Dynamic mapping of cholera outbreak during the Yemeni Civil War, 2016-2019.

Widespread destruction from the Yemeni Civil War (2014-present) triggered the world's largest cholera outbreak. We compiled a comprehensive health dataset and created dynamic maps to demonstrate spatiotemporal changes in cholera infections and war conflicts. We aligned and merged daily, weekly, and monthly epidemiological bulletins of confirmed cholera infections and daily conflict events and fatality records to create a dataset of weekly time series for Yemen at the governorate level (subnational regions administered by governors) from 4 January 2016 through 29 December 2019. We demonstrated the use of dynamic mapping for tracing the onset and spread of infection and manmade factors that amplify the outbreak. We report curated data and visualization techniques to further uncover associations between infectious disease outbreaks and risk factors and to better coordinate humanitarian aid and relief efforts during complex emergencies.

Global seasonal and pandemic patterns in influenza: An application of longitudinal study designs.

The confluence of growing analytic capacities and global surveillance systems for seasonal infections has created new opportunities to further develop statistical methodology and advance the understanding of the global disease dynamics. We developed a framework to characterise the seasonality of infectious diseases for publicly available global health surveillance data. Specifically, we aimed to estimate the seasonal characteristics and their uncertainty using mixed effects models with harmonic components and the δ-method and develop multi-panel visualisations to present complex interplay of seasonal peaks across geographic locations. We compiled a set of 2 422 weekly time series of 14 reported outcomes for 173 Member States from the World Health Organization's (WHO) international influenza virological surveillance system, FluNet, from 02 January 1995 through 20 June 2021. We produced an analecta of data visualisations to describe global travelling waves of influenza while addressing issues of data completeness and credibility. Our results offer directions for further improvements in data collection, reporting, analysis and development of statistical methodology and predictive approaches.

The Seasonal Microbial Ecology of Plankton and Plankton-Associated Vibrio parahaemolyticus in the Northeast United States.

Microbial ecology studies have proven to be important resources for improving infectious disease response and outbreak prevention. Vibrio parahaemolyticus is an ongoing source of shellfish-borne food illness in the Northeast United States, and there is keen interest in understanding the environmental conditions that coincide with V. parahaemolyticus disease risk, in order to aid harvest management and prevent further illness. Zooplankton and chitinous phytoplankton are associated with V. parahaemolyticus dynamics elsewhere; however, this relationship is undetermined for the Great Bay estuary (GBE), an important emerging shellfish growing region in the Northeast United States. A comprehensive evaluation of the microbial ecology of V. parahaemolyticus associated with plankton was conducted in the GBE using 3 years of data regarding plankton community, nutrient concentration, water quality, and V. parahaemolyticus concentration in plankton. The concentrations of V. parahaemolyticus associated with plankton were highly seasonal, and the highest concentrations of V. parahaemolyticus cultured from zooplankton occurred approximately 1 month before the highest concentrations of V. parahaemolyticus from phytoplankton. The two V. parahaemolyticus peaks corresponded with different water quality variables and a few highly seasonal plankton taxa. Importantly, V. parahaemolyticus concentrations and plankton community dynamics were poorly associated with nutrient concentrations and chlorophyll a, commonly applied proxy variables for assessing ecological health risks and human health risks from harmful plankton and V. parahaemolyticus elsewhere. Together, these statistical associations (or lack thereof) provide valuable insights to characterize the plankton-V. parahaemolyticus dynamic and inform approaches for understanding the potential contribution of plankton to human health risks from V. parahaemolyticus for the Northeast United States. IMPORTANCE The Vibrio-plankton interaction is a focal relationship in Vibrio disease research; however, little is known about this dynamic in the Northeast United States, where V. parahaemolyticus is an established public health issue. We integrated phototactic plankton separation with seasonality analysis to determine the dynamics of the plankton community, water quality, and V. parahaemolyticus concentrations. Distinct bimodal peaks in the seasonal timing of V. parahaemolyticus abundance from phyto- versus zooplankton and differing associations with water quality variables and plankton taxa indicate that monitoring and forecasting approaches should consider the source of exposure when designing predictive methods for V. parahaemolyticus. Helicotheca tamensis has not been previously reported in the GBE. Its detection during this study provides evidence of the changes occurring in the ecology of regional estuaries and potential mechanisms for changes in V. parahaemolyticus populations. The Vibrio monitoring approaches can be translated to aid other areas facing similar public health challenges.

Completeness of open access FluNet influenza surveillance data for Pan-America in 2005-2019.

For several decades, the World Health Organization has collected, maintained, and distributed invaluable country-specific disease surveillance data that allow experts to develop new analytical tools for disease tracking and forecasting. To capture the extent of available data within these sources, we proposed a completeness metric based on the effective time series length. Using FluNet records for 29 Pan-American countries from 2005 to 2019, we explored whether completeness was associated with health expenditure indicators adjusting for surveillance system heterogeneity. We observed steady improvements in completeness by 4.2-6.3% annually, especially after the A(H1N1)-2009 pandemic, when 24 countries reached > 95% completeness. Doubling in decadal health expenditure per capita was associated with ~ 7% increase in overall completeness. The proposed metric could navigate experts in assessing open access data quality and quantity for conducting credible statistical analyses, estimating disease trends, and developing outbreak forecasting systems.

Inferring the effectiveness of government interventions against COVID-19.

Governments are attempting to control the COVID-19 pandemic with nonpharmaceutical interventions (NPIs). However, the effectiveness of different NPIs at reducing transmission is poorly understood. We gathered chronological data on the implementation of NPIs for several European and non-European countries between January and the end of May 2020. We estimated the effectiveness of these NPIs, which range from limiting gathering sizes and closing businesses or educational institutions to stay-at-home orders. To do so, we used a Bayesian hierarchical model that links NPI implementation dates to national case and death counts and supported the results with extensive empirical validation. Closing all educational institutions, limiting gatherings to 10 people or less, and closing face-to-face businesses each reduced transmission considerably. The additional effect of stay-at-home orders was comparatively small.

Signatures of Cholera Outbreak during the Yemeni Civil War, 2016-2019.

The Global Task Force on Cholera Control (GTFCC) created a strategy for early outbreak detection, hotspot identification, and resource mobilization coordination in response to the Yemeni cholera epidemic. This strategy requires a systematic approach for defining and classifying outbreak signatures, or the profile of an epidemic curve and its features. We used publicly available data to quantify outbreak features of the ongoing cholera epidemic in Yemen and clustered governorates using an adaptive time series methodology. We characterized outbreak signatures and identified clusters using a weekly time series of cholera rates in 20 Yemeni governorates and nationally from 4 September 2016 through 29 December 2019 as reported by the World Health Organization (WHO). We quantified critical points and periods using Kolmogorov-Zurbenko adaptive filter methodology. We assigned governorates into six clusters sharing similar outbreak signatures, according to similarities in critical points, critical periods, and the magnitude of peak rates. We identified four national outbreak waves beginning on 12 September 2016, 6 March 2017, 28 May 2018, and 28 January 2019. Among six identified clusters, we classified a core regional hotspot in Sana'a, Sana'a City, and Al-Hudaydah-the expected origin of the national outbreak. The five additional clusters differed in Wave 2 and Wave 3 peak frequency, timing, magnitude, and geographic location. As of 29 December 2019, no governorates had returned to pre-Wave 1 levels. The detected similarity in outbreak signatures suggests potentially shared environmental and human-made drivers of infection; the heterogeneity in outbreak signatures implies the potential traveling waves outwards from the core regional hotspot that could be governed by factors that deserve further investigation.

Spatiotemporal Patterns of Cholera Hospitalization in Vellore, India.

Systematically collected hospitalization records provide valuable insight into disease patterns and support comprehensive national infectious disease surveillance networks. Hospitalization records detailing patient's place of residence (PoR) can be utilized to better understand a hospital's case load and strengthen surveillance among mobile populations. This study examined geographic patterns of patients treated for cholera at a major hospital in south India. We abstracted 1401 laboratory-confirmed cases of cholera between 2000-2014 from logbooks and electronic health records (EHRs) maintained by the Christian Medical College (CMC) in Vellore, Tamil Nadu, India. We constructed spatial trend models and identified two distinct clusters of patient residence-one around Vellore (836 records (61.2%)) and one in Bengal (294 records (21.5%)). We further characterized differences in peak timing and disease trend among these clusters to identify differences in cholera exposure among local and visiting populations. We found that the two clusters differ by their patient profiles, with patients in the Bengal cluster being most likely older males traveling to Vellore. Both clusters show well-aligned seasonal peaks in mid-July, only one week apart, with similar downward trend and proportion of predominant O1 serotype. Large hospitals can thus harness EHRs for surveillance by utilizing patients' PoRs to study disease patterns among resident and visitor populations.

Forecasting Seasonal Vibrio parahaemolyticus Concentrations in New England Shellfish.

Seafood-borne Vibrio parahaemolyticus illness is a global public health issue facing resource managers and the seafood industry. The recent increase in shellfish-borne illnesses in the Northeast United States has resulted in the application of intensive management practices based on a limited understanding of when and where risks are present. We aim to determine the contribution of factors that affect V. parahaemolyticus concentrations in oysters (Crassostrea virginica) using ten years of surveillance data for environmental and climate conditions in the Great Bay Estuary of New Hampshire from 2007 to 2016. A time series analysis was applied to analyze V. parahaemolyticus concentrations and local environmental predictors and develop predictive models. Whereas many environmental variables correlated with V. parahaemolyticus concentrations, only a few retained significance in capturing trends, seasonality and data variability. The optimal predictive model contained water temperature and pH, photoperiod, and the calendar day of study. The model enabled relatively accurate seasonality-based prediction of V. parahaemolyticus concentrations for 2014-2016 based on the 2007-2013 dataset and captured the increasing trend in extreme values of V. parahaemolyticus concentrations. The developed method enables the informative tracking of V. parahaemolyticus concentrations in coastal ecosystems and presents a useful platform for developing area-specific risk forecasting models.

From hospitalization records to surveillance: The use of local patient profiles to characterize cholera in Vellore, India.

Despite availability of high quality medical records, health care systems often do not have the resources or tools to utilize these data efficiently. Yet, hospital-based, laboratory-confirmed records may pave the way for building reliable surveillance systems capable of monitoring temporal trends of emerging infections. In this communication, we present a new tool to compress and visualize medical records with a local population profile (LPP) approach, which transforms information into statistically comparable patterns. We provide a step-by-step tutorial on how to build, interpret, and expand the use of LPP using hospitalization records of laboratory-confirmed cholera. We abstracted case information from the databases maintained by the Department of Clinical Microbiology at Christian Medical College in Vellore, India. We used a single-year age distribution to construct LPPs for O1, O139, and non O1/O139 serotypes of Vibrio cholerae. Disease counts and hospitalization rates were converted into fitted kernel-based probability densities. We formally compared LPPs with the Kolmogorov-Smirnov test, and created multi-panel visuals to depict temporal trend, age distribution, and hospitalization rates simultaneously. Our first implementation of LPPs revealed information that is typically gathered from surveillance systems such as: i) estimates of the demographic distribution of diseases and identification of a population at risk, ii) changes in the dominant pathogen presence; and iii) trends in disease occurrence. The LPP demonstrated the benefit of increased resolution in pattern detection of disease for different Vibrio cholerae serotypes and two demographic categories by showing patterns and anomalies that would be obscured by traditional methods of analysis and visualization. LPP can be used effectively to compile basic patient information such as age, sex, diagnosis, location, and time into compact visuals. Future development of the proposed approach will allow public health researchers and practitioners to broadly utilize and efficiently compress large volumes of medical records without loss of information.