1
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McGough SF, Clemente L, Kutz JN, Santillana M. A dynamic, ensemble learning approach to forecast dengue fever epidemic years in Brazil using weather and population susceptibility cycles. J R Soc Interface 2021; 18:20201006. [PMID: 34129785 PMCID: PMC8205538 DOI: 10.1098/rsif.2020.1006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transmission of dengue fever depends on a complex interplay of human, climate and mosquito dynamics, which often change in time and space. It is well known that its disease dynamics are highly influenced by multiple factors including population susceptibility to infection as well as by microclimates: small-area climatic conditions which create environments favourable for the breeding and survival of mosquitoes. Here, we present a novel machine learning dengue forecasting approach, which, dynamically in time and space, identifies local patterns in weather and population susceptibility to make epidemic predictions at the city level in Brazil, months ahead of the occurrence of disease outbreaks. Weather-based predictions are improved when information on population susceptibility is incorporated, indicating that immunity is an important predictor neglected by most dengue forecast models. Given the generalizability of our methodology to any location or input data, it may prove valuable for public health decision-making aimed at mitigating the effects of seasonal dengue outbreaks in locations globally.
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Affiliation(s)
- Sarah F McGough
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Leonardo Clemente
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, USA.,Tecnológico de Monterrey, 64849 Monterrey, Nuevo León, Mexico
| | - J Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, WA 98195, USA
| | - Mauricio Santillana
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
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2
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Tozan Y, Headley TY, Sewe MO, Schwartz E, Shemesh T, Cramer JP, Eberhardt KA, Ramharter M, Harrison N, Leder K, Angheben A, Hatz C, Neumayr A, Chen LH, De Pijper CA, Grobusch MP, Wilder-Smith A. A Prospective Study on the Impact and Out-of-Pocket Costs of Dengue Illness in International Travelers. Am J Trop Med Hyg 2020; 100:1525-1533. [PMID: 30994088 DOI: 10.4269/ajtmh.18-0780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient's perspective and paves the way for future economic burden studies in this population.
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Affiliation(s)
- Yesim Tozan
- New York University College of Global Public Health, New York, New York.,New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Tyler Y Headley
- New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Maquines Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Eli Schwartz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tamar Shemesh
- Sheba Medical Center, Institute of Tropical and Travel Medicine, Ramat-Gan, Israel
| | - Jakob P Cramer
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten A Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Harrison
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrea Angheben
- Centre for Tropical Diseases, IRCCS Hospital Sacro Cuore-Don Calabria, Verona, Italy
| | - Christoph Hatz
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lin Hwei Chen
- Mount Auburn Hospital, Cambridge, and Harvard Medical School, Boston, Massachusetts
| | - Cornelis A De Pijper
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Martin P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Heidelberg Global Health Institute, University of Heidelberg, Heidelberg, Germany.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
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3
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Meslé MMI, Hall IM, Christley RM, Leach S, Read JM. The use and reporting of airline passenger data for infectious disease modelling: a systematic review. Euro Surveill 2019; 24:1800216. [PMID: 31387671 PMCID: PMC6685100 DOI: 10.2807/1560-7917.es.2019.24.31.1800216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/18/2018] [Indexed: 01/06/2023] Open
Abstract
BackgroundA variety of airline passenger data sources are used for modelling the international spread of infectious diseases. Questions exist regarding the suitability and validity of these sources.AimWe conducted a systematic review to identify the sources of airline passenger data used for these purposes and to assess validation of the data and reproducibility of the methodology.MethodsArticles matching our search criteria and describing a model of the international spread of human infectious disease, parameterised with airline passenger data, were identified. Information regarding type and source of airline passenger data used was collated and the studies' reproducibility assessed.ResultsWe identified 136 articles. The majority (n = 96) sourced data primarily used by the airline industry. Governmental data sources were used in 30 studies and data published by individual airports in four studies. Validation of passenger data was conducted in only seven studies. No study was found to be fully reproducible, although eight were partially reproducible.LimitationsBy limiting the articles to international spread, articles focussed on within-country transmission even if they used relevant data sources were excluded. Authors were not contacted to clarify their methods. Searches were limited to articles in PubMed, Web of Science and Scopus.ConclusionWe recommend greater efforts to assess validity and biases of airline passenger data used for modelling studies, particularly when model outputs are to inform national and international public health policies. We also recommend improving reporting standards and more detailed studies on biases in commercial and open-access data to assess their reproducibility.
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Affiliation(s)
- Margaux Marie Isabelle Meslé
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Ian Melvyn Hall
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- School of Mathematics, University of Manchester, Manchester, United Kingdom
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Emergency Preparedness and Response at Kings College London, London, United Kingdom
| | - Robert Matthew Christley
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Steve Leach
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Emergency Preparedness and Response at Kings College London, London, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Modelling Methodology at Imperial College London, London, United Kingdom
| | - Jonathan Michael Read
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Centre for Health Informatics Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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4
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Estimating the probability of dengue virus introduction and secondary autochthonous cases in Europe. Sci Rep 2018; 8:4629. [PMID: 29545610 PMCID: PMC5854675 DOI: 10.1038/s41598-018-22590-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/20/2018] [Indexed: 12/19/2022] Open
Abstract
Given the speed of air travel, diseases even with a short viremia such as dengue can be easily exported to dengue naïve areas within 24 hours. We set out to estimate the risk of dengue virus introductions via travelers into Europe and number of secondary autochthonous cases as a result of the introduction. We applied mathematical modeling to estimate the number of dengue-viremic air passengers from 16 dengue-endemic countries to 27 European countries, taking into account the incidence of dengue in the exporting countries, travel volume and the probability of being viremic at the time of travel. Our models estimate a range from zero to 167 air passengers who are dengue-viremic at the time of travel from dengue endemic countries to each of the 27 receiving countries in one year. Germany receives the highest number of imported dengue-viremic air passengers followed by France and the United Kingdom. Our findings estimate 10 autochthonous secondary asymptomatic and symptomatic dengue infections, caused by the expected 124 infected travelers who arrived in Italy in 2012. The risk of onward transmission in Europe is reassuringly low, except where Aedes aegypti is present.
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Abstract
The timing and origin of Zika virus (ZIKV) introduction in Brazil has been the subject of controversy. Initially, it was assumed that the virus was introduced during the FIFA World Cup in June-July 2014. Then, it was speculated that ZIKV may have been introduced by athletes from French Polynesia (FP) who competed in a canoe race in Rio de Janeiro in August 2014. We attempted to apply mathematical models to determine the most likely time window of ZIKV introduction in Brazil. Given that the timing and origin of ZIKV introduction in Brazil may be a politically sensitive issue, its determination (or the provision of a plausible hypothesis) may help to prevent undeserved blame. We used a simple mathematical model to estimate the force of infection and the corresponding individual probability of being infected with ZIKV in FP. Taking into account the air travel volume from FP to Brazil between October 2013 and March 2014, we estimated the expected number of infected travellers arriving at Brazilian airports during that period. During the period between December 2013 and February 2014, 51 individuals travelled from FP airports to 11 Brazilian cities. Basing on the calculated force of ZIKV infection (the per capita rate of new infections per time unit) and risk of infection (probability of at least one new infection), we estimated that 18 (95% CI 12-22) individuals who arrived in seven of the evaluated cities were infected. When basic ZIKV reproduction numbers greater than one were assumed in the seven evaluated cities, ZIKV could have been introduced in any one of the cities. Based on the force of infection in FP, basic reproduction ZIKV number in selected Brazilian cities, and estimated travel volume, we concluded that ZIKV was most likely introduced and established in Brazil by infected travellers arriving from FP in the period between October 2013 and March 2014, which was prior to the two aforementioned sporting events.
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6
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Abstract
The epidemics of Ebola virus in West Africa and Zika virus in America highlight how viruses can explosively emerge into new territories. These epidemics also exposed how unprepared we are to handle infectious disease emergencies. This is also true when we consider hypothesized new clinical features of infection, such as the associations between Zika virus infection and severe neurological disease, including microcephaly and Guillain-Barré syndrome. On the surface, these pathologies appear to be new features of Zika virus infection, however, causal relationships have not yet been established. Decades of limited Zika virus research are making us scramble to determine the true drivers behind the epidemic, often at the expense of over-speculation without credible evidence. Here we review the literature and find no conclusive evidence at this time for significant biological differences between the American Zika virus strains and those circulating elsewhere. Rather, the epidemic scale in the Americas may be facilitated by an abnormally warm climate, dense human and mosquito populations, and previous exposure to other viruses. Severe disease associated with Zika virus may therefore not be a new trait for the virus, rather it may have been overlooked due to previously small outbreaks. Much of the recent panic regarding Zika virus has been about the Olympics in Brazil. We do not find any substantial evidence that the Olympics will result in a significant number of new Zika virus infections (~10 predicted) or that the Olympics will promote further epidemic spread over what is already expected. The Zika virus epidemic in the Americas is a serious situation and decisions based on solid scientific evidence - not hyped media speculations - are required for effective outbreak response.
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Affiliation(s)
- Nathan D. Grubaugh
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Kristian G. Andersen
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, CA, 92037, USA
- Scripps Translational Science Institute, La Jolla, CA, 92037, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
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7
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Virus Zika: viajes, mosquitos y Juegos Olímpicos. Med Clin (Barc) 2016; 147:113-5. [DOI: 10.1016/j.medcli.2016.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022]
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8
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Burattini MN, Lopez LF, Coutinho FA, Siqueira JB, Homsani S, Sarti E, Massad E. Age and regional differences in clinical presentation and risk of hospitalization for dengue in Brazil, 2000-2014. Clinics (Sao Paulo) 2016; 71:455-63. [PMID: 27626476 PMCID: PMC4975787 DOI: 10.6061/clinics/2016(08)08] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/29/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue's clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014. METHODS We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions. RESULTS Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9). CONCLUSIONS In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days.
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Affiliation(s)
- Marcelo N. Burattini
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
- Hospital São Paulo, Escola Paulista de Medicina, São Paulo/SP, Brazil
- E-mail: //
| | - Luis F. Lopez
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
- CIARA, Florida International University, Miami, Florida, United States of America
| | - Francisco A.B. Coutinho
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
| | - João B. Siqueira
- Universidade Federal de Goiás, Instituto Tropical de Patologia e Saúde Pública, Goiânia/GO, Brazil
| | | | - Elsa Sarti
- Sanofi Pasteur Latinoamerica, Mexico City, Mexico
| | - Eduardo Massad
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil
- London School of Hygiene and Tropical Medicine, London, UK
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9
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Affiliation(s)
- Eduardo Massad
- School of Medicine, University of São Paulo, São Paulo, Brazil; London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
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10
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Codeço C, Villela D, Gomes MF, Bastos L, Cruz O, Struchiner C, Carvalho LM, Coelho F. Zika is not a reason for missing the Olympic Games in Rio de Janeiro: response to the open letter of Dr Attaran and colleagues to Dr Margaret Chan, Director - General, WHO, on the Zika threat to the Olympic and Paralympic Games. Mem Inst Oswaldo Cruz 2016; 111:414-5. [PMID: 27304097 PMCID: PMC4909043 DOI: 10.1590/0074-02760160003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 11/22/2022] Open
Abstract
Attaran and colleagues in an open letter to WHO expressed their concern about the upcoming Olympic and Paralympic Games in Rio de Janeiro and the threat posed by the Zika epidemic (Attaran 2016). We agree that Zika virus is of great public health concern and much remains to be known about this disease. Care should be taken to reduce the risk of infection, especially to pregnant women. However, we argue that this is not sufficient reason for changing the original plans for the Games, in particular because of the time of the year when they will take place. The present article outlines several scientific results related to Zika and mosquito-borne infectious diseases dynamics that we believe ratify the current position of WHO in not endorsing the postponing or relocation of the 2016 Olympic and Paralympic Games (WHO 2016).
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Affiliation(s)
- Claudia Codeço
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de
Janeiro, RJ, Brasil
| | - Daniel Villela
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de
Janeiro, RJ, Brasil
| | - Marcelo F Gomes
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de
Janeiro, RJ, Brasil
| | - Leonardo Bastos
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de
Janeiro, RJ, Brasil
| | - Oswaldo Cruz
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de
Janeiro, RJ, Brasil
| | - Claudio Struchiner
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de
Janeiro, RJ, Brasil
| | - Luis Max Carvalho
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de
Janeiro, RJ, Brasil
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11
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Massad E, Tan SH, Khan K, Wilder-Smith A. Estimated Zika virus importations to Europe by travellers from Brazil. Glob Health Action 2016; 9:31669. [PMID: 27193266 PMCID: PMC4871896 DOI: 10.3402/gha.v9.31669] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Given the interconnectivity of Brazil with the rest of the world, Zika virus (ZIKV) infections have the potential to spread rapidly around the world via viremic travellers. The extent of spread depends on the travel volume and the endemicity in the exporting country. In the absence of reliable surveillance data, we did mathematical modelling to estimate the number of importations of ZIKV from Brazil into Europe. DESIGN We applied a previously developed mathematical model on importations of dengue to estimate the number of ZIKV importations into Europe, based on the travel volume, the probability of being infected at the time of travel, the population size of Brazil, and the estimated incidence of ZIKV infections. RESULTS Our model estimated between 508 and 1,778 imported infections into Europe in 2016, of which we would expect between 116 and 355 symptomatic Zika infections; with the highest number of importations being into France, Portugal and Italy. CONCLUSIONS Our model identified high-risk countries in Europe. Such data can assist policymakers and public health professionals in estimating the extent of importations in order to prepare for the scale up of laboratory diagnostic assays and estimate the occurrence of Guillain-Barré Syndrome, potential sexual transmission, and infants with congenital ZIKV syndrome.
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Affiliation(s)
- Eduardo Massad
- Department of Medicine, University of Sao Paolo, Sao Paolo, Brazil
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ser-Han Tan
- School of Computer Engineering, Nanyang Technological University, Singapore
| | - Kamran Khan
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Annelies Wilder-Smith
- Institute of Public Health, University of Heidelberg, Germany
- Department Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85 Umeå, Sweden
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore;
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12
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Ximenes R, Amaku M, Lopez LF, Coutinho FAB, Burattini MN, Greenhalgh D, Wilder-Smith A, Struchiner CJ, Massad E. The risk of dengue for non-immune foreign visitors to the 2016 summer olympic games in Rio de Janeiro, Brazil. BMC Infect Dis 2016; 16:186. [PMID: 27129407 PMCID: PMC4850678 DOI: 10.1186/s12879-016-1517-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 04/15/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Rio de Janeiro in Brazil will host the Summer Olympic Games in 2016. About 400,000 non-immune foreign tourists are expected to attend the games. As Brazil is the country with the highest number of dengue cases worldwide, concern about the risk of dengue for travelers is justified. METHODS A mathematical model to calculate the risk of developing dengue for foreign tourists attending the Olympic Games in Rio de Janeiro in 2016 is proposed. A system of differential equation models the spread of dengue amongst the resident population and a stochastic approximation is used to assess the risk to tourists. Historical reported dengue time series in Rio de Janeiro for the years 2000-2015 is used to find out the time dependent force of infection, which is then used to estimate the potential risks to a large tourist cohort. The worst outbreak of dengue occurred in 2012 and this and the other years in the history of Dengue in Rio are used to discuss potential risks to tourists amongst visitors to the forthcoming Rio Olympics. RESULTS The individual risk to be infected by dengue is very much dependent on the ratio asymptomatic/symptomatic considered but independently of this the worst month of August in the period studied in terms of dengue transmission, occurred in 2007. CONCLUSIONS If dengue returns in 2016 with the pattern observed in the worst month of August in history (2007), the expected number of symptomatic and asymptomatic dengue cases among tourists will be 23 and 206 cases, respectively. This worst case scenario would have an incidence of 5.75 (symptomatic) and 51.5 (asymptomatic) per 100,000 individuals.
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Affiliation(s)
- Raphael Ximenes
- School of Medicine, University of São Paulo and LIM01-HCFMUSP, São Paulo, SP, Brazil
| | - Marcos Amaku
- School of Medicine, University of São Paulo and LIM01-HCFMUSP, São Paulo, SP, Brazil
| | - Luis Fernandez Lopez
- School of Medicine, University of São Paulo and LIM01-HCFMUSP, São Paulo, SP, Brazil.,Center for Internet Augmented Research &Assessment, Florida International University, Miami, FL, USA
| | | | - Marcelo Nascimento Burattini
- School of Medicine, University of São Paulo and LIM01-HCFMUSP, São Paulo, SP, Brazil.,Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Eduardo Massad
- School of Medicine, University of São Paulo and LIM01-HCFMUSP, São Paulo, SP, Brazil. .,London School of Hygiene and Tropical Medicine, London, UK.
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13
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Potential exposure to Zika virus for foreign tourists during the 2016 Carnival and Olympic Games in Rio de Janeiro, Brazil. Epidemiol Infect 2016; 144:1904-6. [PMID: 27040593 DOI: 10.1017/s0950268816000649] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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14
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Burattini MN. Doenças infecciosas no Século XXI. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Lowe R, Coelho CA, Barcellos C, Carvalho MS, Catão RDC, Coelho GE, Ramalho WM, Bailey TC, Stephenson DB, Rodó X. Evaluating probabilistic dengue risk forecasts from a prototype early warning system for Brazil. eLife 2016; 5. [PMID: 26910315 PMCID: PMC4775211 DOI: 10.7554/elife.11285] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/21/2016] [Indexed: 01/22/2023] Open
Abstract
Recently, a prototype dengue early warning system was developed to produce probabilistic forecasts of dengue risk three months ahead of the 2014 World Cup in Brazil. Here, we evaluate the categorical dengue forecasts across all microregions in Brazil, using dengue cases reported in June 2014 to validate the model. We also compare the forecast model framework to a null model, based on seasonal averages of previously observed dengue incidence. When considering the ability of the two models to predict high dengue risk across Brazil, the forecast model produced more hits and fewer missed events than the null model, with a hit rate of 57% for the forecast model compared to 33% for the null model. This early warning model framework may be useful to public health services, not only ahead of mass gatherings, but also before the peak dengue season each year, to control potentially explosive dengue epidemics.
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Affiliation(s)
- Rachel Lowe
- Climate Dynamics and Impacts Unit, Institut Català de Ciències del Clima, Barcelona, Spain
| | - Caio As Coelho
- Centro de Previsão de Tempo e Estudos Climáticos, Instituto Nacional de Pesquisas Espaciais, Cachoeira Paulista, Brazil
| | | | | | - Rafael De Castro Catão
- Climate Dynamics and Impacts Unit, Institut Català de Ciències del Clima, Barcelona, Spain.,Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
| | - Giovanini E Coelho
- Coordenação Geral do Programa Nacional de Controle da Dengue, Ministério da Saúde, Brasília, Brazil
| | | | - Trevor C Bailey
- Exeter Climate Systems, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - David B Stephenson
- Exeter Climate Systems, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, United Kingdom
| | - Xavier Rodó
- Climate Dynamics and Impacts Unit, Institut Català de Ciències del Clima, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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16
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Lopez LF, Amaku M, Coutinho FAB, Quam M, Burattini MN, Struchiner CJ, Wilder-Smith A, Massad E. Modeling Importations and Exportations of Infectious Diseases via Travelers. Bull Math Biol 2016; 78:185-209. [PMID: 26763222 PMCID: PMC7089300 DOI: 10.1007/s11538-015-0135-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 12/15/2015] [Indexed: 10/31/2022]
Abstract
This paper is an attempt to estimate the risk of infection importation and exportation by travelers. Two countries are considered: one disease-free country and one visited or source country with a running endemic or epidemic infectious disease. Two models are considered. In the first model (disease importation), susceptible individuals travel from their disease-free home country to the endemic country and come back after some weeks. The risk of infection spreading in their home country is then estimated supposing the visitors are submitted to the same force of infection as the local population but do not contribute to it. In the second model (disease exportation), it is calculated the probability that an individual from the endemic (or epidemic) country travels to a disease-free country in the condition of latent infected and eventually introduces the infection there. The input of both models is the force of infection at the visited/source country, assumed known. The models are deterministic, but a preliminary stochastic formulation is presented as an appendix. The models are exemplified with two distinct real situations: the risk of dengue importation from Thailand to Europe and the risk of Ebola exportation from Liberia to the USA.
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Affiliation(s)
- Luis Fernandez Lopez
- School of Medicine, University of São Paulo, São Paulo, Brazil.,CIARA, Florida International University, Miami, FL, USA
| | - Marcos Amaku
- School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Mikkel Quam
- Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Marcelo Nascimento Burattini
- School of Medicine, University of São Paulo, São Paulo, Brazil.,Hospital São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | | | - Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang, Singapore.,Technological University, Singapore, Singapore
| | - Eduardo Massad
- School of Medicine, University of São Paulo, São Paulo, Brazil. .,London School of Hygiene and Tropical Medicine, London, UK.
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17
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Arbex AK, Bizarro VR, Paletti MT, Brandt OJ, de Jesus ALC, Werner I, Dantas LM, de Almeida MH. Zika Virus Controversies: Epidemics as a Legacy of Mega Events? Health (London) 2016. [DOI: 10.4236/health.2016.87074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Gautret P, Simon F. Dengue, chikungunya and Zika and mass gatherings: What happened in Brazil, 2014. Travel Med Infect Dis 2015; 14:7-8. [PMID: 26778293 DOI: 10.1016/j.tmaid.2015.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Philippe Gautret
- Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France.
| | - Fabrice Simon
- Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, Marseille, France
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19
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Interpretation of probabilistic forecasts of epidemics. THE LANCET. INFECTIOUS DISEASES 2015; 15:20. [PMID: 25541169 DOI: 10.1016/s1473-3099(14)71031-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Aguiar M, Rocha F, Pessanha JEM, Mateus L, Stollenwerk N. Carnival or football, is there a real risk for acquiring dengue fever in Brazil during holidays seasons? Sci Rep 2015; 5:8462. [PMID: 25684648 PMCID: PMC4329556 DOI: 10.1038/srep08462] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/20/2015] [Indexed: 11/21/2022] Open
Abstract
More than 600,000 football fans, coming from all over the world, were expected to visit Brazil during the FIFA World Cup 2014. International travel can become a public health problem when the visitors start to become sick, needing medical intervention and eventually hospitalization. The occurrence of dengue fever infections in Brazil is persistent and has been increasing since the 1980s, and the health authorities were expected to take preventive measures and to warn the visitors about the risks during the tournament period. Before the World Cup started, studies have been published stating that dengue could be a significant problem in some of the Brazilian cities hosting the games. These conclusions were taken after a brief observation of the available data, analyzing its mean and standard deviation only, or based on seasonal climate forecasts, causing alarm for the world cup in Brazil. Here, with a more careful data analysis, we show that the seasonality of the disease plays a major role in dengue transmission. The density of dengue cases in Brazil is residual during winter in the Southern hemisphere (mid June to mid September) and the fans of football were not likely to get dengue during the tournament period.
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Affiliation(s)
- Maíra Aguiar
- 1] Centro de Matemática e Aplicações Fundamentais, Lisbon University, Portugal [2] Laboratório de dengue e febre amarela, Fundação Ezequiel Dias, Minas Gerais, Brazil
| | - Filipe Rocha
- Centro de Matemática e Aplicações Fundamentais, Lisbon University, Portugal
| | - José Eduardo Marques Pessanha
- 1] Secretaria Municipal de Saúde de Belo Horizonte, Brazil [2] Observatório de Saúde Urbana de Belo Horizonte, Minas Gerais Federal University, Brazil
| | - Luis Mateus
- Centro de Matemática e Aplicações Fundamentais, Lisbon University, Portugal
| | - Nico Stollenwerk
- Centro de Matemática e Aplicações Fundamentais, Lisbon University, Portugal
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21
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van Panhuis WG, Hyun S, Blaney K, Marques ETA, Coelho GE, Siqueira JB, Tibshirani R, da Silva JB, Rosenfeld R. Risk of dengue for tourists and teams during the World Cup 2014 in Brazil. PLoS Negl Trop Dis 2014; 8:e3063. [PMID: 25079960 PMCID: PMC4120682 DOI: 10.1371/journal.pntd.0003063] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This year, Brazil will host about 600,000 foreign visitors during the 2014 FIFA World Cup. The concern of possible dengue transmission during this event has been raised given the high transmission rates reported in the past by this country. METHODOLOGY/PRINCIPAL FINDINGS We used dengue incidence rates reported by each host city during previous years (2001-2013) to estimate the risk of dengue during the World Cup for tourists and teams. Two statistical models were used: a percentile rank (PR) and an Empirical Bayes (EB) model. Expected IR's during the games were generally low (<10/100,000) but predictions varied across locations and between models. Based on current ticket allocations, the mean number of expected symptomatic dengue cases ranged from 26 (PR, 10th-100th percentile: 5-334 cases) to 59 (EB, 95% credible interval: 30-77 cases) among foreign tourists but none are expected among teams. These numbers will highly depend on actual travel schedules and dengue immunity among visitors. Sensitivity analysis for both models indicated that the expected number of cases could be as low as 4 or 5 with 100,000 visitors and as high as 38 or 70 with 800,000 visitors (PR and EB, respectively). CONCLUSION/SIGNIFICANCE The risk of dengue among tourists during the World Cup is expected to be small due to immunity among the Brazil host population provided by last year's epidemic with the same DENV serotypes. Quantitative risk estimates by different groups and methodologies should be made routinely for mass gathering events.
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Affiliation(s)
- Willem G. van Panhuis
- University of Pittsburgh Graduate School of
Public Health, Pittsburgh, Pennsylvania, United States of
America
- * E-mail:
| | - Sangwon Hyun
- Carnegie Mellon University, Pittsburgh,
Pennsylvania, United States of America
| | - Kayleigh Blaney
- University of Pittsburgh Graduate School of
Public Health, Pittsburgh, Pennsylvania, United States of
America
| | - Ernesto T. A. Marques
- University of Pittsburgh Center for Vaccine
Research, Pittsburgh, Pennsylvania, United States of America
| | | | | | - Ryan Tibshirani
- Carnegie Mellon University, Pittsburgh,
Pennsylvania, United States of America
| | | | - Roni Rosenfeld
- Carnegie Mellon University, Pittsburgh,
Pennsylvania, United States of America
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22
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Affiliation(s)
- Christovam Barcellos
- Health Communication and Information Institute, Fundação Oswaldo Cruz (ICICT/FIOCRUZ), Manguinhos, Rio de Janeiro, Brazil
- * E-mail:
| | - Rachel Lowe
- Institut Català de Ciències del Clima (IC3), Barcelona, Catalonia, Spain
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23
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Massad E, Burattini MN, Ximenes R, Amaku M, Wilder-Smith A. Dengue outlook for the World Cup in Brazil. THE LANCET. INFECTIOUS DISEASES 2014; 14:552-3. [PMID: 24929925 DOI: 10.1016/s1473-3099(14)70807-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Eduardo Massad
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil; London School of Hygiene and Tropical Medicine, London, UK
| | - Marcelo N Burattini
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Raphael Ximenes
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcos Amaku
- Faculty of Veterinarian Medicine, University of São Paulo, São Paulo, Brazil
| | - Annelies Wilder-Smith
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, University of Umea, Umea, 901 85, Sweden; Lee Kong Chian School of Medicine, Nanyang University, Singapore.
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