Person:

McGough, Sarah

Background: Over 400,000 people across the Americas are thought to have been infected with Zika virus as a consequence of the 2015–2016 Latin American outbreak. Official government-led case count data in Latin America are typically delayed by several weeks, making it difficult to track the disease in a timely manner. Thus, timely disease tracking systems are needed to design and assess interventions to mitigate disease transmission. Methodology/Principal Findings We combined information from Zika-related Google searches, Twitter microblogs, and the HealthMap digital surveillance system with historical Zika suspected case counts to track and predict estimates of suspected weekly Zika cases during the 2015–2016 Latin American outbreak, up to three weeks ahead of the publication of official case data. We evaluated the predictive power of these data and used a dynamic multivariable approach to retrospectively produce predictions of weekly suspected cases for five countries: Colombia, El Salvador, Honduras, Venezuela, and Martinique. Models that combined Google (and Twitter data where available) with autoregressive information showed the best out-of-sample predictive accuracy for 1-week ahead predictions, whereas models that used only Google and Twitter typically performed best for 2- and 3-week ahead predictions. Significance Given the significant delay in the release of official government-reported Zika case counts, we show that these Internet-based data streams can be used as timely and complementary ways to assess the dynamics of the outbreak.

Abstract Background: Antibiotic resistance is considered as one of our greatest emerging public health threats. Current understanding of the factors governing spread of antibiotic-resistant organisms and mechanisms among populations is limited. Methods: We explored the roles of local temperature, population density, and additional factors on the distribution of antibiotic resistance across the United States, using a database of regional antibiotic resistance that incorporates over 1.6 million bacterial pathogens from human clinical isolates over the years 2013–2015. Results: We identified that increasing local temperature as well as population density were associated with increasing antibiotic resistance in common pathogens. An increase in temperature of 10oC was associated with increases in antibiotic resistance of 4.2%, 2.2%, and 3.6% for the common pathogens Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. The effect of temperature on antibiotic resistance was robust across almost all classes of antibiotics and pathogens and strengthened over time. Conclusion: These findings suggest that current forecasts of the burden of antibiotic resistance could be significant underestimates in the face of a growing population and warming planet. Figure 1. Antibiotic resistance increases with increasing temperature. (A) A heatmap of mean normalized antibiotic resistance for E. coli for all antibiotics across the USA. (B) A heatmap of 30-year average minimum temperature (oC) across the USA. Disclosures All authors: No reported disclosures.