Doctoral Dissertation Research: Climate Change and the Disease Ecologies of US Dengue Fever

本博士论文研究项目调查了登革热地理和流行病学变化的社会生态因素，重点关注佛罗里达基韦斯特最近的登革热疫情。登革热是一种由受感染的伊蚊传播的病毒性疾病，曾一度被认为接近根除。然而，近年来该疾病在全球范围内死灰复燃，病例增加，地理分布扩大。通常被认为是发展中国家贫困城市地区的疾病，在农村社区，干旱和亚热带气候以及较富裕的发达国家，包括美国南部的几个州也发生了疫情。这些疫情在卫生界引起了呼吁，要求更好地了解登革热不断变化的地理和流行病学方面。在预测气候变化可能通过温度和降水对蚊子和病毒的影响促进传染病传播的情况下，扩大对登革热生态的理解尤为重要。对气候和疾病的讨论特别重要的是影响当地行为者对这些预测作出反应的能力的疾病爆发的社会和政治背景。这包括脆弱性的社会原因以及公民和机构对流行病的反应。特别重要的是了解参与管理，控制和消除蚊子繁殖空间的行为者的拼凑，通常具有不同的利益和目标。 作为美国最近爆发的登革热疫情，基韦斯特提供了一个理想的地点来研究登革热在最近重新出现的地方的社会生态因素。 为此，该项目使用了一种混合方法，将使用气候数据和气候变化情景的动态蚊子建模与社区焦点小组相结合，并与居民，公共卫生和病媒控制官员进行访谈。本研究的最终目的是确定：1。气候对基韦斯特和美国南部其他地区登革热病毒和蚊子种群的当前和预测未来影响，2。如何在整个城市中对蚊子进行差异化管理，3。社会生态变量如何约束或使个人能够坚持登革热和蚊子控制信息，以及4。地方官员和公民如何理解和内化控制战略和责任。更全面地了解基韦斯特疫情爆发的社会生态条件，将有助于了解德克萨斯州和夏威夷等地类似疫情爆发的原因。此外，该研究的结果将突出重要的复杂性，以考虑在美国南部和全球范围内气候变化下疾病的脆弱性和适应性的讨论。公共卫生项目不断面临着多种社区卫生问题的解决。不断变化的社会生态条件可以改变传染病的边界，使有害病媒重新成为健康问题。应对气候变化预测将需要长期规划和适应战略，不仅考虑到蚊子的生物物理特性，而且考虑到可能造成和消除社会脆弱性的过程。了解蚊子控制的复杂性将有助于有登革热出现风险的县，以及美国已确定的其他疾病，如西尼罗河病毒、拉克罗斯脑炎或讨厌的蚊子。这项工作的结果将通过学术期刊，公开讲座和科学推广博客提供。将提供所产生的气候情景，以协助长期规划工作。这个博士论文研究改进奖将提供支持，使一个特别有能力的学生建立一个独立的研究生涯在国家和国际相关的重大社会和环境挑战的高知名度领域。

This doctoral dissertation research project investigates the socio-ecological factors underpinning the changing geography and epidemiology of dengue fever, focusing on the recent dengue fever outbreaks in Key West, Florida. Dengue fever, a viral disease spread by infected Aedes mosquitoes, was once thought to be close to eradication. However, the disease has seen a global resurgence in recent years with increasing cases and a broadened geographical distribution. Typically conceived of as a disease of poor, urban areas in developing countries, outbreaks have also occurred in rural communities, arid and sub-tropical climates, and in wealthier developed countries, including several states in the southern US. These outbreaks have generated calls within the health community to better understand the changing geographic and epidemiological dimensions of dengue fever. A broadened understanding of dengue ecology is particularly important amidst projections that climate change may facilitate infectious disease spread through temperature and precipitation impacts on the mosquito and virus. Particularly important to discussions of climate and disease are the socio and political contexts of outbreaks that influence the abilities of local actors to respond to these projections. This includes social causes of vulnerability, and citizen and institutional responses to epidemics. Of particular importance is understanding the patchwork of actors involved in managing, controlling, and eradicating mosquito breeding spaces, often with divergent interests and goals. As the most recent outbreak to occur in the US, Key West provides an ideal location to study the socio-ecological factors of dengue in a place of recent re-emergence. To do so, this project uses a mixed methods approach that combines dynamic mosquito modeling using climate data and climate change scenarios with neighborhood focus groups, and interviews with residents, public health and vector control officials. The ultimate goals of this research are to identify: 1. Current and projected future impacts of climate on dengue virus and mosquito populations in Key West and other parts of the southern US, 2. How mosquitoes are differentially managed across the city, 3. How socio-ecological variables constrain or enable individuals to adhere to dengue and mosquito control messages, and 4. How control strategies and responsibilities are understood and internalized by local officials and citizens. A fuller understanding of the socio-ecological conditions surrounding the Key West outbreaks will shed light on the causes of similar outbreaks in places such as Texas and Hawaii. Additionally, the results of the study will highlight important complexities to consider in discussions of vulnerability and adaptation to disease under climate change in the southern US, and more globally as well. Public health programs are continuously confronted with multiple community health issues to address. Changing socio-ecological conditions can shift the borders of infectious diseases, re-situating nuisance vectors as health concerns. Confronting climate change projections will require long-term planning and adaptive strategies that consider not only biophysical characteristics of the mosquito, but take into account processes that can create and eliminate social vulnerability. Understanding the complexities surrounding mosquito control will be of use for counties at risk for dengue emergence, as well as other diseases established in the US such as West Nile virus, La Crosse encephalitis, or nuisance mosquitoes. The findings of this work will be available through academic journals, public talks, and science outreach blogs. The climate scenarios generated will be made available to assist with long-term planning efforts. This doctoral dissertation research improvement award will provide support to enable an exceptionally able student to establish an independent research career in a high-visibility field of national and international relevance to major social and environmental challenges.