Integrating and scaling seasonal climate-driven dengue forecasting

气候敏感型疾病的爆发对人类健康构成了日益严重的威胁，但它们是可以预测的，甚至是可以预防的。蚊子传播的登革热是全球增长最快的传染病之一，目前全球每年造成超过4亿例病例。在越南和马来西亚等国，登革热正成为主要的急性传染病威胁。2017年至2019年，越南平均每年有超过20万例登革热病例，在马来西亚，登革热的发病率是所有其他传染病中最高的(每10万例中有398例)。登革热疫情是可以通过现有干预措施预防的，但前提是在正确的地点、正确的时间使用。提前几个月预测疾病暴发的能力可以减轻卫生服务的负担。这在资源有限的低收入和中等收入国家很重要，在这些国家，与昂贵且往往不成功的被动反应相比，它们可以使有效和高效的主动反应有所不同。我们的目标是通过越南和马来西亚的地方登革热预报系统来展示疾病预报的价值，这将为扩大登革热预报和其他气候敏感型疾病的数字健康解决方案铺平道路。我们已经开发了必要的疾病预报技术，作为登革热预报模型卫星系统(D-MOSS)项目的一部分。虽然该系统自2019年7月在越南和2020年7月在马来西亚开始运行，但仍需开展更多工作来弥合实施差距，以确保预报在地方一级预防暴发方面具有直接可操作和可衡量的影响。还需要进一步研究，以确定已投入使用的预报技术是否能够以所需的空间和时间分辨率产生准确的预报，以适应卫生系统特定部门应用的做法。我们将通过共同开发新的预报来测试这一点，这些预报在越南和马来西亚提供提前预报。通过一系列纵向讲习班，我们将制定风险评估方案，将预报与越南和马来西亚卫生系统不同部门的疫情预防活动联系起来。这些知识差距将由来自越南、马来西亚和英国多个研究所的登革热专家、建模人员、公共卫生专家、软件工程师和早期预警系统专家组成的多学科团队来解决。研究的培训和共同设计是我们提议的所有方面的核心，我们打算利用作为D-MOSS项目的一部分建立的公平伙伴关系来实现我们的目标。这项研究将证明越南和马来西亚对登革热和其他伊蚊传播疾病(如基孔肯雅热、寨卡病毒)具有明显的健康价值，并制定了一项计划，说明如何将干预措施扩大到目前正在努力应对登革热和其他气候敏感型疾病日益增长的威胁的其他低中等收入国家。从长远来看，该项目将提供证据，证明对广泛的健康状况进行预测对卫生系统的价值。

Outbreaks of climate sensitive diseases present a major growing threat to human health, but they are predictable and maybe even preventable. The mosquito transmitted disease dengue is one of the fastest growing global infectious diseases and now causes over 400 million annual cases globally. Dengue is becoming the primary acute infectious disease threat in countries such as Vietnam and Malaysia. Between 2017 and 2019, Vietnam averaged over 200,000 cases every year and in Malaysia dengue fever has the highest incidence rate among any other communicable disease (398 cases per 100,000).Dengue outbreaks are preventable with existing interventions, but only if they are used in the right places at the right times. The ability to forecast disease outbreaks months in advance can reduce the burden on health services. This is important in resource-constrained Low and Middle Income Countries (LMICs) where they can make the difference between an effective and efficient proactive response compared to a costly and often unsuccessful reactive response. We aim to demonstrate the value of disease forecasting via a local level dengue forecasting system in Vietnam and Malaysia, which will pave the way for scale up of dengue forecasting and other digital health solutions for climate sensitive diseases.We have developed the necessary disease forecasting techniques as part of the Dengue forecasting MOdel Satellite-based System (D-MOSS) project. Although this system has been operational since July 2019 in Vietnam and July 2020 in Malaysia, more work is needed to bridge the implementation gap to ensure forecasts have direct actionable and measurable impacts on preventing outbreaks at a local level.Further research is required to establish if the forecasting techniques already in operation are capable of producing accurate forecasts at the required spatial and temporal resolutions, tailored to the practices applied by specific sectors of the health system. We will test this by co-developing new forecasts that provide advance predictions in Vietnam and Malaysia. Through a series of longitudinal workshops we will develop risk assessment protocols that link forecasts to outbreak prevention activities at different sectors of the Vietnamese and Malaysian health systems. These knowledge gaps will be addressed by a multidisciplinary team of dengue experts, modellers, public health experts, software engineers and early warning systems experts from multiple institutes in Vietnam, Malaysia and the UK. Training and co-design of the research is central to all aspects of our proposal and we intend to leverage the equitable partnerships established as part of the D-MOSS project to meet our aims. Cross-cutting activities will compare and contrast the operational context in these countries and enable collaboration between them with the goal of deriving generalisable principles and specific guidelines for expansion to other countries.This research will demonstrate clear health value against dengue and other Aedes mosquito-borne diseases (e.g. chikungunya, Zika) in Vietnam and Malaysia, and a plan for how the intervention will be scaled up to other LMICs currently struggling to address the growing threat of dengue and other climate-sensitive diseases. In the longer term, this project will provide evidence on the value of forecasting to health systems for a wide range of health conditions.