Pivotal Interfaces of Environmental Health and Infectious Disease Research to Inform Responses to Outbreaks, Epidemics, and Pandemics Proceedings of a Workshop–in Brief (2021) / Chapter Skim
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Pivotal Interfaces of Environmental Health and Infectious Disease Research to Inform Responses to Outbreaks, Epidemics, and Pandemics
Pivotal Interfaces of Environmental Health and Infectious Disease Research to Inform Responses to Outbreaks, Epidemics, and Pandemics
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The virtual workshop Pivotal Interfaces of Environmental Health and Infectious Disease Research to Inform Responses to Outbreaks, Epidemics, and Pandemics was held on June 8–9, 2021. This workshop provided a venue for experts in infectious diseases, environmental health, and data science from government, academia, and the private sector to examine current knowledge about the environment–infectious disease interface and to explore how this knowledge can be used to inform public health decisions.
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While the 2019 workshop focused on the interplay among environmental stressors, infectious disease, and human health at the individual level, the 2021 workshop focused on the environment's role in infectious disease across populations. In a series of presentations and panel discussions, participants examined the application of environmental science perspectives to pathogen transmission, the translation of technical tools from environmental surveillance to monitor and predict the spread of infectious disease, and the integration of complex data sets to enable the transition from data collection to data utilization.
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In particular, Cassetti suggested that collaboration between public health researchers and ecologists could improve understanding and the prediction of vector-borne diseases, while Collman said that integrating data on infectious diseases into long-term cohort studies on environmental exposures could further elucidate how the environment and pathogens interact to cause or exacerbate disease. KNOWLEDGE AND TOOLS AT THE ENVIRONMENT–INFECTIOUS DISEASE INTERFACE Understanding Exposure and Transmission Basic science and modeling studies have helped elucidate some of the myriad ways environmental factors might affect exposure to pathogens and the pathways through which diseases spread.
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from an infected human host to a susceptible human host, a process that could also involve nonhuman intermediate or alternative hosts; (3) environmentally mediated transmission, in which a pathogen is transmitted to a susceptible human host via the environment with or without the presence of a nonhuman host (examples include respiratory, waterborne, and foodborne pathogens)
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For example, Milton cautioned that many school systems invested in plexiglass partitions for classrooms when this was thought to help block the spread of SARS-CoV-2 via spray droplets, but more recent evidence suggests that these partitions increase, rather than decrease, transmission via BOX 1 Breakout Scenario on Airborne Exposure and Detection Participants in this breakout session considered research and policy interventions relevant to the emergence of an unknown pathogen that is suspected to be airborne. Assuming uncertainties regarding the pathogen, its movement, and its impacts, participants discussed examples of research needs to inform outbreak response and interventions, including • developing diagnostic tools and containment measures; • validating novel technologies; and • bridging research pillars between public health, laboratory science, epidemiology, and big data modeling.
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Bautista underscored the need for concrete, reliable surveillance information, noting that hints from social media or other sources can come too late or be too unreliable to inform accurate predictions. Cascio said it would be helpful to have a standardized methodology for detecting viral RNA and ways to associate detected RNA level in wastewater with infectivity, though Larsen noted that wastewater surveillance can be useful for informing public health decisions even before these details are fully understood.
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They also discussed the importance of a dynamic conceptual site model to organize thoughts and policy interventions available related to the pathogen's source, transport pathways, and exposure routes. IMPROVING MODELS TO INFORM PUBLIC HEALTH DECISIONS Opportunities in Combining Data and Expertise Across Disciplines Collaboration to advance knowledge and inform decisions at the environment–infectious disease interface could benefit from combining data and expertise across disciplines.
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In addition to enhancing and combining the many sources of quantitative data, Bertozzi-Villa, Noor, and Pan emphasized the importance of qualitative data, which informs the interpretation of quantitative data and helps fill the knowledge gaps. "It is absolutely critical that we contextualize the quantitative data with some understanding of what's happening in the place where you've made that measurement qualitatively," Noor said.
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Demonstrating the usefulness of some of these nontraditional data streams, in Bangladesh, Mahmud and colleagues combined epidemiological surveys with telecommunications data to model the spread of chikungunya during a travelintensive holiday period.9 When a cyclone sparked a cholera outbreak in Mozambique, the researchers combined information on previous cholera dynamics with flooding data and models of human mobility to identify populations at high risk and inform vaccine allocation.10 To ensure forecasts are actionable and useful, Mahmud said, requires basic health surveillance infrastructure along with partnerships among government, academia, and private industry that are centered in community needs. While academic research is useful for building capacity and developing tools and methods, she argued that "the bulk of this work really needs to happen within local public health agencies," which she suggested should establish direct links with novel data streams such as telecommunications providers and social media platforms and use the data to inform outbreak response and control efforts.
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Schmitt suggested that approaches such as natural language processing could potentially help fuse data sets across domains. Foley noted that visualizations can help researchers identify the most important pieces on which to focus, and Fung added that many barriers to the use of big data and AI relate to interfaces and design issues, rather than algorithms themselves.
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She underscored the need for many types of tools, including those for detecting and monitoring infectious diseases, such as genomic surveillance and crowdsourcing approaches, and tools for monitoring and modeling the environment. She pointed to the role of AI and data science in advancing the capacity to integrate complex data streams and tools, while recognizing the need to address biases, standards, privacy concerns, and regulatory issues in the collection, integration, and use of data.
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Munster, National Institute of Allergy and Infectious Diseases; and Svitlana Volkova, Pacific Northwest National Laboratory. The Standing Committee on the Use of Emerging Science for Environmental Health Decisions, under which this workshop was organized, is supported by the National Institute of Environmental Health Sciences.
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