As members of the E4Warning consortium, Gina Tsarouchi, Quillon Harpham (HR Wallingford), Lyra Tyson (UPF), and Remy Hoek Spaans (BSC) traveled to Sri Lanka in November to participate in a workshop organized by Dr. Lahiru Kodithuwakku and Gina Tsarouchi. The event, in collaboration with the National Dengue Control Unit (NDCU) and the Ministry of Health, focused on enhancing innovative tools for dengue prediction and control.

The workshop aimed to train participants in using the D-MOSS platform, a live dengue forecasting system combining satellite earth observation data, climate models, and statistical tools to provide probabilistic forecasts of dengue outbreaks. It also served as a valuable opportunity to adapt the methods to Sri Lanka’s unique public health context, informed by input from local professionals.

Bringing Together Experts from Across Sri Lanka

The workshop attracted over 80 participants from districts across the country, including entomologists, regional epidemiologists, medical officers of health, academics, NGOs, and representatives from the NDCU. This diverse group ensured that the discussions were enriched with practical insights and multidisciplinary expertise.

Dr. Preshila Samaraweera kicked off the workshop with an informative presentation on Sri Lanka’s progress in dengue control, highlighting current research projects and interventions. This set the stage for the D-MOSS training sessions, where participants had hands-on opportunities to test the system and provide feedback.

Training, Feedback, and Collaboration

The D-MOSS platform was well-received, with participants exploring its ability to visualize past, current, and forecasted dengue trends. One participant noted:

“These elements collectively offer a comprehensive view of past, present, and predicted dengue trends, supporting proactive planning and response.”

Following a lunch break, attendees learned about the statistical modeling methods used in E4Warning, with a focus on interpreting probabilistic forecasts. A group discussion then explored ways to enhance the dengue early warning system, including the integration of new data sources such as mobility patterns and socio-economic data. The day concluded with a presentation on the Mosquito Alert platform, sparking a lively conversation about how citizen science could contribute to vector control in Sri Lanka.

Lessons Learned and Next Steps

Reflecting on two intensive days of learning, several valuable lessons emerged from the experience. As highlighted during the workshop discussions, effective dengue control—particularly larval source management—requires a multi-sectoral approach. For example, Aedes mosquitoes often breed in artificial containers that fall under the responsibility of different sectors, such as road maintenance crews for potholes or port authorities for harbor areas.

Another critical area for improvement is the integration of entomological data into a digital infrastructure. Currently, much of this data is collected on paper, limiting its accessibility and use for coordinated control efforts. Digitizing these records would enhance monitoring, analysis, and intervention strategies.

Additionally, dengue prediction models could be further refined by incorporating mobility patterns and socio-economic census data, offering a more comprehensive understanding of how the disease spreads and where interventions could be most effective.

By continuously enhancing the digital tools developed through the E4Warning project, we aim to support the Sri Lankan National Dengue Control Unit (NDCU) in achieving its ambitious goals for dengue control and prevention.

Our partner and WP leader, Rachel Lowe, ICREA Research Professor and Global Health Resilience (GHR) Group Leader at the Barcelona Supercomputing Center (BSC), was recently interviewed by HERA (Health Emergency Preparedness and Response Authority) and featured on their website: https://ec.europa.eu/newsroom/hera/items/852413/en

HERA is an EU body established to strengthen Europe’s ability to anticipate and respond to health emergencies, particularly in the wake of the COVID-19 pandemic. It aims to ensure the provision of critical medical countermeasures and enhance Europe’s readiness for future health threats.

In the interview, Rachel Lowe discusses the intricate connections between climate change and the outbreaks of climate-sensitive infectious diseases, exploring why these outbreaks are increasing and spreading to new regions, particularly in Europe. She also explains how shifting climate patterns could influence emergency preparedness and response strategies, highlighting the need for proactive, integrated approaches. She shared insights into specific climate-sensitive diseases that pose a potential threat to the EU, including dengue, chikungunya, and West Nile virus, and discussed ongoing efforts like the development of the EpiOutlook platform within the IDAlert project, which is part of the European Climate-Health Cluster. This platform aims to provide early warnings of climatic suitability for various infectious diseases in Europe. They also track the impact of climate change on these diseases in the Lancet Countdown in Europe collaboration.

As part of E4Warning, Professor Lowe also elaborated on her work in developing decision support tools like the D-MOSS (Dengue forecasting Model Satellite-based System) for dengue in endemic regions in collaboration with HR-Wallingford, as well the efforts on integrating different data sources such as citizen science initiatives like Mosquito Alert, which could enhance the monitoring and management of disease vectors across Europe, providing critical support for future public health interventions.

For more details, read the full interview on the HERA website and gain valuable insights into how E4Warning and its partners are addressing the growing challenges posed by climate-sensitive diseases in Europe.

In a recent study conducted in Brazil by researchers from the Instituto Oswaldo Cruz, the E4Warning project successfully deployed smart traps with the VECTRACK sensor developed by IRIDEON, to improve mosquito surveillance in urban settings. These smart traps, equipped with AI and IoT technologies, have been tested in two Brazilian cities—Rio de Janeiro and Brasilia—where they demonstrated high accuracy in identifying mosquito species such as Aedes aegypti and Culex quinquefasciatus, both key vectors for diseases like dengue, Zika, and chikungunya.

Over a year of field testing, the traps showed a remarkable 99.8% accuracy in distinguishing target mosquito species from other insects and a 93.7% accuracy in differentiating between the two genera of mosquitoes. The smart traps collected data on 9,151 insect flights, of which 1,383 were mosquito vectors.

These findings indicate the potential of the E4Warning tool to provide real-time monitoring and classification of mosquitoes in areas with high vector-borne disease risks: by the end of September 2024, over 9.5 million dengue cases had been reported in Brazil. In this context, the data gathered from the smart traps could be instrumental in aiding public health authorities to make timely interventions, such as targeted vector control measures, enhancing the preparedness and response to mosquito-borne disease outbreaks.  The successful implementation of the IRIDEON smart traps in Brazil showcases how cutting-edge technologies can revolutionize mosquito surveillance, making it faster, more accurate, and less reliant on manual labor.

The paper has been published in the Parasite & Vector journal: Njaime, F.C.B.F.P., Máspero, R.C., Leandro, A.d., Maciel-de-Freitas, R. Automated classification of mixed populations of Aedes aegypti and Culex quinquefasciatus mosquitoes under field conditions. Parasites Vectors 17, 399 (2024).

It can be consulted at the following link: https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-024-06417-z

It can also be founded in the E4Warning Zenodo community: https://zenodo.org/records/13868673

Eva Veronesi (SUPSI) attended the 6th International Workshop on Aedes albopictus in Phnom Penh, Cambodia, from March 28-29, 2024. Organized by the Institute Pasteur of Cambodia, the workshop was led by Dr. Sébastien Boyer (head of the Medical and Veterinary Entomology Unit at the Institute). The opening session was presided over by Prof. André Spiegel, Director of the Institute Pasteur of Cambodia, with the presence of Professor Chheang Ra, Minister of Health of Cambodia, Mr. Jacques Pellet, Ambassador of France to Cambodia, and Dr. Boyer, who delivered the introductory talk.

The Aedes albopictus, commonly known as the tiger mosquito, is a principal carrier of Dengue fever, Chikungunya, Zika, and at least 20 other significant pathogens impacting public health. Originating from the tropical and subtropical zones of Southeast Asia, the tiger mosquito has expanded its reach globally over the last century, facilitated by international trade and travel. Distinguished by distinctive white stripes on its legs and body, the species has adapted well to human environments. As a considerable nuisance, the tiger mosquito typically resides close to human habitats and is known for its daytime biting behavior, especially during early morning and late afternoon periods.

The event was focused on enhancing scientific collaboration and showing innovative vector control strategies. Key research topics covered included vector models of invasion and dispersal, and the role of the species as a bridge vector, including the influence of climate change on vector behavior. For that, the workshop unfolded five sessions:

• Aedes albopictus in Asia.
• Biology and Ecology of Aedes albopictus.
• Vector control: challenges and innovations.
• Vector control: insecticide resistance.
• New surveillance strategies.

It was during the session on innovative surveillance strategies that E4Warning was spotlighted. The presentation titled “The Role of E4Warning in Combating the Spread of Dengue in Asia and its Potential Incursion into Europe” by Eva Veronesi showcased to the audience the surveillance tools involved in the project, such as Mosquito Alert (CSIC, UPF), VECMAP (AVIA-GIS)  and the smart traps designed by IRIDEON. Additionally, it highlighted the dengue models developed by the Barcelona Supercomputing Center (BSC) and HR Wallingford.

Link to the agenda of the event: Agenda 6th International Workshop on Aedes albopictus

E4Warning participated in the high-level conference “Research Perspectives on the Health Impacts of Climate Change,” organized by the Directorate-General for Research and Innovation (DG RTD) of the European Commission. This event, held in Brussels on February 19th and 20th, 2024, aimed to highlight the crucial nexus between climate change and global health issues.

Chloe Fletcher, a PhD candidate from the Global Health Resilience group at the Barcelona Supercomputing Center (BSC), attended the conference. Her research focuses on developing statistical models for predicting outbreaks of climate-sensitive infectious diseases, such as dengue and leptospirosis. Fletcher presented a poster titled “A Generalized Modelling Framework for Dengue Early Warning Systems in South and Southeast Asia,” a collaborative effort involving Ramy Hoek Spaans (BSC), Sophie Belman (BSC), Chloe Fletcher (BSC), Quillon Harpham (HRW), Gina Tsarouchi (HRW), and Rachel Lowe (BSC), all contributing to the E4Warning project.

This study aims to broaden the successful application of the Dengue Forecasting Model Satellite-based System (D-MOSS), originally implemented in Vietnam, to include Sri Lanka and Malaysia. By employing a Bayesian modeling approach and contrasting it with the conventional practices of dengue outbreak monitoring in each nation, the research seeks to identify which dengue predictors remain consistent or vary across these diverse regions.

The goal is to establish a universally applicable template for developing dengue early warning systems. The D-MOSS platform, which underpins this forecasting system, is managed by HR Wallingford. A key ambition of E4Warning is to collaborate intimately with local partners to deliver actionable data visualizations, thereby enabling an informed, data-driven approach to dengue management.

You can view the summaries of other posters presented during the conference at this link.

The early warning system for dengue fever in Vietnam, developed by D-MOSS as part of the E4Warning initiative, has been highlighted as a significant success story during the launch of the World Meteorological Organization’s (WMO) “Climate Services for Health” report launched the past 2th November 2023. Rachel Lowe from the Barcelona Supercomputing Center (BSC) represented the project, elaborating on the vital work performed by E4Warning.

The presentation underscored how this advanced system is making strides in public health by providing early warnings of dengue fever outbreaks. By harnessing climate data and predictive modeling, the system is aiding Vietnam in taking preemptive measures to mitigate the impact of this vector-borne disease, thereby safeguarding communities and strengthening the resilience of health systems.

The latest World Meteorological Organization’s (WMO) State of Climate Services report delivers a compelling message about the intricate connection between our changing climate and public health. The report acts as a clarion call, highlighting the dire need for precise climate information and services to bolster the health sector amid escalating threats from extreme weather events, evolving disease patterns, and the looming specter of food and water scarcity.

Prof. Petteri Taalas, WMO Secretary-General, brings to the forefront the widespread occurrence of heatwaves across the globe, further intensified by the imminent onset of El Niño. This scenario sets a backdrop for heightened temperature records, amplifying the urgency for increased investment and collaborative efforts to elevate the role of climate science. By doing so, health partners can gain critical support in times when our climate’s unpredictability takes a tangible toll on human health.

In alignment with Prof. Taalas’s observations, WHO Director-General Dr. Tedros Adhanom Ghebreyesus defines the climate crisis as an escalating health crisis. He underlines the vital need for access to high-quality climate services within the health sector to counteract the perilous effects of climate change on human well-being.

Despite this clear need, the report reveals a gap: climate data often does not permeate health decision-making processes as it should. This disconnect points to an essential requirement for improved early warning systems, especially since disaster events are anticipated to surge, with less-prepared countries facing significantly higher mortality rates.

The focus then shifts to the underestimation of extreme heat’s health impacts. Highlighting the efforts of the Early Warnings for All initiative, the report underscores the necessity to expand heat warning services, which are currently absent in many vulnerable regions.

Ultimately, the WMO report connects the dots between the adverse effects of climate change on various aspects of health — from the quality of the air we breathe to the nutritional security of our food and the control of infectious diseases. It’s a comprehensive wake-up call for cross-sectoral action, aiming to fortify the health community against the multifaceted challenges posed by a warming world. This post serves to emphasize that climate action is not just an environmental imperative but a crucial facet of global health strategy.

Tangible solutions

The World Meteorological Organization’s (WMO) State of Climate Services report doesn’t just outline the challenges; it showcases tangible solutions through success stories where climate services have made significant inroads in health outcomes. One such example is the early warning system for dengue in Vietnam, which was presented as a beacon of the potential benefits of climate services for health. This system, alongside other initiatives from Africa, Europe, the Pacific, and the Pan-American region, represents the strides being made in marrying meteorological insights with health sector needs.

The State of Climate Services report can be downloaded here.