Impact of human mobility on the emergence of dengue epidemics in Pakistan.
The recent emergence of dengue viruses into new susceptible human populations throughout Asia and the Middle East, driven in part by human travel on both local and global scales, represents a significant global health risk, particularly in areas with changing climatic suitability for the mosquito vector. In Pakistan, dengue has been endemic for decades in the southern port city of Karachi, but large epidemics in the northeast have emerged only since 2011. Pakistan is therefore representative of many countries on the verge of countrywide endemic dengue transmission, where prevention, surveillance, and preparedness are key priorities in previously dengue-free regions. We analyze spatially explicit dengue case data from a large outbreak in Pakistan in 2013 and compare the dynamics of the epidemic to an epidemiological model of dengue virus transmission based on climate and mobility data from ∼40 million mobile phone subscribers. We find that mobile phone-based mobility estimates predict the geographic spread and timing of epidemics in both recently epidemic and emerging locations. We combine transmission suitability maps with estimates of seasonal dengue virus importation to generate fine-scale dynamic risk maps with direct application to dengue containment and epidemic preparedness.
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115; Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA 02115;
Amy
A
Wesolowski
Telenor Research, Telenor Group, N-1360 Fornebu, Norway;
Taimur
T
Qureshi
Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7FZ, United Kingdom;
Maciej F
MF
Boni
Telenor Research, Telenor Group, N-1360 Fornebu, Norway;
Pål Roe
PR
Sundsøy
Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA 02115; Division of Vector-Borne Diseases, Centers for Disease Control, San Juan, Puerto Rico 00920;
Michael A
MA
Johansson
Department of Zoology, University of Peshawar, Peshawar 25120, Pakistan.
Syed Basit
SB
Rasheed
Telenor Research, Telenor Group, N-1360 Fornebu, Norway;
Kenth
K
Engø-Monsen
Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115; Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA 02115; cbuckee@hsph.harvard.edu.
Caroline O
CO
Buckee
D040421:Cell Phone; D003715:Dengue / Q000453:epidemiology* / Q000635:transmission; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D006801:Humans; D008954:Models, Biological; D010154:Pakistan / Q000453:epidemiology; D011156:Population Density; D013997:Time Factors; D014195:Travel
Pakistan; dengue; epidemiology; human mobility; mobile phones