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，重点是最近在佛罗里达州基韦斯特爆发的登革热。登革热是一种由受感染的伊蚊传播的病毒性疾病，曾一度被认为即将被消灭。然而，近年来该病在全球范围内死灰复燃，病例不断增加，地理分布范围扩大。该疾病通常被认为是发展中国家贫穷的城市地区的疾病，但在农村社区、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之际，扩大对登革热生态学的理解尤为重要。对气候和疾病的讨论特别重要的是，疾病爆发的社会和政治背景会影响当地行为体对这些预测作出反应的能力。这包括造成脆弱性的社会原因，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、控制和根除蚊子滋生空间的行为者的拼凑，这些行为者往往有不同的利益和目标。基韦斯特是美国最近爆发的登革热疫情，为在最近再次出现登革热的地方研究登革热的社会生态因素提供了理想的地点。为此，该项目采用混合方法，将利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结合起来，并与居民、公共卫生和病媒控制官员进行访谈。本研究的最终目标是确定：1。目前和预计未来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影响，2。2 .蚊子在城市中的不同管理方式；3 .社会生态变量如何约束或使个人遵守登革热和蚊虫控制信息；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周围的社会生态条件，将有助于了解德克萨斯州和夏威夷等地发生类似疫情的原因。此外，这项研究的结果将强调在讨论美国南部以及全球范围内气候变化下疾病的脆弱性和适应性时需要考虑的重要复杂性。公共卫生项目不断面临着多种社区卫生问题需要解决。不断变化的社会生态条件可以改变传染病的边界，将有害媒介重新定位为健康问题。应对气候变化预测将需要长期规划和适应性战略，不仅要考虑蚊子的生物物理特性，还要考虑可能产生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面临登革热暴发风险的县，以及在美国建立的其他疾病，如西尼罗河病毒、拉克罗斯脑炎或讨厌的蚊子。这项工作的发现将通过学术期刊、公开演讲和科学推广博客发布。所产生的气候情景将用于协助长期规划工作。这项博士论文研究进步奖将提供支持，使特别有能力的学生在与重大社会和环境挑战相关的国内和国际高知名度领域建立独立的研究生涯。

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.