontaneously in the population through a self-reinforcing process and continual feedback from the economy, resulting in the emergence of resistance as externalities of human choice under resource constraints situations. We identify that the disparity between social-optimum and individual interest in self-medication is primarily driven by the effectiveness of treatment, health awareness and public health interventions. Frequent multiple-peaks of resistant strains are also observed when individuals imitate others more readily and self-medication is more likely. Our model exemplifies that timely public health intervention for financial risk protection, and antibiotic stewardship policies can improve the epidemiological situation and prevent economic collapse.

Assessing different historical pathways in the cultural evolution of economic development

A huge number of hypotheses have been put forward to explain the substantial diversity in economic performance we see in the present-day. There has been a growing appreciation that historical and ecological factors have contributed to social and economic development. However, it is not clear whether such factors have exerted a direct effect on modern productivity, or whether they influence economies indirectly by shaping the cultural evolution of norms and institutions. Here we analyse a global cross-national dataset to test between hypotheses involving a number of different ecological, historical, and proximate social factors and a range of direct and indirect pathways. We show that the historical timing of agriculture predicts the timing of the emergence of statehood, which in turn affects economic development indirectly through its effect on institutions. Ecological factors appear to affect economic performance indirectly through their historical effects on the development of agriculture and by shaping patterns of European settler colonization. More effective institutional performance is also predicted by lower-levels of in-group bias which itself appears related to the proportion of a nation's population that descends from European countries. These results support the idea that cultural evolutionary processes have been important in shaping the social norms and institutions that enable large-scale cooperation and economic growth in present-day societies.

Are Temperature Suitability and Socioeconomic Factors Reliable Predictors of Dengue Transmission in Brazil?

Dengue is an ongoing problem, especially in tropical countries. Like many other vector-borne diseases, the spread of dengue is driven by a myriad of climate and socioeconomic factors. Within developing countries, heterogeneities on socioeconomic factors are expected to create variable conditions for dengue transmission. However, the relative role of socioeconomic characteristics and their association with climate in determining dengue prevalence are poorly understood. Here we assembled essential socioeconomic factors over 5570 municipalities across Brazil and assessed their effect on dengue prevalence jointly with a previously predicted temperature suitability for transmission. Using a simultaneous autoregressive approach (SAR), we showed that the variability in the prevalence of dengue cases across Brazil is primarily explained by the combined effect of climate and socioeconomic factors. At some dengue seasons, the effect of temperature on transmission potential showed to be a more significant proxy of dengue cases. Still, socioeconomic factors explained the later increase in dengue prevalence over Brazil. In a heterogeneous country such as Brazil, recognizing the transmission drivers by vectors is a fundamental issue in effectively predicting and combating tropical diseases like dengue. Ultimately, it indicates that not considering socioeconomic factors in disease transmission predictions might compromise efficient surveillance strategies. Our study shows that sanitation, urbanization, and GDP are regional indicators that should be considered along with temperature suitability on dengue transmission, setting effective directions to mosquito-borne disease control.

Relationship between vertical stratification and feeding habits of mosquito (Diptera: Culicidae) assemblages collected in conservation units in the green belt of the city of São Paulo, Brazil

São Paulo is one of the largest cities in the world and has several characteristics that favor a diversity of urban and wild mosquitoes. Little is known about how variations in mosquito diversity and feeding preferences for different hosts in different vegetation strata can influence the risk of pathogen transmission to humans. We investigated vertical stratification of mosquitoes and its relationship with vertebrate hosts in environments with different degrees of conservation in two conservation units in the city of São Paulo. Adult mosquitoes were collected using CDC traps, aspiration and Shannon traps. After morphological identification, host blood in engorged females was analyzed by PCR with a vertebrate-specific primer set based on mitochondrial cytochrome b DNA of vertebrates commonly found in the two conservation units. Although a higher abundance of the species Anopheles cruzii and Culex nigripalpus was found in the canopy, blood not only from birds but also from humans and rodents was identified in these mosquitoes. In one of the units, Wyeomyia confusa and Limatus durhamii were found occupying mainly niches at ground level while Culex vaxus was frequently found in the canopy. Haemagogus leucocelaenus, the main vector of yellow fever, was found in low abundance at all collection points, particularly in the canopy. Species richness and composition tended to vary little between canopy and ground level in the same environment, but the abundance between canopy and ground level varied more depending on the species analyzed, the most abundant and frequent species exhibiting a predilection for the canopy. Even those mosquito species observed more frequently in the canopy did not show an association with hosts found in this stratum as most of the blood identified in these species was from humans, suggesting opportunist feeding behavior, i.e., feeding on the most readily available host in the environment. The two most common species in the study, An. cruzii and Cx. nigripalpus, may be able to act as bridge vectors for pathogens to circulate between the forest canopy and ground level.

Arboviral diseases and poverty in Alabama, 2007-2017

Mosquito-borne viruses cause diseases of great public health concern. Arboviral disease case distributions have complex relationships with socioeconomic and environmental factors. We combined information about socio-economic (population, and poverty rate) and environmental (precipitation, and land use) characteristics with reported human cases of arboviral disease in the counties of Alabama, USA, from 2007–2017. We used county level data on West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), California serogroup virus, Eastern equine encephalitis virus, and Saint Louis encephalitis virus to provide a detailed description of their spatio-temporal pattern. We found a significant spatial convergence between incidence of WNV and poverty rate clustered in the southern part of Alabama. DENV, CHIKV and ZIKV cases showed a different spatial pattern, being mostly located in the northern part, in areas of high socioeconomic status. The results of our study establish that poverty-driven inequities in arboviral risk exist in the southern USA, and should be taken into account when planning prevention and intervention strategies.

Mosquito-borne arboviruses like West Nile virus (WNV), dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), California serogroup virus (CSV), Eastern equine encephalitis virus (EEE), and Saint Louis encephalitis virus (SLE) are on the rise globally. Socioeconomic and environmental conditions have played a role in directing in this expansion by creating conditions ideal for mosquito vectors and transmission. In this study, we used 10 years (2007–2017) of county level human arboviral case data from the US state of Alabama to better understand the roles socioeconomics (poverty rate) and environmental (land use, precipitation, land cover) conditions may play in driving patterns of arboviral disease in the southern US. We found a significant association between poverty rate and incidence of WNV, an arbovirus primarily transmitted by Culex spp. mosquitoes, which are known for thriving in contaminated water sources and sewage overflow. Conversely, cases of DENV, CHIKV, and ZIKV, arboviruses primarily transmitted by Aedes spp. mosquitoes, were reported in areas of high socioeconomic status. These findings suggest differential distribution of arboviruses relevant to human health in Alabama, and that poverty in the southern US is a significant factor that should be considered when planning WNV prevention and intervention strategies.

Patterns and processes of pathogen exposure in gray wolves across North America

The presence of many pathogens varies in a predictable manner with latitude, with infections decreasing from the equator towards the poles. We investigated the geographic trends of pathogens infecting a widely distributed carnivore: the gray wolf (Canis lupus). Specifically, we investigated which variables best explain and predict geographic trends in seroprevalence across North American wolf populations and the implications of the underlying mechanisms. We compiled a large serological dataset of nearly 2000 wolves from 17 study areas, spanning 80° longitude and 50° latitude. Generalized linear mixed models were constructed to predict the probability of seropositivity of four important pathogens: canine adenovirus, herpesvirus, parvovirus, and distemper virus-and two parasites: Neospora caninum and Toxoplasma gondii. Canine adenovirus and herpesvirus were the most widely distributed pathogens, whereas N. caninum was relatively uncommon. Canine parvovirus and distemper had high annual variation, with western populations experiencing more frequent outbreaks than eastern populations. Seroprevalence of all infections increased as wolves aged, and denser wolf populations had a greater risk of exposure. Probability of exposure was positively correlated with human density, suggesting that dogs and synanthropic animals may be important pathogen reservoirs. Pathogen exposure did not appear to follow a latitudinal gradient, with the exception of N. caninum. Instead, clustered study areas were more similar: wolves from the Great Lakes region had lower odds of exposure to the viruses, but higher odds of exposure to N. caninum and T. gondii; the opposite was true for wolves from the central Rocky Mountains. Overall, mechanistic predictors were more informative of seroprevalence trends than latitude and longitude. Individual host characteristics as well as inherent features of ecosystems determined pathogen exposure risk on a large scale. This work emphasizes the importance of biogeographic wildlife surveillance, and we expound upon avenues of future research of cross-species transmission, spillover, and spatial variation in pathogen infection.

Poverty in the time of epidemic: A modelling perspective

We create a network model to study the spread of an epidemic through physically proximate and accidental daily human contacts in a city, and simulate outcomes for two kinds of agents—poor and non-poor. Under non-intervention, peak caseload is maximised, but no differences are observed in infection rates across poor and non-poor. Introducing interventions to control spread, peak caseloads are reduced, but both cumulative infection rates and current infection rates are systematically higher for the poor than for non-poor, across all scenarios. Larger populations, higher fractions of poor, and longer durations of intervention are found to progressively worsen outcomes for the poor; and these are of particular concern for economically vulnerable populations in cities of the developing world. Addressing these challenges requires a deeper, more rigorous understanding of the relationships between structural poverty and epidemy, as well as effective utilization of extant community level infrastructure for primary care in developing cities. Finally, improving iniquitous outcomes for the poor creates better outcomes for the whole population, including the non-poor.

COVID 19—A Qualitative Review for the Reorganization of Human Living Environments

The COVID-19 pandemic is changing people’s habits and behaviors and will reshape city layout and management. Among the different areas of research to be explored, the paper outlines first inputs to use the COVID-19 health crisis as a “window of opportunity” to trigger a sustainable transition of urban living environments, through actions to reshape and territorial organization after COVID-19 and in preparation for future health. Before having a vaccine or medications that ensure a non-lethal disease course, there will be a phase of responsibility and coexistence with the virus. It will be a period whose duration experts are still unable to quantify. What changes in the city organization, behaviors and uses of spaces will we observe in the living environments? Will this lead to a sustainability transition? The paper proposes a qualitative review to investigate how the droplet might travel through the air and how COVID-19 has spread in different urban contexts to outline a comprehensive reflection on the future of the city and strategies for more resilient communities and territories. To achieve this goal, the paper proposes the need of a comparison between skills related to physics aspects, such as fluid dynamics (to assess how droplets spread) and skills related to architectural, urban and territorial design (to evaluate the conditions of indoor and outdoor living environments).

Using local knowledge in emerging infectious disease research

Emerging infectious diseases (EIDs) are a growing global health threat. The Stockholm Paradigm suggests that their toll will grow tragically in the face of climate change, in particular. The best research protocol for predicting and preventing infectious disease emergence states that an urgent search must commence to identify unknown human and animal pathogens. This short communication proposes that the ethnobiological knowledge of indigenous and impoverished communities can be a source of information about some of those unknown pathogens. I present the ecological and anthropological theory behind this proposal, followed by a few case studies that serve as a limited proof of concept. This paper also serves as a call to action for the medical anthropology community. It gives a brief primer on the EID crisis and how anthropology research may be vital to limiting its havoc on global health. Local knowledge is not likely to play a major role in EID research initiatives, but the incorporation of an awareness of EIDs into standard medical anthropological practice would have myriad other benefits.

Amazon deforestation drives malaria transmission, and malaria burden reduces forest clearing

Deforestation and land use change are among the most pressing anthropogenic environmental impacts. In Brazil, a resurgence of malaria in recent decades paralleled rapid deforestation and settlement in the Amazon basin, yet evidence of a deforestation-driven increase in malaria remains equivocal. We hypothesize an underlying cause of this ambiguity is that deforestation and malaria influence each other in bidirectional causal relationships-deforestation increases malaria through ecological mechanisms and malaria reduces deforestation through socioeconomic mechanisms-and that the strength of these relationships depends on the stage of land use transformation. We test these hypotheses with a large geospatial dataset encompassing 795 municipalities across 13 y (2003 to 2015) and show deforestation has a strong positive effect on malaria incidence. Our results suggest a 10% increase in deforestation leads to a 3.3% increase in malaria incidence (∼9,980 additional cases associated with 1,567 additional km² lost in 2008, the study midpoint, Amazon-wide). The effect is larger in the interior and absent in outer Amazonian states where little forest remains. However, this strong effect is only detectable after controlling for a feedback of malaria burden on forest loss, whereby increased malaria burden significantly reduces forest clearing, possibly mediated by human behavior or economic development. We estimate a 1% increase in malaria incidence results in a 1.4% decrease in forest area cleared (∼219 fewer km² cleared associated with 3,024 additional cases in 2008). This bidirectional socioecological feedback between deforestation and malaria, which attenuates as land use intensifies, illustrates the intimate ties between environmental change and human health.

Antibiotic drug-resistance as a complex system driven by socio-economic growth and antibiotic misuse

Overwhelming antibiotic use poses a serious challenge today to the public-health policymakers worldwide. Many empirical studies pointed out this ever-increasing antibiotic consumption as primary driver of the community-acquired antibiotic drug-resistance, especially in the middle- and lower-income countries. The association is well documented across spatio-temporal gradients in many parts of the world, but there is rarely any study that emphasizes the mechanism of the association, which is important for combating drug-resistance. Formulating a mathematical model of emergence and transmission of drug-resistance, we in this paper, present how amalgamating three components: socio-economic growth, population ecology of infectious disease, and antibiotic misuse can instinctively incite proliferation of resistance in the society. We show that combined impact of economy, infections, and self-medication yield synergistic interactions through feedbacks on each other, presenting the emergence of drug-resistance as a self-reinforcing cycle in the population. Analysis of our model not only determines the threshold of antibiotic use beyond which the emergence of resistance may occur, but also characterizes how fast it develops depending on economic growth, and lack of education and awareness of the population. Our model illustrates that proper and timely government aid in population health can break the self-reinforcing process and reduce the burden of drug-resistance in the community.

Risky business: linking Toxoplasma gondii infection and entrepreneurship behaviours across individuals and countries

Disciplines such as business and economics often rely on the assumption of rationality when explaining complex human behaviours. However, growing evidence suggests that behaviour may concurrently be influenced by infectious microorganisms. The protozoan Toxoplasma gondii infects an estimated 2 billion people worldwide and has been linked to behavioural alterations in humans and other vertebrates. Here we integrate primary data from college students and business professionals with national-level information on cultural attitudes towards business to test the hypothesis that T. gondii infection influences individual- as well as societal-scale entrepreneurship activities. Using a saliva-based assay, we found that students (n = 1495) who tested IgG positive for T. gondii exposure were 1.4× more likely to major in business and 1.7× more likely to have an emphasis in 'management and entrepreneurship' over other business-related emphases. Among professionals attending entrepreneurship events, T. gondii-positive individuals were 1.8× more likely to have started their own business compared with other attendees (n = 197). Finally, after synthesizing and combining country-level databases on T. gondii infection from the past 25 years with the Global Entrepreneurship Monitor of entrepreneurial activity, we found that infection prevalence was a consistent, positive predictor of entrepreneurial activity and intentions at the national scale, regardless of whether previously identified economic covariates were included. Nations with higher infection also had a lower fraction of respondents citing 'fear of failure' in inhibiting new business ventures. While correlational, these results highlight the linkage between parasitic infection and complex human behaviours, including those relevant to business, entrepreneurship and economic productivity.

Human infectious disease burdens decrease with urbanization but not with biodiversity

Infectious disease burdens vary from country to country and year to year due to ecological and economic drivers. Recently, Murray et al. (Murray CJ et al 2012 Lancet380, 2197-2223. (doi:10.1016/S0140-6736(12)61689-4)) estimated country-level morbidity and mortality associated with a variety of factors, including infectious diseases, for the years 1990 and 2010. Unlike other databases that report disease prevalence or count outbreaks per country, Murray et al. report health impacts in per-person disability-adjusted life years (DALYs), allowing comparison across diseases with lethal and sublethal health effects. We investigated the spatial and temporal relationships between DALYs lost to infectious disease and potential demographic, economic, environmental and biotic drivers, for the 60 intermediate-sized countries where data were available and comparable. Most drivers had unique associations with each disease. For example, temperature was positively associated with some diseases and negatively associated with others, perhaps due to differences in disease agent thermal optima, transmission modes and host species identities. Biodiverse countries tended to have high disease burdens, consistent with the expectation that high diversity of potential hosts should support high disease transmission. Contrary to the dilution effect hypothesis, increases in biodiversity over time were not correlated with improvements in human health, and increases in forestation over time were actually associated with increased disease burden. Urbanization and wealth were associated with lower burdens for many diseases, a pattern that could arise from increased access to sanitation and healthcare in cities and increased investment in healthcare. The importance of urbanization and wealth helps to explain why most infectious diseases have become less burdensome over the past three decades, and points to possible levers for further progress in improving global public health.This article is part of the themed issue 'Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.

Conservation of biodiversity as a strategy for improving human health and well-being

The Earth's ecosystems have been altered by anthropogenic processes, including land use, harvesting populations, species introductions and climate change. These anthropogenic processes greatly alter plant and animal communities, thereby changing transmission of the zoonotic pathogens they carry. Biodiversity conservation may be a potential win-win strategy for maintaining ecosystem health and protecting public health, yet the causal evidence to support this strategy is limited. Evaluating conservation as a viable public health intervention requires answering four questions: (i) Is there a general and causal relationship between biodiversity and pathogen transmission, and if so, which direction is it in? (ii) Does increased pathogen diversity with increased host biodiversity result in an increase in total disease burden? (iii) Do the net benefits of biodiversity conservation to human well-being outweigh the benefits that biodiversity-degrading activities, such as agriculture and resource utilization, provide? (iv) Are biodiversity conservation interventions cost-effective when compared to other options employed in standard public health approaches? Here, we summarize current knowledge on biodiversity-zoonotic disease relationships and outline a research plan to address the gaps in our understanding for each of these four questions. Developing practical and self-sustaining biodiversity conservation interventions will require significant investment in disease ecology research to determine when and where they will be effective.This article is part of the themed issue 'Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.

General ecological models for human subsistence, health and poverty

The world's rural poor rely heavily on their immediate natural environment for subsistence and suffer high rates of morbidity and mortality from infectious diseases. We present a general framework for modelling subsistence and health of the rural poor by coupling simple dynamic models of population ecology with those for economic growth. The models show that feedbacks between the biological and economic systems can lead to a state of persistent poverty. Analyses of a wide range of specific systems under alternative assumptions show the existence of three possible regimes corresponding to a globally stable development equilibrium, a globally stable poverty equilibrium and bistability. Bistability consistently emerges as a property of generalized disease-economic systems for about a fifth of the feasible parameter space. The overall proportion of parameters leading to poverty is larger than that resulting in healthy/wealthy development. All the systems are found to be most sensitive to human disease parameters. The framework highlights feedbacks, processes and parameters that are important to measure in studies of rural poverty to identify effective pathways towards sustainable development.

Disease ecology, health and the environment: a framework to account for ecological and socio-economic drivers in the control of neglected tropical diseases

Reducing the burden of neglected tropical diseases (NTDs) is one of the key strategic targets advanced by the Sustainable Development Goals. Despite the unprecedented effort deployed for NTD elimination in the past decade, their control, mainly through drug administration, remains particularly challenging: persistent poverty and repeated exposure to pathogens embedded in the environment limit the efficacy of strategies focused exclusively on human treatment or medical care. Here, we present a simple modelling framework to illustrate the relative role of ecological and socio-economic drivers of environmentally transmitted parasites and pathogens. Through the analysis of system dynamics, we show that periodic drug treatments that lead to the elimination of directly transmitted diseases may fail to do so in the case of human pathogens with an environmental reservoir. Control of environmentally transmitted diseases can be more effective when human treatment is complemented with interventions targeting the environmental reservoir of the pathogen. We present mechanisms through which the environment can influence the dynamics of poverty via disease feedbacks. For illustration, we present the case studies of Buruli ulcer and schistosomiasis, two devastating waterborne NTDs for which control is particularly challenging.This article is part of the themed issue 'Conservation, biodiversity and infectious disease: scientific evidence and policy implications'.

Estimating Burdens of Neglected Tropical Zoonotic Diseases on Islands with Introduced Mammals

Many neglected tropical zoonotic pathogens are maintained by introduced mammals, and on islands the most common introduced species are rodents, cats, and dogs. Management of introduced mammals, including control or eradication of feral populations, which is frequently done for ecological restoration, could also reduce or eliminate the pathogens these animals carry. Understanding the burden of these zoonotic diseases is crucial for quantifying the potential public health benefits of introduced mammal management. However, epidemiological data are only available from a small subset of islands where these introduced mammals co-occur with people. We examined socioeconomic and climatic variables as predictors for disease burdens of angiostrongyliasis, leptospirosis, toxoplasmosis, toxocariasis, and rabies from 57 islands or island countries. We found strong correlates of disease burden for leptospirosis, Toxoplasma gondii infection, angiostrongyliasis, and toxocariasis with more than 50% of the variance explained, and an average of 57% (range = 32-95%) predictive accuracy on out-of-sample data. We used these relationships to provide estimates of leptospirosis incidence and T. gondii seroprevalence infection on islands where nonnative rodents and cats are present. These predicted estimates of disease burden could be used in an initial assessment of whether the costs of managing introduced mammal reservoirs might be less than the costs of perpetual treatment of these diseases on islands.

Economic inequality caused by feedbacks between poverty and the dynamics of a rare tropical disease: the case of Buruli ulcer in sub-Saharan Africa

Neglected tropical diseases (NTDs) have received increasing attention in recent years by the global heath community, as they cumulatively constitute substantial burdens of disease as well as barriers for economic development. A number of common tropical diseases such as malaria, hookworm or schistosomiasis have well-documented economic impacts. However, much less is known about the population-level impacts of diseases that are rare but associated with high disability burden, which represent a great number of tropical diseases. Using an individual-based model of Buruli ulcer (BU), we demonstrate that, through feedbacks between health and economic status, such NTDs can have a significant impact on the economic structure of human populations even at low incidence levels. While average wealth is only marginally affected by BU, the economic conditions of certain subpopulations are impacted sufficiently to create changes in measurable population-level inequality. A reduction of the disability burden caused by BU can thus maximize the economic growth of the poorest subpopulations and reduce significantly the economic inequalities introduced by the disease in endemic regions.

The macroecology of infectious diseases: a new perspective on global-scale drivers of pathogen distributions and impacts

Identifying drivers of infectious disease patterns and impacts at the broadest scales of organisation is one of the most crucial challenges for modern science, yet answers to many fundamental questions remain elusive. These include what factors commonly facilitate transmission of pathogens to novel host species, what drives variation in immune investment among host species, and more generally what drives global patterns of parasite diversity and distribution? Here we consider how the perspectives and tools of macroecology, a field that investigates patterns and processes at broad spatial, temporal and taxonomic scales, are expanding scientific understanding of global infectious disease ecology. In particular, emerging approaches are providing new insights about scaling properties across all living taxa, and new strategies for mapping pathogen biodiversity and infection risk. Ultimately, macroecology is establishing a framework to more accurately predict global patterns of infectious disease distribution and emergence.

Global Patterns of Zoonotic Disease in Mammals

As the frequency and prevalence of zoonotic diseases increase worldwide, investigating how mammal host distributions determine patterns of human disease and predicting which regions are at greatest risk for future zoonotic disease emergence are two goals which both require better understanding of the current distributions of zoonotic hosts and pathogens. We review here the existing data about mammalian host species, comparing and contrasting these patterns against global maps of zoonotic hosts from all 27 orders of terrestrial mammals. We discuss the zoonotic potential of host species from the top six most species-rich mammal groups, and review the literature to identify analytical and conceptual gaps that must be addressed to improve our ability to generate testable predictions about zoonotic diseases originating from wild mammals.

Predicting zoonotic disease events remains a prominent scientific challenge.

In response to increasing frequency of emerging infectious disease events caused by animal-borne (zoonotic) pathogens, recent advances assess the biogeographic patterns of human infectious diseases.

A disproportionate representation of mammal-borne zoonoses among emerging human disease has sparked research emphasis on mammal reservoirs because improved understanding of mammal host distributions may lead to improved predictions of future hotspots for zoonotic disease emergence.

In addition to spatial distributions of animal hosts and human disease, the concept of ‘disease risk’ is a topic of intense analysis, and has been quantified on the basis of hindsight where regions undergoing frequent or intense human disease events are categorized as possessing numerous factors that interact to increase disease risk.

The diversity-disease relationship: evidence for and criticisms of the dilution effect

The dilution effect, that high host species diversity can reduce disease risk, has attracted much attention in the context of global biodiversity decline and increasing disease emergence. Recent studies have criticized the generality of the dilution effect and argued that it only occurs under certain circumstances. Nevertheless, evidence for the existence of a dilution effect was reported in about 80% of the studies that addressed the diversity-disease relationship, and a recent meta-analysis found that the dilution effect is widespread. We here review supporting and critical studies, point out the causes underlying the current disputes. The dilution is expected to be strong when the competent host species tend to remain when species diversity declines, characterized as a negative relationship between species' reservoir competence and local extinction risk. We here conclude that most studies support a negative competence-extinction relationship. We then synthesize the current knowledge on how the diversity-disease relationship can be modified by particular species in community, by the scales of analyses, and by the disease risk measures. We also highlight the complex role of habitat fragmentation in the diversity-disease relationship from epidemiological, evolutionary and ecological perspectives, and construct a synthetic framework integrating these three perspectives. We suggest that future studies should test the diversity-disease relationship across different scales and consider the multiple effects of landscape fragmentation.

Quantitative analyses and modelling to support achievement of the 2020 goals for nine neglected tropical diseases

Quantitative analysis and mathematical models are useful tools in informing strategies to control or eliminate disease. Currently, there is an urgent need to develop these tools to inform policy to achieve the 2020 goals for neglected tropical diseases (NTDs). In this paper we give an overview of a collection of novel model-based analyses which aim to address key questions on the dynamics of transmission and control of nine NTDs: Chagas disease, visceral leishmaniasis, human African trypanosomiasis, leprosy, soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. Several common themes resonate throughout these analyses, including: the importance of epidemiological setting on the success of interventions; targeting groups who are at highest risk of infection or re-infection; and reaching populations who are not accessing interventions and may act as a reservoir for infection,. The results also highlight the challenge of maintaining elimination 'as a public health problem' when true elimination is not reached. The models elucidate the factors that may be contributing most to persistence of disease and discuss the requirements for eventually achieving true elimination, if that is possible. Overall this collection presents new analyses to inform current control initiatives. These papers form a base from which further development of the models and more rigorous validation against a variety of datasets can help to give more detailed advice. At the moment, the models' predictions are being considered as the world prepares for a final push towards control or elimination of neglected tropical diseases by 2020.

Global rise in human infectious disease outbreaks

To characterize the change in frequency of infectious disease outbreaks over time worldwide, we encoded and analysed a novel 33-year dataset (1980-2013) of 12,102 outbreaks of 215 human infectious diseases, comprising more than 44 million cases occuring in 219 nations. We merged these records with ecological characteristics of the causal pathogens to examine global temporal trends in the total number of outbreaks, disease richness (number of unique diseases), disease diversity (richness and outbreak evenness) and per capita cases. Bacteria, viruses, zoonotic diseases (originating in animals) and those caused by pathogens transmitted by vector hosts were responsible for the majority of outbreaks in our dataset. After controlling for disease surveillance, communications, geography and host availability, we find the total number and diversity of outbreaks, and richness of causal diseases increased significantly since 1980 (p < 0.0001). When we incorporate Internet usage into the model to control for biased reporting of outbreaks (starting 1990), the overall number of outbreaks and disease richness still increase significantly with time (p < 0.0001), but per capita cases decrease significantly ( p = 0.005). Temporal trends in outbreaks differ based on the causal pathogen's taxonomy, host requirements and transmission mode. We discuss our preliminary findings in the context of global disease emergence and surveillance.

Frontiers in research on biodiversity and disease

Global losses of biodiversity have galvanised efforts to understand how changes to communities affect ecological processes, including transmission of infectious pathogens. Here, we review recent research on diversity-disease relationships and identify future priorities. Growing evidence from experimental, observational and modelling studies indicates that biodiversity changes alter infection for a range of pathogens and through diverse mechanisms. Drawing upon lessons from the community ecology of free-living organisms, we illustrate how recent advances from biodiversity research generally can provide necessary theoretical foundations, inform experimental designs, and guide future research at the interface between infectious disease risk and changing ecological communities. Dilution effects are expected when ecological communities are nested and interactions between the pathogen and the most competent host group(s) persist or increase as biodiversity declines. To move beyond polarising debates about the generality of diversity effects and develop a predictive framework, we emphasise the need to identify how the effects of diversity vary with temporal and spatial scale, to explore how realistic patterns of community assembly affect transmission, and to use experimental studies to consider mechanisms beyond simple changes in host richness, including shifts in trophic structure, functional diversity and symbiont composition.

Introducing One Health to the Ethical Debate About Zoonotic Diseases in Southeast Asia

Pandemic plans recommend phases of response to an emergent infectious disease (EID) outbreak, and are primarily aimed at preventing and mitigating human-to-human transmission. These plans carry presumptive weight and are increasingly being operationalized at the national, regional and international level with the support of the World Health Organization (WHO). The conventional focus of pandemic preparedness for EIDs of zoonotic origin has been on public health and human welfare. However, this focus on human populations has resulted in strategically important disciplinary silos. As the risks of zoonotic diseases have implications that reach across many domains outside traditional public health, including anthropological, environmental, and veterinary fora, a more inclusive ecological perspective is paramount for an effective response to future outbreaks.

Rodent reservoirs of future zoonotic diseases

The increasing frequency of zoonotic disease events underscores a need to develop forecasting tools toward a more preemptive approach to outbreak investigation. We apply machine learning to data describing the traits and zoonotic pathogen diversity of the most speciose group of mammals, the rodents, which also comprise a disproportionate number of zoonotic disease reservoirs. Our models predict reservoir status in this group with over 90% accuracy, identifying species with high probabilities of harboring undiscovered zoonotic pathogens based on trait profiles that may serve as rules of thumb to distinguish reservoirs from nonreservoir species. Key predictors of zoonotic reservoirs include biogeographical properties, such as range size, as well as intrinsic host traits associated with lifetime reproductive output. Predicted hotspots of novel rodent reservoir diversity occur in the Middle East and Central Asia and the Midwestern United States.

Household illness, poverty and physical and emotional child abuse victimisation: findings from South Africa's first prospective cohort study

Background

Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa.

Methods

Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person’s disability as hypothesised mediators.

Results

For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed.

Conclusions

These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1792-4) contains supplementary material, which is available to authorized users.

Climate change and Arctic parasites

Climate is changing rapidly in the Arctic. This has important implications for parasites of Arctic ungulates, and hence for the welfare of Arctic peoples who depend on caribou, reindeer, and muskoxen for food, income, and a focus for cultural activities. In this Opinion article we briefly review recent work on the development of predictive models for the impacts of climate change on helminth parasites and other pathogens of Arctic wildlife, in the hope that such models may eventually allow proactive mitigation and conservation strategies. We describe models that have been developed using the metabolic theory of ecology. The main strength of these models is that they can be easily parameterized using basic information about the physical size of the parasite. Initial results suggest they provide important new insights that are likely to generalize to a range of host-parasite systems.

Poverty, disease, and the ecology of complex systems

Understanding why some human populations remain persistently poor remains a significant challenge for both the social and natural sciences. The extremely poor are generally reliant on their immediate natural resource base for subsistence and suffer high rates of mortality due to parasitic and infectious diseases. Economists have developed a range of models to explain persistent poverty, often characterized as poverty traps, but these rarely account for complex biophysical processes. In this Essay, we argue that by coupling insights from ecology and economics, we can begin to model and understand the complex dynamics that underlie the generation and maintenance of poverty traps, which can then be used to inform analyses and possible intervention policies. To illustrate the utility of this approach, we present a simple coupled model of infectious diseases and economic growth, where poverty traps emerge from nonlinear relationships determined by the number of pathogens in the system. These nonlinearities are comparable to those often incorporated into poverty trap models in the economics literature, but, importantly, here the mechanism is anchored in core ecological principles. Coupled models of this sort could be usefully developed in many economically important biophysical systems--such as agriculture, fisheries, nutrition, and land use change--to serve as foundations for deeper explorations of how fundamental ecological processes influence structural poverty and economic development.