The risk of contact between visitors and Borrelia burgdorferi-infected ticks is associated with fine-scale landscape features in a southeastern Canadian nature park

BACKGROUND

Infectious diseases are emerging across temperate regions of the world, and, for some, links have been made between landscapes and emergence dynamics. For tick-borne diseases, public parks may be important exposure sites for people living in urbanized areas of North America and Europe. In most cases, we know more about the ecological processes that determine the hazard posed by ticks as disease vectors than we do about how human population exposure varies in urban natural parks.

METHODS

In this study, infrared counters were used to monitor visitor use of a public natural park in southern Quebec, Canada. A risk index representing the probability of encounters between humans and infected vectors was constructed. This was done by combining the intensity of visitor trail use and the density of infected nymphs obtained from field surveillance. Patterns of risk were examined using spatial cluster analysis. Digital forest data and park infrastructure data were then integrated using spatially explicit models to test whether encounter risk levels and its components vary with forest fragmentation indicators and proximity to park infrastructure.

RESULTS

Results suggest that, even at a very fine scales, certain landscape features and infrastructure can be predictors of risk levels. Both visitors and Borrelia burgdorferi-infected ticks concentrated in areas where forest cover was dominant, so there was a positive association between forest cover and the risk index. However, there were no associations between indicators of forest fragmentation and risk levels. Some high-risk clusters contributed disproportionately to the risk distribution in the park relative to their size. There were also two high-risk periods, one in early summer coinciding with peak nymphal activity, and one in early fall when park visitation was highest.

CONCLUSIONS

Here, we demonstrate the importance of integrating indicators of human behaviour visitation with tick distribution data to characterize risk patterns for tick-borne diseases in public natural areas. Indeed, understanding the environmental determinants of human-tick interactions will allow organisations to deploy more effective risk reduction interventions targeted at key locations and times, and improve the management of public health risks associated with tick-borne diseases in public spaces.

A methodology for estimating SARS-CoV-2 importation risk by air travel into Canada between July and November 2021

BACKGROUND

Estimating rates of disease importation by travellers is a key activity to assess both the risk to a country from an infectious disease emerging elsewhere in the world and the effectiveness of border measures. We describe a model used to estimate the number of travellers infected with SARS-CoV-2 into Canadian airports in 2021, and assess the impact of pre-departure testing requirements on importation risk.

METHODS

A mathematical model estimated the number of essential and non-essential air travellers infected with SARS-CoV-2, with the latter requiring a negative pre-departure test result. The number of travellers arriving infected (i.e. imported cases) depended on air travel volumes, SARS-CoV-2 exposure risk in the departure country, prior infection or vaccine acquired immunity, and, for non-essential travellers, screening from pre-departure molecular testing. Importation risk was estimated weekly from July to November 2021 as the number of imported cases and percent positivity (PP; i.e. imported cases normalised by travel volume). The impact of pre-departure testing was assessed by comparing three scenarios: baseline (pre-departure testing of all non-essential travellers; most probable importation risk given the pre-departure testing requirements), counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers), and counterfactual scenario 2 (no pre-departure testing of non-essential travellers).

RESULTS

In the baseline scenario, weekly imported cases and PP varied over time, ranging from 145 to 539 cases and 0.15 to 0.28%, respectively. Most cases arrived from the USA, Mexico, the United Kingdom, and France. While modelling suggested that essential travellers had a higher weekly PP (0.37 - 0.65%) than non-essential travellers (0.12 - 0.24%), they contributed fewer weekly cases (62 - 154) than non-essential travellers (84 - 398 per week) given their lower travel volume. Pre-departure testing was estimated to reduce imported cases by one third (counterfactual scenario 1) to one half (counterfactual scenario 2).

CONCLUSIONS

The model results highlighted the weekly variation in importation by traveller group (e.g., reason for travel and country of departure) and enabled a framework for measuring the impact of pre-departure testing requirements. Quantifying the contributors of importation risk through mathematical simulation can support the design of appropriate public health policy on border measures.

Knowledge, protective behaviours, and perception of Lyme disease in an area of emerging risk: results from a cross-sectional survey of adults in Ottawa, Ontario

BACKGROUND

The number of Lyme disease risk areas in Canada is growing. In regions with emerging tick populations, it is important to emphasize peridomestic risk and the importance of protective behaviours in local public health communication. This study aims to identify characteristics associated with high levels of Lyme disease knowledge and adoption of protective behaviours among residents in the Ottawa, Ontario region.

METHODS

A geographically stratified web survey was conducted in November 2020 (n = 2018) to determine knowledge, attitudes, and practices regarding Lyme disease among adult residents. Responses were used to calculate: (i) composite scores for knowledge and adoption of protective practices; and (ii) an exposure risk index based on reported activity in woodlands during the spring-to-fall tick exposure risk period.

RESULTS

60% of respondents had a high knowledge of Lyme disease, yet only 14% indicated they often use five or more measures to protect themselves. Factors strongly associated with a high level of Lyme disease knowledge included being 55 or older (Odds Ratio (OR) = 2.04), living on a property with a yard (OR = 3.22), having a high exposure index (OR = 1.59), and knowing someone previously infected with Lyme disease (OR = 2.05). Strong associations with the adoption of a high number of protective behaviours were observed with membership in a non-Indigenous racialized group (OR = 1.70), living on a property with a yard (OR = 2.37), previous infection with Lyme disease (OR = 2.13), prior tick bite exposure (OR = 1.62), and primarily occupational activity in wooded areas (OR = 2.31).

CONCLUSIONS

This study highlights the dynamics between Lyme disease knowledge, patterns of exposure risk awareness, and vigilance of personal protection in a Canadian region with emerging Lyme disease risk. Notably, this study identified gaps between perceived local risk and protective behaviours, presenting opportunities for targeted enhanced communication efforts in areas of Lyme disease emergence.

Modeling West Nile Virus transmission in birds and humans: Advantages of using a cellular automata approach

In Canada, the periodic circulation of West Nile Virus (WNV) is difficult to predict and, beyond climatic factors, appears to be related to the migratory movements of infected birds from the southern United States. This hypothesis has not yet been explored in a spatially distributed model. The main objective of this work was to develop a spatially explicit dynamic model for the transmission of WNV in Canada, that allows us to explore non-climate related hypotheses associated with WNV transmission. A Cellular Automata (CA) approach for multiple hosts (birds and humans) is used for a test region in eastern Ontario, Canada. The tool is designed to explore the role of host and vector spatial heterogeneity, host migration, and vector feeding preferences. We developed a spatialized compartmental SEIRDS-SEI model for WNV transmission with a study region divided into 4 k m 2 rectangular cells. We used 2010-2021 bird data from the eBird project and 2010-2019 mosquito data collected by Ontario Public Health to mimic bird and mosquito seasonal variation. We considered heterogeneous bird densities (high and low suitability areas) and homogeneous mosquito and human densities. In high suitability areas for birds, we identified 5 entry points for WNV-infected birds. We compared our simulations with pools of WNV-infected field collected mosquitoes. Simulations and sensitivity analyses were performed using MATLAB software. The results showed good correspondence between simulated and observed epidemics, supporting the validity of our model assumptions and calibration. Sensitivity analysis showed that a 5% increase or decrease in each parameter of our model except for the biting rate of bird by mosquito (c ( B , M ) ) and mosquito natural mortality rate (d M ), had a very limited effect on the total number of cases (newly infected birds and humans), prevalence peak, or date of occurrence. We demonstrate the utility of the CA approach for studying WNV transmission in a heterogeneous landscape with multiple hosts.

Estimating the Incidence and Economic Cost of Lyme Disease Cases in Canada in the 21st Century with Projected Climate Change

BACKGROUND

Lyme disease (LD) is emerging in Canada owing to the range expansion of the tick vector Ixodes scapularis (I. scapularis).

OBJECTIVES

Our objective was to estimate future LD incidence in Canada, and economic costs, for the 21st century with projected climate change.

METHODS

Future regions of climatic suitability for I. scapularis were projected from temperature output of the North American Coordinated Regional Climate Downscaling Experiment regional climate model ensemble using greenhouse gas Representative Concentration Pathways (RCPs) 4.5 and 8.5. Once regions became climatically suitable for ticks, an algorithm derived from tick and LD case surveillance data projected subsequent increasing LD incidence. Three scenarios (optimistic, intermediate, and pessimistic) for maximum incidence at endemicity were selected based on LD surveillance, and underreporting estimates, from the United States. Health care and productivity cost estimates of LD cases were obtained from the literature.

RESULTS

Projected annual LD cases for Canada ranged from 120,000 to > 500,000 by 2050. Variation in incidence was mostly due to the maximum incidence at endemicity selected, with minor contributions from variations among climate models and RCPs. Projected annual costs were substantial, ranging from CA $ 0.5  billion to $ 2.0  billion a year by 2050. There was little difference in projected incidence and economic cost between RCPs, and from 2050 to 2100, because projected climate up to 2050 is similar for RCP4.5 and RCP8.5 (mitigation of greenhouse gas emissions captured in RCP4.5 does not impact climate before the 2050s) and by 2050 the most densely populated areas of the study region are projected to be climatically suitable for ticks.

CONCLUSIONS

Future incidence and economic costs of LD in Canada are likely to be substantial, but uncertainties remain. Because densely populated areas of Canada are projected to become endemic under conservative climate change scenarios, mitigation of greenhouse gas emissions is unlikely to provide substantial health co-benefits for LD. https://doi.org/10.1289/EHP13759.

Exploring the dynamics of the 2022 mpox outbreak in Canada

The 2022 mpox outbreak predominantly impacted gay, bisexual, and other men who have sex with men (gbMSM). Two models were developed to support situational awareness and management decisions in Canada. A compartmental model characterized epidemic drivers at national/provincial levels, while an agent-based model (ABM) assessed municipal-level impacts of vaccination. The models were parameterized and calibrated using empirical case and vaccination data between 2022 and 2023. The compartmental model explored: (1) the epidemic trajectory through community transmission, (2) the potential for transmission among non-gbMSM, and (3) impacts of vaccination and the proportion of gbMSM contributing to disease transmission. The ABM incorporated sexual-contact data and modeled: (1) effects of vaccine uptake on disease dynamics, and (2) impacts of case importation on outbreak resurgence. The calibrated, compartmental model followed the trajectory of the epidemic, which peaked in July 2022, and died out in December 2022. Most cases occurred among gbMSM, and epidemic trajectories were not consistent with sustained transmission among non-gbMSM. The ABM suggested that unprioritized vaccination strategies could increase the outbreak size by 47%, and that consistent importation (≥5 cases per 10 000) is necessary for outbreak resurgence. These models can inform time-sensitive situational awareness and policy decisions for similar future outbreaks.

Possible effect of mutations on serological detection of Borrelia burgdorferi sensu stricto ospC major groups: An in-silico study

The outer surface protein C (OspC) of the agent of Lyme disease, Borrelia burgdorferi sensu stricto, is a major lipoprotein surface-expressed during early-phase human infections. Antibodies to OspC are used in serological diagnoses. This study explored the hypothesis that serological test sensitivity decreases as genetic similarity of ospC major groups (MGs) of infecting strains, and ospC A (the MG in the strain B31 used to prepare antigen for serodiagnosis assays) decreases. We used a previously published microarray dataset to compare serological reactivity to ospC A (measured as pixel intensity) versus reactivity to 22 other ospC MGs, within a population of 55 patients diagnosed by two-tier serological testing using B. burgdorferi s.s. strain B31 as antigen, in which the ospC MG is OspC A. The difference in reactivity of sera to ospC A and reactivity to each of the other 22 ospC MGs (termed 'reactivity difference') was the outcome variable in regression analysis in which genetic distance of the ospC MGs from ospC A was the explanatory variable. Genetic distance was computed for the whole ospC sequence, and 9 subsections, from Neighbour Joining phylogenetic trees of the 23 ospC MGs. Regression analysis was conducted using genetic distance for the full ospC sequence, and the subsections individually. There was a significant association between the reactivity difference and genetic distance of ospC MGs from ospC A: increased genetic distance reduced reactivity to OspC A. No single ospC subsection sequence fully explained the relationship between genetic distance and reactivity difference. An analysis of single nucleotide polymorphisms supported a biological explanation via specific amino acid modifications likely to change protein binding affinity. This adds support to the hypothesis that genetic diversity of B. burgdorferi s.s. (here specifically OspC) may impact serological diagnostic test performance. Further prospective studies are necessary to explore the clinical implications of these findings.

Ecological Niche and Positive Clusters of Two West Nile Virus Vectors in Ontario, Canada

West Nile virus (WNV) is a mosquito-borne pathogen associated with uncommon but severe neurological complications in humans, especially among the elderly and immune-compromised. In Northeastern North America, the Culex pipiens/restuans complex and Aedes vexans are the two principal vector mosquito species/species groups of WNV. Using a 10-year surveillance dataset of WNV vector captures at 118 sites across an area of 40,000 km2 in Eastern Ontario, Canada, the ecological niches of Cx. pipiens/restuans and Aedes vexans were modeled by random forest analysis. Spatiotemporal clusters of WNV-positive mosquito pools were identified using Kulldorf's spatial scan statistic. The study region encompasses land cover types and climate representative of highly populated Southeastern Canada. We found highest vector habitat suitability in the eastern half of the study area, where temperatures are generally warmer (variable importance > 0.40) and residential and agricultural cropland cover is more prominent (variable importance > 0.25). We found spatiotemporal clusters of high WNV infection rates around the city of Ottawa in both mosquito vector species. These results support the previous literature in the same region and elsewhere suggesting areas surrounding highly populated areas are also high-risk areas for vector-borne zoonoses such as the WNV.

Risk factors for Lyme disease resulting from residential exposure amidst emerging Ixodes scapularis populations: A neighbourhood-level analysis of Ottawa, Ontario

Lyme disease is an emerging health threat in Canada due to the continued northward expansion of the main tick vector, Ixodes scapularis. It is of particular concern to populations living in expanding peri-urban areas where residential development and municipal climate change response impact neighbourhood structure and composition. The objective of this study was to estimate associations of socio-ecological characteristics with residential Lyme disease risk at the neighbourhood scale. We used Lyme disease case data for 2017-2020 reported for Ottawa, Ontario to determine where patients' residential property, or elsewhere within their neighbourhood, was the suspected site of tick exposure. Cases meeting this exposure definition (n = 118) were aggregated and linked to neighbourhood boundaries. We calculated landscape characteristics from composited and classified August 2018 PlanetScope satellite imagery. Negative binomial generalized linear models guided by a priori hypothesized relationships explored the association between hypothesized interactions of landscape structure and the outcome. Increases in median household income, the number of forest patches, the proportion of forested area, forest edge density, and mean forest patch size were associated with higher residential Lyme disease incidence at the neighbourhood scale, while increases in forest shape complexity and average distance to forest edge were associated with reduced incidence (P<0.001). Among Ottawa neighbourhoods, the combined effect of forest shape complexity and average forest patch size was associated with higher residential Lyme disease incidence (P<0.001). These findings suggest that Lyme disease risk in residential settings is associated with urban design elements. This is particularly relevant in urban centres where local ecological changes may impact the presence of emerging tick populations and how residents interact with tick habitat. Further research into the mechanistic underpinnings of these associations would be an asset to both urban development planning and public health management.

Variation among strains of Borrelia burgdorferi in host tissue abundance and lifetime transmission determine the population strain structure in nature

Pathogen life history theory assumes a positive relationship between pathogen load in host tissues and pathogen transmission. Empirical evidence for this relationship is surprisingly rare due to the difficulty of measuring transmission for many pathogens. The comparative method, where a common host is experimentally infected with a set of pathogen strains, is a powerful approach for investigating the relationships between pathogen load and transmission. The validity of such experimental estimates of strain-specific transmission is greatly enhanced if they can predict the pathogen population strain structure in nature. Borrelia burgdorferi is a multi-strain, tick-borne spirochete that causes Lyme disease in North America. This study used 11 field-collected strains of B. burgdorferi, a rodent host (Mus musculus, C3H/HeJ) and its tick vector (Ixodes scapularis) to determine the relationship between pathogen load in host tissues and lifetime host-to-tick transmission (HTT). Mice were experimentally infected via tick bite with 1 of 11 strains. Lifetime HTT was measured by infesting mice with I. scapularis larval ticks on 3 separate occasions. The prevalence and abundance of the strains in the mouse tissues and the ticks were determined by qPCR. We used published databases to obtain estimates of the frequencies of these strains in wild I. scapularis tick populations. Spirochete loads in ticks and lifetime HTT varied significantly among the 11 strains of B. burgdorferi. Strains with higher spirochete loads in the host tissues were more likely to infect feeding larval ticks, which molted into nymphal ticks that had a higher probability of B. burgdorferi infection (i.e., higher HTT). Our laboratory-based estimates of lifetime HTT were predictive of the frequencies of these strains in wild I. scapularis populations. For B. burgdorferi, the strains that establish high abundance in host tissues and that have high lifetime transmission are the strains that are most common in nature.

Mechanistic movement models to predict geographic range expansions of ticks and tick-borne pathogens: Case studies with Ixodes scapularis and Amblyomma americanum in eastern North America

The geographic range of the blacklegged tick, Ixodes scapularis, is expanding northward from the United States into southern Canada, and studies suggest that the lone star tick, Amblyomma americanum, will follow suit. These tick species are vectors for many zoonotic pathogens, and their northward range expansion presents a serious threat to public health. Climate change (particularly increasing temperature) has been identified as an important driver permitting northward range expansion of blacklegged ticks, but the impacts of host movement, which is essential to tick dispersal into new climatically suitable regions, have received limited investigation. Here, a mechanistic movement model was applied to landscapes of eastern North America to explore 1) relationships between multiple ecological drivers and the speed of the northward invasion of blacklegged ticks infected with the causative agent of Lyme disease, Borrelia burgdorferi sensu stricto, and 2) its capacity to simulate the northward range expansion of infected blacklegged ticks and uninfected lone star ticks under theoretical scenarios of increasing temperature. Our results suggest that the attraction of migratory birds (long-distance tick dispersal hosts) to resource-rich areas during their spring migration and the mate-finding Allee effect in tick population dynamics are key drivers for the spread of infected blacklegged ticks. The modeled increases in temperature extended the climatically suitable areas of Canada for infected blacklegged ticks and uninfected lone star ticks towards higher latitudes by up to 31% and 1%, respectively, and with an average predicted speed of the range expansion reaching 61 km/year and 23 km/year, respectively. Differences in the projected spatial distribution patterns of these tick species were due to differences in climate envelopes of tick populations, as well as the availability and attractiveness of suitable habitats for migratory birds. Our results indicate that the northward invasion process of lone star ticks is primarily driven by local dispersal of resident terrestrial hosts, whereas that of blacklegged ticks is governed by long-distance migratory bird dispersal. The results also suggest that mechanistic movement models provide a powerful approach for predicting tick-borne disease risk patterns under complex scenarios of climate, socioeconomic and land use/land cover changes.

Future land-use change predictions using Dyna-Clue to support mosquito-borne disease risk assessment

Mosquitoes are known vectors for viral diseases in Canada, and their distribution is driven by climate and land use. Despite that, future land-use changes have not yet been used as a driver in mosquito distribution models in North America. In this paper, we developed land-use change projections designed to address mosquito-borne disease (MBD) prediction in a 38 761 km2 area of Eastern Ontario. The landscape in the study area is marked by urbanization and intensive agriculture and hosts a diverse mosquito community. The Dyna-CLUE model was used to project land-use for three time horizons (2030, 2050, and 2070) based on historical trends (from 2014 to 2020) for water, forest, agriculture, and urban land uses. Five scenarios were generated to reflect urbanization, agricultural expansion, and natural areas. An ensemble of thirty simulations per scenario was run to account for land-use conversion uncertainty. The simulation closest to the average map generated was selected to represent the scenario. A concordance matrix generated using map pair analysis showed a good agreement between the simulated 2020 maps and 2020 observed map. By 2050, the most significant changes are predicted to occur mainly in the southeastern region's rural and forested areas. By 2070, high deforestation is expected in the central west. These results will be integrated into risk models predicting mosquito distribution to study the possibility of humans' increased exposure risk to MBDs.

Quantifying the economic gains associated with COVID-19 vaccination in the Canadian population: A cost-benefit analysis

Background

Vaccination has been a key part of Canada's coronavirus disease 2019 (COVID-19) pandemic response. Although the clinical benefits of vaccination are clear, an understanding of the population-level benefits of vaccination relative to the programmatic costs is of value. The objective of this article is to quantify the economic impact of COVID-19 vaccination in the Canadian population between December 2020 and March 2022.

Methods

We conducted a model-based cost-benefit analysis of Canada's COVID-19 vaccination program. We used an epidemiological model to estimate the number of COVID-19 symptomatic cases, hospitalizations, post-COVID condition (PCC) cases, and deaths in the presence and absence of vaccination. Median, lower and upper 95% credible interval (95% CrI) outcome values from 100 model simulations were used to estimate the direct and indirect costs of illness, including the value of health. We used a societal perspective and a 1.5% discount rate.

Results

We estimated that the costs of the vaccination program were far outweighed by the savings associated with averted infections and associated downstream consequences. Vaccination increased the net benefit by CAD $298.1 billion (95% CrI: 27.2-494.6) compared to the no vaccination counterfactual. The largest benefits were due to averted premature mortality, resulting in an estimated $222.0 billion (95% CrI: 31.2-379.0) benefit.

Conclusion

Our model-based economic evaluation provides a retrospective assessment of COVID-19 vaccination during the first 16 months of the program in Canada and suggests that it was welfare-improving, considering the decreased hospitalizations and use of healthcare resources, deaths averted and lower morbidity from conditions such as PCC.

Integrated human behavior and tick risk maps to prioritize Lyme disease interventions using a 'One Health' approach

Lyme disease (LD) risk is emerging rapidly in Canada due to range expansion of its tick vectors, accelerated by climate change. The risk of contracting LD varies geographically due to variability in ecological characteristics that determine the hazard (the densities of infected host-seeking ticks) and vulnerability of the human population determined by their knowledge and adoption of preventive behaviors. Risk maps are commonly used to support public health decision-making on Lyme disease, but the ability of the human public to adopt preventive behaviors is rarely taken into account in their development, which represents a critical gap. The objective of this work was to improve LD risk mapping using an integrated social-behavioral and ecological approach to: (i) compute enhanced integrated risk maps for prioritization of interventions and (ii) develop a spatially-explicit assessment tool to examine the relative contribution of different risk factors. The study was carried out in the Estrie region located in southern Québec. The blacklegged tick, Ixodes scapularis, infected with the agent of LD is widespread in Estrie and as a result, regional LD incidence is the highest in the province. LD knowledge and behaviors in the population were measured in a cross-sectional health survey conducted in 2018 reaching 10,790 respondents in Estrie. These data were used to create an index for the social-behavioral component of risk in 2018. Local Empirical Bayes estimator technique were used to better quantify the spatial variance in the levels of adoption of LD preventive activities. For the ecological risk analysis, a tick abundance model was developed by integrating data from ongoing long-term tick surveillance programs from 2007 up to 2018. Social-behavioral and ecological components of the risk measures were combined to create vulnerability index maps and, with the addition of human population densities, prioritization index maps. Map predictions were validated by testing the association of high-risk areas with the current spatial distribution of human cases of LD and reported tick exposure. Our results demonstrated that social-behavioral and ecological components of LD risk have markedly different distributions within Estrie. The occurrence of human LD cases or reported tick exposure in a municipality was positively associated with tick density and the prioritization risk index (p < 0.001). This research is a second step towards a more comprehensive integrated LD risk assessment approach, examining social-behavioral risk factors that interact with ecological risk factors to influence the management of emerging tick-borne diseases, an approach that could be applied more widely to vector-borne and zoonotic diseases.

Assessing transmission risks and control strategy for monkeypox as an emerging zoonosis in a metropolitan area

To model the spread of monkeypox (MPX) in a metropolitan area for assessing the risk of possible outbreaks, and identifying essential public health measures to contain the virus spread. The animal reservoir is the key element in the modeling of zoonotic disease. Using a One Health approach, we model the spread of the MPX virus in humans considering potential animal hosts such as rodents (e.g., rats, mice, squirrels, chipmunks, etc.) and emphasize their role and transmission of the virus in a high-risk group, including gay and bisexual men-who-have-sex-with-men (gbMSM). From model and sensitivity analysis, we identify key public health factors and present scenarios under different transmission assumptions. We find that the MPX virus may spill over from gbMSM high-risk groups to broader populations if the efficiency of transmission increases in the higher-risk group. However, the risk of outbreak can be greatly reduced if at least 65% of symptomatic cases can be isolated and their contacts traced and quarantined. In addition, infections in an animal reservoir will exacerbate MPX transmission risk in the human population. Regions or communities with a higher proportion of gbMSM individuals need greater public health attention. Tracing and quarantine (or "effective quarantine" by postexposure vaccination) of contacts with MPX cases in high-risk groups would have a significant effect on controlling the spreading. Also, monitoring for animal infections would be prudent.

Modeling vaccination and control strategies for outbreaks of monkeypox at gatherings

Background

The monkeypox outbreak in non-endemic countries in recent months has led the World Health Organization (WHO) to declare a public health emergency of international concern (PHEIC). It is thought that festivals, parties, and other gatherings may have contributed to the outbreak.

Methods

We considered a hypothetical metropolitan city and modeled the transmission of the monkeypox virus in humans in a high-risk group (HRG) and a low-risk group (LRG) using a Susceptible-Exposed-Infectious-Recovered (SEIR) model and incorporated gathering events. Model simulations assessed how the vaccination strategies combined with other public health measures can contribute to mitigating or halting outbreaks from mass gathering events.

Results

The risk of a monkeypox outbreak was high when mass gathering events occurred in the absence of public health control measures. However, the outbreaks were controlled by isolating cases and vaccinating their close contacts. Furthermore, contact tracing, vaccinating, and isolating close contacts, if they can be implemented, were more effective for the containment of monkeypox transmission during summer gatherings than a broad vaccination campaign among HRG, when accounting for the low vaccination coverage in the overall population, and the time needed for the development of the immune responses. Reducing the number of attendees and effective contacts during the gathering could also prevent a burgeoning outbreak, as could restricting attendance through vaccination requirements.

Conclusion

Monkeypox outbreaks following mass gatherings can be made less likely with some restrictions on either the number and density of attendees in the gathering or vaccination requirements. The ring vaccination strategy inoculating close contacts of confirmed cases may not be enough to prevent potential outbreaks; however, mass gatherings can be rendered less risky if that strategy is combined with public health measures, including identifying and isolating cases and contact tracing. Compliance with the community and promotion of awareness are also indispensable to containing the outbreak.

Fluralaner Baits Reduce the Infestation of Peromyscus spp. Mice (Rodentia: Cricetidae) by Ixodes scapularis (Acari: Ixodidae) Larvae and Nymphs in a Natural Environment

The development of interventions that reduce Lyme disease incidence remains a challenge. Reservoir-targeted approaches aiming to reduce tick densities or tick infection prevalence with Borrelia burgdorferi have emerged as promising ways to reduce the density of infected ticks. Acaricides of the isoxazoline family offer high potential for reducing infestation of ticks on small mammals as they have high efficacy at killing feeding ticks for a long period. Fluralaner baits were recently demonstrated as effective, in the laboratory, at killing Ixodes scapularis larvae infesting Peromyscus mice, the main reservoir for B. burgdorferi in northeastern North America. Here, effectiveness of this approach for reducing the infestation of small mammals by immature stages of I. scapularis was tested in a natural environment. Two densities of fluralaner baits (2.1 baits/1,000 m2 and 4.4 baits/1,000 m2) were used during three years in forest plots. The number of I. scapularis larvae and nymphs per mouse from treated and control plots were compared. Fluralaner baiting reduced the number of larvae per mouse by 68% (CI95: 51-79%) at 2.1 baits/1,000 m2 and by 86% (CI95: 77-92%) at 4.4 baits/1,000 m2. The number of nymphs per mouse was reduced by 72% (CI95: 22-90%) at 4.4 baits/1,000 m2 but was not significantly reduced at 2.1 baits/1,000 m2. Reduction of Peromyscus mouse infestation by immature stages of I. scapularis supports the hypothesis that an approach targeting reservoirs of B. burgdorferi with isoxazolines has the potential to reduce tick-borne disease risk by decreasing the density of infected ticks in the environment.

An ecological approach to predict areas with established populations of Ixodes scapularis in Quebec, Canada

Public health management of Lyme disease (LD) is a dynamic challenge in Canada. Climate warming is driving the northward expansion of suitable habitat for the tick vector, Ixodes scapularis. Information about tick population establishment is used to inform the risk of LD but is challenged by sampling biases from surveillance data. Misclassifying areas as having no established tick population underestimates the LD risk classification. We used a logistic regression model at the municipal level to predict the probability of I. scapularis population establishment based on passive tick surveillance data during the period of 2010-2017 in southern Quebec. We tested for the effect of abiotic and biotic factors hypothesized to influence tick biology and ecology. Additional variables controlled for sampling biases in the passive surveillance data. In our final selected model, tick population establishment was positively associated with annual cumulative degree-days > 0°C, precipitation and deer density, and negatively associated with coniferous and mixed forest types. Sampling biases from passive tick surveillance were controlled for using municipal population size and public health instructions on tick submissions. The model performed well as indicated by an area under the curve (AUC) of 0.92, sensitivity of 86% and specificity of 81%. Our model enables prediction of I. scapularis population establishment in areas which lack data from passive tick surveillance and may improve the sensitivity of LD risk categorization in these areas. A more sensitive system of LD risk classification is important for increasing awareness and use of protective measures employed against ticks, and decreasing the morbidity associated with LD.

Borrelia burgdorferi strain and host sex influence pathogen prevalence and abundance in the tissues of a laboratory rodent host

Experimental infections with different pathogen strains give insight into pathogen life history traits. The purpose of the present study was to compare variation in tissue infection prevalence and spirochete abundance among strains of Borrelia burgdorferi in a rodent host (Mus musculus, C3H/HeJ). Male and female mice were experimentally infected via tick bite with one of 12 strains. Ear tissue biopsies were taken at days 29, 59 and 89 postinfection, and seven tissues were collected at necropsy. The presence and abundance of spirochetes in the mouse tissues were measured by quantitative polymerase chain reaction. To determine the frequencies of our strains in nature, their multilocus sequence types were matched to published data sets. For the infected mice, 56.6% of the tissues were infected with B. burgdorferi. The mean spirochete load in the mouse necropsy tissues varied 4.8-fold between the strains. The mean spirochete load in the ear tissue biopsies decreased rapidly over time for some strains. The percentage of infected tissues in male mice (65.4%) was significantly higher compared to female mice (50.5%). The mean spirochete load in the seven tissues was 1.5× higher in male mice compared to female mice; this male bias was 15.3× higher in the ventral skin. Across the 11 strains, the mean spirochete loads in the infected mouse tissues were positively correlated with the strain-specific frequencies in their tick vector populations. The study suggests that laboratory-based estimates of pathogen abundance in host tissues can predict the strain composition of this important tick-borne pathogen in nature.

Assessing the mechanism of citywide test-trace-isolate Zero-COVID policy and exit strategy of COVID-19 pandemic

BACKGROUND

Countries that aimed for eliminating the cases of COVID-19 with test-trace-isolate policy are found to have lower infections, deaths, and better economic performance, compared with those that opted for other mitigation strategies. However, the continuous evolution of new strains has raised the question of whether COVID-19 eradication is still possible given the limited public health response capacity and fatigue of the epidemic. We aim to investigate the mechanism of the Zero-COVID policy on outbreak containment, and to explore the possibility of eradication of Omicron transmission using the citywide test-trace-isolate (CTTI) strategy.

METHODS

We develop a compartmental model incorporating the CTTI Zero-COVID policy to understand how it contributes to the SARS-CoV-2 elimination. We employ our model to mimic the Delta outbreak in Fujian Province, China, from September 10 to October 9, 2021, and the Omicron outbreak in Jilin Province, China for the period from March 1 to April 1, 2022. Projections and sensitivity analyses were conducted using dynamical system and Latin Hypercube Sampling/ Partial Rank Correlation Coefficient (PRCC).

RESULTS

Calibration results of the model estimate the Fujian Delta outbreak can end in 30 (95% confidence interval CI: 28-33) days, after 10 (95% CI: 9-11) rounds of citywide testing. The emerging Jilin Omicron outbreak may achieve zero COVID cases in 50 (95% CI: 41-57) days if supported with sufficient public health resources and population compliance, which shows the effectiveness of the CTTI Zero-COVID policy.

CONCLUSIONS

The CTTI policy shows the capacity for the eradication of the Delta outbreaks and also the Omicron outbreaks. Nonetheless, the implementation of radical CTTI is challenging, which requires routine monitoring for early detection, adequate testing capacity, efficient contact tracing, and high isolation compliance, which constrain its benefits in regions with limited resources. Moreover, these challenges become even more acute in the face of more contagious variants with a high proportion of asymptomatic cases. Hence, in regions where CTTI is not possible, personal protection, public health control measures, and vaccination are indispensable for mitigating and exiting the COVID-19 pandemic.

Effectiveness of non-pharmaceutical interventions to reduce SARS-CoV-2 transmission in Canada and their association with COVID-19 hospitalization rates

Background

Non-pharmaceutical interventions (NPIs) aim to reduce the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections mostly by limiting contacts between people where virus transmission can occur. However, NPIs limit social interactions and have negative impacts on economic, physical, mental and social well-being. It is, therefore, important to assess the impact of NPIs on reducing the number of coronavirus disease 2019 (COVID-19) cases and hospitalizations to justify their use.

Methods

Dynamic regression models accounting for autocorrelation in time series data were used with data from six Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Québec) to assess 1) the effect of NPIs (measured using a stringency index) on SARS-CoV-2 transmission (measured by the effective reproduction number), and 2) the effect of the number of hospitalized COVID-19 patients on the stringency index.

Results

Increasing stringency index was associated with a statistically significant decrease in the transmission of SARS-CoV-2 in Alberta, Saskatchewan, Manitoba, Ontario and Québec. The effect of stringency on transmission was time-lagged in all of these provinces except for Ontario. In all provinces except for Saskatchewan, increasing hospitalization rates were associated with a statistically significant increase in the stringency index. The effect of hospitalization on stringency was time-lagged.

Conclusion

These results suggest that NPIs have been effective in Canadian provinces, and that their implementation has been, in part, a response to increasing hospitalization rates of COVID-19 patients.

Counterfactuals of effects of vaccination and public health measures on COVID-19 cases in Canada: What could have happened?

This study illustrates what may have happened, in terms of coronavirus disease 2019 (COVID-19) infections, hospitalizations and deaths in Canada, had public health measures not been used to control the COVID-19 epidemic, and had restrictions been lifted with low levels of vaccination, or no vaccination, of the Canadian population. The timeline of the epidemic in Canada, and the public health interventions used to control the epidemic, are reviewed. Comparisons against outcomes in other countries and counterfactual modelling illustrate the relative success of control of the epidemic in Canada. Together, these observations show that without the use of restrictive measures and without high levels of vaccination, Canada could have experienced substantially higher numbers of infections and hospitalizations and almost a million deaths.

Spatiotemporal trends and socioecological factors associated with Lyme disease in eastern Ontario, Canada from 2010-2017

Currently, there is limited knowledge about socioeconomic, neighbourhood, and local ecological factors that contribute to the growing Lyme disease incidence in the province of Ontario, Canada. In this study, we sought to identify these factors that play an important role at the local scale, where people are encountering ticks in their communities. We used reported human Lyme disease case data and tick surveillance data submitted by the public from 2010–2017 to analyze trends in tick exposure, spatiotemporal clusters of infection using the spatial scan statistic and Local Moran’s I statistic, and socioecological risk factors for Lyme disease using a multivariable negative binomial regression model. Data were analyzed at the smallest geographic unit, consisting of 400–700 individuals, for which census data are disseminated in Canada. We found significant heterogeneity in tick exposure patterns based on location of residence, with 65.2% of Lyme disease patients from the city of Ottawa reporting tick exposures outside their health unit of residence, compared to 86.1%—98.1% of patients from other, largely rural, health units, reporting peri-domestic exposures. We detected eight spatiotemporal clusters of human Lyme disease incidence in eastern Ontario, overlapping with three clusters of Borrelia burgdorferi-infected ticks. When adjusting for population counts, Lyme disease case counts increased with larger numbers of Borrelia burgdorferi-infected ticks submitted by the public, higher proportion of treed landcover, lower neighbourhood walkability due to fewer intersections, dwellings, and points of interest, as well as with regions of higher residential instability and lower ethnic concentration (Relative Risk [RR] = 1.25, 1.02, 0.67–0.04, 1.34, and 0.57, respectively, p < .0001). Our study shows that there are regional differences in tick exposure patterns in eastern Ontario and that multiple socioecological factors contribute to Lyme disease risk in this region.

Efficacy of a "stay-at-home" policy on SARS-CoV-2 transmission in Toronto, Canada: a mathematical modelling study

BACKGROUND

Globally, nonpharmaceutical interventions for COVID-19, including stay-at-home policies, limitations on gatherings and closure of public spaces, are being lifted. We explored the effect of lifting a stay-at-home policy on virus resurgence under different conditions.

METHODS

Using confirmed case data from Toronto, Canada, between Feb. 24 and June 24, 2020, we ran a compartmental model with household structure to simulate the impact of the stay-at-home policy considering different levels of compliance. We estimated threshold values for the maximum number of contacts, probability of transmission and testing rates required for the safe reopening of the community.

RESULTS

After the implementation of the stay-at-home policy, the contact rate outside the household fell by 39% (from 11.58 daily contacts to 7.11). The effective reproductive number decreased from 3.56 (95% confidence interval [CI] 3.02-4.14) on Mar. 12 to 0.84 (95% CI 0.79-0.89) on May 6. Strong adherence to stay-at-home policies appeared to prevent SARS-CoV-2 resurgence, but extending the duration of stay-at-home policies beyond 2 months had little added effect on cumulative cases (25 958 for 65 days of a stay-at-home policy and 23 461 for 95 days, by July 2, 2020) and deaths (1404 for 65 days and 1353 for 95 days). To avoid a resurgence, the average number of contacts per person per day should be kept below 9, with strict nonpharmaceutical interventions in place.

INTERPRETATION

Our study demonstrates that the stay-at-home policy implemented in Toronto in March 2020 had a substantial impact on mitigating the spread of SARS-CoV-2. In the context of the early pandemic, before the emergence of variants of concern, reopening schools and workplaces was possible only with other nonpharmaceutical interventions in place.

Effects of land use and weather on the presence and abundance of mosquito-borne disease vectors in a urban and agricultural landscape in Eastern Ontario, Canada

Weather and land use can significantly impact mosquito abundance and presence, and by consequence, mosquito-borne disease (MBD) dynamics. Knowledge of vector ecology and mosquito species response to these drivers will help us better predict risk from MBD. In this study, we evaluated and compared the independent and combined effects of weather and land use on mosquito species occurrence and abundance in Eastern Ontario, Canada. Data on occurrence and abundance (245,591 individuals) of 30 mosquito species were obtained from mosquito capture at 85 field sites in 2017 and 2018. Environmental variables were extracted from weather and land use datasets in a 1-km buffer around trapping sites. The relative importance of weather and land use on mosquito abundance (for common species) or occurrence (for all species) was evaluated using multivariate hierarchical statistical models. Models incorporating both weather and land use performed better than models that include weather only for approximately half of species (59% for occurrence model and 50% for abundance model). Mosquito occurrence was mainly associated with temperature whereas abundance was associated with precipitation and temperature combined. Land use was more often associated with abundance than occurrence. For most species, occurrence and abundance were positively associated with forest cover but for some there was a negative association. Occurrence and abundance of some species (47% for occurrence model and 88% for abundance model) were positively associated with wetlands, but negatively associated with urban (Culiseta melanura and Anopheles walkeri) and agriculture (An. quadrimaculatus, Cs. minnesotae and An. walkeri) environments. This study provides predictive relationships between weather, land use and mosquito occurrence and abundance for a wide range of species including those that are currently uncommon, yet known as arboviruses vectors. Elucidation of these relationships has the potential to contribute to better prediction of MBD risk, and thus more efficiently targeted prevention and control measures.

Projections of the transmission of the Omicron variant for Toronto, Ontario, and Canada using surveillance data following recent changes in testing policies

At the end of 2021, with the rapid escalation of COVID19 cases due to the Omicron variant, testing centers in Canada were overwhelmed. To alleviate the pressure on the PCR testing capacity, many provinces implemented new strategies that promote self testing and adjust the eligibility for PCR tests, making the count of new cases underreported. We designed a novel compartmental model which captures the new testing guidelines, social behaviours, booster vaccines campaign and features of the newest variant Omicron. To better describe the testing eligibility, we considered the population divided into high risk and non-high-risk settings. The model is calibrated using data from January 1 to February 9, 2022, on cases and severe outcomes in Canada, the province of Ontario and City of Toronto. We conduct analyses on the impact of PCR testing capacity, self testing, different levels of reopening and vaccination coverage on cases and severe outcomes. Our results show that the total number of cases in Canada, Ontario and Toronto are 2.34 (95%CI: 1.22–3.38), 2.20 (95%CI: 1.15–3.72), and 1.97(95%CI: 1.13–3.41), times larger than reported cases, respectively. The current testing strategy is efficient if partial restrictions, such as limited capacity in public spaces, are implemented. Allowing more people to have access to PCR reduces the daily cases and severe outcomes; however, if PCR test capacity is insufficient, then it is important to promote self testing. Also, we found that reopening to a pre-pandemic level will lead to a resurgence of the infections, peaking in late March or April 2022. Vaccination and adherence to isolation protocols are important supports to the testing policies to mitigate any possible spread of the virus.

Context-dependent host dispersal and habitat fragmentation determine heterogeneity in infected tick burdens: an agent-based modelling study

As the incidence of tick-borne diseases has sharply increased over the past decade, with serious consequences for human and animal health, there is a need to identify ecological drivers contributing to heterogeneity in tick-borne disease risk. In particular, the relative importance of animal host dispersal behaviour in its three context-dependent phases of emigration, transfer and settlement is relatively unexplored. We built a spatially explicit agent-based model to investigate how the host dispersal process, in concert with the tick and host demographic processes, habitat fragmentation and the pathogen transmission process, affects infected tick distributions among hosts. A sensitivity analysis explored the impacts of different input parameters on infected tick burdens on hosts and infected tick distributions among hosts. Our simulations indicate that ecological predictors of infected tick burdens differed among the post-egg life stages of ticks, with tick attachment and detachment, tick questing activity and pathogen transmission dynamics identified as key processes, in a coherent way. We also found that the type of host settlement strategy and the proportion of habitat suitable for hosts determined super-spreading of infected ticks. We developed a theoretical mechanistic framework that can serve as a first step towards applied studies of on-the-ground public health intervention strategies.

Context-dependent host dispersal and habitat fragmentation determine heterogeneity in infected tick burdens: an agent-based modelling study

As the incidence of tick-borne diseases has sharply increased over the past decade, with serious consequences for human and animal health, there is a need to identify ecological drivers contributing to heterogeneity in tick-borne disease risk. In particular, the relative importance of animal host dispersal behaviour in its three context-dependent phases of emigration, transfer and settlement is relatively unexplored. We built a spatially explicit agent-based model to investigate how the host dispersal process, in concert with the tick and host demographic processes, habitat fragmentation and the pathogen transmission process, affects infected tick distributions among hosts. A sensitivity analysis explored the impacts of different input parameters on infected tick burdens on hosts and infected tick distributions among hosts. Our simulations indicate that ecological predictors of infected tick burdens differed among the post-egg life stages of ticks, with tick attachment and detachment, tick questing activity and pathogen transmission dynamics identified as key processes, in a coherent way. We also found that the type of host settlement strategy and the proportion of habitat suitable for hosts determined super-spreading of infected ticks. We developed a theoretical mechanistic framework that can serve as a first step towards applied studies of on-the-ground public health intervention strategies.

Modelling the impact of age-stratified public health measures on SARS-CoV-2 transmission in Canada

Public health measures applied exclusively within vulnerable populations have been suggested as an alternative to community-wide interventions to mitigate SARS-CoV-2 transmission. With the population demography and healthcare capacity of Canada as an example, a stochastic age-stratified agent-based model was used to explore the progression of the COVID-19 epidemic under three intervention scenarios (infection-preventing vaccination, illness-preventing vaccination and shielding) in individuals above three age thresholds (greater than or equal to 45, 55 and 65 years) while lifting shutdowns and physical distancing in the community. Compared with a scenario with sustained community-wide measures, all age-stratified intervention scenarios resulted in a substantial epidemic resurgence, with hospital and ICU bed usage exceeding healthcare capacities even at the lowest age threshold. Individuals under the age threshold were severely impacted by the implementation of all age-stratified interventions, with large numbers of avoidable deaths. Among all explored scenarios, shielding older individuals led to the most detrimental outcomes (hospitalizations, ICU admissions and mortality) for all ages, including the targeted population. This study suggests that, in the absence of community-wide measures, implementing interventions exclusively within vulnerable age groups could result in unmanageable levels of infections, with serious outcomes within the population. Caution is therefore warranted regarding early relaxation of community-wide restrictions.

Fine-scale determinants of the spatiotemporal distribution of Ixodes scapularis in Quebec (Canada)

The tick vector of Lyme disease, Ixodes scapularis, is currently expanding its geographical distribution northward into southern Canada driving emergence of Lyme disease in the region. Despite large-scale studies that attributed different factors such as climate change and changes in land use to the geographical expansion of the tick, a comprehensive understanding of local patterns of tick abundance is still lacking in that region. Using a newly endemic periurban nature park located in Quebec (Canada) as a model, we explored intra-habitat patterns in tick distribution and their relationship with biotic and abiotic factors. We verified the hypotheses that (1) there is spatial heterogeneity in tick densities at the scale of the park and (2) these patterns can be explained by host availability, habitat characteristics and microclimatic conditions. During tick activity season in three consecutive years, tick, deer, rodent and bird abundance, as well as habitat characteristics and microclimatic conditions, were estimated at thirty-two sites. Patterns of tick distribution and abundance were investigated by spatial analysis. Generalised additive mixed models were constructed for each developmental stage of the tick and the relative importance of significant drivers on tick abundance were derived from final models. We found fine-scale spatial heterogeneity in densities of all tick stages across the park, with interannual variability in the location of hotspots. For all stages, the local density was related to the density of the previous stage in the previous season, in keeping with the tick's life cycle. Adult tick density was highest where drainage was moderate (neither waterlogged nor dry). Microclimatic conditions influenced the densities of immature ticks, through the effects of weather at the time of tick sampling (ambient temperature and relative humidity) and of the seasonal microclimate at the site level (degree-days and number of tick adverse moisture events). Seasonal phenology patterns were generally consistent with expected curves for the region, with exceptions in some years that may be attributable to founder events. This study highlights fine scale patterns of tick population dynamics thus providing fundamental knowledge in Lyme disease ecology and information applicable to the development of well-targeted prevention and control strategies for public natural areas affected by this growing problem in southern Canada.

Correction: Why Lyme disease is common in the northern US, but rare in the south: The roles of host choice, host-seeking behavior, and tick density

[This corrects the article DOI: 10.1371/journal.pbio.3001066.].

Zika virus outbreak in Brazil under current and future climate

INTRODUCTION

Zika virus (ZIKV) is primarily transmitted byAedes aegypti and Aedes albopictus mosquitoes between humans and non-human primates. Climate change may enhance virus reproduction in Aedes spp. mosquito populations, resulting in intensified ZIKV outbreaks. The study objective was to explore how an outbreak similar to the 2016 ZIKV outbreak in Brazil might unfold with projected climate change.

METHODS

A compartmental infectious disease model that included compartments for humans and mosquitoes was developed to fit the 2016 ZIKV outbreak data from Brazil using least squares optimization. To explore the impact of climate change, published polynomial relationships between temperature and temperature-sensitive mosquito population and virus transmission parameters (mosquito mortality, development rate, and ZIKV extrinsic incubation period) were used. Projections for future outbreaks were obtained by simulating transmission with effects of projected average monthly temperatures on temperature-sensitive model parameters at each of three future time periods: 2011-2040, 2041-2070, and 2071-2100. The projected future climate was obtained from an ensemble of regional climate models (RCMs) obtained from the Co-Ordinated Regional Downscaling Experiment (CORDEX) that used Representative Concentration Pathways (RCP) with two radiative forcing values, RCP4.5 and RCP8.5. A sensitivity analysis was performed to explore the impact of temperature-dependent parameters on the model outcomes.

RESULTS

Climate change scenarios impacted the model outcomes, including the peak clinical case incidence, cumulative clinical case incidence, time to peak incidence, and the duration of the ZIKV outbreak. Comparing 2070-2100 to 2016, using RCP4.5, the peak incidence was 22,030 compared to 10,473; the time to epidemic peak was 12 compared to 9 weeks, and the outbreak duration was 52 compared to 41 weeks. Comparing 2070-2100 to 2016, using RCP8.5, the peak incidence was 21,786 compared to 10,473; the time to epidemic peak was 11 compared to 9 weeks, and the outbreak duration was 50 compared to 41weeks. The increases are due to optimal climate conditions for mosquitoes, with the mean temperature reaching 28 °C in the warmest months. Under a high emission scenario (RCP8.5), mean temperatures extend above optimal for mosquito survival in the warmest months.

CONCLUSION

Outbreaks of ZIKV in locations similar to Brazil are expected to be more intense with a warming climate. As climate change impacts are becoming increasingly apparent on human health, it is important to quantify the effect and use this knowledge to inform decisions on prevention and control strategies.

Mechanistic movement models reveal ecological drivers of tick-borne pathogen spread

Identifying ecological drivers of tick-borne pathogen spread has great value for tick-borne disease management. However, theoretical investigations into the consequences of host movement behaviour on pathogen spread dynamics in heterogeneous landscapes remain limited because spatially explicit epidemiological models that incorporate more realistic mechanisms governing host movement are rare. We built a mechanistic movement model to investigate how the interplay between multiple ecological drivers affects the risk of tick-borne pathogen spread across heterogeneous landscapes. We used the model to generate simulations of tick dispersal by migratory birds and terrestrial hosts across theoretical landscapes varying in resource aggregation, and we performed a sensitivity analysis to explore the impacts of different parameters on the infected tick spread rate, tick infection prevalence and infected tick density. Our findings highlight the importance of host movement and tick population dynamics in explaining the infected tick spread rate into new regions. Tick infection prevalence and infected tick density were driven by predictors related to the infection process and tick population dynamics, respectively. Our results suggest that control strategies aiming to reduce tick burden on tick reproduction hosts and encounter rate between immature ticks and pathogen amplification hosts will be most effective at reducing tick-borne disease risk.

The origins and potential future of SARS-CoV-2 variants of concern in the evolving COVID-19 pandemic

One year into the global COVID-19 pandemic, the focus of attention has shifted to the emergence and spread of SARS-CoV-2 variants of concern (VOCs). After nearly a year of the pandemic with little evolutionary change affecting human health, several variants have now been shown to have substantial detrimental effects on transmission and severity of the virus. Public health officials, medical practitioners, scientists, and the broader community have since been scrambling to understand what these variants mean for diagnosis, treatment, and the control of the pandemic through nonpharmaceutical interventions and vaccines. Here we explore the evolutionary processes that are involved in the emergence of new variants, what we can expect in terms of the future emergence of VOCs, and what we can do to minimise their impact.

Risk of transfusion-transmitted Babesia microti in Canada

BACKGROUND

Babesia microti has gained a foothold in Canada as tick vectors become established in broader geographic areas. B. microti infection is associated with mild or no symptoms in healthy individuals but is transfusion-transmissible and can be fatal in immunocompromised individuals. This is the first estimate of clinically significant transfusion-transmitted babesiosis (TTB) risk in Canada.

STUDY DESIGN AND METHODS

The proportion of B. microti-antibody (AB)/nucleic acid amplification test (NAT)-positive whole blood donations was estimated at 5.5% of the proportion of the general population with reported Lyme Disease (also tick-borne) based on US data. Monte Carlo simulation estimated the number and proportion of infectious red cell units for three scenarios: base, localized incidence (risk in Manitoba only), and donor study informed (prevalence from donor data). The model simulated 1,029,800 donations repeated 100,000 times for each.

RESULTS

In the base scenario 0.5 (0.01, 1.75), B. microti-NAT-positive donations would be expected per year, with 0.08 (0, 0.38) recipients suffering clinically significant TTB (1 every 12.5 years). In the localized incidence scenario, there were 0.21(0, 0.7) B. microti-NAT-positive donations, with 0.04 (0, 0.14) recipient infections (about 1 every 25 years). In the donor study informed scenario, there were 4.6 (0.3, 15.8) B. microti-NAT-positive donations expected, and 0.81 (0.05, 3.14) clinically significant TTB cases per year.

DISCUSSION

The likelihood of clinically relevant TTB is low. Testing would have very little utility in Canada at this time. Ongoing pathogen surveillance in tick vectors is important as B. microti prevalence appears to be slowly increasing in Canada.

Possible Effects of Climate Change on Ixodid Ticks and the Pathogens They Transmit: Predictions and Observations

The global climate has been changing over the last century due to greenhouse gas emissions and will continue to change over this century, accelerating without effective global efforts to reduce emissions. Ticks and tick-borne diseases (TTBDs) are inherently climate-sensitive due to the sensitivity of tick lifecycles to climate. Key direct climate and weather sensitivities include survival of individual ticks, and the duration of development and host-seeking activity of ticks. These sensitivities mean that in some regions a warming climate may increase tick survival, shorten life-cycles and lengthen the duration of tick activity seasons. Indirect effects of climate change on host communities may, with changes in tick abundance, facilitate enhanced transmission of tick-borne pathogens. High temperatures, and extreme weather events (heat, cold, and flooding) are anticipated with climate change, and these may reduce tick survival and pathogen transmission in some locations. Studies of the possible effects of climate change on TTBDs to date generally project poleward range expansion of geographical ranges (with possible contraction of ranges away from the increasingly hot tropics), upslope elevational range spread in mountainous regions, and increased abundance of ticks in many current endemic regions. However, relatively few studies, using long-term (multi-decade) observations, provide evidence of recent range changes of tick populations that could be attributed to recent climate change. Further integrated 'One Health' observational and modeling studies are needed to detect changes in TTBD occurrence, attribute them to climate change, and to develop predictive models of public- and animal-health needs to plan for TTBD emergence.

Mosquito Identification From Bulk Samples Using DNA Metabarcoding: a Protocol to Support Mosquito-Borne Disease Surveillance in Canada

Approximately 80 species of mosquitoes (Diptera: Culicidae) have been documented in Canada. Exotic species such as Aedes albopictus (Skuse) (Diptera: Culicidae) are becoming established. Recently occurring endemic mosquito-borne diseases (MBD) in Canada including West-Nile virus (WNV) and Eastern Equine Encephalitis (EEE) are having significant public health impacts. Here we explore the use of DNA metabarcoding to identify mosquitoes from CDC light-trap collections from two locations in eastern Canada. Two primer pairs (BF2-BR2 and F230) were used to amplify regions of the cytochrome c oxidase subunit I (CO1) gene. High throughput sequencing was conducted using an Illumina MiSeq platform and GenBank-based species identification was applied using a QIIME 1.9 bioinformatics pipeline. From a site in southeastern Ontario, Canada, 26 CDC light trap collections of 72 to >300 individual mosquitoes were used to explore the capacity of DNA metabarcoding to identify and quantify captured mosquitoes. The DNA metabarcoding method identified 33 species overall while 24 species were identified by key. Using replicates from each trap, the dried biomass needed to identify the majority of species was determined to be 76 mg (equivalent to approximately 72 mosquitoes), and at least two replicates from the dried biomass would be needed to reliably detect the majority of species in collections of 144-215 mosquitoes and three replicates would be advised for collections with >215 mosquitoes. This study supports the use of DNA metabarcoding as a mosquito surveillance tool in Canada which can help identify the emergence of new mosquito-borne disease potential threats.

Modelling the impact of shutdowns on resurging SARS-CoV-2 transmission in Canada

BACKGROUND

Shutdowns are enacted when alternative public health measures are insufficient to control the epidemic and the population is largely susceptible. An age-stratified agent-based model was developed to explore the impact of shutdowns to control SARS-CoV-2 transmission in Canada under the assumption that current efforts to control the epidemic remains insufficient and in the absence of a vaccine.

METHODS

We estimated the current levels of interventions in Canada to generate a baseline scenario from 7 February to 7 September 2020. Four aspects of shutdowns were explored in scenarios that ran from 8 September 2020 to 7 January 2022, these included the impact of how quickly shutdowns are implemented, the duration of shutdowns, the minimum break (delays) between shutdowns and the types of sectors to shutdown. Comparisons among scenarios were made using cases, hospitalizations, deaths and shutdown days during the 700-day model runs.

RESULTS

We found a negative relationship between reducing SARS-CoV-2 transmission and the number of shutdown days. However, we also found that for shutdowns to be optimally effective, they need to be implemented fast with minimal delay, initiated when community transmission is low, sustained for an adequate period and be stringent and target multiple sectors, particularly those driving transmission. By applying shutdowns in this manner, the total number of shutdown days could be reduced compared to delaying the shutdowns until further into the epidemic when transmission is higher and/or implementing short insufficient shutdowns that would require frequent re-implementation. This paper contrasts a range of shutdown strategies and trade-offs between health outcomes and economic metrics that need to be considered within the local context.

INTERPRETATION

Given the immense socioeconomic impact of shutdowns, they should be avoided where possible and used only when other public health measures are insufficient to control the epidemic. If used, the time it buys to delay the epidemic should be used to enhance other equally effective, but less disruptive, public health measures.

Simple mathematical modelling approaches to assessing the transmission risk of SARS-CoV-2 at gatherings

BACKGROUND

Gatherings may contribute significantly to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For this reason, public health interventions have sought to constrain unrepeated or recurrent gatherings to curb the coronavirus disease 2019 (COVID-19) pandemic. Unfortunately, the range of different types of gatherings hinders specific guidance from setting limiting parameters (e.g. total size, number of cohorts, the extent of physical distancing).

METHODS

We used a generic modelling framework, based on fundamental probability principles, to derive simple formulas to assess introduction and transmission risks associated with gatherings, as well as the potential efficiency of some testing strategies to mitigate these risks.

RESULTS

Introduction risk can be broadly assessed with the population prevalence and the size of the gathering, while transmission risk at a gathering is mainly driven by the gathering size. For recurrent gatherings, the cohort structure does not have a significant impact on transmission between cohorts. Testing strategies can mitigate risk, but frequency of testing and test performance are factors in finding a balance between detection and false positives.

CONCLUSION

The generality of the modelling framework used here helps to disentangle the various factors affecting transmission risk at gatherings and may be useful for public health decision-making.

Yellow fever virus outbreak in Brazil under current and future climate

Introduction

Yellow fever (YF) is primarily transmitted by Haemagogus species of mosquitoes. Under climate change, mosquitoes and the pathogens that they carry are expected to develop faster, potentially impacting the case count and duration of YF outbreaks. The aim of this study was to determine how YF virus outbreaks in Brazil may change under future climate, using ensemble simulations from regional climate models under RCP4.5 and RCP8.5 scenarios for three time periods: 2011–2040 (short-term), 2041–2070 (mid-term), and 2071–2100 (long-term).

Methods

A compartmental model was developed to fit the 2017/18 YF outbreak data in Brazil using least squares optimization. To explore the impact of climate change, temperature-sensitive mosquito parameters were set to change over projected time periods using polynomial equations fitted to their relationship with temperature according to the average temperature for years 2011–2040, 2041–2070, and 2071–2100 for climate change scenarios using RCP4.5 and RCP8.5, where RCP4.5/RCP8.5 corresponds to intermediate/high radiative forcing values and to moderate/higher warming trends. A sensitivity analysis was conducted to determine how the temperature-sensitive parameters impacted model results, and to determine how vaccination could play a role in reducing YF in Brazil.

Results

Yellow fever case projections for Brazil from the models varied when climate change scenarios were applied, including the peak clinical case incidence, cumulative clinical case incidence, time to peak incidence, and the outbreak duration. Overall, a decrease in YF cases and outbreak duration was observed. Comparing the observed incidence in 2017/18 to the projected incidence in 2070–2100, for RCP4.5, the cumulative case incidence decreased from 184 to 161, and the outbreak duration decreased from 21 to 20 weeks. For RCP8.5, the peak case incidence decreased from 184 to 147, and the outbreak duration decreased from 21 to 17 weeks. The observed decrease was primarily due to temperature increasing beyond that suitable for Haemagogus mosquito survival.

Conclusions

Climate change is anticipated to have an impact on mosquito-borne diseases. We found outbreaks of YF may reduce in intensity as temperatures increase in Brazil; however, temperature is not the only factor involved with disease transmission. Other factors must be explored to determine the attributable impact of climate change on mosquito-borne diseases.

A renewal equation model to assess roles and limitations of contact tracing for disease outbreak control

We propose a deterministic model capturing essential features of contact tracing as part of public health non-pharmaceutical interventions to mitigate an outbreak of an infectious disease. By incorporating a mechanistic formulation of the processes at the individual level, we obtain an integral equation (delayed in calendar time and advanced in time since infection) for the probability that an infected individual is detected and isolated at any point in time. This is then coupled with a renewal equation for the total incidence to form a closed system describing the transmission dynamics involving contact tracing. We define and calculate basic and effective reproduction numbers in terms of pathogen characteristics and contact tracing implementation constraints. When applied to the case of SARS-CoV-2, our results show that only combinations of diagnosis of symptomatic infections and contact tracing that are almost perfect in terms of speed and coverage can attain control, unless additional measures to reduce overall community transmission are in place. Under constraints on the testing or tracing capacity, a temporary interruption of contact tracing may, depending on the overall growth rate and prevalence of the infection, lead to an irreversible loss of control even when the epidemic was previously contained.

A multi-year assessment of blacklegged tick (Ixodes scapularis) population establishment and Lyme disease risk areas in Ottawa, Canada, 2017-2019

Canadians face an emerging threat of Lyme disease due to the northward expansion of the tick vector, Ixodes scapularis. We evaluated the degree of I. scapularis population establishment and Borrelia burgdorferi occurrence in the city of Ottawa, Ontario, Canada from 2017–2019 using active surveillance at 28 sites. We used a field indicator tool developed by Clow et al. to determine the risk of I. scapularis establishment for each tick cohort at each site using the results of drag sampling. Based on results obtained with the field indicator tool, we assigned each site an ecological classification describing the pattern of tick colonization over two successive cohorts (cohort 1 was comprised of ticks collected in fall 2017 and spring 2018, and cohort 2 was collected in fall 2018 and spring 2019). Total annual site-specific I. scapularis density ranged from 0 to 16.3 ticks per person-hour. Sites with the highest density were located within the Greenbelt zone, in the suburban/rural areas in the western portion of the city of Ottawa, and along the Ottawa River; the lowest densities occurred at sites in the suburban/urban core. B. burgdorferi infection rates exhibited a similar spatial distribution pattern. Of the 23 sites for which data for two tick cohorts were available, 11 sites were classified as “high-stable”, 4 were classified as “emerging”, 2 were classified as “low-stable”, and 6 were classified as “non-zero”. B. burgdorferi-infected ticks were found at all high-stable sites, and at one emerging site. These findings suggest that high-stable sites pose a risk of Lyme disease exposure to the community as they have reproducing tick populations with consistent levels of B. burgdorferi infection. Continued surveillance for I. scapularis, B. burgdorferi, and range expansion of other tick species and emerging tick-borne pathogens is important to identify areas posing a high risk for human exposure to tick-borne pathogens in the face of ongoing climate change and urban expansion.

Why Lyme disease is common in the northern US, but rare in the south: The roles of host choice, host-seeking behavior, and tick density

Lyme disease is common in the northeastern United States, but rare in the southeast, even though the tick vector is found in both regions. Infection prevalence of Lyme spirochetes in host-seeking ticks, an important component to the risk of Lyme disease, is also high in the northeast and northern midwest, but declines sharply in the south. As ticks must acquire Lyme spirochetes from infected vertebrate hosts, the role of wildlife species composition on Lyme disease risk has been a topic of lively academic discussion. We compared tick–vertebrate host interactions using standardized sampling methods among 8 sites scattered throughout the eastern US. Geographical trends in diversity of tick hosts are gradual and do not match the sharp decline in prevalence at southern sites, but tick–host associations show a clear shift from mammals in the north to reptiles in the south. Tick infection prevalence declines north to south largely because of high tick infestation of efficient spirochete reservoir hosts (rodents and shrews) in the north but not in the south. Minimal infestation of small mammals in the south results from strong selective attachment to lizards such as skinks (which are inefficient reservoirs for Lyme spirochetes) in the southern states. Selective host choice, along with latitudinal differences in tick host-seeking behavior and variations in tick densities, explains the geographic pattern of Lyme disease in the eastern US.

Lyme disease is common in the northeastern United States, but rare in the southeast, even though the tick vector is found in both regions. This study shows that this is largely because the tick vectors attach abundantly to rodents (which are good hosts for the Lyme bacteria) in the north, and to lizards (which are relatively poor hosts for Lyme bacteria) in the south.

Exploring the percentage of COVID-19 cases reported in the community in Canada and associated case fatality ratios

While surveillance can identify changes in COVID-19 transmission patterns over time and space, sections of the population at risk, and the efficacy of public health measures, reported cases of COVID-19 are generally understood to only capture a subset of the actual number of cases. Our primary objective was to estimate the percentage of cases reported in the general community, considered as those that occurred outside of long-term care facilities (LTCFs), in specific provinces and Canada as a whole. We applied a methodology using the delay-adjusted case fatality ratio (CFR) to all cases and deaths, as well as those representing the general community. Our second objective was to assess whether the assumed CFR (mean = 1.38%) was appropriate for calculating underestimation of cases in Canada. Estimates were developed for the period from March 11th, 2020 to September 16th, 2020. Estimates of the percentage of cases reported (PrCR) and CFR varied spatially and temporally across Canada. For the majority of provinces, and for Canada as a whole, the PrCR increased through the early stages of the pandemic. The estimated PrCR in general community settings for all of Canada increased from 18.1% to 69.0% throughout the entire study period. Estimates were greater when considering only those data from outside of LTCFs. The estimated upper bound CFR in general community settings for all of Canada decreased from 9.07% on March 11th, 2020 to 2.00% on September 16th, 2020. Therefore, the true CFR in the general community in Canada was likely less than 2% on September 16th. According to our analysis, some provinces, such as Alberta, Manitoba, Newfoundland and Labrador, Nova Scotia, and Saskatchewan reported a greater percentage of cases as of September 16th, compared to British Columbia, Ontario, and Québec. This could be due to differences in testing rates and criteria, demographics, socioeconomic factors, race, and access to healthcare among the provinces. Further investigation into these factors could reveal differences among provinces that could partially explain the variation in estimates of PrCR and CFR identified in our study. The estimates provide context to the summative state of the pandemic in Canada, and can be improved as knowledge of COVID-19 reporting rates and disease characteristics are advanced.

Quantifying the shift in social contact patterns in response to non-pharmaceutical interventions

Social contact mixing plays a critical role in influencing the transmission routes of infectious diseases. Moreover, quantifying social contact mixing patterns and their variations in a rapidly evolving pandemic intervened by changing public health measures is key for retroactive evaluation and proactive assessment of the effectiveness of different age- and setting-specific interventions. Contact mixing patterns have been used to inform COVID-19 pandemic public health decision-making; but a rigorously justified methodology to identify setting-specific contact mixing patterns and their variations in a rapidly developing pandemic, which can be informed by readily available data, is in great demand and has not yet been established. Here we fill in this critical gap by developing and utilizing a novel methodology, integrating social contact patterns derived from empirical data with a disease transmission model, that enables the usage of age-stratified incidence data to infer age-specific susceptibility, daily contact mixing patterns in workplace, household, school and community settings; and transmission acquired in these settings under different physical distancing measures. We demonstrated the utility of this methodology by performing an analysis of the COVID-19 epidemic in Ontario, Canada. We quantified the age- and setting (household, workplace, community, and school)-specific mixing patterns and their evolution during the escalation of public health interventions in Ontario, Canada. We estimated a reduction in the average individual contact rate from 12.27 to 6.58 contacts per day, with an increase in household contacts, following the implementation of control measures. We also estimated increasing trends by age in both the susceptibility to infection by SARS-CoV-2 and the proportion of symptomatic individuals diagnosed. Inferring the age- and setting-specific social contact mixing and key age-stratified epidemiological parameters, in the presence of evolving control measures, is critical to inform decision- and policy-making for the current COVID-19 pandemic.

Effets projetés des mesures de santé publique non pharmacologiques visant à prévenir la recrudescence de la transmission du SRAS-CoV-2 au Canada

CONTEXTE:

Il faudra prendre des mesures continues contre la transmission communautaire du coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) pour prévenir d’autres vagues d’infection. Nous avons exploré les effets des interventions non pharmacologiques sur la transmission projetée du SRAS-CoV-2 au Canada.

MÉTHODES:

Nous avons créé un modèle de la population canadienne à base d’agents intégrant l’âge qui simule les effets des mesures de santé publique, selon leur intensité actuelle et projetée, sur la transmission du SRAS-CoV-2. Les mesures étudiées sont le dépistage et l’isolement des cas, la recherche de contacts et la mise en quarantaine, l’éloignement sanitaire et la fermeture des espaces partagés. Nous avons évalué l’effet des mesures prises individuellement et celui des mesures combinées.

RÉSULTATS:

En l’absence de mesures, 64,6 % (intervalle de crédibilité [ICr] à 95 % : 63,9 %–65,0 %) des Canadiens contracteraient le SRAS-CoV-2 (taux d’attaque global), et 3,6 % (ICr à 95 % 2,4 %–3,8 %) des personnes infectées en mourraient. En poursuivant le dépistage et la recherche de contacts à la même intensité que pendant la période de référence, sans maintenir l’éloignement sanitaire ou refermer certains endroits, le pays connaîtrait un taux d’attaque global de 56,1 % (ICr à 95 % 0,05 %–57,1 %); si ces mesures étaient accrues, le taux d’attaque chuterait à 0,4 % (ICr à 95 % 0,03 %–23,5 %). En combinant ce dernier scénario et le maintien de l’éloignement sanitaire, le taux tomberait à 0,2 % (ICr à 95 % 0,03 %–1,7 %). Ce scénario est le seul qui garderait la demande en soins hospitaliers et intensifs sous la capacité, qui préviendrait presque tous les décès et qui mettrait fin à l’épidémie. La prolongation de la fermeture des écoles aurait un effet minime, mais réduirait la transmission en milieu scolaire. Par contre, la prolongation de la fermeture des lieux de travail et des lieux publics réduirait de manière marquée le taux d’attaque et mettait habituellement ou toujours fin à l’épidémie, selon les différents scénarios simulés.

INTERPRÉTATION:

Le contrôle de la transmission du SRAS-CoV-2 passera par l’amélioration et le maintien des mesures, tant communautaires qu’individuelles. Autrement, il y aura une recrudescence de l’épidémie, et un risque de surcharger le système de santé.

Seasonality of acarological risk of exposure to Borrelia miyamotoi from questing life stages of Ixodes scapularis collected from Wisconsin and Massachusetts, USA

Measures of acarological risk of exposure to Ixodes scapularis-borne disease agents typically focus on nymphs; however, the relapsing fever group spirochete Borrelia miyamotoi can be passed transovarially, and I. scapularis larvae are capable of transmitting B. miyamotoi to their hosts. To quantify the larval contribution to acarological risk, relative to nymphs and adults, we collected questing I. scapularis for 3 yr at Fort McCoy, Wisconsin (WI, n = 23,367 ticks), and Cape Cod, Massachusetts (MA, n = 4190) in the United States. Borrelia miyamotoi infection prevalence was estimated for I. scapularis larvae, nymphs, females, and males, respectively, as 0.88, 2.05, 0.63, and 1.22 % from the WI site and 0.33, 2.32, 2.83, and 2.11 % from the MA site. Densities of B. miyamotoi-infected ticks (DIT, per 1000 m²) were estimated for larvae, nymphs, females, and males, respectively, as 0.36, 0.14, 0.01, and 0.03 from the WI site and 0.05, 0.06, 0.03, and 0.02 from the MA site. Thus, although larval infection prevalence with B. miyamotoi was significantly lower than that of nymphs and similar to that of adults, because of their higher abundance, the larval contribution to the overall DIT was similar to that of nymphs and trended towards a greater contribution than adults. Assuming homogenous contact rates with humans, these results suggest that eco-epidemiological investigations of B. miyamotoi disease in North America should include larvae. A fuller appreciation of the epidemiological implications of these results, therefore, requires an examination of the heterogeneity in contact rates with humans among life stages.

Projected effects of nonpharmaceutical public health interventions to prevent resurgence of SARS-CoV-2 transmission in Canada

BACKGROUND

Continual efforts to eliminate community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will be needed to prevent additional waves of infection. We explored the impact of nonpharmaceutical interventions on projected SARS-CoV-2 transmission in Canada.

METHODS

We developed an age-structured agent-based model of the Canadian population simulating the impact of current and projected levels of public health interventions on SARS-CoV-2 transmission. Interventions included case detection and isolation, contact tracing and quarantine, physical distancing and community closures, evaluated alone and in combination.

RESULTS

Without any interventions, 64.6% (95% credible interval [CrI] 63.9%-65.0%) of Canadians will be infected with SARS-CoV-2 (total attack rate) and 3.6% (95% CrI 2.4%-3.8%) of those infected and symptomatic will die. If case detection and contact tracing continued at baseline levels without maintained physical distancing and reimplementation of restrictive measures, this combination brought the total attack rate to 56.1% (95% CrI 0.05%-57.1%), but it dropped to 0.4% (95% CrI 0.03%-23.5%) with enhanced case detection and contact tracing. Combining the latter scenario with maintained physical distancing reduced the total attack rate to 0.2% (95% CrI 0.03%-1.7%) and was the only scenario that consistently kept hospital and intensive care unit bed use under capacity, prevented nearly all deaths and eliminated the epidemic. Extending school closures had minimal effects but did reduce transmission in schools; however, extending closures of workplaces and mixed-age venues markedly reduced attack rates and usually or always eliminated the epidemic under any scenario.

INTERPRETATION

Controlling SARS-CoV-2 transmission will depend on enhancing and maintaining interventions at both the community and individual levels. Without such interventions, a resurgent epidemic will occur, with the risk of overwhelming our health care systems.

Species distribution models for the eastern blacklegged tick, Ixodes scapularis, and the Lyme disease pathogen, Borrelia burgdorferi, in Ontario, Canada

The blacklegged tick, Ixodes scapularis, is established in several regions of Ontario, Canada, and continues to spread into new geographic areas across the province at a rapid rate. This poses a significant public health risk since I. scapularis transmits the Lyme disease-causing bacterium, Borrelia burgdorferi, and other pathogens of potential public health concern. The objective of this study was to develop species distribution models for I. scapularis and B. burgdorferi to predict and compare the potential distributions of the tick vector and the Lyme disease pathogen as well as the ecological factors most important for species establishment. Ticks were collected via tick dragging at 120 sites across southern, central, and eastern Ontario between 2015 and 2018 and tested for tick-borne pathogens. A maximum entropy (Maxent) approach was used to model the potential distributions of I. scapularis and B. burgdorferi. Two independent datasets derived from tick dragging at 25 new sites in 2019 and ticks submitted by the public to local health units between 2015 and 2017 were used to validate the predictive accuracy of the models. The model for I. scapularis showed high suitability for blacklegged ticks in eastern Ontario and some regions along the shorelines of the Great Lakes, and moderate suitability near Algonquin Provincial Park and the Georgian Bay with good predictive accuracy (tick dragging 2019: AUC = 0.898; ticks from public: AUC = 0.727). The model for B. burgdorferi showed a similar predicted distribution but was more constrained to eastern Ontario, particularly between Ottawa and Kingston, and along Lake Ontario, with similarly good predictive accuracy (tick dragging 2019: AUC = 0.958; ticks from public: AUC = 0.863. The ecological variables most important for predicting the distributions of I. scapularis and B. burgdorferi included elevation, distance to deciduous and coniferous forest, proportions of agricultural land, water, and infrastructure, mean summer/spring temperature, and cumulative annual degree days above 0°C. Our study presents a novel application of species distribution modelling for I. scapularis and B. burgdorferi in Ontario, Canada, and provides an up to date projection of their potential distributions for public health knowledge users.

Current and Projected Distributions of Aedes aegypti and Ae. albopictus in Canada and the U.S

BACKGROUND

Aedes aegypti and Ae. albopictus are mosquito vectors of more than 22 arboviruses that infect humans.

OBJECTIVES

Our objective was to develop regional ecological niche models for Ae. aegypti and Ae. albopictus in the conterminous United States and Canada with current observed and simulated climate and land-use data using boosted regression trees (BRTs).

METHODS

We used BRTs to assess climatic suitability for Ae. albopictus and Ae. aegypti mosquitoes in Canada and the United States under current and future projected climates.

RESULTS

Models for both species were mostly influenced by minimum daily temperature and demonstrated high accuracy for predicting their geographic ranges under the current climate. The northward range expansion of suitable niches for both species was projected under future climate models. Much of the United States and parts of southern Canada are projected to be suitable for both species by 2100, with Ae. albopictus projected to expand its range north earlier this century and further north than Ae. aegypti.

DISCUSSION

Our projections suggest that the suitable ecological niche for Aedes will expand with climate change in Canada and the United States, thus increasing the risk of Aedes-transmitted arboviruses. Increased surveillance for these vectors and the pathogens they carry would be prudent. https://doi.org/10.1289/EHP5899.