Health leaders in southeast Asia confirmed the high transmission of mosquito-borne dengue virus anticipated by a University of Pittsburgh-led analysis and found challenges with data-sharing to be a major bottleneck for regional epidemic forecasting.
The findings come out of an unprecedented international gathering of public health scientists and officials in Kuala Lumpur recently organized by Pitt's Graduate School of Public Health and the University of Malaya.
With funding from the Bill & Melinda Gates Foundation, the meeting was convened to explore how the results of Pitt Public Health's recent study on dengue and climate can be applied to improve epidemic forecasting. The study, published last October in the Proceedings of the National Academy of Sciences (PNAS), found that the intense El Niño emerging in the Pacific may be a harbinger of a spike in cases of the dangerous hemorrhagic fever throughout southeast Asia this year.
"This was an exceptional gathering to discuss potentially life-saving public health interventions to address a possible dengue epidemic this year," said Willem G. van Panhuis, M.D., Ph.D., assistant professor of epidemiology at Pitt Public Health and lead author of the PNAS paper. "It also was an opportunity to freely exchange data and preliminary epidemic forecast results, which could improve future disease forecasting at a larger scale."
Several dozen participants representing ministries of health, universities in Asia and the U.S., and U.S. government agencies gathered Jan. 26 from 10 countries to discuss the risk of dengue and mitigation strategies for 2016. The participants shared their best predictions and updates on the dengue situation in their respective countries.
Some of the countries reported high dengue transmission at the closing of 2015 and elevated temperatures in the last few weeks, with the potential of a large 2016 outbreak. Interventions, such as mosquito abatement, are being implemented country-by-country.
While each country does some type of epidemic-risk forecasting, ranging from qualitative to highly quantitative modeling, many countries could benefit from improved quantitative models, like that done in Pitt Public Health's Public Health Dynamics Laboratory. While a lack of country-to-country data-sharing limits regional forecasting, the countries are willing to share data for the good of all. However, political and technical issues are preventing this. Pitt Public Health plans to play a significant role in improving the data-sharing framework in southeast Asia.
"The dialogue that began at this conference will continue with the intent of lessening the public health burden from dengue that we expect over the next year," said Lam Sai Kit, Ph.D., professor at the University of Malaya and co-author of the PNAS paper. "We represent one of the first examples of countries coming together to counter an epidemic before it happens."
Many of the participants were co-authors on the PNAS paper, funded by the National Institutes of Health, which analyzed 18 years of monthly dengue surveillance reports on 3.5 million reported cases in 273 provinces in eight countries in southeast Asia. The analysis revealed patterns - or synchronicity - in dengue transmission across the entire region.
The high temperatures associated with a strong El Niño allow mosquitoes to reproduce faster and spread dengue more efficiently. One of the largest El Niño episodes in recent memory occurred in the past several months, and temperatures are rising throughout southeast Asia.
Pitt Public Health plans to continue working with all the country partners, Bill & Melinda Gates Foundation and the U.S. government to establish an infrastructure for continuous forecasting of the risk for major threats to public health using historical biomedical and climate data. The aim of this initiative is to enable governments to protect their populations by mitigating these risks.
"Disease forecasting can help public health officials prioritize limited resources on prevention and control efforts in the times and places where they may have the greatest effect," said Michael Johansson, Ph.D., a U.S. Centers for Disease Control and Prevention biologist who specializes in disease forecasting. "Our hope is to not only assess the current dengue situation in southeast Asia, but build upon the efforts discussed in the meeting to improve disease forecasting in the future."
The conference was supported by Bill & Melinda Gates Foundation grant OPP1091931.