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  • 1. Burattini, M N
    et al.
    Coutinho, F A B
    Lopez, L F
    Ximenes, R
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilder-Smith, Annelies
    Massad, E
    Potential exposure to Zika virus for foreign tourists during the 2016 Carnival and Olympic Games in Rio de Janeiro, Brazil2016Ingår i: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 144, nr 9, s. 1904-1906Artikel i tidskrift (Refereegranskat)
  • 2. Kien, Vu Duy
    et al.
    Minh, Hoang Van
    Ngoc, Nguyen Bao
    Phuong, Tran Bich
    Ngan, Tran Thu
    Quam, Mikkel B.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Inequalities in Household Catastrophic Health Expenditure and Impoverishment Associated With Noncommunicable Diseases in Chi Linh, Hai Duong, Vietnam2017Ingår i: Asia-Pacific journal of public health, ISSN 1010-5395, Vol. 29, s. 35S-44SArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    A costly modern-day double burden, the expenses of noncommunicable diseases (NCDs) are becoming a devastating epidemic. The World Health Organization estimates $7 trillion in economic losses from NCDs in 2011-2025. Although regarded as affluent diseases, the burden of NCDs is shifting into poorer groups. In this study, we assessed the socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with NCDs in Northern Vietnam. We also identified associated factors for catastrophic health expenditure and impoverishment. Households self-reporting NCD diagnoses had the highest association with both catastrophic health expenditure and impoverishment, followed by those in urban areas. Such households were likely poorer according to our calculations estimating socioeconomic inequalities. Households with at least 1 member older than 60 years were also more likely to suffer catastrophic health expenditures. These findings suggest that targeted policy to prevent or subsidize care for NCDs could prevent catastrophic health expenditure and impoverishment among those already most disadvantaged.

  • 3.
    Kien, Vu Duy
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Center for Population Health Sciences, Hanoi School of Public Health.
    Van Minh, Hoang
    Giang, Kim Bao
    Mai, Vu Quynh
    Tuan, Ngo Tri
    Quam, Mikkel B.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Trends in childhood measles vaccination highlight socioeconomic inequalities in Vietnam2017Ingår i: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 62, s. S41-S49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe trends in measles vaccine coverage rates and their association with socioeconomic characteristics among children from age 12 to 23 months in Vietnam from the year 2000 to 2014.

    METHODS: Data were drawn from the Vietnam Multiple Indicator Cluster Surveys in years 2000, 2006, 2011, and 2014. Concentration indices were used to determine the magnitude of socioeconomic inequalities in measles vaccine coverage. Associations between measles vaccine coverage and relevant social factors were assessed using logistic regression.

    RESULTS: Socioeconomic inequalities in measles vaccine coverage rates decreased during 2000-2014. Children belonging to ethnic minority groups, having mothers with lower education, and belonging to the poorest group were less likely to receive measles vaccine; although, their vaccine coverage rates did increase with time. Measles vaccine coverage declined among children of mothers with more education and belonging to the wealthiest socioeconomic group.

    CONCLUSIONS: Understanding the social factors influencing adherence to recommend childhood vaccination protocols is essential. Attempts to regain and retain herd immunity must be guided by an understanding of these social factors if they are to succeed.

  • 4.
    Liu-Helmersson, Jing
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Stenlund, Hans
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för molekylärbiologi (Teknisk-naturvetenskaplig fakultet).
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    Ebi, K
    Massad, E
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Seasonality of dengue epidemic potential in Europe - based on vectorial capacity for Aedes mosquitoes2015Ingår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, nr Suppl. 1, s. 113-113Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Dengue is a mosquito-borne viral infection that has become a major public health concern. About 390 million people are infected yearly. Increased global connectivity and population movement as well as climate change affect the global distribution of both dengue vectors and the virus, facilitating the spread of dengue to new geographic areas. Weather is an important factor determining mosquito behaviour and effectiveness of dengue virus transmission. Dengue epidemic potential depends on vectorial capacity of Aedes mosquitoes, which depend on climate, such as, temperature and diurnal temperature range. This study aims at identifying high-risk areas and high-risk time windows in Europe based on temperature, in order for timely vector surveillance and control.

    Methods: Relative vectorial capacity (rVc) was used to estimate dengue epidemic potential. Using historical and projected temperature data over two centuries (1901–2099) and temperature dependent vector parameters for Aedes vectors, rVc was calculated for 10 selected European cities from Stockholm in the North to Malaga in the South.

    Results: Compared to dengue endemic areas, rVc in Europe was lower and showed more prominent seasonality. The peak and width of the seasonal windows in rVc were generally higher in the South than the North. Currently, only South and Central-East Europe and the summer season corresponds to rVc that is over the threshold for possible dengue transmission. By the end of this century, in the best case scenario, all the Central and Southern European cities would be at risk for dengue transmission during the warmer months; in the worst case scenario, this risk would extend to Northern European to include Stockholm if dengue vectors were established and virus introduced.

    Conclusion: As travel and globalization become more frequent channels for dengue vector and virus introduction, Europe may face the reality of more frequent dengue outbreaks in their warmer months. Madeira's outbreak in 2012 underlines this concern. The future's high risk area and time window depend sensitively on climate scenarios. Therefore, it is important to emphasize climate change mitigation and enhance vector surveillance and control in Europe.

    Acknowledgement: This research was funded by the European Union 7th Framework Programme through 'DengueTools' (www.denguetools.net).

    Disclosure: Nothing to disclose.

  • 5.
    Liu-Helmersson, Jing
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för molekylärbiologi (Medicinska fakulteten).
    Ebi, Kristie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. University of Washington, Seattle, Washington, USA.
    Massad, Eduardo
    School of Medicine, University of Sao Paulo, Brazil.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Climate change and Aedes vectors: 21st century projections for dengue transmission in Europe2016Ingår i: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 7, s. 267-277Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Warming temperatures may increase the geographic spread of vector-borne diseases into temperate areas. Although a tropical mosquito-borne viral disease, a dengue outbreak occurred in Madeira, Portugal, in 2012; the first in Europe since 1920s. This outbreak emphasizes the potential for dengue re-emergence in Europe given changing climates. We present estimates of dengue epidemic potential using vectorial capacity (VC) based on historic and projected temperature (1901–2099). VC indicates the vectors' ability to spread disease among humans. We calculated temperature-dependent VC for Europe, highlighting 10 European cities and three non-European reference cities. Compared with the tropics, Europe shows pronounced seasonality and geographical heterogeneity. Although low, VC during summer is currently sufficient for dengue outbreaks in Southern Europe to commence–if sufficient vector populations (either Ae. aegypti and Ae. albopictus) were active and virus were introduced. Under various climate change scenarios, the seasonal peak and time window for dengue epidemic potential increases during the 21st century. Our study maps dengue epidemic potential in Europe and identifies seasonal time windows when major cities are most conducive for dengue transmission from 1901 to 2099. Our findings illustrate, that besides vector control, mitigating greenhouse gas emissions crucially reduces the future epidemic potential of dengue in Europe.

  • 6.
    Liyanage, Prasad
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Ministry of Health, Colombo 01000, Sri Lanka.
    Tissera, Hasitha
    Sewe, Maquins
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. KEMRI Centre for Global Health Research, Kisumu, Kenya, Box 1578, Kisumu 40100, Kenya.
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Amarasinghe, Ananda
    Palihawadana, Paba
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.
    Louis, Valerie R.
    Tozan, Yesim
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    A Spatial Hierarchical Analysis of the Temporal Influences of the El Niño-Southern Oscillation and Weather on Dengue in Kalutara District, Sri Lanka2016Ingår i: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, nr 11, artikel-id 1087Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Dengue is the major public health burden in Sri Lanka. Kalutara is one of the highly affected districts. Understanding the drivers of dengue is vital in controlling and preventing the disease spread. This study focuses on quantifying the influence of weather variability on dengue incidence over 10 Medical Officer of Health (MOH) divisions of Kalutara district. Weekly weather variables and data on dengue notifications, measured at 10 MOH divisions in Kalutara from 2009 to 2013, were retrieved and analysed. Distributed lag non-linear model and hierarchical-analysis was used to estimate division specific and overall relationships between weather and dengue. We incorporated lag times up to 12 weeks and evaluated models based on the Akaike Information Criterion. Consistent exposure-response patterns between different geographical locations were observed for rainfall, showing increasing relative risk of dengue with increasing rainfall from 50 mm per week. The strongest association with dengue risk centred around 6 to 10 weeks following rainfalls of more than 300 mm per week. With increasing temperature, the overall relative risk of dengue increased steadily starting from a lag of 4 weeks. We found similarly a strong link between the Oceanic Niño Index to weather patterns in the district in Sri Lanka and to dengue at a longer latency time confirming these relationships. Part of the influences of rainfall and temperature can be seen as mediator in the causal pathway of the Ocean Niño Index, which may allow a longer lead time for early warning signals. Our findings describe a strong association between weather, El Niño-Southern Oscillation and dengue in Sri Lanka.

  • 7. Lopez, Luis Fernandez
    et al.
    Amaku, Marcos
    Coutinho, Francisco Antonio Bezerra
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Burattini, Marcelo Nascimento
    Struchiner, Claudio José
    Wilder-Smith, Annelies
    Massad, Eduardo
    Modeling Importations and Exportations of Infectious Diseases via Travelers2016Ingår i: Bulletin of Mathematical Biology, ISSN 0092-8240, E-ISSN 1522-9602, Vol. 78, nr 2, s. 185-209Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper is an attempt to estimate the risk of infection importation and exportation by travelers. Two countries are considered: one disease-free country and one visited or source country with a running endemic or epidemic infectious disease. Two models are considered. In the first model (disease importation), susceptible individuals travel from their disease-free home country to the endemic country and come back after some weeks. The risk of infection spreading in their home country is then estimated supposing the visitors are submitted to the same force of infection as the local population but do not contribute to it. In the second model (disease exportation), it is calculated the probability that an individual from the endemic (or epidemic) country travels to a disease-free country in the condition of latent infected and eventually introduces the infection there. The input of both models is the force of infection at the visited/source country, assumed known. The models are deterministic, but a preliminary stochastic formulation is presented as an appendix. The models are exemplified with two distinct real situations: the risk of dengue importation from Thailand to Europe and the risk of Ebola exportation from Liberia to the USA.

  • 8. Massad, E
    et al.
    Lopez, L F
    Amaku, M
    Coutinho, F A B
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Burattini, M N
    Struchiner, C J
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    The risk of infectious diseases introduction into non-infected countries by travelers visiting endemic countries2015Ingår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, nr Suppl. 1, s. 340-340Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    This work is an attempt to estimate the risk of infections importation and exportation by travelers. In it we propose a model that takes into account the force of infection of the disease in the endemic country, which can either be a visited country (source of infection importation) or a country from where local residents export the infection when travel in the latent condition for disease-free countries. The model is deterministic but a preliminary stochastic formulation is presented in the appendix. It considers two countries: one is the host home-country and the other is the source country (with an endemic infectious disease). Susceptible individuals travel from their home-country to the endemic country and eventually return infected. The input of the model is the force of infection at the visited/source country which is assumed to be known and we assume that, in the case of disease importation, travelers are subject to the same risk of infection as local residents but do not contribute to it. In the case of disease exportation, the model calculates the probability that a latent individual travels from an endemic (or epidemic) country to a disease-free country. We exemplify the model with two distinct situation, namely, the risk of dengue importation from Thailand to Europe and the risk of Ebola exportation from Liberia to the USA.

    Disclosure: Nothing to disclose.

  • 9.
    Murray, Natasha Evelyn Anne
    et al.
    Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Population Health, Waikato District Health Board, Hamilton, New Zealand.
    Quam, Mikkel B.
    Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Wilder-Smith, Annelies
    Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Epidemiology of dengue: past, present and future prospects2013Ingår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, nr 5, s. 299-309Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Dengue is currently regarded globally as the most important mosquito-borne viral disease. A history of symptoms compatible with dengue can be traced back to the Chin Dynasty of 265-420 AD. The virus and its vectors have now become widely distributed throughout tropical and subtropical regions of the world, particularly over the last half-century. Significant geographic expansion has been coupled with rapid increases in incident cases, epidemics, and hyperendemicity, leading to the more severe forms of dengue. Transmission of dengue is now present in every World Health Organization (WHO) region of the world and more than 125 countries are known to be dengue endemic. The true impact of dengue globally is difficult to ascertain due to factors such as inadequate disease surveillance, misdiagnosis, and low levels of reporting. Currently available data likely grossly underestimates the social, economic, and disease burden. Estimates of the global incidence of dengue infections per year have ranged between 50 million and 200 million; however, recent estimates using cartographic approaches suggest this number is closer to almost 400 million. The expansion of dengue is expected to increase due to factors such as the modern dynamics of climate change, globalization, travel, trade, socioeconomics, settlement and also viral evolution. No vaccine or specific antiviral therapy currently exists to address the growing threat of dengue. Prompt case detection and appropriate clinical management can reduce the mortality from severe dengue. Effective vector control is the mainstay of dengue prevention and control. Surveillance and improved reporting of dengue cases is also essential to gauge the true global situation as indicated in the objectives of the WHO Global Strategy for Dengue Prevention and Control, 2012-2020. More accurate data will inform the prioritization of research, health policy, and financial resources toward reducing this poorly controlled disease. The objective of this paper is to review historical and current epidemiology of dengue worldwide and, additionally, reflect on some potential reasons for expansion of dengue into the future.

  • 10.
    Quam, Mikkel B.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Imported infections’ importance: global change driving Dengue dynamics2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background Dengue is a significant problem of international health concern. According to the World Health Organization in 2012, globally, dengue is “the most important mosquito borne viral disease” with incidence 30 higher than it had been 50 years ago. While most of the burden of disease associated with dengue is located in areas with a tropical and sub-tropical climate, increasing evidence suggests temperate areas are also at risk. Considering the recent introduction of relevant mosquito vectors into Southern Europe, and increasing numbers of imported dengue via travelers, Europe and other temperate areas may be increasingly at risk for dengue emergence, establishment and local transmission in the foreseeable future.

    Methods Recent dengue emergence in Madeira and reemergence in Tokyo underline the hypothesis that passenger air-travel can be an important conduit for the importation of vector-borne disease leading to emergence in naïve areas climatically suitable for dengue transmission, including parts of Europe. Combining information on travel with virus genetic similarity was useful in discerning likely pathways of for the importation of infections. Generalizing information learned from outbreaks in Tokyo and Madeira with global epidemic intelligence, global travel networks, and climate change projections, leads to more refined understanding of the magnitude of dengue infectious imported into temperate areas and these virus introduction events’ potential implications for seeding epidemics in the 21st century.

    Results While compared to total travel, imported dengue events and epidemics of dengue outside the tropics are rare, our combined evidence and modeled estimations suggest strongly that epidemic dengue emergence in temperate areas is possible and will continue to increase. We found that global change dynamics including warming temperatures in the much of the northern hemisphere and increasing passenger interconnectivity between areas endemic for dengue and dengue free areas are key mechanisms partly explaining these unprecedented epidemiological transitions.

    Conclusion While we calibrated our models on information known about dengue, many elements of the methods and conclusions may increase understanding of the potentially global implications for imported infections of other climate-sensitive infectious diseases’ that may have similar parameters. During 2016 and the years to come, techniques developed in this doctoral research will contribute to models used in risk analysis for vector-borne diseases of interest, including the increasing important potential for imported Chikungunya and Zika viruses into a variety of unexposed areas. 

  • 11.
    Quam, Mikkel B.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Khan, Kamran
    Sears, Jennifer
    Hu, Wei
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå Centre for Global Health Research, Umeå, Sweden.
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Estimating Air Travel-Associated Importations of Dengue Virus Into Italy2015Ingår i: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 22, nr 3, s. 186-193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Southern Europe is increasingly at risk for dengue emergence, given the seasonal presence of relevant mosquito vectors and suitable climatic conditions. For example, Aedes mosquitoes, the main vector for both dengue and chikungunya, are abundant in Italy, and Italy experienced the first ever outbreak of chikungunya in Europe in 2007. We set out to estimate the extent of dengue virus importations into Italy via air travelers.

    Methods: We attempted to quantify the number of dengue virus importations based on modeling of published estimates on dengue incidence in the countries of disembarkation and analysis of data on comprehensive air travel from these countries into Italy's largest international airport in Rome.

    Results: From 2005 to 2012, more than 7.3 million air passengers departing from 100 dengue-endemic countries arrived in Rome. Our Importation Model, which included air traveler volume, estimated the incidence of dengue infections in the countries of disembarkation, and the probability of infection coinciding with travel accounted for an average of 2,320 (1,621–3,255) imported dengue virus infections per year, of which 572 (381–858) were “apparent” dengue infections and 1,747 (1,240–2,397) “inapparent.”

    Conclusions: Between 2005 and 2012, we found an increasing trend of dengue virus infections imported into Rome via air travel, which may pose a potential threat for future emergence of dengue in Italy, given that the reoccurring pattern of peak importations corresponds seasonally with periods of relevant mosquito vector activity. The observed increasing annual trends of dengue importation and the consistent peaks in late summer underpin the urgency in determining the threshold levels for the vector and infected human populations that could facilitate novel autochthonous transmission of dengue in Europe.

  • 12.
    Quam, Mikkel B
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Liu-Helmersson, Jing
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Massad, E
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Madeira's dengue outbreak in 2012: could it happen again in the near future?2015Ingår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, nr Suppl. 1, s. 408-409Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: A dengue outbreak in 2012 having 2000 + reported cases, followed vector introduction to the Portuguese island of Madeira in 2005. We describe contributing factors for the 2012 outbreak through modeling of temperature dependent vectorial capacity, meteorological observations of environmental factors pertinent to vector lifecycle, and dynamics of travellers arriving from dengue endemic areas. In combination with reported vector and human surveillance, the temporal onset of the 2012 outbreak and factors setting 2012 apart from other years were used to generate a predictive model for potential re- emergence of dengue in Madeira.

    Methods: Relative Vectorial capacity (rVC) was calculated with previously published methods for Madeira (Island) and Funchal (City) from 2005 to 2014 based on both remotely sensed satellite data and observation stations. We also estimated potentially imported dengue infections using previously published methods. Epidemiological features of the 2012 outbreak combined with generated data to inform a predictive model. Projected travel and seasonal weather forecasting inputs for the predictive model described the dengue importation-driven transmission likelihood for Madeira in 2015.

    Results: Longitudinal comparisons of available data were displayed simultaneously to show periods of greatest potential for dengue emergence in Madeira, historically. The modeled outputs especially during the months before the outbreak provide more precise quantification and visualization of the temporal coincidence, which may have primed Madeira for emergence of dengue in late summer 2012. When seasonal forecast information is applied to the historically informed model for spring and summer 2015, potential for local dengue

    transmission in Madeira was determined. Conclusions Local transmission of dengue in Madeira may re occur given the environmental envelope and continuous importation of the dengue virus via travelers, even with strengthened vector control efforts; however, the severity of the 2012 outbreak will hopefully remain the highest. Our results clearly display the coalescence of multiple factors necessary for initial emergence of a dengue epidemic in a naïve population. Descriptive modeling of a known outbreak can better inform the development of predictive modeling of dengue emergence in Madeira and other areas of Europe.

    Acknowledgment: European Union 7th Framework Programme through DengueTools (www.denguetools.net) funded this research.

    Disclosure: Nothing to disclose.

  • 13.
    Quam, Mikkel B.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sessions, October
    Kamaraj, Uma Sangumathi
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilder-Smith, Annelies
    Dissecting Japan's Dengue Outbreak in 20142016Ingår i: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 94, nr 2, s. 409-412Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite Japan's temperate climate, a dengue outbreak occurred in Tokyo for the first time in over 70 years in 2014. We dissected this dengue outbreak based on phylogenetic analysis, travel interconnectivity, and environmental drivers for dengue epidemics. Comparing the available dengue virus 1 (DENV1) E gene sequence from this outbreak with 3,282 unique DENV1 sequences in National Center for Biotechnology Information suggested that the DENV might have been imported from China, Indonesia, Singapore, or Vietnam. With travelers arriving into Japan, Guangzhou (China) may have been the source of DENV introduction, given that Guangzhou also reported a large-scale dengue outbreak in 2014. Coinciding with the 2014 outbreak, Tokyo's climate conditions permitted the amplification of Aedes vectors and the annual peak of vectorial capacity. Given suitable vectors and climate conditions in addition to increasing interconnectivity with endemic areas of Asia, Tokyo's 2014 outbreak did not come as a surprise and may foretell more to come.

  • 14.
    Quam, Mikkel B
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Importation index of dengue to determine the most probable origin of importation2015Ingår i: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 22, nr 1, s. 72-Artikel i tidskrift (Refereegranskat)
  • 15.
    Quam, Mikkel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kien, Tran Mai
    Hanh, Tran Thi Tuyet
    Long, Tran Khanh
    Rocklov, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Quyen, Nguyen Huu
    Huong, Le Thi Thanh
    Minh, Hoang Van
    Climate Services For Infectious Disease Control: A Nexus Between Public Health Preparedness and Sustainable Development, Lessons Learned From Long-Term Multi Site Time Series Analysis of Dengue Fever in Vietnam2016Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Climate Services provide valuable information for making actionable, data-driven decisions to protect public health in a myriad of manners. There is mounting global evidence of the looming threat climate change poses to human health, including the variability and intensity of infectious disease outbreaks in Vietnam and other low-resource and developing areas. In light of the Sustainable Development Goals, lessons learned from time-series analysis may inform public health preparedness strategies for sustainable urban development in terms of dengue epidemiology, surveillance, control, and early warnings.

    Subjects and Methods: Nearly 40 years of spatial and temporal (times-series) dataset of meteorological records, including rainfall, temperature, and humidity (among others) which can be predictors of dengue were assembled for all provinces of Vietnam and associated with case data reported to General Department of Preventive Medicine, Ministry of Health of Vietnam during the same period. Time series of climate and disease variables was analyzed for trends and changing patterns of those variables over time. The time-series statistical analysis methods sought to identify spatial (when possible) and temporal trends, seasonality, cyclical patterns of disease, and to discover anomalous outbreak events, which departed from expected epidemiological patterns and corresponding meteorological phenomena, such as El Nino Southern Oscillation (ENSO).

    Results: Analysis yielded largely conserved finding with other locations in South East Asia for larger Outbreak years and events such as ENSO. Seasonality, trend, and cycle in many provinces were persistent throughout the dataset, indicating strong potential for Climate Services to be used in dengue early warnings.

    Conclusion: Even public health practitioners, having adequate tools for dengue control available must plan and budget vector control and patient treatment efforts well in advance of large scale dengue epidemics to curb such events overall morbidity and mortality. Similarly, urban and sustainable development in Vietnam might benefit from evidence linking climate change, and ill-health events spatially and temporally in future planning. Long term analysis of dengue case data and meteorological records, provided a cases study evidence for emerging opportunities that on how refined climate services could contribute to protection of public health.

  • 16.
    Quam, Mikkel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Massad, Eduardo
    Wilder-Smith, Annelies
    Effects of India's new polio policy on travellers2014Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 383, nr 9929, s. 1632-1632Artikel i tidskrift (Refereegranskat)
  • 17.
    Quam, Mikkel
    et al.
    Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Murray, Natasha Evelyn Anne
    Wilder-Smith, Annelies
    Dengue: factors driving the emerging epidemic; Authors’ reply2013Ingår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 5, s. 461-463Artikel i tidskrift (Refereegranskat)
  • 18.
    Quam, Mikkel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Khan, K.
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Flight travel related risk of dengue introduction in Mediterranean cities2013Konferensbidrag (Övrigt vetenskapligt)
  • 19.
    Quam, Mikkel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sessions, O
    Liu-Helmersson, Jing
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Dissecting the origin of the 2014 dengue outbreak in Japan2015Ingår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, nr Suppl. 1, s. 408-408Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Endemic in at least 100 countries, dengue is currently regarded as world's most important mosquito borne viral disease. While most of the disease burden is limited to areas with tropical and sub-tropical climates, evidence suggests that temperate areas may be increasingly at risk as the geographic distribution of relevant vectors expands. Japan, a country with a temperate climate, reported the first major dengue outbreak in 2014. We examined the factors that may have facilitated the dengue outbreak in Tokyo during 2014.

    Methods: Multiple sequence alignment of the dengue virus 1 (DENV1) sequence from the 2014 dengue outbreak in Tokyo was carried out using a fast Fourier transformation method in MAFFT v6.940b. We collected the Japan National Tourism Organization’s data on inbound travelers between January and September 2014 from dengue endemic countries in Asia to Japan. Daily observations of temperature (minimum, maximum, and mean) and precipitation were obtained from the MIDAS dataset for Tokyo. We calculated the relative vectorial capacity (rVc) for Aedes vectors to quantify the dengue epidemic potential based on temperature dependent parameters, by applying a modified Ross-McDonald model.

    Findings: Tourist arrivals into Japan in 2014 coincided by 70% with its warm summer months suitable for dengue transmission, The phylogenetic similarity of DENV-1 isolated from the 2014 outbreak in Japan with viruses from China, Indonesia, Singapore, and Vietnam renders any of these four countries a likely source of importation. Several conducive climate factors converged preceding and during the time of the dengue outbreak in Tokyo, August until October 2014. Climate conditions, in particular mean temperature and precipitation, were favorable for the amplification of Aedes vectors. Furthermore, the ability for the vector to transmit dengue, as measured by the relative vectorial capacity, was highest at the time of the 2014 outbreak.

    Conclusions: Taking into account the travel volume into Japan, China appears the most probable source of dengue virus introduction that triggered Tokyo's outbreak. Despite Japan's temperate climate, dengue epidemic potential already exists. Under scenarios of changing climate and increasing regional travel, Japan will likely face more dengue outbreaks in the future.

    Acknowledgements: The study was financially supported by the European Union's Seventh Framework Programme- DengueTools (www.denguetools.net).

    Disclosure: Nothing to disclose.

  • 20.
    Quam, Mikkel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilder-Smith, Annelies
    Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Estimated global exportations of Zika virus infections via travellers from Brazil from 2014 to 20152016Ingår i: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 23, nr 6, artikel-id taw059Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The ongoing Zika pandemic in Latin America illustrates a potential source for further globalized spread. Here, we assessed global travel-related Zika virus exportations from Brazil during the initial year of the epidemic. Similar to subsequent national notifications, we estimated 584-1786 exported Zika cases from Brazil occurred September 2014-August 2015.

  • 21.
    Rocklöv, Joacim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Landsprofiler viktigt verktyg vid COP21 i Paris2015Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, nr 50Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 22.
    Rocklöv, Joacim
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Quam, Mikkel Brandon
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sudre, Bertrand
    German, Matthew
    Kraemer, Moritz U.G.
    Brady, Oliver
    Bogoch, Isaac I.
    Liu-Helmersson, Jing
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Semenza, Jan C.
    Ong, Mark
    Aaslav, Kaja Kaasik
    Khan, Kamran
    Assessing Seasonal Risks for the Introduction and Mosquito-borne Spread of Zika Virus in Europe2016Ingår i: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 9, s. 250-256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The explosive Zika virus epidemic in the Americas is amplifying spread of this emerging pathogen into previously unaffected regions of the world, including Europe (Gulland, 2016), where local populations are immunologically naïve. As summertime approaches in the northern hemisphere, Aedes mosquitoes in Europe may find suitable climatic conditions to acquire and subsequently transmit Zika virus from viremic travellers to local populations. While Aedes albopictus has proven to be a vector for the transmission of dengue and chikungunya viruses in Europe (Delisle et al., 2015; ECDC, n.d.) there is growing experimental and ecological evidence to suggest that it may also be competent for Zika virus(Chouin-Carneiro et al., 2016; Grard et al., 2014; Li et al., 2012; Wong et al., 2013). Here we analyze and overlay the monthly flows of airline travellers arriving into European cities from Zika affected areas across the Americas, the predicted monthly estimates of the basic reproduction number of Zika virus in areas where Aedes mosquito populations reside in Europe (Aedes aegypti in Madeira, Portugal and Ae. albopictus in continental Europe), and human populations living within areas where mosquito-borne transmission of Zika virus may be possible. We highlight specific geographic areas and timing of risk for Zika virus introduction and possible spread within Europe to inform the efficient use of human disease surveillance, vector surveillance and control, and public education resources.

  • 23. Sessions, October M
    et al.
    Khan, Kamran
    Hou, Yan'an
    Meltzer, Eyal
    Quam, Mikkel
    Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
    Schwartz, Eli
    Gubler, Duane J
    Wilder-Smith, Annelies
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Exploring the origin and potential for spread of the 2013 dengue outbreak in Luanda, Angola2013Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, artikel-id 21822Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Dengue in Africa is underreported. Simultaneous reports of travellers with dengue returning from Luanda, Angola, to six countries on four continents suggest that a major dengue outbreak is currently occurring in Angola, South West Africa.

    METHODS: To identify the origin of the imported dengue virus, we sequenced the virus from Angola and investigated the interconnectivity via air travel between dengue-endemic countries and Angola.

    RESULTS AND CONCLUSION: Our analyses show that the Angola outbreak was most likely caused by an endemic virus strain that had been circulating in West Africa for many years. We also show that Portugal and South Africa are most likely at the highest risk of importation of dengue from Angola due to the large number of air passengers between Angola and these countries.

  • 24. Wilder-Smith, Annelies
    et al.
    Leong, Wei-Yee
    Lopez, Luis Fernandez
    Amaku, Marcos
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Khan, Kamran
    Massad, Eduardo
    Potential for international spread of wild poliovirus via travelers2015Ingår i: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 13, artikel-id 133Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The endgame of polio eradication is hampered by the international spread of poliovirus via travelers. In response to ongoing importations of poliovirus into polio-free countries, on 5 May 2014, WHO's Director-General declared the international spread of wild poliovirus a public health emergency of international concern. Our objective was to develop a mathematical model to estimate the international spread of polio infections. Methods: Our model took into account polio endemicity in polio-infected countries, population size, polio immunization coverage rates, infectious period, the asymptomatic-to-symptomatic ratio, and also the probability of a traveler being infectious at the time of travel. We applied our model to three scenarios: (1) number of exportations of both symptomatic and asymptomatic polio infections out of currently polio-infected countries, (2) the risk of spread of poliovirus to Saudi Arabia via Hajj pilgrims, and (3) the importation risk of poliovirus into India. Results: Our model estimated 665 polio exportations (>99 % of which were asymptomatic) from nine polio-infected countries in 2014, of which 78.3 % originated from Pakistan. Our model also estimated 21 importations of poliovirus into Saudi Arabia via Hajj pilgrims and 20 poliovirus infections imported to India in the same year. Conclusion: The extent of importations of asymptomatic and symptomatic polio infections is substantial. For countries that are vulnerable to polio outbreaks due to poor national polio immunization coverage rates, our newly developed model may help guide policy-makers to decide whether imposing an entry requirement in terms of proof of vaccination against polio would be justified.

  • 25.
    Wilder-Smith, Annelies
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
    Quam, Mikkel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sessions, O.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Liu-Helmersson, Jing
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Franco, L.
    Khan, K.
    The 2012 dengue outbreak in Madeira: exploring the origins2014Ingår i: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 19, nr 8, s. 20718-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 2012, Madeira reported its first major outbreak of dengue. To identify the origin of the imported dengue virus, we investigated the interconnectivity via air travel between dengue-endemic countries and Madeira, and compared available sequences against GenBank. There were 22,948 air travellers to Madeira in 2012, originating from twenty-nine dengue-endemic countries; 89.6% of these international travellers originated from Venezuela and Brazil. We developed an importation index that takes into account both travel volume and the extent of dengue incidence in the country of origin. Venezuela and Brazil had by far the highest importation indices compared with all other dengue-endemic countries. The importation index for Venezuela was twice as high as that for Brazil. When taking into account seasonality in the months preceding the onset of the Madeira outbreak, this index was even seven times higher for Venezuela than for Brazil during this time. Dengue sequencing shows that the virus responsible for the Madeira outbreak was most closely related to viruses circulating in Venezuela, Brazil and Columbia. Applying the importation index, Venezuela was identified as the most likely origin of importation of dengue virus via travellers to Madeira. We propose that the importation index is a new additional tool that can help to identify and anticipate the most probable country of origin for importation of dengue into currently non-endemic countries.

  • 26. Zaki, Rafdzah
    et al.
    Roffeei, Siti Norsyuhada
    Hii, Yien Ling
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Yahya, Abqariyah
    Appannan, Mahesh
    Said, Mas Ayu
    Wan, Ng Chiu
    Aghamohammadi, Nasrin
    Hairi, Noran Naqiah
    Bulgiba, Awang
    Quam, Mikkel Brandon
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Rocklöv, Joacim
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Public perception and attitude towards dengue prevention activity and response to dengue early warning in Malaysia2019Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, nr 2, artikel-id e0212497Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An early warning system for dengue is meant to predict outbreaks and prevent dengue cases by aiding timely decision making and deployment of interventions. However, only a system which is accepted and utilised by the public would be sustainable in the long run. This study aimed to explore the perception and attitude of the Malaysian public towards a dengue early warning system. The sample consisted of 847 individuals who were 18 years and above and living/working in the Petaling District, an area adjacent to Kuala Lumpur, Malaysia. A questionnaire consisting of personal information and three sub-measures of; i) perception, ii) attitude towards dengue early warning and iii) response towards early warning; was distributed to participants. We found that most of the respondents know about dengue fever (97.1%) and its association with climate factors (90.6%). Most of them wanted to help reduce the number of dengue cases in their area (91.5%). A small percentage of the respondents admitted that they were not willing to be involved in public activities, and 64% of them admitted that they did not check dengue situations or hotspots around their area regularly. Despite the high awareness on the relationship between climate and dengue, about 45% of respondents do not know or are not sure how this can be used to predict dengue. Respondents would like to know more about how climate data can be used to predict a dengue outbreak (92.7%). Providing more information on how climate can influence dengue cases would increase public acceptability and improve response towards climate-based warning system. The most preferred way of communicating early warning was through the television (66.4%). This study shows that the public in Petaling District considers it necessary to have a dengue warning system to be necessary, but more education is required.

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