Weekly Forecasting of Yellow Fever Occurrence and Incidence via Eco-Meteorological Dynamics.

Yellow Fever (YF), a mosquito-borne disease, requires ongoing surveillance and prevention due to its persistence and ability to cause major epidemics, including one that began in Brazil in 2016. Forecasting based on factors influencing YF risk can improve efficiency in prevention. This study aimed to produce weekly forecasts of YF occurrence and incidence in Brazil using weekly meteorological and ecohydrological conditions. Occurrence was forecast as the probability of observing any cases, and incidence was forecast to represent morbidity if YF occurs. We fit gamma hurdle models, selecting predictors from several meteorological and ecohydrological factors, based on forecast accuracy defined by receiver operator characteristic curves and mean absolute error. We fit separate models for data before and after the start of the 2016 outbreak, forecasting occurrence and incidence for all municipalities of Brazil weekly. Different predictor sets were found to produce most accurate forecasts in each time period, and forecast accuracy was high for both time periods. Temperature, precipitation, and previous YF burden were most influential predictors among models. Minimum, maximum, mean, and range of weekly temperature, precipitation, and humidity contributed to forecasts, with optimal lag times of 2, 6, and 7 weeks depending on time period. Results from this study show the use of environmental predictors in providing regular forecasts of YF burden and producing nationwide forecasts. Weekly forecasts, which can be produced using the forecast model developed in this study, are beneficial for informing immediate preparedness measures.

Algal Bloom Ties: Spreading Network Inference and Extreme Eco-Environmental Feedback.

Coastal marine ecosystems worldwide are increasingly affected by tide alterations and anthropogenic disturbances affecting the water quality and leading to frequent algal blooms. Increased bloom persistence is a serious threat due to the long-lasting impacts on ecological processes and services, such as carbon cycling and sequestration. The exploration of eco-environmental feedback and algal bloom patterns remains challenging and poorly investigated, mostly due to the paucity of data and lack of model-free approaches to infer universal bloom dynamics. Florida Bay, taken as an epitome for biodiversity and blooms, has long experienced algal blooms in its central and western regions, and, in 2006, an unprecedented bloom occurred in the eastern habitats rich in corals and vulnerable habitats. With global aims, we analyze the occurrence of blooms in Florida Bay from three perspectives: (1) the spatial spreading networks of chlorophyll-a (CHLa) that pinpoint the source and unbalanced habitats; (2) the fluctuations of water quality factors pre- and post-bloom outbreaks to assess the environmental impacts of ecological imbalances and target the prevention and control of algal blooms; and (3) the topological co-evolution of biogeochemical and spreading networks to quantify ecosystem stability and the likelihood of ecological shifts toward endemic blooms in the long term. Here, we propose the transfer entropy (TE) difference to infer salient dynamical inter actions between the spatial areas and biogeochemical factors (ecosystem connectome) underpinning bloom emergence and spread as well as environmental effects. A Pareto principle, defining the top 20% of areal interactions, is found to identify bloom spreading and the salient eco-environmental interactions of CHLa associated with endemic and epidemic regimes. We quantify the spatial dynamics of algal blooms and, thus, obtain areas in critical need for ecological monitoring and potential bloom control. The results show that algal blooms are increasingly persistent over space with long-term negative effects on water quality factors, in particular, about how blooms affect temperature locally. A dichotomy is reported between spatial ecological corridors of spreading and biogeochemical networks as well as divergence from the optimal eco-organization: randomization of the former due to nutrient overload and temperature increase leads to scale-free CHLa spreading and extreme outbreaks a posteriori. Subsequently, the occurrence of blooms increases bloom persistence, turbidity and salinity with potentially strong ecological effects on highly biodiverse and vulnerable habitats, such as tidal flats, salt-marshes and mangroves. The probabilistic distribution of CHLa is found to be indicative of endemic and epidemic regimes, where the former sets the system to higher energy dissipation, larger instability and lower predictability. Algal blooms are important ecosystem regulators of nutrient cycles; however, chlorophyll-a outbreaks cause vast ecosystem impacts, such as aquatic species mortality and carbon flux alteration due to their effects on water turbidity, nutrient cycling (nitrogen and phosphorus in particular), salinity and temperature. Beyond compromising the local water quality, other socio-ecological services are also compromised at large scales, including carbon sequestration, which affects climate regulation from local to global environments. Yet, ecological assessment models, such as the one presented, inferring bloom regions and their stability to pinpoint risks, are in need of application in aquatic ecosystems, such as subtropical and tropical bays, to assess optimal preventive controls.

In.To. COVID-19 socio-epidemiological co-causality.

Social media can forecast disease dynamics, but infoveillance remains focused on infection spread, with little consideration of media content reliability and its relationship to behavior-driven epidemiological outcomes. Sentiment-encoded social media indicators have been poorly developed for expressed text to forecast healthcare pressure and infer population risk-perception patterns. Here we introduce Infodemic Tomography (InTo) as the first web-based interactive infoveillance cybertechnology that forecasts and visualizes spatio-temporal sentiments and healthcare pressure as a function of social media positivity (i.e., Twitter here), considering both epidemic information and potential misinformation. Information spread is measured on volume and retweets, and the Value of Misinformation (VoMi) is introduced as the impact on forecast accuracy where misinformation has the highest dissimilarity in information dynamics. We validated InTo for COVID-19 in New Delhi and Mumbai by inferring distinct socio-epidemiological risk-perception patterns. We forecast weekly hospitalization and cases using ARIMA models and interpolate spatial hospitalization using geostatistical kriging on inferred risk perception curves between tweet positivity and epidemiological outcomes. Geospatial tweet positivity tracks accurately [Formula: see text]60[Formula: see text] of hospitalizations and forecasts hospitalization risk hotspots along risk aversion gradients. VoMi is higher for risk-prone areas and time periods, where misinformation has the highest non-linear predictability, with high incidence and positivity manifesting popularity-seeking social dynamics. Hospitalization gradients, VoMi, effective healthcare pressure and spatial model-data gaps can be used to predict hospitalization fluxes, misinformation, healthcare capacity gaps and surveillance uncertainty. Thus, InTo is a participatory instrument to better prepare and respond to public health crises by extracting and combining salient epidemiological and social surveillance at any desired space-time scale.

Environmental determinants predicting population vulnerability to high yellow fever incidence.

Yellow fever (YF) is an endemic mosquito-borne disease in Brazil, though many locations have not observed cases in recent decades. Some locations with low disease burden may resemble locations with higher disease burden through environmental and ecohydrological characteristics, which are known to impact YF burden, motivating increased or continued prevention measures such as vaccination, mosquito control or surveillance. This study aimed to use environmental characteristics to estimate vulnerability to observing high YF burden among all Brazilian municipalities. Vulnerability was defined in three categories based on yearly incidence between 2000 and 2017: minimal, low and high vulnerability. A cumulative logit model was fit to these categories using environmental and ecohydrological predictors, selecting those that provided the most accurate model fit. Per cent of days with precipitation, mean temperature, biome, population density, elevation, vegetation and nearby disease occurrence were included in best-fitting models. Model results were applied to estimate vulnerability nationwide. Municipalities with highest probability of observing high vulnerability was found in the North and Central-West (2000-2016) as well as the Southeast (2017) regions. Results of this study serve to identify specific locations to prioritize new or ongoing surveillance and prevention of YF based on underlying ecohydrological conditions.

The Eco-Evo Mandala: Simplifying Bacterioplankton Complexity into Ecohealth Signatures.

The microbiome emits informative signals of biological organization and environmental pressure that aid ecosystem monitoring and prediction. Are the many signals reducible to a habitat-specific portfolio that characterizes ecosystem health? Does an optimally structured microbiome imply a resilient microbiome? To answer these questions, we applied our novel Eco-Evo Mandala to bacterioplankton data from four habitats within the Great Barrier Reef, to explore how patterns in community structure, function and genetics signal habitat-specific organization and departures from theoretical optimality. The Mandala revealed communities departing from optimality in habitat-specific ways, mostly along structural and functional traits related to bacterioplankton abundance and interaction distributions (reflected by ϵ and λ as power law and exponential distribution parameters), which are not linearly associated with each other. River and reef communities were similar in their relatively low abundance and interaction disorganization (low ϵ and λ) due to their protective structured habitats. On the contrary, lagoon and estuarine inshore reefs appeared the most disorganized due to the ocean temperature and biogeochemical stress. Phylogenetic distances (D) were minimally informative in characterizing bacterioplankton organization. However, dominant populations, such as Proteobacteria, Bacteroidetes, and Cyanobacteria, were largely responsible for community patterns, being generalists with a large functional gene repertoire (high D) that increases resilience. The relative balance of these populations was found to be habitat-specific and likely related to systemic environmental stress. The position on the Mandala along the three fundamental traits, as well as fluctuations in this ecological state, conveys information about the microbiome's health (and likely ecosystem health considering bacteria-based multitrophic dependencies) as divergence from the expected relative optimality. The Eco-Evo Mandala emphasizes how habitat and the microbiome's interaction network topology are first- and second-order factors for ecosystem health evaluation over taxonomic species richness. Unhealthy microbiome communities and unbalanced microbes are identified not by macroecological indicators but by mapping their impact on the collective proportion and distribution of interactions, which regulates the microbiome's ecosystem function.

Temperature increase drives critical slowing down of fish ecosystems.

Fish ecosystems perform ecological functions that are critically important for the sustainability of marine ecosystems, such as global food security and carbon stock. During the 21st century, significant global warming caused by climate change has created pressing challenges for fish ecosystems that threaten species existence and global ecosystem health. Here, we study a coastal fish community in Maizuru Bay, Japan, and investigate the relationships between fluctuations of ST, abundance-based species interactions and salient fish biodiversity. Observations show that a local 20% increase in temperature from 2002 to 2014 underpins a long-term reduction in fish diversity (∼25%) played out by some native and invasive species (e.g. Chinese wrasse) becoming exceedingly abundant; this causes a large decay in commercially valuable species (e.g. Japanese anchovy) coupled to an increase in ecological productivity. The fish community is analyzed considering five temperature ranges to understand its atemporal seasonal sensitivity to ST changes, and long-term trends. An optimal information flow model is used to reconstruct species interaction networks that emerge as topologically different for distinct temperature ranges and species dynamics. Networks for low temperatures are more scale-free compared to ones for intermediate (15-20°C) temperatures in which the fish ecosystem experiences a first-order phase transition in interactions from locally stable to metastable and globally unstable for high temperatures states as suggested by abundance-spectrum transitions. The dynamic dominant eigenvalue of species interactions shows increasing instability for competitive species (spiking in summer due to intermediate-season critical transitions) leading to enhanced community variability and critical slowing down despite higher time-point resilience. Native competitive species whose abundance is distributed more exponentially have the highest total directed interactions and are keystone species (e.g. Wrasse and Horse mackerel) for the most salient links with cooperative decaying species. Competitive species, with higher eco-climatic memory and synchronization, are the most affected by temperature and play an important role in maintaining fish ecosystem stability via multitrophic cascades (via cooperative-competitive species imbalance), and as bioindicators of change. More climate-fitted species follow temperature increase causing larger divergence divergence between competitive and cooperative species. Decreasing dominant eigenvalues and lower relative network optimality for warmer oceans indicate fishery more attracted toward persistent oscillatory states, yet unpredictable, with lower cooperation, diversity and fish stock despite the increase in community abundance due to non-commercial and venomous species. We emphasize how changes in species interaction organization, primarily affected by temperature fluctuations, are the backbone of biodiversity dynamics and yet for functional diversity in contrast to taxonomic richness. Abundance and richness manifest gradual shifts while interactions show sudden shift. The work provides data-driven tools for analyzing and monitoring fish ecosystems under the pressure of global warming or other stressors. Abundance and interaction patterns derived by network-based analyses proved useful to assess ecosystem susceptibility and effective change, and formulate predictive dynamic information for science-based fishery policy aimed to maintain marine ecosystems stable and sustainable.

Estimating case fatality risk of severe Yellow Fever cases: systematic literature review and meta-analysis.

BACKGROUND: Case fatality risk (CFR), commonly referred to as a case fatality ratio or rate, represents the probability of a disease case being fatal. It is often estimated for various diseases through analysis of surveillance data, case reports, or record examinations. Reported CFR values for Yellow Fever vary, offering wide ranges. Estimates have not been found through systematic literature review, which has been used to estimate CFR of other diseases. This study aims to estimate the case fatality risk of severe Yellow Fever cases through a systematic literature review and meta-analysis. METHODS: A search strategy was implemented in PubMed and Ovid Medline in June 2019 and updated in March 2021, seeking reported severe case counts, defined by fever and either jaundice or hemorrhaging, and the number of those that were fatal. The searches yielded 1,133 studies, and title/abstract review followed by full text review produced 14 articles reporting 32 proportions of fatal cases, 26 of which were suitable for meta-analysis. Four studies with one proportion each were added to include clinical case data from the recent outbreak in Brazil. Data were analyzed through an intercept-only logistic meta-regression with random effects for study. Values of the I2 statistic measured heterogeneity across studies. RESULTS: The estimated CFR was 39 % (95 % CI: 31 %, 47 %). Stratifying by continent showed that South America observed a higher CFR than Africa, though fewer studies reported estimates for South America. No difference was seen between studies reporting surveillance data and studies investigating outbreaks, and no difference was seen among different symptom definitions. High heterogeneity was observed across studies. CONCLUSIONS: Approximately 39 % of severe Yellow Fever cases are estimated to be fatal. This study provides the first systematic literature review to estimate the CFR of Yellow Fever, which can provide insight into outbreak preparedness and estimating underreporting.

COVID-19 non-pharmaceutical intervention portfolio effectiveness and risk communication predominance.

Non-pharmaceutical interventions (NPIs) including resource allocation, risk communication, social distancing and travel restriction, are mainstream actions to control the spreading of Coronavirus disease 2019 (COVID-19) worldwide. Different countries implemented their own combinations of NPIs to prevent local epidemics and healthcare system overloaded. Portfolios, as temporal sets of NPIs have various systemic impacts on preventing cases in populations. Here, we developed a probabilistic modeling framework to evaluate the effectiveness of NPI portfolios at the macroscale. We employed a deconvolution method to back-calculate incidence of infections and estimate the effective reproduction number by using the package EpiEstim. We then evaluated the effectiveness of NPIs using ratios of the reproduction numbers and considered them individually and as a portfolio systemically. Based on estimates from Japan, we estimated time delays of symptomatic-to-confirmation and infection-to-confirmation as 7.4 and 11.4 days, respectively. These were used to correct surveillance data of other countries. Considering 50 countries, risk communication and returning to normal life were the most and least effective yielding the aggregated effectiveness of 0.11 and - 0.05 that correspond to a 22.4% and 12.2% reduction and increase in case growth. The latter is quantified by the change in reproduction number before and after intervention implementation. Countries with the optimal NPI portfolio are along an empirical Pareto frontier where mean and variance of effectiveness are maximized and minimized independently of incidence levels. Results indicate that implemented interventions, regardless of NPI portfolios, had distinct incidence reductions and a clear timing effect on infection dynamics measured by sequences of reproduction numbers. Overall, the successful suppression of the epidemic cannot work without the non-linear effect of NPI portfolios whose effectiveness optimality may relate to country-specific socio-environmental factors.

Inferring ecosystem networks as information flows.

The detection of causal interactions is of great importance when inferring complex ecosystem functional and structural networks for basic and applied research. Convergent cross mapping (CCM) based on nonlinear state-space reconstruction made substantial progress about network inference by measuring how well historical values of one variable can reliably estimate states of other variables. Here we investigate the ability of a developed optimal information flow (OIF) ecosystem model to infer bidirectional causality and compare that to CCM. Results from synthetic datasets generated by a simple predator-prey model, data of a real-world sardine-anchovy-temperature system and of a multispecies fish ecosystem highlight that the proposed OIF performs better than CCM to predict population and community patterns. Specifically, OIF provides a larger gradient of inferred interactions, higher point-value accuracy and smaller fluctuations of interactions and [Formula: see text]-diversity including their characteristic time delays. We propose an optimal threshold on inferred interactions that maximize accuracy in predicting fluctuations of effective [Formula: see text]-diversity, defined as the count of model-inferred interacting species. Overall OIF outperforms all other models in assessing predictive causality (also in terms of computational complexity) due to the explicit consideration of synchronization, divergence and diversity of events that define model sensitivity, uncertainty and complexity. Thus, OIF offers a broad ecological information by extracting predictive causal networks of complex ecosystems from time-series data in the space-time continuum. The accurate inference of species interactions at any biological scale of organization is highly valuable because it allows to predict biodiversity changes, for instance as a function of climate and other anthropogenic stressors. This has practical implications for defining optimal ecosystem management and design, such as fish stock prioritization and delineation of marine protected areas based on derived collective multispecies assembly. OIF can be applied to any complex system and used for model evaluation and design where causality should be considered as non-linear predictability of diverse events of populations or communities.

A chemical prioritization process: Applications to contaminants of emerging concern in freshwater ecosystems (Phase I).

Contaminants of emerging concern (CECs), such as pharmaceuticals, personal care products, and hormones, are frequently found in aquatic ecosystems around the world. Information on sublethal effects from exposure to commonly detected concentrations of CECs is lacking and the limited availability of toxicity data makes it difficult to interpret the biological significance of occurrence data. However, the ability to evaluate the effects of CECs on aquatic ecosystems is growing in importance, as detection frequency increases. The goal of this study was to prioritize the chemical hazards of 117 CECs detected in subsistence species and freshwater ecosystems on the Grand Portage Indian Reservation and adjacent 1854 Ceded Territory in Minnesota, USA. To prioritize CECs for management actions, we adapted Minnesota Pollution Control Agency's Aquatic Toxicity Profiles framework, a tool for the rapid assessment of contaminants to cause adverse effects on aquatic life by incorporating chemical-specific information. This study aimed to 1) perform a rapid-screening assessment and prioritization of detected CECs based on their potential environmental hazard; 2) identify waterbodies in the study region that contain high priority CECs; and 3) inform future monitoring, assessment, and potential remediation in the study region. In water samples alone, 50 CECs were deemed high priority. Twenty-one CECs were high priority among sediment samples and seven CECs were high priority in fish samples. Azithromycin, DEET, diphenhydramine, fluoxetine, miconazole, and verapamil were high priority in all three media. Due to the presence of high priority CECs throughout the study region, we recommend future monitoring of particular CECs based on the prioritization method used here. We present an application of a chemical hazard prioritization process and identify areas where the framework may be adapted to meet the objectives of other management-related assessments.

Anthropogenic factors associated with contaminants of emerging concern detected in inland Minnesota lakes (Phase II).

Contaminants of emerging concern (CECs) include a variety of pharmaceuticals, personal care products, and hormones commonly detected in surface waters. Human activities, such as wastewater treatment and discharge, contribute to the distribution of CECs in water, but other sources and pathways are less frequently examined. This study aimed to identify anthropogenic activities and environmental characteristics associated with the presence of CECs, previously determined to be of high priority for further research and mitigation, in rural inland lakes in northeastern Minnesota, United States. The setting for this study consisted of 21 lakes located within both the Grand Portage Indian Reservation and the 1854 Ceded Territory, where subsistence hunting and fishing are important to the cultural heritage of the indigenous community. We used data pertaining to numbers of buildings, healthcare facilities, wastewater treatment plants, impervious surfaces, and wetlands within defined areas surrounding the lakes as potential predictors of the detection of high priority CECs in water, sediment, and fish. Separate models were run for each contaminant detected in each sample media. We used least absolute shrinkage and selection operator (LASSO) models to account for both predictor selection and parameter estimation for CEC detection. Across contaminants and sample media, the percentage of impervious surface was consistently positively associated with CEC detection. Number of buildings in the surrounding area was often negatively associated with CEC detection, though nonsignificant. Surrounding population, presence of wastewater treatment facilities, and percentage of wetlands in surrounding areas were positively, but inconsistently, associated with CECs, while catchment area and healthcare centers were generally not associated. The results of this study highlight human activities and environmental characteristics associated with CEC presence in a rural area, informing future work regarding specific sources and transport pathways. We also demonstrate the utility of LASSO modeling in the identification of these important relationships.

Information differences across spatial resolutions and scales for disease surveillance and analysis: The case of Visceral Leishmaniasis in Brazil.

Nationwide disease surveillance at a high spatial resolution is desired for many infectious diseases, including Visceral Leishmaniasis. Statistical and mathematical models using data collected from surveillance activities often use a spatial resolution and scale either constrained by data availability or chosen arbitrarily. Sensitivity of model results to the choice of spatial resolution and scale is not, however, frequently evaluated. This study aims to determine if the choice of spatial resolution and scale are likely to impact statistical and mathematical analyses. Visceral Leishmaniasis in Brazil is used as a case study. Probabilistic characteristics of disease incidence, representing a likely outcome in a model, are compared across spatial resolutions and scales. Best fitting distributions were fit to annual incidence from 2004 to 2014 by municipality and by state. Best fits were defined as the distribution family and parameterization minimizing the sum of absolute error, evaluated through a simulated annealing algorithm. Gamma and Poisson distributions provided best fits for incidence, both among individual states and nationwide. Comparisons of distributions using Kullback-Leibler divergence shows that incidence by state and by municipality do not follow distributions that provide equivalent information. Few states with Gamma distributed incidence follow a distribution closely resembling that for national incidence. These results demonstrate empirically how choice of spatial resolution and scale can impact mathematical and statistical models.

Occurrence of contaminants of emerging concern in aquatic ecosystems utilized by Minnesota tribal communities.

Pharmaceuticals, personal care products, hormones, and other chemicals lacking water quality standards are frequently found in surface water. While evidence is growing that these contaminants of emerging concern (CECs) - those previously unknown, unrecognized, or unregulated - can affect the behavior and reproduction of fish and wildlife, little is known about the distribution of these chemicals in rural, tribal areas. Therefore, we surveyed the presence of CECs in water, sediment, and subsistence fish species across various waterbodies, categorized as undeveloped (i.e., no human development along shorelines), developed (i.e., human development along shorelines), and wastewater effluent-impacted (i.e., contain effluence from wastewater treatment plants), within the Grand Portage Indian Reservation and 1854 Ceded Territory in northeastern Minnesota, U.S.A. Overall, in 28 sites across three years (2016-2018), 117 of the 158 compounds tested were detected in at least one form of medium (i.e., water, sediment, or fish). CECs were detected most frequently at wastewater effluent-impacted sites, with up to 83 chemicals detected in one such lake, while as many as 17 were detected in an undeveloped lake. Although there was no statistically significant difference between the number of CECs present in developed versus undeveloped lakes, a range of 3-17 CECs were detected across these locations. Twenty-two CECs were detected in developed and undeveloped sites that were not detected in wastewater effluent-impacted sites. The detection of CECs in remote, undeveloped locations, where subsistence fish are harvested, raises scientific questions about the safety and security of subsistence foods for indigenous communities. Further investigation is warranted so that science-based solutions to reduce chemical risks to aquatic life and people can be developed locally and be informative for indigenous communities elsewhere.

Emerging Priorities for Microbiome Research.

Microbiome research has increased dramatically in recent years, driven by advances in technology and significant reductions in the cost of analysis. Such research has unlocked a wealth of data, which has yielded tremendous insight into the nature of the microbial communities, including their interactions and effects, both within a host and in an external environment as part of an ecological community. Understanding the role of microbiota, including their dynamic interactions with their hosts and other microbes, can enable the engineering of new diagnostic techniques and interventional strategies that can be used in a diverse spectrum of fields, spanning from ecology and agriculture to medicine and from forensics to exobiology. From June 19-23 in 2017, the NIH and NSF jointly held an Innovation Lab on Quantitative Approaches to Biomedical Data Science Challenges in our Understanding of the Microbiome. This review is inspired by some of the topics that arose as priority areas from this unique, interactive workshop. The goal of this review is to summarize the Innovation Lab's findings by introducing the reader to emerging challenges, exciting potential, and current directions in microbiome research. The review is broken into five key topic areas: (1) interactions between microbes and the human body, (2) evolution and ecology of microbes, including the role played by the environment and microbe-microbe interactions, (3) analytical and mathematical methods currently used in microbiome research, (4) leveraging knowledge of microbial composition and interactions to develop engineering solutions, and (5) interventional approaches and engineered microbiota that may be enabled by selectively altering microbial composition. As such, this review seeks to arm the reader with a broad understanding of the priorities and challenges in microbiome research today and provide inspiration for future investigation and multi-disciplinary collaboration.

An open challenge to advance probabilistic forecasting for dengue epidemics.

A wide range of research has promised new tools for forecasting infectious disease dynamics, but little of that research is currently being applied in practice, because tools do not address key public health needs, do not produce probabilistic forecasts, have not been evaluated on external data, or do not provide sufficient forecast skill to be useful. We developed an open collaborative forecasting challenge to assess probabilistic forecasts for seasonal epidemics of dengue, a major global public health problem. Sixteen teams used a variety of methods and data to generate forecasts for 3 epidemiological targets (peak incidence, the week of the peak, and total incidence) over 8 dengue seasons in Iquitos, Peru and San Juan, Puerto Rico. Forecast skill was highly variable across teams and targets. While numerous forecasts showed high skill for midseason situational awareness, early season skill was low, and skill was generally lowest for high incidence seasons, those for which forecasts would be most valuable. A comparison of modeling approaches revealed that average forecast skill was lower for models including biologically meaningful data and mechanisms and that both multimodel and multiteam ensemble forecasts consistently outperformed individual model forecasts. Leveraging these insights, data, and the forecasting framework will be critical to improve forecast skill and the application of forecasts in real time for epidemic preparedness and response. Moreover, key components of this project-integration with public health needs, a common forecasting framework, shared and standardized data, and open participation-can help advance infectious disease forecasting beyond dengue.

Degrees and dollars - Health costs associated with suboptimal ambient temperature exposure.

Suboptimal ambient temperature exposure significantly affects public health. Previous studies have primarily focused on risk assessment, with few examining the health outcomes from an economic perspective. To inform environmental health policies, we estimated the economic costs of health outcomes associated with suboptimal temperature in the Minneapolis/St. Paul Twin Cities Metropolitan Area. We used a distributed lag nonlinear model to estimate attributable fractions/cases for mortality, emergency department visits, and emergency hospitalizations at various suboptimal temperature levels. The analyses were stratified by age group (i.e., youth (0-19 years), adult (20-64 years), and senior (65+ years)). We considered both direct medical costs and loss of productivity during economic cost assessment. Results show that youth have a large number of temperature-related emergency department visits, while seniors have large numbers of temperature-related mortality and emergency hospitalizations. Exposures to extremely low and high temperatures lead to $2.70 billion [95% empirical confidence interval (eCI): $1.91 billion, $3.48 billion] (costs are all based on 2016 USD value) economic costs annually. Moderately and extremely low and high temperature leads to $9.40 billion [eCI: $6.05 billion, $12.57 billion] economic costs. The majority of the economic costs are consistently attributed to cold (>75%), rather than heat exposures and to mortality (>95%), rather than morbidity. Our findings support prioritizing temperature-related health interventions designed to minimize the economic costs by targeting seniors and to reduce attributable cases by targeting youth.

Collaborative efforts to forecast seasonal influenza in the United States, 2015-2016.

Since 2013, the Centers for Disease Control and Prevention (CDC) has hosted an annual influenza season forecasting challenge. The 2015-2016 challenge consisted of weekly probabilistic forecasts of multiple targets, including fourteen models submitted by eleven teams. Forecast skill was evaluated using a modified logarithmic score. We averaged submitted forecasts into a mean ensemble model and compared them against predictions based on historical trends. Forecast skill was highest for seasonal peak intensity and short-term forecasts, while forecast skill for timing of season onset and peak week was generally low. Higher forecast skill was associated with team participation in previous influenza forecasting challenges and utilization of ensemble forecasting techniques. The mean ensemble consistently performed well and outperformed historical trend predictions. CDC and contributing teams will continue to advance influenza forecasting and work to improve the accuracy and reliability of forecasts to facilitate increased incorporation into public health response efforts.

Demographic Inequities in Health Outcomes and Air Pollution Exposure in the Atlanta Area and its Relationship to Urban Infrastructure.

Environmental burdens such as air pollution are inequitably distributed with groups of lower socioeconomic statuses, which tend to comprise of large proportions of racial minorities, typically bearing greater exposure. Such groups have also been shown to present more severe health outcomes which can be related to adverse pollution exposure. Air pollution exposure, especially in urban areas, is usually impacted by the built environment, such as major roadways, which can be a significant source of air pollution. This study aims to examine inequities in prevalence of cardiovascular and respiratory diseases in the Atlanta metropolitan region as they relate to exposure to air pollution and characteristics of the built environment. Census tract level data were obtained from multiple sources to model health outcomes (asthma, chronic obstructive pulmonary disease, coronary heart disease, and stroke), pollution exposure (particulate matter and nitrogen oxides), demographics (ethnicity and proportion of elderly residents), and infrastructure characteristics (tree canopy cover, access to green space, and road intersection density). Conditional autoregressive models were fit to the data to account for spatial autocorrelation among census tracts. The statistical model showed areas with majority African-American populations had significantly higher exposure to both air pollutants and higher prevalence of each disease. When considering univariate associations between pollution and health outcomes, the only significant association existed between nitrogen oxides and COPD being negatively correlated. Greater percent tree canopy cover and green space access were associated with higher prevalence of COPD, CHD, and stroke. Overall, in considering health outcomes in connection with pollution exposure infrastructure and ethnic demographics, demographics remained the most significant explanatory variable.

Optimal Microbiome Networks: Macroecology and Criticality.

The human microbiome is an extremely complex ecosystem considering the number of bacterial species, their interactions, and its variability over space and time. Here, we untangle the complexity of the human microbiome for the Irritable Bowel Syndrome (IBS) that is the most prevalent functional gastrointestinal disorder in human populations. Based on a novel information theoretic network inference model, we detected potential species interaction networks that are functionally and structurally different for healthy and unhealthy individuals. Healthy networks are characterized by a neutral symmetrical pattern of species interactions and scale-free topology versus random unhealthy networks. We detected an inverse scaling relationship between species total outgoing information flow, meaningful of node interactivity, and relative species abundance (RSA). The top ten interacting species are also the least relatively abundant for the healthy microbiome and the most detrimental. These findings support the idea about the diminishing role of network hubs and how these should be defined considering the total outgoing information flow rather than the node degree. Macroecologically, the healthy microbiome is characterized by the highest Pareto total species diversity growth rate, the lowest species turnover, and the smallest variability of RSA for all species. This result challenges current views that posit a universal association between healthy states and the highest absolute species diversity in ecosystems. Additionally, we show how the transitory microbiome is unstable and microbiome criticality is not necessarily at the phase transition between healthy and unhealthy states. We stress the importance of considering portfolios of interacting pairs versus single node dynamics when characterizing the microbiome and of ranking these pairs in terms of their interactions (i.e., species collective behavior) that shape transition from healthy to unhealthy states. The macroecological characterization of the microbiome is useful for public health and disease diagnosis and etiognosis, while species-specific analyses can detect beneficial species leading to personalized design of pre- and probiotic treatments and microbiome engineering.