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The interactions of environmental, geographic, socio-demographic, and epidemiological factors in shaping mosquito-borne disease transmission dynamics are complex and changeable, influencing the abundance and distribution of vectors and the pathogens they transmit. In this study, 27 years of cross-sectional malaria survey data (1990-2017) were used to examine the effects of these factors on Plasmodium falciparum and Plasmodium vivax malaria presence at the community level in Africa and Asia. Monthly long-term, open-source data for each factor were compiled and analyzed using generalized linear models and classification and regression trees. Both temperature and precipitation exhibited unimodal relationships with malaria, with a positive effect up to a point after which a negative effect was observed as temperature and precipitation increased. Overall decline in malaria from 2000 to 2012 was well captured by the models, as was the resurgence after that. The models also indicated higher malaria in regions with lower economic and development indicators. Malaria is driven by a combination of environmental, geographic, socioeconomic, and epidemiological factors, and in this study, we demonstrated two approaches to capturing this complexity of drivers within models. Identifying these key drivers, and describing their associations with malaria, provides key information to inform planning and prevention strategies and interventions to reduce malaria burden.
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Malaria Falciparum , Humanos , Estudios Transversales , África/epidemiología , Asia/epidemiología , Malaria Falciparum/epidemiología , Malaria Falciparum/parasitología , Malaria Falciparum/transmisión , Malaria Vivax/epidemiología , Malaria Vivax/parasitología , Malaria Vivax/transmisión , Factores Socioeconómicos , Geografía , Plasmodium falciparum , Malaria/epidemiología , Malaria/transmisión , Temperatura , Mosquitos Vectores/parasitología , Animales , Plasmodium vivax , AmbienteRESUMEN
BACKGROUND: Tick-borne diseases are a growing public health threat in the United States. Despite the prevalence and rising burden of tick-borne diseases, there are major gaps in baseline knowledge and surveillance efforts for tick vectors, even among vector control districts and public health agencies. To address this issue, an online tick training course (OTTC) was developed through the Southeastern Center of Excellence in Vector-Borne Diseases (SECOEVBD) to provide a comprehensive knowledge base on ticks, tick-borne diseases, and their management. METHODS: The OTTC consisted of training modules covering topics including tick biology, tick identification, tick-borne diseases, and public health, personal tick safety, and tick surveillance. The course was largely promoted to vector control specialists and public health employees throughout the Southeastern US. We collected assessment and survey data on participants to gauge learning outcomes, perceptions of the utility of knowledge gained, and barriers and facilitators to applying the knowledge in the field. RESULTS: The OTTC was successful in increasing participants' baseline knowledge across all course subject areas, with the average score on assessment increasing from 62.6% (pre-course) to 86.7% (post-course). More than half of participants (63.6%) indicated that they would definitely use information from the course in their work. Barriers to using information identified in the delayed assessment included lack of opportunities to apply skills (18.5%) and the need for additional specialized training beyond what the OTTC currently offers (18.5%), while the main facilitator (70.4%) for applying knowledge was having opportunities at work, such as an existing tick surveillance program. CONCLUSIONS: Overall, this OTTC demonstrated capacity to improve knowledge in a necessary and underserved public health field, and more than half of participants use or plan to use the information in their work. The geographic reach of this online resource was much larger than simply for the Southeastern region for which it was designed, suggesting a much broader need for this resource. Understanding the utility and penetrance of training programs such as these is important for refining materials and assessing optimal targets for training.
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Conocimientos, Actitudes y Práctica en Salud , Enfermedades por Picaduras de Garrapatas , Humanos , Sudeste de Estados Unidos , Enfermedades por Picaduras de Garrapatas/prevención & control , Animales , Garrapatas , Masculino , Internet , Femenino , Control de Ácaros y Garrapatas/métodos , Evaluación de Programas y Proyectos de Salud , Educación a Distancia/métodos , AdultoRESUMEN
We performed an arboviral survey in mosquitoes from four endemic Ecuadorian cities (Huaquillas, Machala, Portovelo and Zaruma) during the epidemic period 2016-2018. Collections were performed during the pre-rainy season (2016), peak transmission season (2017) and post-rainy season (2018). Ae. aegypti mosquitoes were pooled by date, location and sex. Pools were screened by RT-PCR for the presence of ZIKV RNA, and infection rates (IRs) per 1,000 specimens were calculated. A total of 2,592 pools (comprising 6,197 mosquitoes) were screened. Our results reveal high IRs in all cities and periods sampled. Overall IRs among female mosquitoes were highest in Machala (89.2), followed by Portovelo (66.4), Zaruma (47.4) and Huaquillas (41.9). Among male mosquitoes, overall IRs were highest in Machala (35.6), followed by Portovelo (33.1), Huaquillas (31.9) and Zaruma (27.9), suggesting that alternative transmission routes (vertical/venereal) can play important roles for ZIKV maintenance in the vector population of these areas. Additionally, we propose that the stabilization of ZIKV vertical transmission in the vector population could help explain the presence of high IRs in field-caught mosquitoes during inter-epidemic periods.
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Aedes , Infección por el Virus Zika , Virus Zika , Animales , Masculino , Femenino , Humanos , Virus Zika/genética , Ecuador/epidemiología , Prevalencia , Mosquitos VectoresRESUMEN
BACKGROUND: Aedes (Stegomyia)-borne diseases are an expanding global threat, but gaps in surveillance make comprehensive and comparable risk assessments challenging. Geostatistical models combine data from multiple locations and use links with environmental and socioeconomic factors to make predictive risk maps. Here we systematically review past approaches to map risk for different Aedes-borne arboviruses from local to global scales, identifying differences and similarities in the data types, covariates, and modelling approaches used. METHODS: We searched on-line databases for predictive risk mapping studies for dengue, Zika, chikungunya, and yellow fever with no geographical or date restrictions. We included studies that needed to parameterise or fit their model to real-world epidemiological data and make predictions to new spatial locations of some measure of population-level risk of viral transmission (e.g. incidence, occurrence, suitability, etc.). RESULTS: We found a growing number of arbovirus risk mapping studies across all endemic regions and arboviral diseases, with a total of 176 papers published 2002-2022 with the largest increases shortly following major epidemics. Three dominant use cases emerged: (i) global maps to identify limits of transmission, estimate burden and assess impacts of future global change, (ii) regional models used to predict the spread of major epidemics between countries and (iii) national and sub-national models that use local datasets to better understand transmission dynamics to improve outbreak detection and response. Temperature and rainfall were the most popular choice of covariates (included in 50% and 40% of studies respectively) but variables such as human mobility are increasingly being included. Surprisingly, few studies (22%, 31/144) robustly tested combinations of covariates from different domains (e.g. climatic, sociodemographic, ecological, etc.) and only 49% of studies assessed predictive performance via out-of-sample validation procedures. CONCLUSIONS: Here we show that approaches to map risk for different arboviruses have diversified in response to changing use cases, epidemiology and data availability. We identify key differences in mapping approaches between different arboviral diseases, discuss future research needs and outline specific recommendations for future arbovirus mapping.
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Aedes , Infecciones por Arbovirus , Arbovirus , Fiebre Chikungunya , Dengue , Fiebre Amarilla , Infección por el Virus Zika , Virus Zika , Animales , Humanos , Infecciones por Arbovirus/epidemiología , Fiebre Amarilla/epidemiología , Mosquitos Vectores , Dengue/epidemiologíaRESUMEN
Species distribution modeling (SDM) has become an increasingly common approach to explore questions about ecology, geography, outbreak risk, and global change as they relate to infectious disease vectors. Here, we conducted a systematic review of the scientific literature, screening 563 abstracts and identifying 204 studies that used SDMs to produce distribution estimates for mosquito species. While the number of studies employing SDM methods has increased markedly over the past decade, the overwhelming majority used a single method (maximum entropy modeling; MaxEnt) and focused on human infectious disease vectors or their close relatives. The majority of regional models were developed for areas in Africa and Asia, while more localized modeling efforts were most common for North America and Europe. Findings from this study highlight gaps in taxonomic, geographic, and methodological foci of current SDM literature for mosquitoes that can guide future efforts to study the geography of mosquito-borne disease risk.
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Culicidae , Mosquitos Vectores , Humanos , Animales , África/epidemiología , Asia/epidemiología , Brotes de EnfermedadesRESUMEN
Climate-sensitive infectious disease modelling is crucial for public health planning and is underpinned by a complex network of software tools. We identified only 37 tools that incorporated both climate inputs and epidemiological information to produce an output of disease risk in one package, were transparently described and validated, were named (for future searching and versioning), and were accessible (ie, the code was published during the past 10 years or was available on a repository, web platform, or other user interface). We noted disproportionate representation of developers based at North American and European institutions. Most tools (n=30 [81%]) focused on vector-borne diseases, and more than half (n=16 [53%]) of these tools focused on malaria. Few tools (n=4 [11%]) focused on food-borne, respiratory, or water-borne diseases. The under-representation of tools for estimating outbreaks of directly transmitted diseases represents a major knowledge gap. Just over half (n=20 [54%]) of the tools assessed were described as operationalised, with many freely available online.
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Enfermedades Transmisibles , Malaria , Estados Unidos , Humanos , Enfermedades Transmisibles/epidemiología , Brotes de Enfermedades , Salud Pública , Malaria/epidemiología , Programas InformáticosRESUMEN
Nepal aims to eliminate malaria by 2026. This study analyzed district-level spatio-temporal patterns of malaria in Nepal from 2005 to 2018, following the introduction of Long-Lasting Insecticidal Nets (LLINs) for vector control intervention. The spatial variation in a temporal trend (SVTT) method in SaTScan was used to detect significantly high or low temporal trends of five malaria indicators: Indigenous, Imported, PV (Plasmodium vivax), PF (Plasmodium falciparum), and Total Malaria; results were mapped as clusters with associated trends. Spatial clusters of increasing malaria were found for all five indicators. Indigenous Malaria increased 113.71% in a cluster of three previously non-endemic mountainous districts. The most prominent cluster of Imported Malaria increased by 156.22%, and included the capital, Kathmandu. While some clusters had decreasing malaria, the rate of decrease in clusters was lower than outside the clusters. Overall, malaria burden is decreasing in Nepal as the country progresses closer to the elimination deadline. However, spatial clusters of increasing malaria, and clusters of lower rates of decreasing malaria, point to a need to focus vector control interventions on these clusters.
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Malaria Falciparum , Malaria Vivax , Malaria , Humanos , Malaria Vivax/epidemiología , Malaria Vivax/prevención & control , Nepal/epidemiología , Malaria/epidemiología , Malaria/prevención & controlRESUMEN
Keystone orthobunyavirus (KEYV), a member of the genus Orthobunyavirus, was first isolated in 1964 from mosquitoes in Keystone, Florida. Although data on human infections are limited, the virus has been linked to a fever/rash syndrome and, possibly, encephalitis, with early studies suggesting that 20% of persons in the Tampa, Florida, region had antibodies to KEYV. To assess the distribution and diversity of KEYV in other regions of Florida, we collected > 6,000 mosquitoes from 43 sampling sites in St. Johns County between June 2019 and April 2020. Mosquitoes were separated into pools by species and collection date and site. All pools with Aedes spp. (293 pools, 2,171 mosquitoes) were screened with a real-time reverse transcriptase polymerase chain reaction (rRT-PCR) assay that identifies KEYV and other closely related virus species of what was previously designated as the California encephalitis serogroup. In 2020, screening for KEYV was expanded to include 211 pools of Culex mosquitoes from sites where KEYV-positive Aedes spp. had been identified. rRT-PCR-positive samples were inoculated into cell cultures, and five KEYV isolates from Aedes atlanticus pools were isolated and sequenced. Analyses of the KEYV large genome segment sequences revealed two distinct KEYV clades, whereas analyses of the medium and small genome segments uncovered past reassortment events. Our data documented the ongoing seasonal circulation of multiple KEYV clades within Ae. atlanticus mosquito populations along the east coast of Florida, highlighting the need for further studies of the impact of this virus on human health.
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Aedes , Culex , Virus de la Encefalitis de California , Orthobunyavirus , Animales , Humanos , Florida/epidemiología , Orthobunyavirus/genética , Reacción en Cadena de la Polimerasa , Mosquitos VectoresRESUMEN
Background: Understanding the geographic distribution of Rickettsia montanensis infections in Dermacentor variabilis is important for tick-borne disease management in the United States, as both a tick-borne agent of interest and a potential confounder in surveillance of other rickettsial diseases. Two previous studies modeled niche suitability for D. variabilis with and without R. montanensis, from 2002 to 2012, indicating that the D. variabilis niche overestimates the infected niche. This study updates these, adding data since 2012. Methods: Newer surveillance and testing data were used to update Species Distribution Models (SDMs) of D. variabilis, and R. montanensis-infected D. variabilis, in the United States. Using random forest models, found to perform best in previous work, we updated the SDMs and compared them with prior results. Warren's I niche overlap metric was used to compare between predicted suitability for all ticks and "R. montanensis-positive niche" models across datasets. Results: Warren's I indicated <2% change in predicted niche, and there was no change in order of importance of environmental predictors, for D. variabilis or R. montanensis-positive niche. The updated D. variabilis niche model overpredicted suitability compared with the updated R. montanensis-positive niche in key peripheral parts of the range, but slightly underpredicted through the northern and midwestern parts of the range. This reinforces previous findings of a more constrained R. montanensis-positive niche than predicted by D. variabilis records alone. Conclusions: The consistency of predicted niche suitability for D. variabilis in the United States, with the addition of nearly a decade of new data, corroborates this is a species with generalist habitat requirements. Yet a slight shift in updated niche distribution, even of low suitability, included more southern areas, pointing to a need for continued and extended monitoring and surveillance. This further underscores the importance of revisiting vector and vector-borne disease distribution maps.
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Dermacentor , Enfermedades de los Perros , Ixodidae , Rhipicephalus sanguineus , Infecciones por Rickettsia , Rickettsia , Rickettsiaceae , Perros , Estados Unidos/epidemiología , Animales , Rickettsiales , Dermacentor/microbiología , Infecciones por Rickettsia/epidemiología , Infecciones por Rickettsia/veterinariaRESUMEN
Arboviruses receive heightened research attention during major outbreaks or when they cause unusual or severe clinical disease, but they are otherwise undercharacterized. Global change is also accelerating the emergence and spread of arboviral diseases, leading to time-sensitive questions about potential interactions between viruses and novel vectors. Vector competence experiments help determine the susceptibility of certain arthropods to a given arbovirus, but these experiments are often conducted in real time during outbreaks, rather than with preparedness in mind. We conducted a systematic review of reported mosquito-arbovirus competence experiments, screening 570 abstracts to arrive at 265 studies testing in vivo arboviral competence. We found that more than 90% of potential mosquito-virus combinations are untested in experimental settings and that entire regions and their corresponding vectors and viruses are undersampled. These knowledge gaps stymie outbreak response and limit attempts to both build and validate predictive models of the vector-virus network.
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Aedes , Infecciones por Arbovirus , Arbovirus , Culicidae , Animales , Humanos , Arbovirus/fisiología , Mosquitos Vectores , Infecciones por Arbovirus/epidemiología , Brotes de EnfermedadesRESUMEN
Background: Nepal is preparing to eliminate malaria by 2026. To evaluate the progress of vector control and prioritize areas for targeted intervention, understanding the recent changing distribution of high and moderate malaria risk areas is vital. Methods: Patterns of designated high and moderate malaria risk wards in Nepal between 2018 and 2021 were analyzed to identify stable and newly generated high- and moderate-risk (HaMR) wards, using the Spatial Temporal Analysis of Moving Polygons (STAMP) method. Results and Conclusions: High-risk and moderate-risk wards decreased by about 55% and the number of districts containing these wards also decreased from 20 to 14. However, several stable and new HaMR wards, mostly in the northwest and the southwest of the country, are apparent, despite intervention efforts. Public health officials should prioritize those wards for malaria surveillance and vector control, and future studies should explore the underlying reasons for persistent risk wards.
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Malaria , Animales , Nepal/epidemiología , Malaria/epidemiología , Malaria/prevención & control , Malaria/veterinaria , Análisis Espacio-TemporalRESUMEN
BACKGROUND: Anopheles stephensi is a malaria-transmitting mosquito that has recently expanded from its primary range in Asia and the Middle East, to locations in Africa. This species is a competent vector of both Plasmodium falciparum and Plasmodium vivax malaria. Perhaps most alarming, the characteristics of An. stephensi, such as container breeding and anthropophily, make it particularly adept at exploiting built environments in areas with no prior history of malaria risk. METHODS: In this paper, global maps of thermal transmission suitability and people at risk (PAR) for malaria transmission by An. stephensi were created, under current and future climate. Temperature-dependent transmission suitability thresholds derived from recently published species-specific thermal curves were used to threshold gridded, monthly mean temperatures under current and future climatic conditions. These temperature driven transmission models were coupled with gridded population data for 2020 and 2050, under climate-matched scenarios for future outcomes, to compare with baseline predictions for 2020 populations. RESULTS: Using the Global Burden of Disease regions approach revealed that heterogenous regional increases and decreases in risk did not mask the overall pattern of massive increases of PAR for malaria transmission suitability with An. stephensi presence. General patterns of poleward expansion for thermal suitability were seen for both P. falciparum and P. vivax transmission potential. CONCLUSIONS: Understanding the potential suitability for An. stephensi transmission in a changing climate provides a key tool for planning, given an ongoing invasion and expansion of the vector. Anticipating the potential impact of onward expansion to transmission suitable areas, and the size of population at risk under future climate scenarios, and where they occur, can serve as a large-scale call for attention, planning, and monitoring.
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Anopheles , Malaria Falciparum , Malaria Vivax , Malaria , Humanos , Animales , Malaria/epidemiología , Malaria Falciparum/epidemiología , Plasmodium falciparum , África/epidemiología , Mosquitos VectoresRESUMEN
A growing body of information on vector-borne diseases has arisen as increasing research focus has been directed towards the need for anticipating risk, optimizing surveillance, and understanding the fundamental biology of vector-borne diseases to direct control and mitigation efforts. The scope and scale of this information, in the form of data, comprising database efforts, data storage, and serving approaches, means that it is distributed across many formats and data types. Data ranges from collections records to molecular characterization, geospatial data to interactions of vectors and traits, infection experiments to field trials. New initiatives arise, often spanning the effort traditionally siloed in specific research disciplines, and other efforts wane, perhaps in response to funding declines, different research directions, or lack of sustained interest. Thusly, the world of vector data - the Vector Data Ecosystem - can become unclear in scope, and the flows of data through these various efforts can become stymied by obsolescence, or simply by gaps in access and interoperability. As increasing attention is paid to creating FAIR (Findable Accessible Interoperable, and Reusable) data, simply characterizing what is 'out there', and how these existing data aggregation and collection efforts interact, or interoperate with each other, is a useful exercise. This study presents a snapshot of current vector data efforts, reporting on level of accessibility, and commenting on interoperability using an illustration to track a specimen through the data ecosystem to understand where it occurs for the database efforts anticipated to describe it (or parts of its extended specimen data).
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Ecosistema , Enfermedades Transmitidas por Vectores , Animales , Bases de Datos FactualesRESUMEN
BACKGROUND: West Nile virus (WNV), primarily vectored by mosquitoes of the genus Culex, is the most important mosquito-borne pathogen in North America, having infected thousands of humans and countless wildlife since its arrival in the USA in 1999. In locations with dedicated mosquito control programs, surveillance methods often rely on frequent testing of mosquitoes collected in a network of gravid traps (GTs) and CO2-baited light traps (LTs). Traps specifically targeting oviposition-seeking (e.g. GTs) and host-seeking (e.g. LTs) mosquitoes are vulnerable to trap bias, and captured specimens are often damaged, making morphological identification difficult. METHODS: This study leverages an alternative mosquito collection method, the human landing catch (HLC), as a means to compare sampling of potential WNV vectors to traditional trapping methods. Human collectors exposed one limb for 15 min at crepuscular periods (5:00-8:30 am and 6:00-9:30 pm daily, the time when Culex species are most actively host-seeking) at each of 55 study sites in suburban Chicago, Illinois, for two summers (2018 and 2019). RESULTS: A total of 223 human-seeking mosquitoes were caught by HLC, of which 46 (20.6%) were mosquitoes of genus Culex. Of these 46 collected Culex specimens, 34 (73.9%) were Cx. salinarius, a potential WNV vector species not thought to be highly abundant in upper Midwest USA. Per trapping effort, GTs and LTs collected > 7.5-fold the number of individual Culex specimens than HLC efforts. CONCLUSIONS: The less commonly used HLC method provides important insight into the complement of human-biting mosquitoes in a region with consistent WNV epidemics. This study underscores the value of the HLC collection method as a complementary tool for surveillance to aid in WNV vector species characterization. However, given the added risk to the collector, novel mitigation methods or alternative approaches must be explored to incorporate HLC collections safely and strategically into control programs.
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Culex , Fiebre del Nilo Occidental , Virus del Nilo Occidental , Animales , Femenino , Humanos , Mosquitos Vectores , Animales Salvajes , Control de Mosquitos/métodosRESUMEN
Background: Understanding the geographic distribution of Rickettsia montanensis infections in Dermacentor variabilis is important for tick-borne disease management in the United States, as both a tick-borne agent of interest and a potential confounder in surveillance of other rickettsial diseases. Two previous studies modeled niche suitability for D. variabilis with and without R. montanensis , from 2002-2012, indicating that the D. variabilis niche overestimates the infected niche. This study updates these, adding data since 2012. Methods: Newer surveillance and testing data were used to update Species Distribution Models (SDMs) of D. variabilis , and R. montanensis infected D. variabilis , in the United States. Using random forest (RF) models, found to perform best in previous work, we updated the SDMs and compared them with prior results. Warren's I niche overlap metric was used to compare between predicted suitability for all ticks and 'pathogen positive niche' models across datasets. Results: Warren's I indicated <2% change in predicted niche, and there was no change in order of importance of environmental predictors, for D. variabilis or R. montanensis positive niche. The updated D. variabilis niche model overpredicted suitability compared to the updated R. montanensis positive niche in key peripheral parts of the range, but slightly underpredicted through the northern and midwestern parts of the range. This reinforces previous findings of a more constrained pathogen-positive niche than predicted by D. variabilis records alone. Conclusions: The consistency of predicted niche suitability for D. variabilis in the United States, with the addition of nearly a decade of new data, corroborates this is a species with generalist habitat requirements. Yet a slight shift in updated niche distribution, even of low suitability, included more southern areas, pointing to a need for continued and extended monitoring and surveillance. This further underscores the importance of revisiting vector and vector-borne disease distribution maps.
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Purpose of Review: Preparing for pandemics requires a degree of interdisciplinary work that is challenging under the current paradigm. This review summarizes the challenges faced by the field of pandemic science and proposes how to address them. Recent Findings: The structure of current siloed systems of research organizations hinders effective interdisciplinary pandemic research. Moreover, effective pandemic preparedness requires stakeholders in public policy and health to interact and integrate new findings rapidly, relying on a robust, responsive, and productive research domain. Neither of these requirements are well supported under the current system. Summary: We propose a new paradigm for pandemic preparedness wherein interdisciplinary research and close collaboration with public policy and health practitioners can improve our ability to prevent, detect, and treat pandemics through tighter integration among domains, rapid and accurate integration, and translation of science to public policy, outreach and education, and improved venues and incentives for sustainable and robust interdisciplinary work.
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BACKGROUND: Climate and climate change affect the spatial pattern and seasonality of malaria risk. Season lengths and spatial extents of mapped current and future malaria transmission suitability predictions for Nepal were assessed for a combination of malaria vector and parasites: Anopheles stephensi and Plasmodium falciparum (ASPF) and An. stephensi and Plasmodium vivax (ASPV) and compared with observed estimates of malaria risk in Nepal. METHODS: Thermal bounds of malaria transmission suitability for baseline (1960-1990) and future climate projections (RCP 4.5 and RCP 8.5 in 2030 and 2050) were extracted from global climate models and mapped for Nepal. Season length and spatial extent of suitability between baseline and future climate scenarios for ASPF and ASPV were compared using the Warren's I metric. Official 2010 DoHS risk districts (DRDs) and 2021 DoHS risk wards (DRWs), and spatiotemporal incidence trend clusters (ITCs) were overlaid on suitability season length and extent maps to assess agreement, and potential mismatches. RESULTS: Shifts in season length and extent of malaria transmission suitability in Nepal are anticipated under both RCP 4.5 and RCP 8.5 scenarios in 2030 and 2050, compared to baseline climate. The changes are broadly consistent across both future climate scenarios for ASPF and ASPV. There will be emergence of suitability and increasing length of season for both ASPF and ASPV and decreasing length of season for ASPV by 2050. The emergence of suitability will occur in low and no-risk DRDs and outside of high and moderate-risk DRWs, season length increase will occur across all DRD categories, and outside of high and moderate-risk DRWs. The high and moderate risk DRWs of 2021 fall into ITCs with decreasing trend. CONCLUSIONS: The study identified areas of Nepal where malaria transmission suitability will emerge, disappear, increase, and decrease in the future. However, most of these areas are anticipated outside of the government's current and previously designated high and moderate-risk areas, and thus outside the focus of vector control interventions. Public health officials could use these anticipated changing areas of malaria risk to inform vector control interventions for eliminating malaria from the country, and to prevent malaria resurgence.
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Anopheles , Malaria Falciparum , Malaria , Animales , Humanos , Malaria/epidemiología , Malaria Falciparum/epidemiología , Cambio Climático , Estaciones del Año , Nepal/epidemiología , Mosquitos VectoresRESUMEN
To date, there are few examples of implementation science studies that help guide climate-related health adaptation. Implementation science is the study of methods to promote the adoption and integration of evidence-based tools, interventions, and policies into practice to improve population health. These studies can provide the needed empirical evidence to prioritise and inform implementation of health adaptation efforts. This Personal View discusses five case studies that deployed disease early warning systems around the world. These cases studies illustrate challenges to deploying early warning systems and guide recommendations for implementation science approaches to enhance future research. We propose theory-informed approaches to understand multilevel barriers, design strategies to overcome those barriers, and analyse the ability of those strategies to advance the uptake and scale-up of climate-related health interventions. These findings build upon previous theoretical work by grounding implementation science recommendations and guidance in the context of real-world practice, as detailed in the case studies.