Measuring human behavior and ecological dimensions of pathogen transmission for outbreak control and prevention

该项目提出了跨生物学和地理学的跨学科研究，以检查人类与环境的相互作用、人类流动的时空模式和健康地理以及地方性和新发传染病之间的联系。这项工作的重点是刚果民主共和国埃夸特尔省的麻疹和埃博拉病毒的预防和管理，这两种病原体都会导致严重的发病率和死亡率。反复暴发强调了重大公共卫生改善的迫切需要。这项研究调查了病原体传播的潜在机制，确定了发生传播的流行病学单位，并衡量了它们对暴发的脆弱性。将与刚果民主共和国的流动保健小组一起制定产出，并将为在各种情况下更广泛地应用这一办法提供一个概括性的蓝图。拟议的研究以理论框架的交集为目标，以审查四个相互关联的主题。首先，继2003年Cutter之后，该项目将开发正式的空间方法，以确定和划定病原体传播的流行病学单位，并衡量其流行病脆弱性。脆弱性是由当地特定传播过程的潜在机制决定的，不同疾病的传播过程不同。这项工作将卫生数据质量作为一个问题，允许公共卫生问题在最需要改进的地方持续存在。其次，在关颖珊2013年工作的基础上，这项研究将从R1‘S流行病学单位和脆弱性指数开始，并整合季节性和长期人口流动、连通性和分布的动态。人口动态推动了传染性病原体的接触、传播和传播，必须将其纳入疫苗接种和暴发应对。第三，扩展舒尔曼2011年的工作，这项研究将直观地表示这些动态的流行病单位和脆弱性指数，以改进地理可视化的方法，并为移动卫生工作提供可用的空间决策支持系统(SDSS)。为了最大限度地提高清晰度和易用性，这些可视化将与我们合作的人道主义组织的现场团队和传染病和地理专业的研究生一起严格开发和测试。第四，这项工作将开发动态量化模型，以产生干预策略的正式比较，并反复改进它们。模型将比较A)使用拟议的SDSS的战略，该战略强调在疫情发生之前对流行病传播单位的脆弱性采取行动进行免疫接种和疫情应对，以及B)当前的系统，该系统由行政边界和病例比率阈值指导以触发响应。将人-环境相互作用的空间和时间因素联系起来，以支持传染病预防和暴发管理，将极大地推动该领域当前的方法和理论。

This project proposes interdisciplinary research across biology and geography to examine links between human-environment interactions, spatiotemporal patterns of human mobility and health geographies, and endemic and emerging infectious diseases. This work focuses on measles and Ebola prevention and management in the Équateur province in the Democratic Republic of Congo (DRC), where both pathogens cause significant morbidity and mortality. Recurring outbreaks emphasize an urgent need for significant public health improvements. This research investigates the mechanisms underlying pathogen transmission and identifies epidemiological units, across which transmission occurs, and measure their vulnerability to outbreaks. Outputs will be developed with and for mobile health teams in the DRC and will provide a generalizable blueprint for the broader application of this approach across a range of contexts. The proposed research targets the intersection of theoretical frameworks to examine four interlinked topics. First, following Cutter in 2003, this project will develop formal spatial methods to identify and delineate epidemiological units of pathogen transmission and measure their epidemiological vulnerability. Vulnerability is determined by the mechanisms underlying locally specific transmission processes, which differ across diseases. This work includes health data quality as a problem that allow public health problems to persist where they most need improvement. Second, building on Kwan’s 2013 work, this research will start with R1’s epidemiological units and vulnerability indices and integrate the dynamics of seasonal and long-term population mobility, connectivity, and distribution. Population dynamics drive contacts, transmission, and spread for communicable pathogens and must be included in vaccinations and outbreak response. Third, extending Shuurman’s 2011 work, this research will visually represent these dynamic epidemiological units and vulnerability indices cartographically to advance methods in geovisualizations and provide usable spatial decision support systems (SDSS) for mobile health efforts. To maximize clarity and usability, these visualizations will be rigorously developed and tested with our collaborating humanitarian organization’s field teams and graduate students in infectious diseases and geography. Fourth, this work will develop dynamic quantitative models to produce formal comparisons of intervention strategies and iteratively improve them. Models will compare A) strategies using the proposed SDSS, which highlight acting on the vulnerability of epidemiological units of transmission before outbreaks occur for immunizations and outbreak responses and B) the current system, which is guided by administrative boundaries and case rate thresholds to trigger response. Linking spatial and temporal elements of human-environment interactions to support infectious disease prevention and outbreak management will significantly advance the current methods and theory in this field.