Anne E. Jones

Development of a new version of the Liverpool Malaria Model. I. Refining the parameter settings and mathematical formulation of basic processes based on a literature review.

BackgroundA warm and humid climate triggers several water-associated diseases such as malaria. Climate- or weather-driven malaria models, therefore, allow for a better understanding of malaria transmission dynamics. The Liverpool Malaria Model (LMM) is a mathematical-biological model of malaria parasite dynamics using daily temperature and precipitation data. In this study, the parameter settings of the LMM are refined and a new mathematical formulation of key processes related to the growth and size of the vector population are developed.MethodsOne of the most comprehensive studies to date in terms of gathering entomological and parasitological information from the literature was undertaken for the development of a new version of an existing malaria model. The knowledge was needed to allow the justification of new settings of various model parameters and motivated changes of the mathematical formulation of the LMM.ResultsThe first part of the present study developed an improved set of parameter settings and mathematical formulation of the LMM. Important modules of the original LMM version were enhanced in order to achieve a higher biological and physical accuracy. The oviposition as well as the survival of immature mosquitoes were adjusted to field conditions via the application of a fuzzy distribution model. Key model parameters, including the mature age of mosquitoes, the survival probability of adult mosquitoes, the human blood index, the mosquito-to-human (human-to-mosquito) transmission efficiency, the human infectious age, the recovery rate, as well as the gametocyte prevalence, were reassessed by means of entomological and parasitological observations. This paper also revealed that various malaria variables lack information from field studies to be set properly in a malaria modelling approach.ConclusionsDue to the multitude of model parameters and the uncertainty involved in the setting of parameters, an extensive literature survey was carried out, in order to produce a refined set of settings of various model parameters. This approach limits the degrees of freedom of the parameter space of the model, simplifying the final calibration of undetermined parameters (see the second part of this study). In addition, new mathematical formulations of important processes have improved the model in terms of the growth of the vector population.

Climate prediction of El Niño malaria epidemics in north-west Tanzania

BackgroundMalaria is a significant public health problem in Tanzania. Approximately 16 million malaria cases are reported every year and 100,000 to 125,000 deaths occur. Although most of Tanzania is endemic to malaria, epidemics occur in the highlands, notably in Kagera, a region that was subject to widespread malaria epidemics in 1997 and 1998. This study examined the relationship between climate and malaria incidence in Kagera with the aim of determining whether seasonal forecasts may assist in predicting malaria epidemics.MethodsA regression analysis was performed on retrospective malaria and climatic data during each of the two annual malaria seasons to determine the climatic factors influencing malaria incidence. The ability of the DEMETER seasonal forecasting system in predicting the climatic anomalies associated with malaria epidemics was then assessed for each malaria season.ResultsIt was found that malaria incidence is positively correlated with rainfall during the first season (Oct-Mar) (R-squared = 0.73, p < 0.01). For the second season (Apr-Sep), high malaria incidence was associated with increased rainfall, but also with high maximum temperature during the first rainy season (multiple R-squared = 0.79, p < 0.01). The robustness of these statistical models was tested by excluding the two epidemic years from the regression analysis. DEMETER would have been unable to predict the heavy El Niño rains associated with the 1998 epidemic. Nevertheless, this epidemic could still have been predicted using the temperature forecasts alone. The 1997 epidemic could have been predicted from observed temperatures in the preceding season, but the consideration of the rainfall forecasts would have improved the temperature-only forecasts over the remaining years.ConclusionThese results demonstrate the potential of a seasonal forecasting system in the development of a malaria early warning system in Kagera region.

Development of a new version of the Liverpool Malaria Model. II. Calibration and validation for West Africa

BackgroundIn the first part of this study, an extensive literature survey led to the construction of a new version of the Liverpool Malaria Model (LMM). A new set of parameter settings was provided and a new development of the mathematical formulation of important processes related to the vector population was performed within the LMM. In this part of the study, so far undetermined model parameters are calibrated through the use of data from field studies. The latter are also used to validate the new LMM version, which is furthermore compared against the original LMM version.MethodsFor the calibration and validation of the LMM, numerous entomological and parasitological field observations were gathered for West Africa. Continuous and quality-controlled temperature and precipitation time series were constructed using intermittent raw data from 34 weather stations across West Africa. The meteorological time series served as the LMM data input. The skill of LMM simulations was tested for 830 different sets of parameter settings of the undetermined LMM parameters. The model version with the highest skill score in terms of entomological malaria variables was taken as the final setting of the new LMM version.ResultsValidation of the new LMM version in West Africa revealed that the simulations compare well with entomological field observations. The new version reproduces realistic transmission rates and simulated malaria seasons are comparable to field observations. Overall the new model version performs much better than the original model. The new model version enables the detection of the epidemic malaria potential at fringes of endemic areas and, more importantly, it is now applicable to the vast area of malaria endemicity in the humid African tropics.ConclusionsA review of entomological and parasitological data from West Africa enabled the construction of a new LMM version. This model version represents a significant step forward in the modelling of a weather-driven malaria transmission cycle. The LMM is now more suitable for the use in malaria early warning systems as well as for malaria projections based on climate change scenarios, both in epidemic and endemic malaria areas.

Application and Validation of a Seasonal Ensemble Prediction System Using a Dynamic Malaria Model

Abstract Seasonal multimodel forecasts from the Development of a European Multimodel Ensemble System for Seasonal-to-Interannual Prediction (DEMETER) project are used to drive a malaria model and create reforecasts of malaria incidence for Botswana, in southern Africa, in a unique integration of a fully dynamic, process-based malaria model with an ensemble forecasting system. The forecasts are verified against a 20-yr malaria index and compared against reference simulations obtained by driving the malaria model with data from the 40-yr European Centre for Medium-Range Weather Forecasts (ECMWF) Re-Analysis (ERA-40). Performance assessment reveals skill in the DEMETER-driven malaria forecasts for prediction of low (below the lower tercile), above-average (above the median), and high (above the upper tercile) malaria events, with the best results obtained for low malaria events [relative operating characteristics (ROC) area = 0.84, 95% confidence interval = 0.63–1.0]. For high malaria events, the DEMETER-dri...

Towards seasonal forecasting of malaria in India

BackgroundMalaria presents public health challenge despite extensive intervention campaigns. A 30-year hindcast of the climatic suitability for malaria transmission in India is presented, using meteorological variables from a state of the art seasonal forecast model to drive a process-based, dynamic disease model.MethodsThe spatial distribution and seasonal cycles of temperature and precipitation from the forecast model are compared to three observationally-based meteorological datasets. These time series are then used to drive the disease model, producing a simulated forecast of malaria and three synthetic malaria time series that are qualitatively compared to contemporary and pre-intervention malaria estimates. The area under the Relative Operator Characteristic (ROC) curve is calculated as a quantitative metric of forecast skill, comparing the forecast to the meteorologically-driven synthetic malaria time series.Results and discussionThe forecast shows probabilistic skill in predicting the spatial distribution of Plasmodium falciparum incidence when compared to the simulated meteorologically-driven malaria time series, particularly where modelled incidence shows high seasonal and interannual variability such as in Orissa, West Bengal, and Jharkhand (North-east India), and Gujarat, Rajastan, Madhya Pradesh and Maharashtra (North-west India). Focusing on these two regions, the malaria forecast is able to distinguish between years of “high”, “above average” and “low” malaria incidence in the peak malaria transmission seasons, with more than 70% sensitivity and a statistically significant area under the ROC curve. These results are encouraging given that the three month forecast lead time used is well in excess of the target for early warning systems adopted by the World Health Organization. This approach could form the basis of an operational system to identify the probability of regional malaria epidemics, allowing advanced and targeted allocation of resources for combatting malaria in India.

Demonstration of successful malaria forecasts for Botswana using an operational seasonal climate model

The severity and timing of seasonal malaria epidemics is strongly linked with temperature and rainfall. Advance warning of meteorological conditions from seasonal climate models can therefore potentially anticipate unusually strong epidemic events, building resilience and adapting to possible changes in the frequency of such events. Here we present validation of a process-based, dynamic malaria model driven by hindcasts from a state-of-the-art seasonal climate model from the European Centre for Medium-Range Weather Forecasts. We validate the climate and malaria models against observed meteorological and incidence data for Botswana over the period 1982–2006; the longest record of observed incidence data which has been used to validate a modeling system of this kind. We consider the impact of climate model biases, the relationship between climate and epidemiological predictability and the potential for skillful malaria forecasts. Forecast skill is demonstrated for upper tercile malaria incidence for the Botswana malaria season (January–May), using forecasts issued at the start of November; the forecast system anticipates six out of the seven upper tercile malaria seasons in the observational period. The length of the validation time series gives confidence in the conclusion that it is possible to make reliable forecasts of seasonal malaria risk, forming a key part of a health early warning system for Botswana and contributing to efforts to adapt to climate change.

Environmental change and Rift Valley fever in eastern Africa: projecting beyond HEALTHY FUTURES

Outbreaks of Rift Valley fever (RVF), a relatively recently emerged zoonosis endemic to large parts of sub-Saharan Africa that has the potential to spread beyond the continent, have profound health and socio-economic impacts, particularly in communities where resilience is already low. Here output from a new, dynamic disease model [the Liverpool RVF (LRVF) model], driven by downscaled, bias-corrected climate change data from an ensemble of global circulation models from the Inter-Sectoral Impact Model Intercomparison Project run according to two radiative forcing scenarios [representative concentration pathway (RCP)4.5 and RCP8.5], is combined with results of a spatial assessment of social vulnerability to the disease in eastern Africa. The combined approach allowed for analyses of spatial and temporal variations in the risk of RVF to the end of the current century. Results for both scenarios highlight the high-risk of future RVF outbreaks, including in parts of eastern Africa to date unaffected by the disease. The results also highlight the risk of spread from/to countries adjacent to the study area, and possibly farther afield, and the value of considering the geography of future projections of disease risk. Based on the results, there is a clear need to remain vigilant and to invest not only in surveillance and early warning systems, but also in addressing the socio-economic factors that underpin social vulnerability in order to mitigate, effectively, future impacts.

Projecting malaria hazard from climate change in eastern Africa using large ensembles to estimate uncertainty.

The effect of climate change on the spatiotemporal dynamics of malaria transmission is studied using an unprecedented ensemble of climate projections, employing three diverse bias correction and downscaling techniques, in order to partially account for uncertainty in climate- driven malaria projections. These large climate ensembles drive two dynamical and spatially explicit epidemiological malaria models to provide future hazard projections for the focus region of eastern Africa. While the two malaria models produce very distinct transmission patterns for the recent climate, their response to future climate change is similar in terms of sign and spatial distribution, with malaria transmission moving to higher altitudes in the East African Community (EAC) region, while transmission reduces in lowland, marginal transmission zones such as South Sudan. The climate model ensemble generally projects warmer and wetter conditions over EAC. The simulated malaria response appears to be driven by temperature rather than precipitation effects. This reduces the uncertainty due to the climate models, as precipitation trends in tropical regions are very diverse, projecting both drier and wetter conditions with the current state-of-the-art climate model ensemble. The magnitude of the projected changes differed considerably between the two dynamical malaria models, with one much more sensitive to climate change, highlighting that uncertainty in the malaria projections is also associated with the disease modelling approach.

A dynamic, climate-driven model of Rift Valley fever

Outbreaks of Rift Valley fever (RVF) in eastern Africa have previously occurred following specific rainfall dynamics and flooding events that appear to support the emergence of large numbers of mosquito vectors. As such, transmission of the virus is considered to be sensitive to environmental conditions and therefore changes in climate can impact the spatiotemporal dynamics of epizootic vulnerability. Epidemiological information describing the methods and parameters of RVF transmission and its dependence on climatic factors are used to develop a new spatio-temporal mathematical model that simulates these dynamics and can predict the impact of changes in climate. The Liverpool RVF (LRVF) model is a new dynamic, process-based model driven by climate data that provides a predictive output of geographical changes in RVF outbreak susceptibility as a result of the climate and local livestock immunity. This description of the multi-disciplinary process of model development is accessible to mathematicians, epidemiological modellers and climate scientists, uniting dynamic mathematical modelling, empirical parameterisation and state-of-the-art climate information.

Development of dynamical weather-disease models to project and forecast malaria in Africa

Background Weather and climate play an important role in the spread of malaria. Suitable weather conditions for malaria are found in sub-Saharan Africa, where most of the worldwide malaria cases and deaths are found. For this reason, integrated weather-disease malaria models are useful tools to project the malaria future and to provide monthly-toseasonal forecasts. Methods Malaria projections and forecasts are undertaken by two dynamical mathematical-biological malaria models: (i) the LMM (Liverpool Malaria Model) [1-3] and (ii) VECTRI (VECtor-borne disease community model of the International Centre for Theoretical Physics, TRIeste). Both models are driven by daily temperature and precipitation values. An improved version of the LMM was introduced by [2], which was calibrated by malaria field observations from West Africa [3]. Regarding the assessment of the impact of climate change on malaria [4], the LMM was driven by data from the REgional MOdel (REMO) including the effect of land surface changes. For the QWeCI (Quantifying Weather and Climate Impacts on health in developing countries) project, a seamless weather prediction system has been developed at ECMWF by appending the first 25 days of the monthly forecasting system with the Seasonal Forecasting System 4 to provide a continuous 120 day lead time prediction. The forecast is calibrated to correct for displacement errors of West African monsoonal precipitation. Results and outlook The malaria projections up to 2050 [4] based on the integrated REMO-LMM reveal a southward shift of the epidemic malaria area in West Africa due to the precipitation decline. The increased temperatures lead to an increase of transmission in highland territories. Formerly, malaria free areas become epidemic, whereas the epidemic risk is