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The Meningitis Forecasting Project for Africa and Recent Developments

The Meningitis Forecasting Project for Africa and Recent Developments. Madeleine C. Thomson International research Institute for Climate and Society Columbia University, New York GEO Meningitis Meeting, Geneva 26-27 th September 2007. WHO Collaborating Centre for Climate Sensitive Disease.

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The Meningitis Forecasting Project for Africa and Recent Developments

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  1. The Meningitis Forecasting Project for Africa and Recent Developments Madeleine C. Thomson International research Institute for Climate and Society Columbia University, New York GEO Meningitis Meeting, Geneva 26-27th September 2007 WHO Collaborating Centre for Climate Sensitive Disease

  2. THE MENINGITIS FORECASTING PROJECT 1998-2002 Meningitis Research Foundation LIVERPOOL SCHOOL OF TROPICAL MEDICINE with Centre d’Etudes et de Recherches Medicales et Sanitaires (CERMES) Liverpool University Department of Geography Epicentre Medecins sans Frontieres (MSF) Ministère de la Santé Burkina Faso Ministère de la Santé Mali Ministère de la Santé Publique Niger Ministère de la Santé Togo World Health Organisation (WHO-HQ) WHO-Regional Office for Africa (WHO-AFRO)

  3. The Meningitis Belt • High seasonal endemicity. • Frequent large epidemics. • Elsewhere in Africa • Low inter-epidemic incidence. • Infrequent small epidemics. INTRODUCTION SPATIAL EPIDEMIOLOGY Cheesbrough JS, Morse AP, Green SDR. Meningococcal meningitis and carriage in western Zaire: a hypoendemic zone related to climate? Epidemiology and Infection 1995: 114; 75-92

  4. AIMS & OBJECTIVES Aims To increase knowledge which may be used to improve epidemic preparedness and timely response strategies to epidemic meningitis in Africa. Objectives Predicting the spatial distribution of epidemics. Assess evidence of the impact of environmental change. Forecasting the temporal occurrence of epidemics.

  5. THE SPATIAL DISTRIBUTION OF EPIDEMICS METHODS: EPIDEMIOLOGICAL DATA DOCUMENTED EPIDEMICS Published and unpublished reports 1841-99 Pan-Africa EXTENSIVE SEARCH METHODS EPIDEMIC LOCATIONS VERIFIED & MAPPED

  6. Affected districts (n = 1232 / 3281) Reported to district Reported to province THE SPATIAL DISTRIBUTION OF EPIDEMICS METHODS: EPIDEMIC MAPPING Molesworth, A.M. Thomson, M.C. Connor, S.J. Cresswell, M.C. Morse, AP. Shears, P. Hart, C.A. Cuevas, L.E. (2002). Where is the Meningitis Belt? Transactions of the Royal Society of Tropical Medicine and Hygiene 96, 242-249

  7. THE SPATIAL DISTRIBUTION OF EPIDEMICS RESULTS: EPIDEMIC RISK MAPPING • Identification of risk factors that can be routinely monitored (at appropriate scales for decision-making) • Immunological susceptibility and circulation of virulent strain • Demographic and socio-economic factors • Other infections • Environmental Risk Factors

  8. 0.0 - (lower) 0.4 - (medium) 0.6 - (high) 0.8 - (very high) THE SPATIAL DISTRIBUTION OF EPIDEMICS RESULTS: EPIDEMIC RISK MAPPING Risk factors Land cover type Seasonal absolute humidity profile Seasonal dust profile* Population density* Soil type* * Significant but not included in final model Molesworth, A.M. Cuevas, L.E. Connor, S.J. Morse, A.P. and Thomson. M.C. (2003). Environmental risk and meningitis epidemics in Africa. Emerging infectious diseases. 9, 10.

  9. THE SPATIAL DISTRIBUTION OF EPIDEMICS: LESSONS LEARNED and NEXT STEPS • Environmental models developed using epidemic reports predict well the meningitis belt and its areas of potential extension • Opportunities for improvement include: • Statistcal techniques • Standardised epidemic data • Contemperaneous environment/climate data

  10. THE IMPACT OF ENVIRONMENTAL CHANGE CHANGE IN EPIDEMIC DISTRIBUTION <1980 (n = c.300) 1980+ (n = c.125)

  11. THE IMPACT OF ENVIRONMENTAL CHANGE CHANGE IN EPIDEMIC RISK Risk difference (1980-99) - (1841-1979) < - 10% No change 10% - 19% 20% +

  12. THE IMPACT OF ENVIRONMENTAL CHANGE CHANGE IN EPIDEMIC RISK Evaluating the risk map using recent epidemics Savory, E.C., Cuevas, L.E., Yassin, M.A., Hart, C.A., Molesworth, A.M., & Thomson, M.C. (2006) Evaluation of the meningitis epidemics risk model in Africa. Epidemiology & Infection Feb 14; 1- 13

  13. THE SPATIAL DISTRIBUTION OF EPIDEMICS METHODS: EPIDEMIC MAPPING Cuevas, L.E., Yassin, M.A., Savory, E.C., Hart, C.A. and Thomson, M.C. (in prep) Where to deploy the new meningitis conjugate vaccines in Africa?

  14. THE IMPACT OF ENVIRONMENTAL CHANGE LESSONS LEARNED AND NEXT STEPS • An extension of the meningitis belt southwards appears to be consistent with environmental and climate change • Opportunities for improvement include: • Regionally relevant climate models – on multiple time scales – seasonal, decadal to climate change • Analysis of epidemics in the southern margins

  15. Vaccination starts not preventable THE TEMPORAL OCCURRENCE OF EPIDEMICS METHODS: THE PROBLEM Without vaccination Actual Vaccination with WHO guidelines 7000 6000 5000 4000 Cases 3000 2000 1000 0 29 5 12 19 26 2 9 16 23 2 9 16 23 30 6 13 20 27 4 11 18 25 February Dec. January March April May Date

  16. THE TEMPORAL OCCURRENCE OF EPIDEMICS METHODS: EPIDEMIOLOGICAL DATA ANNUAL TOTAL MENINGITIS INCIDENCE BY DISTRICTBY BIOLOGICAL YEAR (OCT_SEP) BURKINA FASO (Jan’97-Dec’99, 50 districts) NIGER (Jan’93-Dec’99, 38 districts) MALI (Jul’89-Jul’98, 7 districts) TOGO (Aug’90-Jul’97, 4 districts)

  17. THE TEMPORAL OCCURRENCE OF EPIDEMICS METHODS: SEASONAL ANALYSIS Molesworth A.M., Djingary M.H., Thomson M.C. (2001) Seasonality of meningococcal disease in Niger, West Africa: a preliminary investigation. Proceedings GEOMED 1999 92-97 .Eds. A. Flahault, L. Toubiana and A.J. Valleron. Elsevier: Paris.

  18. FORECASTING MENINGITIS EPIDEMICS THE FORECASTING PRINCIPLE Early______________Peak__________Late________ Rain/Humidity Rain/Humidity Dust

  19. THE TEMPORAL OCCURRENCE OF EPIDEMICS METHODS: EPIDEMIC MODELLING Thomson, M.C., Molesworth, A.M., Djingarey, M.H., Yameogo, K.R., Belanger, F., Cuevas. L.E. (2006) Potential of environmental models to predict meningitis epidemics in Africa. Tropical Medicine & International Health 11 (6) pp 773�780

  20. THE TEMPORAL OCCURRENCE OF EPIDEMICS METHODS: EPIDEMIC MODELLING Thomson, M.C., Molesworth, A.M., Djingarey, M.H., Yameogo, K.R., Belanger, F., Cuevas. L.E. (2006) Potential of environmental models to predict meningitis epidemics in Africa. Tropical Medicine & International Health 11 (6) pp 773�780

  21. THE TEMPORAL OCCURRENCE OF EPIDEMICS LESSONS LEARNED AND NEXT STEPS Seasonality of disease clearly associated with seasonal chanages in climate Inter-annual variability in incidence may be associated with climate but further analysis needed Fundemental Question Is climate a ‘vulnerability indicator ‘or a ‘driver’ of epidemics

  22. THE TEMPORAL OCCURRENCE OF EPIDEMICS: OPPORTUNITIES FOR IMPROVEMENT IN:

  23. Implementation of GCOS-Africa Climate for Development Phase I COP12, 8th November, 2006, Nairobi Madeleine Thomson International Research Institute for Climate and Society, Columbia University, New York

  24. D.L. Balk, U. Deichmann, G. Yetman, F. Pozzi, S.I. Hay, A. Nelson(2006). Determining Global Population Distribution: Methods, Applications and Data and. Advances in Parasitology, Vol 62

  25. September A 1.49’W; 12.44’N Mean weekly cases at subdistrict level over 9 years (data from WHO) Sep Judy Omumbo

  26. October A B 1.49’W; 12.44’N 8.15’W; 12.77’N Oct

  27. November C A B 7.67’W; 13.47’N 1.49’W; 12.44’N 8.15’W; 12.77’N Nov

  28. December C A B Dec

  29. C A B Jan

  30. February C A B Feb

  31. March C A B Mar

  32. April C A B Apr

  33. May C A B May

  34. June C A B Jun

  35. July C A B Jul

  36. August C A B Aug

  37. Maximum cases BURKINA FASO Pissy PaulIV Kossodo Secteur 30 MALI Commune 1-6 C B A NIGER Aguié

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