One Health Regional Approach for Integrated and Interconnected Urban Dengue Surveillance Southeast Asia

"Many of the major infectious diseases are transmitted by mosquitoes, notably malaria and the arboviral diseases. The WHO estimates that one of the main consequences of global warming is the increasing burden of these vector-borne diseases, that extend their range from tropical and subtropical regions to temperate regions. The potential for the spread of mosquito-borne diseases into temperate regions has already occurred with autochthonous transmission of dengue virus in southern France. Several of the mosquito-borne diseases are of particular concern, as the mosquito species in question adapt to the urban environment. This is the case for Aedes aegypti, the main vector of dengue, Zika, chikungunya and yellow fever viruses, as well as several new species of mosquito invading Europe and capable of transmitting arboviruses, such as the tiger mosquito Aedes albopictus, which is also present in South-East Asia. Thus, increasing global temperatures and the establishment of vector species in urban areas pose a significant public health risk for arbovirus outbreaks in Europe and needs to be addressed using an evidence-based rationale. The Southeast Asian region has been afflicted for decades by epidemics of dengue fever occurring at regular intervals, and provides the theater within which a deeper understanding of urban mosquito-borne diseases can be gleaned with the aim of developing appropriate mitigation strategies in Europe, where arboviruses will inevitably become entrenched. The main challenges to orient the development of mitigation strategies are (i) a more complete understanding of the intra-urban spatial distribution of mosquito-borne pathogen risk, (ii) how currently inadequate entomological surveillance can be improved and (iii) what is needed to improve surveillance tools at the local, national and regional levels. This project proposes a multi-level approach to understanding dengue risk from the intra-urban scale to the national and finally to the regional scale. Key to understanding local risk is the integration of human mobility and actual and predicted mosquito habitat suitability under climate change scenarios at these geographic scales. The project will thus calibrate an agent-based intra-urban model incorporating mobility and habitat suitability within Bangkok using new mosquito indices that go beyond the current traditional ones that remain ineffectual. This model will then be extrapolated to the other major cities in Southeast Asia and validated using local information on dengue and mosquito densities. From the city level, we will then scale up to the national and regional levels using coarser measures of human mobility related to dengue incidence from national surveillance systems. Finally, we will develop a regional surveillance platform that will enhance national programs and create an interoperability layer to connect each national surveillance platform to the regional dashboard level. The platform will integrate modeling components using different data sources, with a focus on satellite-based environmental surveillance, to provide the basis for an Early Warning System. This ambitious project aims to generate a prediction and surveillance system implementable in cities worldwide, enabling public health authorities to respond rapidly to any mosquito-borne pathogen emergence. It will contribute directly to several EMERGENCE PRFI 2023 objectives by accelerating the acquisition of knowledge on emerging infectious diseases, sharing knowledge between countries and disciplines, and allowing us to define standardized surveillance tools. It targets emergence in humans by developing surveillance methods and tools to enable us to understand the dynamics at several scales and model the occurrence of epidemics. "