Dengue prediction by the web: Tweets are a useful tool for estimating and forecasting Dengue at country and city level

Use of Digital Tools in Arbovirus Surveillance: Scoping Review

BACKGROUND

The development of technology and information systems has led to important changes in public health surveillance.

OBJECTIVE

This scoping review aimed to assess the available evidence and gather information about the use of digital tools for arbovirus (dengue virus [DENV], zika virus [ZIKV], and chikungunya virus [CHIKV]) surveillance.

METHODS

The databases used were MEDLINE, SCIELO, LILACS, SCOPUS, Web of Science, and EMBASE. The inclusion criterion was defined as studies that described the use of digital tools in arbovirus surveillance. The exclusion criteria were defined as follows: letters, editorials, reviews, case reports, series of cases, descriptive epidemiological studies, laboratory and vaccine studies, economic evaluation studies, and studies that did not clearly describe the use of digital tools in surveillance. Results were evaluated in the following steps: monitoring of outbreaks or epidemics, tracking of cases, identification of rumors, decision-making by health agencies, communication (cases and bulletins), and dissemination of information to society).

RESULTS

Of the 2227 studies retrieved based on screening by title, abstract, and full-text reading, 68 (3%) studies were included. The most frequent digital tools used in arbovirus surveillance were apps (n=24, 35%) and Twitter, currently called X (n=22, 32%). These were mostly used to support the traditional surveillance system, strengthening aspects such as information timeliness, acceptability, flexibility, monitoring of outbreaks or epidemics, detection and tracking of cases, and simplicity. The use of apps to disseminate information to society (P=.02), communicate (cases and bulletins; P=.01), and simplicity (P=.03) and the use of Twitter to identify rumors (P=.008) were statistically relevant in evaluating scores. This scoping review had some limitations related to the choice of DENV, ZIKV, and CHIKV as arboviruses, due to their clinical and epidemiological importance.

CONCLUSIONS

In the contemporary scenario, it is no longer possible to ignore the use of web data or social media as a complementary strategy to health surveillance. However, it is important that efforts be combined to develop new methods that can ensure the quality of information and the adoption of systematic measures to maintain the integrity and reliability of digital tools' data, considering ethical aspects.

Development of data-driven machine learning models and their potential role in predicting dengue outbreak

Dengue fever is one of the most widespread vector-borne viral infections in the world, resulting in increased socio-economic burden. WHO has reported that 2.5 billion people are infected with dengue fever across the world, resulting in high mortalities in tropical and subtropical regions. The current article endeavors to present an overview of predicting dengue outbreaks through data-based machine-learning models. This artificial intelligence model uses real world data such as dengue surveillance, climatic variables, and epidemiological data and combines big data with machine learning algorithms to forecast dengue. Monitoring and predicting dengue incidences has been significantly enhanced through innovative approaches. This involves gathering data on various climatic factors, including temperature, rainfall, relative humidity, and wind speed, along with monthly records of dengue cases. The study functions as an efficient warning system, enabling the anticipation of dengue outbreaks. This early warning system not only alerts communities but also aids relevant authorities in implementing crucial preventive measures.

Internet-based Surveillance Systems and Infectious Diseases Prediction: An Updated Review of the Last 10 Years and Lessons from the COVID-19 Pandemic

The last decade has seen major advances and growth in internet-based surveillance for infectious diseases through advanced computational capacity, growing adoption of smart devices, increased availability of Artificial Intelligence (AI), alongside environmental pressures including climate and land use change contributing to increased threat and spread of pandemics and emerging infectious diseases. With the increasing burden of infectious diseases and the COVID-19 pandemic, the need for developing novel technologies and integrating internet-based data approaches to improving infectious disease surveillance is greater than ever. In this systematic review, we searched the scientific literature for research on internet-based or digital surveillance for influenza, dengue fever and COVID-19 from 2013 to 2023. We have provided an overview of recent internet-based surveillance research for emerging infectious diseases (EID), describing changes in the digital landscape, with recommendations for future research directed at public health policymakers, healthcare providers, and government health departments to enhance traditional surveillance for detecting, monitoring, reporting, and responding to influenza, dengue, and COVID-19.

Socioeconomic and environmental factors associated with dengue fever incidence in Guatemala: Rising temperatures increase dengue risk

Dengue fever is a mosquito-borne illness that infects 390 million people annually. Dengue outbreaks in Guatemala have been occurring more often and at increased rates since the first dengue outbreak in Guatemala in the 1970s. This study will examine environmental and socioeconomic factors associated with dengue in Guatemala at the municipality (county) level. Socioeconomic factors included population density, Mayan population, economic activity, and attending school. Environmental factors included average minimum annual temperature and annual precipitation. The relationship between environmental and socioeconomic variables and dengue fever incidence was initially evaluated through univariate zero-inflated negative binomial models, and then again through three zero-inflated multivariate negative binomial regression models. For all three models, elevation was considered a predictor of zero-inflation. In the combined model, there was a positive relationship between minimum temperature, economic activity and dengue fever incidence, and a negative relationship between population density, Mayan population and dengue fever. Predicted rates of dengue fever incidence and adjusted confidence intervals were calculated after increasing minimum yearly temperature by 1°C and 2°C. The three municipalities with the highest minimum yearly temperature (El Estor, Iztapa, and Panzós) and the municipality of Guatemala, all had an increase in the magnitude of the risk of dengue fever incidence following 1°C and 2°C increase in temperature. This research suggests that these socioeconomic and environmental factors are associated with risk of dengue in Guatemala. The predicted rates of dengue fever also highlight the potential effect that climate change in the form of increasing temperature can have on dengue in Guatemala.

Social media network analysis of Smallholder livestock farming communities in the United Kingdom

The creation of targeted policies and actions to help small-scale livestock keepers and reduce the risks associated with disease outbreaks in this sector is hampered by the scarcity of information about smallholder farmers. Smallholders play a crucial part in disease outbreaks containment, hence there is a need for better monitoring methods that take this population into account while gathering data. According to the literature, these communities frequently use social media as a channel for communication and information exchange. In this study we conducted social network analysis of an influential smallholder within the UK and visualised the user follower network. Additionally, we performed influential user analysis, Twitter user categorisation, and community detection to uncover more insights into the livestock farming networks. Our findings reveal distinct communities within the smallholder farming sector and identify influential users with the potential to impact information dissemination and animal health practices. The study also highlights the role of community structure in surveillance and control of animal diseases and emphasises the need for further research to refine our understanding of these communities and their unique characteristics. This work contributes to the growing body of literature on small-scale livestock farming in the UK and underscores the importance of incorporating smallholder communities into disease surveillance and control efforts.

Development of an early alert model for pandemic situations in Germany

The COVID-19 pandemic has pointed out the need for new technical approaches to increase the preparedness of healthcare systems. One important measure is to develop innovative early warning systems. Along those lines, we first compiled a corpus of relevant COVID-19 related symptoms with the help of a disease ontology, text mining and statistical analysis. Subsequently, we applied statistical and machine learning (ML) techniques to time series data of symptom related Google searches and tweets spanning the time period from March 2020 to June 2022. In conclusion, we found that a long-short-term memory (LSTM) jointly trained on COVID-19 symptoms related Google Trends and Twitter data was able to accurately forecast up-trends in classical surveillance data (confirmed cases and hospitalization rates) 14 days ahead. In both cases, F1 scores were above 98% and 97%, respectively, hence demonstrating the potential of using digital traces for building an early alert system for pandemics in Germany.

Characterizing dengue transmission in rural areas: A systematic review

Dengue has historically been considered an urban disease associated with dense human populations and the built environment. Recently, studies suggest increasing dengue virus (DENV) transmission in rural populations. It is unclear whether these reports reflect recent spread into rural areas or ongoing transmission that was previously unnoticed, and what mechanisms are driving this rural transmission. We conducted a systematic review to synthesize research on dengue in rural areas and apply this knowledge to summarize aspects of rurality used in current epidemiological studies of DENV transmission given changing and mixed environments. We described how authors defined rurality and how they defined mechanisms for rural dengue transmission. We systematically searched PubMed, Web of Science, and Embase for articles evaluating dengue prevalence or cumulative incidence in rural areas. A total of 106 articles published between 1958 and 2021 met our inclusion criteria. Overall, 56% (n = 22) of the 48 estimates that compared urban and rural settings reported rural dengue incidence as being as high or higher than in urban locations. In some rural areas, the force of infection appears to be increasing over time, as measured by increasing seroprevalence in children and thus likely decreasing age of first infection, suggesting that rural dengue transmission may be a relatively recent phenomenon. Authors characterized rural locations by many different factors, including population density and size, environmental and land use characteristics, and by comparing their context to urban areas. Hypothesized mechanisms for rural dengue transmission included travel, population size, urban infrastructure, vector and environmental factors, among other mechanisms. Strengthening our understanding of the relationship between rurality and dengue will require a more nuanced definition of rurality from the perspective of DENV transmission. Future studies should focus on characterizing details of study locations based on their environmental features, exposure histories, and movement dynamics to identify characteristics that may influence dengue transmission.

Can the Content of Social Networks Explain Epidemic Outbreaks?

People share and seek information online that reflects a variety of social phenomena, including concerns about health conditions. We analyze how the contents of social networks provide real-time information to monitor and anticipate policies aimed at controlling or mitigating public health outbreaks. In November 2020, we collected tweets on the COVID-19 pandemic with content ranging from safety measures, vaccination, health, to politics. We then tested different specifications of spatial econometrics models to relate the frequency of selected keywords with administrative data on COVID-19 cases and deaths. Our results highlight how mentions of selected keywords can significantly explain future COVID-19 cases and deaths in one locality. We discuss two main mechanisms potentially explaining the links we find between Twitter contents and COVID-19 diffusion: risk perception and health behavior.

Digital health for climate change mitigation and response: a scoping review

OBJECTIVE

Climate change poses a major threat to the operation of global health systems, triggering large scale health events, and disrupting normal system operation. Digital health may have a role in the management of such challenges and in greenhouse gas emission reduction. This scoping review explores recent work on digital health responses and mitigation approaches to climate change.

MATERIALS AND METHODS

We searched Medline up to February 11, 2022, using terms for digital health and climate change. Included articles were categorized into 3 application domains (mitigation, infectious disease, or environmental health risk management), and 6 technical tasks (data sensing, monitoring, electronic data capture, modeling, decision support, and communication). The review was PRISMA-ScR compliant.

RESULTS

The 142 included publications reported a wide variety of research designs. Publication numbers have grown substantially in recent years, but few come from low- and middle-income countries. Digital health has the potential to reduce health system greenhouse gas emissions, for example by shifting to virtual services. It can assist in managing changing patterns of infectious diseases as well as environmental health events by timely detection, reducing exposure to risk factors, and facilitating the delivery of care to under-resourced areas.

DISCUSSION

While digital health has real potential to help in managing climate change, research remains preliminary with little real-world evaluation.

CONCLUSION

Significant acceleration in the quality and quantity of digital health climate change research is urgently needed, given the enormity of the global challenge.

Chimeric forecasting: combining probabilistic predictions from computational models and human judgment

Forecasts of the trajectory of an infectious agent can help guide public health decision making. A traditional approach to forecasting fits a computational model to structured data and generates a predictive distribution. However, human judgment has access to the same data as computational models plus experience, intuition, and subjective data. We propose a chimeric ensemble-a combination of computational and human judgment forecasts-as a novel approach to predicting the trajectory of an infectious agent. Each month from January, 2021 to June, 2021 we asked two generalist crowds, using the same criteria as the COVID-19 Forecast Hub, to submit a predictive distribution over incident cases and deaths at the US national level either two or three weeks into the future and combined these human judgment forecasts with forecasts from computational models submitted to the COVID-19 Forecasthub into a chimeric ensemble. We find a chimeric ensemble compared to an ensemble including only computational models improves predictions of incident cases and shows similar performance for predictions of incident deaths. A chimeric ensemble is a flexible, supportive public health tool and shows promising results for predictions of the spread of an infectious agent.

Faster indicators of chikungunya incidence using Google searches

Chikungunya, a mosquito-borne disease, is a growing threat in Brazil, where over 640,000 cases have been reported since 2017. However, there are often long delays between diagnoses of chikungunya cases and their entry in the national monitoring system, leaving policymakers without the up-to-date case count statistics they need. In contrast, weekly data on Google searches for chikungunya is available with no delay. Here, we analyse whether Google search data can help improve rapid estimates of chikungunya case counts in Rio de Janeiro, Brazil. We build on a Bayesian approach suitable for data that is subject to long and varied delays, and find that including Google search data reduces both model error and uncertainty. These improvements are largest during epidemics, which are particularly important periods for policymakers. Including Google search data in chikungunya surveillance systems may therefore help policymakers respond to future epidemics more quickly.

To respond quickly to disease outbreaks, policymakers need rapid data on the number of new infections. However, for many diseases, such data is very delayed, due to the administrative work required to record each case in a disease surveillance system. This is a problem for data on chikungunya, a mosquito-borne disease which is a growing threat in Brazil. In Rio de Janeiro, delays in chikungunya cases being recorded average four weeks. These delays are sometimes longer and sometimes shorter. In stark contrast to chikungunya data, data on what people are searching for on Google is available almost immediately. People suffering from chikungunya might search on Google for information about the disease. Here, we investigate whether rapidly available Google data can help generate quick estimates of the number of chikungunya cases in Rio de Janeiro in the previous week. Our model uses a Bayesian methodology to help account for the varying delays in the chikungunya data. We show that including Google search data in the model reduces both the error and uncertainty of the chikungunya case count estimates, in particular during epidemics. Our method could be used to help policymakers to respond more quickly to future chikungunya epidemics.

Predicting dengue incidence leveraging internet-based data sources. A case study in 20 cities in Brazil

The dengue virus affects millions of people every year worldwide, causing large epidemic outbreaks that disrupt people’s lives and severely strain healthcare systems. In the absence of a reliable vaccine against dengue or an effective treatment to manage the illness in humans, most efforts to combat dengue infections have focused on preventing its vectors, mainly the Aedes aegypti mosquito, from flourishing across the world. These mosquito-control strategies need reliable disease activity surveillance systems to be deployed. Despite significant efforts to estimate dengue incidence using a variety of data sources and methods, little work has been done to understand the relative contribution of the different data sources to improved prediction. Additionally, scholarship on the topic had initially focused on prediction systems at the national- and state-levels, and much remains to be done at the finer spatial resolutions at which health policy interventions often occur. We develop a methodological framework to assess and compare dengue incidence estimates at the city level, and evaluate the performance of a collection of models on 20 different cities in Brazil. The data sources we use towards this end are weekly incidence counts from prior years (seasonal autoregressive terms), weekly-aggregated weather variables, and real-time internet search data. We find that both random forest-based models and LASSO regression-based models effectively leverage these multiple data sources to produce accurate predictions, and that while the performance between them is comparable on average, the former method produces fewer extreme outliers, and can thus be considered more robust. For real-time predictions that assume long delays (6–8 weeks) in the availability of epidemiological data, we find that real-time internet search data are the strongest predictors of dengue incidence, whereas for predictions that assume short delays (1–3 weeks), in which the error rate is halved (as measured by relative RMSE), short-term and seasonal autocorrelation are the dominant predictors. Despite the difficulties inherent to city-level prediction, our framework achieves meaningful and actionable estimates across cities with different demographic, geographic and epidemic characteristics.

As the incidence of infectious diseases like dengue continues to increase throughout the world, tracking their spread in real time poses a significant challenge to local and national health authorities. Accurate incidence data are often difficult to obtain as outbreaks emerge and unfold, both due the partial reach of serological surveillance (especially in rural areas), and due to delays in reporting, which result in post-hoc adjustments to what should have been real-time data. Thus, a range of ‘nowcasting’ tools have been developed to estimate disease trends, using different mathematical and statistical methodologies to fill the temporal data gap. Over the past several years, researchers have investigated how to best incorporate internet search data into predictive models, since these can be obtained in real-time. Still, most such models have been regression-based, and have tended to underperform in cases when epidemiological data are only available after long reporting delays. Moreover, in tropical countries, attention has increasingly turned from testing and applying models at the national level to models at higher spatial resolutions, such as states and cities. Here, we develop machine learning models based on both LASSO regression and on random forest ensembles, and proceed to apply and compare them across 20 cities in Brazil. We find that our methodology produces meaningful and actionable disease estimates at the city level with both underlying model classes, and that the two perform comparably across most metrics, although the ensemble method produces fewer outliers. We also compare model performance and the relative contribution of different data sources across diverse geographic, demographic and epidemic conditions.

Data-driven methods for dengue prediction and surveillance using real-world and Big Data: A systematic review

Background

Traditionally, dengue surveillance is based on case reporting to a central health agency. However, the delay between a case and its notification can limit the system responsiveness. Machine learning methods have been developed to reduce the reporting delays and to predict outbreaks, based on non-traditional and non-clinical data sources. The aim of this systematic review was to identify studies that used real-world data, Big Data and/or machine learning methods to monitor and predict dengue-related outcomes.

Methodology/Principal findings

We performed a search in PubMed, Scopus, Web of Science and grey literature between January 1, 2000 and August 31, 2020. The review (ID: CRD42020172472) focused on data-driven studies. Reviews, randomized control trials and descriptive studies were not included. Among the 119 studies included, 67% were published between 2016 and 2020, and 39% used at least one novel data stream. The aim of the included studies was to predict a dengue-related outcome (55%), assess the validity of data sources for dengue surveillance (23%), or both (22%). Most studies (60%) used a machine learning approach. Studies on dengue prediction compared different prediction models, or identified significant predictors among several covariates in a model. The most significant predictors were rainfall (43%), temperature (41%), and humidity (25%). The two models with the highest performances were Neural Networks and Decision Trees (52%), followed by Support Vector Machine (17%). We cannot rule out a selection bias in our study because of our two main limitations: we did not include preprints and could not obtain the opinion of other international experts.

Conclusions/Significance

Combining real-world data and Big Data with machine learning methods is a promising approach to improve dengue prediction and monitoring. Future studies should focus on how to better integrate all available data sources and methods to improve the response and dengue management by stakeholders.

Dengue is one of the most important arbovirus infections in the world and its public health, societal and economic burden is increasing. Although the majority of dengue cases are asymptomatic or mild, severe disease forms can lead to death. For this reason, early diagnosis and monitoring of dengue are crucial to decrease mortality. However, most endemic regions still rely on traditional monitoring methods, despite the growing availability of novel data sources and data-driven methods based on real-world data, Big Data, and machine learning algorithms. In this systematic review, we identified and analyzed studies that used these novel approaches for dengue monitoring and/or prediction. We found that novel data streams, such as Internet search engines and social media platforms, and machine learning methods can be successfully used to improve dengue management, but are still vastly ignored in real life. These approaches should be combined with traditional methods to help stakeholders better prepare for each outbreak and improve early responsiveness.

A Pipeline to Understand Emerging Illness Via Social Media Data Analysis: Case Study on Breast Implant Illness

Background

A new illness can come to public attention through social media before it is medically defined, formally documented, or systematically studied. One example is a condition known as breast implant illness (BII), which has been extensively discussed on social media, although it is vaguely defined in the medical literature.

Objective

The objective of this study is to construct a data analysis pipeline to understand emerging illnesses using social media data and to apply the pipeline to understand the key attributes of BII.

Methods

We constructed a pipeline of social media data analysis using natural language processing and topic modeling. Mentions related to signs, symptoms, diseases, disorders, and medical procedures were extracted from social media data using the clinical Text Analysis and Knowledge Extraction System. We mapped the mentions to standard medical concepts and then summarized these mapped concepts as topics using latent Dirichlet allocation. Finally, we applied this pipeline to understand BII from several BII-dedicated social media sites.

Results

Our pipeline identified topics related to toxicity, cancer, and mental health issues that were highly associated with BII. Our pipeline also showed that cancers, autoimmune disorders, and mental health problems were emerging concerns associated with breast implants, based on social media discussions. Furthermore, the pipeline identified mentions such as rupture, infection, pain, and fatigue as common self-reported issues among the public, as well as concerns about toxicity from silicone implants.

Conclusions

Our study could inspire future studies on the suggested symptoms and factors of BII. Our study provides the first analysis and derived knowledge of BII from social media using natural language processing techniques and demonstrates the potential of using social media information to better understand similar emerging illnesses.

Google Trends correlation and sensitivity for outbreaks of dengue and yellow fever in the state of São Paulo

Objective

To assess Google Trends accuracy for epidemiological surveillance of dengue and yellow fever, and to compare the incidence of these diseases with the popularity of its terms in the state of São Paulo.

Methods

Retrospective cohort. Google Trends survey results were compared to the actual incidence of diseases, obtained from Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac”, in São Paulo, Brazil, in periods between 2017 and 2019. The correlation was calculated by Pearson’s coefficient and cross-correlation function. The accuracy was analyzed by sensitivity and specificity values.

Results

There was a statistically significant correlation between the variables studied for both diseases, Pearson coefficient of 0.91 for dengue and 0.86 for yellow fever. Correlation with up to 4 weeks of anticipation for time series was identified. Sensitivity was 87% and 90%, and specificity 69% and 78% for dengue and yellow fever, respectively.

Conclusion

The incidence of dengue and yellow fever in the State of São Paulo showed a strong correlation with the popularity of its terms measured by Google Trends in weekly periods. Google Trends tool provided early warning, with high sensitivity, for the detection of outbreaks of these diseases.

Assessing the Predictive Power of Online Social Media to Analyze COVID-19 Outbreaks in the 50 U.S. States

As the coronavirus disease 2019 (COVID-19) continues to rage worldwide, the United States has become the most affected country, with more than 34.1 million total confirmed cases up to 1 June 2021. In this work, we investigate correlations between online social media and Internet search for the COVID-19 pandemic among 50 U.S. states. By collecting the state-level daily trends through both Twitter and Google Trends, we observe a high but state-different lag correlation with the number of daily confirmed cases. We further find that the accuracy measured by the correlation coefficient is positively correlated to a state’s demographic, air traffic volume and GDP development. Most importantly, we show that a state’s early infection rate is negatively correlated with the lag to the previous peak in Internet searches and tweeting about COVID-19, indicating that earlier collective awareness on Twitter/Google correlates with a lower infection rate. Lastly, we demonstrate that correlations between online social media and search trends are sensitive to time, mainly due to the attention shifting of the public.

Social networks applied to Dengue, H1N1, and Zika epidemics: An integrative literature review

BACKGROUND

Health crises occur both regionally and globally. Online social networks are widely used technical resources that allow users to share large amounts of information with increasing reach and velocity. Thus, the capacity of spreading information about epidemics through social media allows members of a population and health professionals or agencies to collaborate.

METHOD

This study presents results obtained in an integrative review, including examples of how social media enabled collaboration in health surveillance to treat the epidemies of Dengue, Zika, and H1N1. The literature review covers studies published between 2009 and 2017.

RESULTS

The studies reviewed indicate that social media interactions are tools for the rapid dissemination of information. These networks operate at low cost and allow information to reach audiences in need of information and who otherwise would not receive it. Social media allowed researchers to monitor evolving epidemics and obtain epidemiological data useful for decision-making in health surveillance.

CONCLUSIONS

Despite the widespread use of social networks, there are opportunities for improvement, especially in technology for treatment.

A dynamic, ensemble learning approach to forecast dengue fever epidemic years in Brazil using weather and population susceptibility cycles

Transmission of dengue fever depends on a complex interplay of human, climate and mosquito dynamics, which often change in time and space. It is well known that its disease dynamics are highly influenced by multiple factors including population susceptibility to infection as well as by microclimates: small-area climatic conditions which create environments favourable for the breeding and survival of mosquitoes. Here, we present a novel machine learning dengue forecasting approach, which, dynamically in time and space, identifies local patterns in weather and population susceptibility to make epidemic predictions at the city level in Brazil, months ahead of the occurrence of disease outbreaks. Weather-based predictions are improved when information on population susceptibility is incorporated, indicating that immunity is an important predictor neglected by most dengue forecast models. Given the generalizability of our methodology to any location or input data, it may prove valuable for public health decision-making aimed at mitigating the effects of seasonal dengue outbreaks in locations globally.

Can technological advancements help to alleviate COVID-19 pandemic? a review

The COVID-19 pandemic is continuing, and the innovative and efficient contributions of the emerging modern technologies to the pandemic responses are too early and cannot be completely quantified at this moment. Digital technologies are not a final solution but are the tools that facilitate a quick and effective pandemic response. In accordance, mobile applications, robots and drones, social media platforms (such as search engines, Twitter, and Facebook), television, and associated technologies deployed in tackling the COVID-19 (SARS-CoV-2) outbreak are discussed adequately, emphasizing the current-state-of-art. A collective discussion on reported literature, press releases, and organizational claims are reviewed. This review addresses and highlights how these effective modern technological solutions can aid in healthcare (involving contact tracing, real-time isolation monitoring/screening, disinfection, quarantine enforcement, syndromic surveillance, and mental health), communication (involving remote assistance, information sharing, and communication support), logistics, tourism, and hospitality. The study discusses the benefits of these digital technologies in curtailing the pandemic and 'how' the different sectors adapted to these in a shorter period. Social media and television's role in ensuring global connectivity and serving as a common platform to share authentic information among the general public were summarized. The World Health Organization and Governments' role globally in-line with the prevention of propagation of false news, spreading awareness, and diminishing the severity of the COVID-19 was discussed. Furthermore, this collective review is helpful to investigators, health departments, Government organizations, and policymakers alike to facilitate a quick and effective pandemic response.

Harnessing Social Media in the Modelling of Pandemics-Challenges and Opportunities

As COVID-19 spreads throughout the world without a straightforward treatment or widespread vaccine coverage in the near future, mathematical models of disease spread and of the potential impact of mitigation measures have been thrust into the limelight. With their popularity and ability to disseminate information relatively freely and rapidly, information from social media platforms offers a user-generated, spontaneous insight into users' minds that may capture beliefs, opinions, attitudes, intentions and behaviour towards outbreaks of infectious disease not obtainable elsewhere. The interactive, immersive nature of social media may reveal emergent behaviour that does not occur in engagement with traditional mass media or conventional surveys. In recognition of the dramatic shift to life online during the COVID-19 pandemic to mitigate disease spread and the increasing threat of further pandemics, we examine the challenges and opportunities inherent in the use of social media data in infectious disease modelling with particular focus on their inclusion in compartmental models.

Visual analytics of COVID-19 dissemination in São Paulo state, Brazil

Visual analytics techniques are useful tools to support decision-making and cope with increasing data, particularly to monitor natural or artificial phenomena. When monitoring disease progression, visual analytics approaches help decision-makers to understand or even prevent dissemination paths. In this paper, we propose a new visual analytics tool for monitoring COVID-19 dissemination. We use k-nearest neighbors of cities to mimic neighboring cities and analyze COVID-19 dissemination based on comparing a city under consideration and its neighborhood. Moreover, such analysis is performed within periods, which facilitates the assessment of isolation policies. We validate our tool by analyzing the progression of COVID-19 in neighboring cities of São Paulo state, Brazil.

Social media: A new tool for outbreak surveillance

Social media platforms allow users to share news, ideas, thoughts, and opinions on a global scale. Data processing methods allow researchers to automate the collection and interpretation of social media posts for efficient and valuable disease surveillance. Data derived from social media and internet search trends have been used successfully for monitoring and forecasting disease outbreaks such as Zika, Dengue, MERS, and Ebola viruses. More recently, data derived from social media have been used to monitor and model disease incidence during the coronavirus disease 2019 (COVID-19) pandemic. We discuss the use of social media for disease surveillance.

Enhancing fine-grained intra-urban dengue forecasting by integrating spatial interactions of human movements between urban regions

Background

As a mosquito-borne infectious disease, dengue fever (DF) has spread through tropical and subtropical regions worldwide in recent decades. Dengue forecasting is essential for enhancing the effectiveness of preventive measures. Current studies have been primarily conducted at national, sub-national, and city levels, while an intra-urban dengue forecasting at a fine spatial resolution still remains a challenging feat. As viruses spread rapidly because of a highly dynamic population flow, integrating spatial interactions of human movements between regions would be potentially beneficial for intra-urban dengue forecasting.

Methodology

In this study, a new framework for enhancing intra-urban dengue forecasting was developed by integrating the spatial interactions between urban regions. First, a graph-embedding technique called Node2Vec was employed to learn the embeddings (in the form of an N-dimensional real-valued vector) of the regions from their population flow network. As strongly interacting regions would have more similar embeddings, the embeddings can serve as “interaction features.” Then, the interaction features were combined with those commonly used features (e.g., temperature, rainfall, and population) to enhance the supervised learning–based dengue forecasting models at a fine-grained intra-urban scale.

Results

The performance of forecasting models (i.e., SVM, LASSO, and ANN) integrated with and without interaction features was tested and compared on township-level dengue forecasting in Guangzhou, the most threatened sub-tropical city in China. Results showed that models using both common and interaction features can achieve better performance than that using common features alone.

Conclusions

The proposed approach for incorporating spatial interactions of human movements using graph-embedding technique is effective, which can help enhance fine-grained intra-urban dengue forecasting.

Dengue fever, a mosquito-borne infectious disease, has become a serious public health problem in many tropical and subtropical regions worldwide, such as Southeast Asian countries and the Guangdong Province in China. In the absence of an effective vaccine at present, disease surveillance and mosquito control remain the primary means of controlling the spread of the disease. At an intra-urban setting, it is important to predict the spatial distribution of future patients, which can help government agencies to establish precise and targeted prevention measures beforehand. Considering the fast virus spread within a city because of a highly dynamic population flow, we proposed a novel approach to enhancing fine-grained intra-urban dengue forecasting by integrating spatial interactions of human movements between urban regions. First, using a graph-embedding model called Node2Vec, the embeddings of the regions were learned from their population interaction network so that strongly interacted regions would have more similar embeddings. Secondly, serving as interaction features, the embeddings were combined with the commonly used features as inputs of the forecasting models. The experimental results indicated that the performance of the models can be improved by incorporating the interaction features, confirming the effectiveness of our proposed strategy in enhancing fine-grained intra-urban dengue forecasting.

Retrospective analysis of the accuracy of predicting the alert level of COVID-19 in 202 countries using Google Trends and machine learning

Background

Internet search engine data, such as Google Trends, was shown to be correlated with the incidence of COVID-19, but only in several countries. We aim to develop a model from a small number of countries to predict the epidemic alert level in all the countries worldwide.

Methods

The “interest over time” and “interest by region” Google Trends data of Coronavirus, pneumonia, and six COVID symptom-related terms were searched. The daily incidence of COVID-19 from 10 January to 23 April 2020 of 202 countries was retrieved from the World Health Organization. Three alert levels were defined. Ten weeks' data from 20 countries were used for training with machine learning algorithms. The features were selected according to the correlation and importance. The model was then tested on 2830 samples of 202 countries.

Results

Our model performed well in 154 (76.2%) countries, of which each had no more than four misclassified samples. In these 154 countries, the accuracy was 0.8133, and the kappa coefficient was 0.6828. While in all 202 countries, the accuracy was 0.7527, and the kappa coefficient was 0.5841. The proposed algorithm based on Random Forest Classification and nine features performed better compared to other machine learning methods and the models with different numbers of features.

Conclusions

Our result suggested that the model developed from 20 countries with Google Trends data and Random Forest Classification can be applied to predict the epidemic alert levels of most countries worldwide.

Large-scale multivariate forecasting models for Dengue - LSTM versus random forest regression

Effective management of seasonal diseases such as dengue fever depends on timely deployment of control measures prior to the high transmission season. As the epidemic season fluctuates from year to year, the availability of accurate forecasts of incidence can be decisive in attaining control of such diseases. Obtaining such forecasts from classical time series models has proven a difficult task. Here we propose and compare machine learning models incorporating feature selection,such as LASSO and Random Forest regression with LSTM a deep recurrent neural network, to forecast weekly dengue incidence in 790 cities in Brazil. We use multivariate time-series as predictors and also utilize time series from similar cities to capture the spatial component of disease transmission. The LSTM recurrent neural network model attained the highest performance in predicting future incidence on dengue in cities of different sizes.

Correlations Between COVID-19 Cases and Google Trends Data in the United States: A State-by-State Analysis

OBJECTIVE

To evaluate whether a digital surveillance model using Google Trends is feasible for obtaining accurate data on coronavirus disease 2019 and whether accurate predictions can be made regarding new cases.

METHODS

Data on total and daily new cases in each US state were collected from January 22, 2020, to April 6, 2020. Information regarding 10 keywords was collected from Google Trends, and correlation analyses were performed for individual states as well as for the United States overall.

RESULTS

Among the 10 keywords analyzed from Google Trends, face mask, Lysol, and COVID stimulus check had the strongest correlations when looking at the United States as a whole, with R values of 0.88, 0.82, and 0.79, respectively. Lag and lead Pearson correlations were assessed for every state and all 10 keywords from 16 days before the first case in each state to 16 days after the first case. Strong correlations were seen up to 16 days prior to the first reported cases in some states.

CONCLUSION

This study documents the feasibility of syndromic surveillance of internet search terms to monitor new infectious diseases such as coronavirus disease 2019. This information could enable better preparation and planning of health care systems.

A scoping review of the use of Twitter for public health research

Public health practitioners and researchers have used traditional medical databases to study and understand public health for a long time. Recently, social media data, particularly Twitter, has seen some use for public health purposes. Every large technological development in history has had an impact on the behaviour of society. The advent of the internet and social media is no different. Social media creates public streams of communication, and scientists are starting to understand that such data can provide some level of access into the people's opinions and situations. As such, this paper aims to review and synthesize the literature on Twitter applications for public health, highlighting current research and products in practice. A scoping review methodology was employed and four leading health, computer science and cross-disciplinary databases were searched. A total of 755 articles were retreived, 92 of which met the criteria for review. From the reviewed literature, six domains for the application of Twitter to public health were identified: (i) Surveillance; (ii) Event Detection; (iii) Pharmacovigilance; (iv) Forecasting; (v) Disease Tracking; and (vi) Geographic Identification. From our review, we were able to obtain a clear picture of the use of Twitter for public health. We gained insights into interesting observations such as how the popularity of different domains changed with time, the diseases and conditions studied and the different approaches to understanding each disease, which algorithms and techniques were popular with each domain, and more.

Untapped Potential: A Qualitative Study of a Hospital-Based Dengue Surveillance System

The incidence and geographical distribution of dengue fever has increased in recent decades. The actual disease burden is unknown owing to frequent underreporting and misclassification of cases. A well-functioning system for diagnosing, treating, and reporting cases is of prime importance as disease statistics is the foundation for decisions aiming to control the disease. This study aimed to explore the hospital-based disease surveillance system in Yogyakarta, a dengue-endemic region on Java, Indonesia. Semi-structured interviews were performed with 16 informants from four hospitals, including five general practitioners, three internists, four pediatricians, and four administrative staff working with administration relating to dengue diagnostics and reporting. Data were analyzed using content analysis. A theme arose from the analysis “Dengue surveillance stands and falls by the rigor of the health system.” The theme, and underlying categories and subcategories, describes a surveillance system that in the best-case scenario works well and is likely to produce reliable dengue case data. However, there is a lack of synchronization between regulations and guidelines in different hospitals and some friction between regulatory bodies and the care provider. Knowledge among the staff appears to vary, and many clinical and financial decisions are made rather arbitrarily, which ultimately might lead to unequal health service delivery. In conclusion, the dengue surveillance system under study could improve further, particularly by ensuring that all regulations and recommended procedures are standardized and that all staff are given the best opportunity to stay updated on dengue-related matters, clinical as well as regulatory, on a regular basis.

Google Health Trends performance reflecting dengue incidence for the Brazilian states

BACKGROUND

Dengue fever is a mosquito-borne infection transmitted by Aedes aegypti and mainly found in tropical and subtropical regions worldwide. Since its re-introduction in 1986, Brazil has become a hotspot for dengue and has experienced yearly epidemics. As a notifiable infectious disease, Brazil uses a passive epidemiological surveillance system to collect and report cases; however, dengue burden is underestimated. Thus, Internet data streams may complement surveillance activities by providing real-time information in the face of reporting lags.

METHODS

We analyzed 19 terms related to dengue using Google Health Trends (GHT), a free-Internet data-source, and compared it with weekly dengue incidence between 2011 to 2016. We correlated GHT data with dengue incidence at the national and state-level for Brazil while using the adjusted R squared statistic as primary outcome measure (0/1). We used survey data on Internet access and variables from the official census of 2010 to identify where GHT could be useful in tracking dengue dynamics. Finally, we used a standardized volatility index on dengue incidence and developed models with different variables with the same objective.

RESULTS

From the 19 terms explored with GHT, only seven were able to consistently track dengue. From the 27 states, only 12 reported an adjusted R squared higher than 0.8; these states were distributed mainly in the Northeast, Southeast, and South of Brazil. The usefulness of GHT was explained by the logarithm of the number of Internet users in the last 3 months, the total population per state, and the standardized volatility index.

CONCLUSIONS

The potential contribution of GHT in complementing traditional established surveillance strategies should be analyzed in the context of geographical resolutions smaller than countries. For Brazil, GHT implementation should be analyzed in a case-by-case basis. State variables including total population, Internet usage in the last 3 months, and the standardized volatility index could serve as indicators determining when GHT could complement dengue state level surveillance in other countries.

The Application of Internet-Based Sources for Public Health Surveillance (Infoveillance): Systematic Review

Background

Public health surveillance is based on the continuous and systematic collection, analysis, and interpretation of data. This informs the development of early warning systems to monitor epidemics and documents the impact of intervention measures. The introduction of digital data sources, and specifically sources available on the internet, has impacted the field of public health surveillance. New opportunities enabled by the underlying availability and scale of internet-based sources (IBSs) have paved the way for novel approaches for disease surveillance, exploration of health communities, and the study of epidemic dynamics. This field and approach is also known as infodemiology or infoveillance.

Objective

This review aimed to assess research findings regarding the application of IBSs for public health surveillance (infodemiology or infoveillance). To achieve this, we have presented a comprehensive systematic literature review with a focus on these sources and their limitations, the diseases targeted, and commonly applied methods.

Methods

A systematic literature review was conducted targeting publications between 2012 and 2018 that leveraged IBSs for public health surveillance, outbreak forecasting, disease characterization, diagnosis prediction, content analysis, and health-topic identification. The search results were filtered according to previously defined inclusion and exclusion criteria.

Results

Spanning a total of 162 publications, we determined infectious diseases to be the preferred case study (108/162, 66.7%). Of the eight categories of IBSs (search queries, social media, news, discussion forums, websites, web encyclopedia, and online obituaries), search queries and social media were applied in 95.1% (154/162) of the reviewed publications. We also identified limitations in representativeness and biased user age groups, as well as high susceptibility to media events by search queries, social media, and web encyclopedias.

Conclusions

IBSs are a valuable proxy to study illnesses affecting the general population; however, it is important to characterize which diseases are best suited for the available sources; the literature shows that the level of engagement among online platforms can be a potential indicator. There is a necessity to understand the population’s online behavior; in addition, the exploration of health information dissemination and its content is significantly unexplored. With this information, we can understand how the population communicates about illnesses online and, in the process, benefit public health.

Retrospective analysis of the possibility of predicting the COVID-19 outbreak from Internet searches and social media data, China, 2020

The peak of Internet searches and social media data about the coronavirus disease 2019 (COVID-19) outbreak occurred 10-14 days earlier than the peak of daily incidences in China. Internet searches and social media data had high correlation with daily incidences, with the maximum r > 0.89 in all correlations. The lag correlations also showed a maximum correlation at 8-12 days for laboratory-confirmed cases and 6-8 days for suspected cases.

Syndromic surveillance using web data: a systematic review

During the recent years, a lot of debate is taken place about the evolution of Smart Healthcare systems. Particularly, how these systems can help people improve human conditions of health, by taking advantages of the new Information and Communication Technologies (ICT), regarding early prediction and efficient treatment. The purpose of this study is to provide a systematic review of the current literature available that focuses on information systems on syndromic surveillance using web data. All published items concern articles, books, reviews, reports, conference announcements, and dissertations. We used a variation of PRISMA Statements methodology to conduct a systematic review. The review identifies the relevant published papers from the year 2004 to 2018, systematically includes and explores them to extract similarities, gaps, and conclusions on the research that has been done so far. The results presented concern the year, the examined disease, the web data source, the geographic location/country, and the data analysis method used. The results show that influenza is the most examined infectious disease. The internet tools most used are Twitter and Google. Regarding the geographical areas explored in the published papers, the most examined country is the United States, since many scientists come from this country. There is a significant growth of articles since 2009. There are also various statistical methods used to correlate the data retrieved from the internet to the data from national authorities. The conclusion of all researches is that the Web can be a useful tool for the detection of serious epidemics and for a creation of a syndromic surveillance system using the Web, since we can predict epidemics from web data before they are officially detected in population. With the advance of ICT, Smart Healthcare can benefit from the monitoring of epidemics and the early prediction of such a system, improving national or international health strategies and policy decision. This can be achieved through the provision of new technology tools to enhance health monitoring systems toward the new innovations of Smart Health or eHealth, even with the emerging technologies of Internet of Things. The challenges and impacts of an electronic system based on internet data include the social, medical, and technological disciplines. These can be further extended to Smart Healthcare, as the data streaming can provide with real-time information, awareness on epidemics and alerts for both patients or medical scientists. Finally, these new systems can help improve the standards of human life.

Online Searching and Social Media to Detect Alcohol Use Risk at Population Scale

INTRODUCTION

Harnessing engagement in online searching and social media may provide complementary information for monitoring alcohol use, informing prevention and policy evaluation, and extending knowledge available from national surveys.

METHODS

Relative search volumes for 7 alcohol-related keywords were estimated from Google Trends (data, 2014-2017), and the proportion of alcohol use-related Twitter posts (data, 2014-2015) was estimated using natural language processing. Searching/posting measures were created for all 50 U.S. states plus Washington, D.C. Survey reports of alcohol use and summaries of state alcohol policies were obtained from the Behavioral Risk Factor Surveillance System (data, 2014-2016) and the Alcohol Policy Scale. In 2018-2019, associations among searching/posting measures and same state/year Behavioral Risk Factor Surveillance System reports of recent (past-30-day) alcohol use and maximum number of drinks consumed on an occasion were estimated using logistic and linear regression, adjusting for sociodemographics and Internet use, with moderation tested in regressions that included interactions of select searching/posting measures and the Alcohol Policy Scale.

RESULTS

Recent alcohol use was reported by 52.93% of 1,297,168 Behavioral Risk Factor Surveillance System respondents, which was associated with all state-level searching/posting measures in unadjusted and adjusted models (p<0.0001). Among drinkers, most searching/posting measures were associated with maximum number of drinks consumed (p<0.0001). Associations varied with exposure to high versus low levels of state policy controls on alcohol.

CONCLUSIONS

Strong associations were found among individual alcohol use and state-level alcohol-related searching/posting measures, which were moderated by the strength of state alcohol policies. Findings support using novel personally generated data to monitor alcohol use and possibly evaluate effects of alcohol control policies.

Forecasting dengue and influenza incidences using a sparse representation of Google trends, electronic health records, and time series data

Dengue and influenza-like illness (ILI) are two of the leading causes of viral infection in the world and it is estimated that more than half the world’s population is at risk for developing these infections. It is therefore important to develop accurate methods for forecasting dengue and ILI incidences. Since data from multiple sources (such as dengue and ILI case counts, electronic health records and frequency of multiple internet search terms from Google Trends) can improve forecasts, standard time series analysis methods are inadequate to estimate all the parameter values from the limited amount of data available if we use multiple sources. In this paper, we use a computationally efficient implementation of the known variable selection method that we call the Autoregressive Likelihood Ratio (ARLR) method. This method combines sparse representation of time series data, electronic health records data (for ILI) and Google Trends data to forecast dengue and ILI incidences. This sparse representation method uses an algorithm that maximizes an appropriate likelihood ratio at every step. Using numerical experiments, we demonstrate that our method recovers the underlying sparse model much more accurately than the lasso method. We apply our method to dengue case count data from five countries/states: Brazil, Mexico, Singapore, Taiwan, and Thailand and to ILI case count data from the United States. Numerical experiments show that our method outperforms existing time series forecasting methods in forecasting the dengue and ILI case counts. In particular, our method gives a 18 percent forecast error reduction over a leading method that also uses data from multiple sources. It also performs better than other methods in predicting the peak value of the case count and the peak time.

Dengue and influenza-like illness (ILI) are leading causes of viral infection in the world and hence it is important to develop accurate methods for forecasting their incidence. We use Autoregressive Likelihood Ratio method, which is a computationally efficient implementation of the variable selection method, in order to obtain a sparse (non-lasso) representation of time series, Google Trends and electronic health records (for ILI) data. This method is used to forecast dengue incidence in five countries/states and ILI incidence in USA. We show that this method outperforms existing time series methods in forecasting these diseases. The method is general and can also be used to forecast other diseases.

A dynamic neural network model for predicting risk of Zika in real time

BACKGROUND

In 2015, the Zika virus spread from Brazil throughout the Americas, posing an unprecedented challenge to the public health community. During the epidemic, international public health officials lacked reliable predictions of the outbreak's expected geographic scale and prevalence of cases, and were therefore unable to plan and allocate surveillance resources in a timely and effective manner.

METHODS

In this work, we present a dynamic neural network model to predict the geographic spread of outbreaks in real time. The modeling framework is flexible in three main dimensions (i) selection of the chosen risk indicator, i.e., case counts or incidence rate; (ii) risk classification scheme, which defines the high-risk group based on a relative or absolute threshold; and (iii) prediction forecast window (1 up to 12 weeks). The proposed model can be applied dynamically throughout the course of an outbreak to identify the regions expected to be at greatest risk in the future.

RESULTS

The model is applied to the recent Zika epidemic in the Americas at a weekly temporal resolution and country spatial resolution, using epidemiological data, passenger air travel volumes, and vector habitat suitability, socioeconomic, and population data for all affected countries and territories in the Americas. The model performance is quantitatively evaluated based on the predictive accuracy of the model. We show that the model can accurately predict the geographic expansion of Zika in the Americas with the overall average accuracy remaining above 85% even for prediction windows of up to 12 weeks.

CONCLUSIONS

Sensitivity analysis illustrated the model performance to be robust across a range of features. Critically, the model performed consistently well at various stages throughout the course of the outbreak, indicating its potential value at any time during an epidemic. The predictive capability was superior for shorter forecast windows and geographically isolated locations that are predominantly connected via air travel. The highly flexible nature of the proposed modeling framework enables policy makers to develop and plan vector control programs and case surveillance strategies which can be tailored to a range of objectives and resource constraints.

Social networks as a tool for science communication and public engagement: focus on Twitter

Social networks have been used to teach and engage people about the importance of science. The integration of social networks in the daily routines of faculties and scientists is strongly recommended to increase their personal brand, improve their skills, enhance their visibility, share and communicate science to society, promote scientific culture, and even as a tool for teaching and learning. Here we review the use of Twitter in science and comment on our previous experience of using this social network as a platform for a Massive Online Open Course (MOOC) in Spain and Latin America. We propose to extend this strategy to a pan-European Microbiology MOOC in the near future.

Forecasting Zoonotic Infectious Disease Response to Climate Change: Mosquito Vectors and a Changing Environment

Infectious diseases are changing due to the environment and altered interactions among hosts, reservoirs, vectors, and pathogens. This is particularly true for zoonotic diseases that infect humans, agricultural animals, and wildlife. Within the subset of zoonoses, vector-borne pathogens are changing more rapidly with climate change, and have a complex epidemiology, which may allow them to take advantage of a changing environment. Most mosquito-borne infectious diseases are transmitted by mosquitoes in three genera: Aedes, Anopheles, and Culex, and the expansion of these genera is well documented. There is an urgent need to study vector-borne diseases in response to climate change and to produce a generalizable approach capable of generating risk maps and forecasting outbreaks. Here, we provide a strategy for coupling climate and epidemiological models for zoonotic infectious diseases. We discuss the complexity and challenges of data and model fusion, baseline requirements for data, and animal and human population movement. Disease forecasting needs significant investment to build the infrastructure necessary to collect data about the environment, vectors, and hosts at all spatial and temporal resolutions. These investments can contribute to building a modeling community around the globe to support public health officials so as to reduce disease burden through forecasts with quantified uncertainty.

Google Searches and Detection of Conjunctivitis Epidemics Worldwide

PURPOSE

Epidemic and seasonal infectious conjunctivitis outbreaks can impact education, workforce, and economy adversely. Yet conjunctivitis typically is not a reportable disease, potentially delaying mitigating intervention. Our study objective was to determine if conjunctivitis epidemics could be identified using Google Trends search data.

DESIGN

Search data for conjunctivitis-related and control search terms from 5 years and countries worldwide were obtained. Country and term were masked. Temporal scan statistics were applied to identify candidate epidemics. Candidates then were assessed for geotemporal concordance with an a priori defined collection of known reported conjunctivitis outbreaks, as a measure of sensitivity.

PARTICIPANTS

Populations by country that searched Google's search engine using our study terms.

MAIN OUTCOME MEASURES

Percent of known conjunctivitis outbreaks also found in the same country and period by our candidate epidemics, identified from conjunctivitis-related searches.

RESULTS

We identified 135 candidate conjunctivitis epidemic periods from 77 countries. Compared with our a priori defined collection of known reported outbreaks, candidate conjunctivitis epidemics identified 18 of 26 (69% sensitivity) of the reported country-wide or island nationwide outbreaks, or both; 9 of 20 (45% sensitivity) of the reported region or district-wide outbreaks, or both; but far fewer nosocomial and reported smaller outbreaks. Similar overall and individual sensitivity, as well as specificity, were found on a country-level basis. We also found that 83% of our candidate epidemics had start dates before (of those, 20% were more than 12 weeks before) their concurrent reported outbreak's report issuance date. Permutation tests provided evidence that on average, conjunctivitis candidate epidemics occurred geotemporally closer to outbreak reports than chance alone suggests (P < 0.001) unlike control term candidates (P = 0.40).

CONCLUSIONS

Conjunctivitis outbreaks can be detected using temporal scan analysis of Google search data alone, with more than 80% detected before an outbreak report's issuance date, some as early as the reported outbreak's start date. Future approaches using data from smaller regions, social media, and more search terms may improve sensitivity further and cross-validate detected candidates, allowing identification of candidate conjunctivitis epidemics from Internet search data potentially to complementarily benefit traditional reporting and detection systems to improve epidemic awareness.

A combination of incidence data and mobility proxies from social media predicts the intra-urban spread of dengue in Yogyakarta, Indonesia

Only a few studies have investigated the potential of using geotagged social media data for predicting the patterns of spatio-temporal spread of vector-borne diseases. We herein demonstrated the role of human mobility in the intra-urban spread of dengue by weighting local incidence data with geo-tagged Twitter data as a proxy for human mobility across 45 neighborhoods in Yogyakarta city, Indonesia. To estimate the dengue virus importation pressure in each study neighborhood monthly, we developed an algorithm to estimate a dynamic mobility-weighted incidence index (MI), which quantifies the level of exposure to virus importation in any given neighborhood. Using a Bayesian spatio-temporal regression model, we estimated the coefficients and predictiveness of the MI index for lags up to 6 months. Specifically, we used a Poisson regression model with an unstructured spatial covariance matrix. We compared the predictability of the MI index to that of the dengue incidence rate over the preceding months in the same neighborhood (autocorrelation) and that of the mobility information alone. We based our estimates on a volume of 1·302·405 geotagged tweets (from 118·114 unique users) and monthly dengue incidence data for the 45 study neighborhoods in Yogyakarta city over the period from August 2016 to June 2018. The MI index, as a standalone variable, had the highest explanatory power for predicting dengue transmission risk in the study neighborhoods, with the greatest predictive ability at a 3-months lead time. The MI index was a better predictor of the dengue risk in a neighborhood than the recent transmission patterns in the same neighborhood, or just the mobility patterns between neighborhoods. Our results suggest that human mobility is an important driver of the spread of dengue within cities when combined with information on local circulation of the dengue virus. The geotagged Twitter data can provide important information on human mobility patterns to improve our understanding of the direction and the risk of spread of diseases, such as dengue. The proposed MI index together with traditional data sources can provide useful information for the development of more accurate and efficient early warning and response systems.

Probability of dengue transmission and propagation in a non-endemic temperate area: conceptual model and decision risk levels for early alert, prevention and control

BACKGROUND

Dengue viruses have spread rapidly across tropical regions of the world in recent decades. Today, dengue transmission is observed in the Americas, Southeast Asia, Western Pacific, Africa and in non-endemic areas of the USA and Europe. Dengue is responsible for 16% of travel-related febrile illnesses. Although most prevalent in tropical areas, risk maps indicate that subtropical regions are suitable for transmission. Dengue-control programs in these regions should focus on minimizing virus importation, community engagement, improved vector surveillance and control.

RESULTS

We developed a conceptual model for the probability of local introduction and propagation of dengue, comprising disease vulnerability and receptivity, in a temperate area, considering risk factors and social media indicators. Using a rich data set from a temperate area in the south of Brazil (where there is active surveillance of mosquitoes, viruses and human cases), we used a conceptual model as a framework to build two probabilistic models to estimate the probability of initiation and propagation of local dengue transmission. The final models estimated with good accuracy the probabilities of local transmission and propagation, with three and four weeks in advance, respectively. Vulnerability indicators (number of imported cases and dengue virus circulation in mosquitoes) and a receptivity indicator (vector abundance) could be optimally integrated with tweets and temperature data to estimate probability of early local dengue transmission.

CONCLUSIONS

We demonstrated how vulnerability and receptivity indicators can be integrated into probabilistic models to estimate initiation and propagation of dengue transmission. The models successfully estimate disease risk in different scenarios and periods of the year. We propose a decision model with three different risk levels to assist in the planning of prevention and control measures in temperate regions at risk of dengue introduction.

Opioid Discussion in the Twittersphere

BACKGROUND

The rise in opioid use and overdose has increased the importance of improving data collection methods for the purpose of targeting resources to high-need populations and responding rapidly to emerging trends.

OBJECTIVE

To determine whether Twitter data could be used to identify geographic differences in opioid-related discussion and whether opioid topics were significantly correlated with opioid overdose death rate.

METHODS

We filtered approximately 10 billion tweets for keywords related to opioids between July 2009 and October 2015. The content of the messages was summarized into 50 topics generated using Latent Dirchlet Allocation, a machine learning analytic tool. The correlation between topic distribution and census region, census division, and opioid overdose death rate were quantified.

RESULTS

We evaluated a tweet cohort of 84,023 tweets from 72,211 unique users across the US. Unique opioid-related topics were significantly correlated with different Census Bureau divisions and with opioid overdose death rates at the state and county level. Drug-related crime, language of use, and online drug purchasing emerged as themes in various Census Bureau divisions. Drug-related crime, opioid-related news, and pop culture themes were significantly correlated with county-level opioid overdose death rates, and online drug purchasing was significantly correlated with state-level opioid overdoses.

CONCLUSIONS

Regional differences in opioid-related topics reflect geographic variation in the content of Twitter discussion about opioids. Analysis of Twitter data also produced topics significantly correlated with opioid overdose death rates. Ongoing analysis of Twitter data could provide a means of identifying emerging trends related to opioids.

Neighbourhood level real-time forecasting of dengue cases in tropical urban Singapore

BACKGROUND

Dengue, a vector-borne infectious disease caused by the dengue virus, has spread through tropical and subtropical regions of the world. All four serotypes of dengue viruses are endemic in the equatorial city state of Singapore, and frequent localised outbreaks occur, sometimes leading to national epidemics. Vector control remains the primary and most effective measure for dengue control and prevention. The objective of this study is to develop a novel framework for producing a spatio-temporal dengue forecast at a neighbourhood level spatial resolution that can be routinely used by Singapore's government agencies for planning of vector control for best efficiency.

METHODS

The forecasting algorithm uses a mixture of purely spatial, purely temporal and spatio-temporal data to derive dynamic risk maps for dengue transmission. LASSO-based regression was used for the prediction models and separate sub-models were constructed for each forecast window. Data were divided into training and testing sets for out-of-sample validation. Neighbourhoods were categorised as high or low risk based on the forecast number of cases within the cell. The predictive accuracy of the categorisation was measured.

RESULTS

Close concordance between the projections and the eventual incidence of dengue were observed. The average Matthew's correlation coefficient for a classification of the upper risk decile (operational capacity) is similar to the predictive performance at the optimal 30% cut-off. The quality of the spatial predictive algorithm as a classifier shows areas under the curve at all forecast windows being above 0.75 and above 0.80 within the next month.

CONCLUSIONS

Spatially resolved forecasts of geographically structured diseases like dengue can be obtained at a neighbourhood level in highly urban environments at a precision that is suitable for guiding control efforts. The same method can be adapted to other urban and even rural areas, with appropriate adjustment to the grid size and shape.

Harnessing Big Data for Communicable Tropical and Sub-Tropical Disorders: Implications From a Systematic Review of the Literature

Aim

According to the World Health Organization (WHO), communicable tropical and sub-tropical diseases occur solely, or mainly in the tropics, thriving in hot, and humid conditions. Some of these disorders termed as neglected tropical diseases are particularly overlooked. Communicable tropical/sub-tropical diseases represent a diverse group of communicable disorders occurring in 149 countries, favored by tropical and sub-tropical conditions, affecting more than one billion people and imposing a dramatic societal and economic burden.

Methods

A systematic review of the extant scholarly literature was carried out, searching in PubMed/MEDLINE and Scopus. The search string used included proper keywords, like big data, nontraditional data sources, social media, social networks, infodemiology, infoveillance, novel data streams (NDS), digital epidemiology, digital behavior, Google Trends, Twitter, Facebook, YouTube, Instagram, Pinterest, Ebola, Zika, dengue, Chikungunya, Chagas, and the other neglected tropical diseases.

Results

47 original, observational studies were included in the current systematic review: 1 focused on Chikungunya, 6 on dengue, 19 on Ebola, 2 on Malaria, 1 on Mayaro virus, 2 on West Nile virus, and 16 on Zika. Fifteen were dedicated on developing and validating forecasting techniques for real-time monitoring of neglected tropical diseases, while the remaining studies investigated public reaction to infectious outbreaks. Most studies explored a single nontraditional data source, with Twitter being the most exploited tool (25 studies).

Conclusion

Even though some studies have shown the feasibility of utilizing NDS as an effective tool for predicting epidemic outbreaks and disseminating accurate, high-quality information concerning neglected tropical diseases, some gaps should be properly underlined. Out of the 47 articles included, only 7 were focusing on neglected tropical diseases, while all the other covered communicable tropical/sub-tropical diseases, and the main determinant of this unbalanced coverage seems to be the media impact and resonance. Furthermore, efforts in integrating diverse NDS should be made. As such, taking into account these limitations, further research in the field is needed.

Discrepancies Between Classic and Digital Epidemiology in Searching for the Mayaro Virus: Preliminary Qualitative and Quantitative Analysis of Google Trends

BACKGROUND

Mayaro virus (MAYV), first discovered in Trinidad in 1954, is spread by the Haemagogus mosquito. Small outbreaks have been described in the past in the Amazon jungles of Brazil and other parts of South America. Recently, a case was reported in rural Haiti.

OBJECTIVE

Given the emerging importance of MAYV, we aimed to explore the feasibility of exploiting a Web-based tool for monitoring and tracking MAYV cases.

METHODS

Google Trends is an online tracking system. A Google-based approach is particularly useful to monitor especially infectious diseases epidemics. We searched Google Trends from its inception (from January 2004 through to May 2017) for MAYV-related Web searches worldwide.

RESULTS

We noted a burst in search volumes in the period from July 2016 (relative search volume [RSV]=13%) to December 2016 (RSV=18%), with a peak in September 2016 (RSV=100%). Before this burst, the average search activity related to MAYV was very low (median 1%). MAYV-related queries were concentrated in the Caribbean. Scientific interest from the research community and media coverage affected digital seeking behavior.

CONCLUSIONS

MAYV has always circulated in South America. Its recent appearance in the Caribbean has been a source of concern, which resulted in a burst of Internet queries. While Google Trends cannot be used to perform real-time epidemiological surveillance of MAYV, it can be exploited to capture the public's reaction to outbreaks. Public health workers should be aware of this, in that information and communication technologies could be used to communicate with users, reassure them about their concerns, and to empower them in making decisions affecting their health.