title: Rainfall and sentinel chicken seroconversions predict human cases of Murray Valley encephalitis in the north of Western Australia.
abstract: BACKGROUND
  Murray Valley encephalitis virus (MVEV) is a flavivirus that occurs in Australia and New Guinea. While clinical cases are uncommon, MVEV can cause severe encephalitis with high mortality. Sentinel chicken surveillance is used at many sites around Australia to provide an early warning system for risk of human infection in areas that have low population density and geographical remoteness. MVEV in Western Australia occurs in areas of low population density and geographical remoteness, resulting in logistical challenges with surveillance systems and few human cases. While epidemiological data has suggested an association between rainfall and MVEV activity in outbreak years, it has not been quantified, and the association between rainfall and sporadic cases is less clear. In this study we analysed 22 years of sentinel chicken and human case data from Western Australia in order to evaluate the effectiveness of sentinel chicken surveillance for MVEV and assess the association between rainfall and MVEV activity.
  
  
  METHODS
  Sentinel chicken seroconversion, human case and rainfall data from the Kimberley and Pilbara regions of Western Australia from 1990 to 2011 were analysed using negative binomial regression. Sentinel chicken seroconversion and human cases were used as dependent variables in the model. The model was then tested against sentinel chicken and rainfall data from 2012 and 2013.
  
  
  RESULTS
  Sentinel chicken seroconversion preceded all human cases except two in March 1993. Rainfall in the prior three months was significantly associated with both sentinel chicken seroconversion and human cases across the regions of interest. Sentinel chicken seroconversion was also predictive of human cases in the models. The model predicted sentinel chicken seroconversion in the Kimberley but not in the Pilbara, where seroconversions early in 2012 were not predicted. The latter may be due to localised MVEV activity in isolated foci at dams, which do not reflect broader virus activity in the region.
  
  
  CONCLUSIONS
  We showed that rainfall and sentinel chickens provide a useful early warning of MVEV risk to humans across endemic and epidemic areas, and that a combination of the two indicators improves the ability to assess MVEV risk and inform risk management measures.
authors.affiliation: School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. Linda.selvey@curtin.edu.au.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Selvey
authors.affiliation: The Arbovirus Surveillance and Research Laboratory, M504 School of Pathology and Laboratory Medicine, QEII Medical Centre, The University of Western Australia, Nedlands, WA, 6009, Australia. cheryl.johansen@uwa.edu.au.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Johansen
authors.affiliation: PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, 6009, Australia. Annette.broom@pathwest.wa.gov.au.
authors.forename: Annette K
authors.initials: AK
authors.lastname: Broom
authors.affiliation: NSW Department of Family and Community Services, 320 Liverpool Rd, Ashfield, NSW, 2131, Australia. catarinantao@gmail.com.
authors.forename: Catarina
authors.initials: C
authors.lastname: Antão
authors.affiliation: Environmental Health Directorate, WA Health, Perth, WA, Australia. Michael.lindsay@health.wa.gov.au.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Lindsay
authors.affiliation: Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. J.Mackenzie@curtin.edu.au.
authors.forename: John S
authors.initials: JS
authors.lastname: Mackenzie
authors.affiliation: School of Pathology and Laboratory Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, WA, Australia. David.smith@health.wa.gov.au.
authors.forename: David W
authors.initials: DW
authors.lastname: Smith
mesh_terms: D000818:Animals; D000914:Antibodies, Viral / Q000276:immunology*; D001102:Arbovirus Infections / Q000276:immunology / Q000662:veterinary*; D001315:Australia / Q000453:epidemiology; D002645:Chickens / Q000276:immunology*; D004196:Disease Outbreaks; D018068:Encephalitis Virus, Murray Valley / Q000276:immunology*; D004671:Encephalitis, Arbovirus / Q000453:epidemiology*; D006801:Humans; D011891:Rain; D018571:Sentinel Surveillance; D014904:Western Australia / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral