Improving early detection of yellow fever outbreaks: predicting risk and assessing diagnostic strategies in Ghana - Yellow fever is a mosquito-borne viral hemorrhagic fever and re-emerging threat, causing multiple recent outbreaks in Africa and South America. Delayed detection of yellow fever in endemic regions leads to epidemics and increased mortality. Factors contributing to delayed recognition of outbreaks in Africa include the changing populations at risk for yellow fever, diagnostic delays, and resource constraints. The overall objective of the proposed study is to improve early detection of yellow fever outbreaks through predicting areas at greatest risk, identifying relative diagnostic delays, and comparing the impact of new diagnostic strategies. This work will take place in Ghana, a high-risk country for yellow fever with multiple recent outbreaks. The central hypothesis is that yellow fever outbreaks are most likely to originate in rural locations with limited access to diagnostics, and local data-informed models can identify these areas to allocate diagnostic resources. The central hypothesis will be tested through pursuing three specific aims: 1) to develop subnational risk maps for yellow fever in Ghana using local data and machine learning, 2) to quantify patient and specimen delays using local yellow fever diagnostic data and spatial statistics, and 3) to compare the cost- effectiveness of different strategies for yellow fever diagnostic resource allocation. Each aim will involve field data collection, novel analytical and modeling methods, and evidence translation for policymakers. This innovative approach could then be applied to improve detection of yellow fever and other emerging zoonotic and vector-borne diseases in other countries. The results of this research will be directly translatable to national and international policymakers. It will also increase knowledge about the risk for yellow fever and other Aedes-borne arboviruses in Africa in the setting of environmental change. This K08 award will also support the career development of the PI, Dr. Seth Judson, an infectious disease physician who aims to become an independent investigator at the nexus of virus eco-epidemiology, modeling, and policy. To achieve these goals and the proposed research, Dr. Judson has created a career development plan and mentorship team to gain expertise in field epidemiology, virus ecology, laboratory diagnostics, spatial modeling, and evidence translation for policymakers. This includes primary mentor, Dr. David Dowdy (Johns Hopkins University), and co-mentors Drs. Vincent Munster (NIAID), Amy Wesolowski (Johns Hopkins University), and Ernest Kenu (University of Ghana). By conducting this research and developing a unique skillset combining field data collection, modeling, and policy translation, Dr. Judson will be well-prepared to become an independent investigator who creates tools for decision-makers to improve early detection and mitigation of arboviruses and hemorrhagic fever viruses.
