Dengue Track, digital disease surveillance and eHealth – an interview

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This month Infectious Diseases Hub is investigating all aspects of mosquito-borne diseases – in light of this we spoke to the Aaron Hoyles, the Program Manager of Break Dengue about their disease-surveillance tool, Dengue Track.

Dengue Track is pioneering an innovative, community-driven approach to mapping dengue outbreaks and has plans to expand and possible incorporate related diseases such as Zika and chikungunya. Read our interview below to find out more about dengue, the Dengue Track project and their plans for the future.

First, could you outline Dengue Track and the rationale behind this project?

The WHO estimates that there are over 390 million dengue infections per year with an economic impact estimated at over €7.5 billion (US$8 billion). It’s likely that dengue is more significant than malaria in terms of lives lost and global economic impact; however, the lack of accurate mechanisms to track the spread and impact of the disease severely limits efforts to make an impact.

“Break Dengue responded to the WHO’s call for new approaches to the fight against dengue by working to develop a digital solution to the surveillance problem”

With these circumstances in mind, Break Dengue responded to the WHO’s call for new approaches to the fight against dengue by working to develop a digital solution to the surveillance problem. Dengue Track – an innovative self-learning, digital surveillance tool – is the first result from this project.

The Dengue Track application uses crowd-sourced information to track the spread of dengue fever and provide ‘tool kits’ of resources targeted to those affected by the disease. Through geo-localization and a scripted chat, Dengue Track identifies the location of users and collects key information. By talking about dengue cases near them, “Dengue Trackers” collectively paint a more accurate picture of dengue fever in their area and can help to predict future outbreaks. Because the effectiveness of our model relies on having a high volume of users, the application is scalable and we offer it for free installation on partner’s websites.

Why do you feel dengue specifically is a research area of unmet need?

In addition to the reasons I listed above, the last few years have seen a dramatic increase in the number of diagnosed dengue cases along with the appearance of explosive outbreaks of dengue, such as the one declared by the WHO this May in Peru that killed 19. This led the WHO to establish goals aiming to drastically reduce the disease’s impact by 2020.

With the recent approval of the first dengue vaccine and more vaccination options soon to be available, there’s an additional need for dengue surveillance to monitor and assess strategies related to vaccination.

Have any results from the project been particularly surprising or promising so far?

The initial results from the launch of Dengue Track are promising. Users of the application have a high level of engagement with over 90% of visitors to the application providing qualitative data.

“The initial results from the launch of Dengue Track are promising.”

Working with our partners at Harvard Medical School and Boston Children’s Hospital (both MA, USA), Break Dengue has tested the efficacy of a more advanced surveillance model that incorporates data from multiple, internet-based data sources in addition to crowd-sourcing information via the scripted chat. Analyzing trends in dengue-related Google searches has been demonstrated to correlate with dengue activity and our coalition’s methodology is the focus of a peer-reviewed research paper to be published later this year.

Break Dengue’s results in advancing eHealth have also been featured in a WHO case study on the subject. Our goal now is to build a coalition with the right funding and resources to further develop our innovation and make a greater impact.

You are looking to incorporate Dengue Track into a wider tool – could you describe some of the future developments you’re hoping carry out?

Yes, right now we’re calling this next step in the development of our dengue surveillance tool the ‘Dengue eBarometer’. The concept is to build upon learnings from Dengue Track to develop a near real-time, geolocalized alert system for dengue and other vector-borne diseases.

By incorporating the best components from multiple data sources and processing this data through the proprietary algorithm developed by our partners at Boston Children’s Hospital and Harvard Medical School, we can deliver an overall accuracy greater than the sum of each individual data source.

“The concept is to build upon learnings from Dengue Track to develop a near real-time, geolocalized alert system for dengue and other vector-borne diseases.”

The surveillance tool will then display the results of processing this data on an interactive map, providing a disease ‘forecast’ by country and region. The goal is to accomplish this in near real-time. Key components of our approach have already received initial validation, explained in our upcoming peer-reviewed paper.

The Dengue eBarometer will process and displays data compiled from traditional epidemiological sources, crowd-surveillance with Dengue Track, Google search queries and other data from social media (e.g., Facebook, Twitter). We want to build this tool with an iterative approach that has the ability to incorporate future data sources, such as the results of rapid diagnostic tests, demographic data, socioeconomic data, vector data, weather data etc.

Do you feel the principles established by Dengue Track are applicable to the surveillance of other diseases?

The Aedes aegypti mosquito that provides the vector for dengue fever is also the vector for chikungunya, Rift Valley fever, yellow fever and Zika. Therefore, our surveillance tool, and the collaborative approach Break Dengue has taken to build the eBarometer, can be extended to all of these vector-borne diseases. They each lack effective and near real-time surveillance tools. A multi-disease approach can also lead to the discovery of new synergies in combating these diseases and foster the sharing of best practices.

How important has collaboration been in this project?

Break Dengue’s entire approach to driving change is by acting as a partner and catalyst in enabling and implementing integrated solutions towards the WHO 2020 dengue objectives.

“The mission of the Break Dengue alliance is to connect, share and develop innovative solutions to dengue fever.”

The mission of the Break Dengue alliance is to connect, share and develop innovative solutions to dengue fever. Vector control, surveillance, drugs, diagnostics and vaccines all hold exciting potential but none can solve the problem alone. Because we need an integrated approach we must work with a diverse range of stakeholders; each of whom brings a particular perspective and unique resources to bear on the problem.

Our work developing Dengue Track in partnership with Boston Children’s Hospital and Harvard Medical School was important training in how to build effective partnerships to solve complex societal problems – not an easy task!

Finally, how has epidemiology changed in recent years with the advent of digital technologies and how do you feel this will progress going forwards?

The WHO eHealth case study that Break Dengue’s work was featured does a good job of highlighting many of the ways digital technologies have changed the landscape of global health in general. The explosion of data sources, the maturation of ‘Big Data’ and the democratization of access to data provides a wealth of opportunities for epidemiology.

This opportunity is tied to a crucial challenge, the need to harness the data, clean it and process it in a way that is reliable for use by the epidemiological community and public health institutions.

Further Reading
  1. Yang S, Kou SC, Lu F, Brownstein JS, Brooke N & Santillana M. Advances in using Internet searches to track dengue. PLoS Computational Biol. doi:10.1371/journal.pcbi.1005607 (2017)
  2. “Dengue and Severe Dengue.” World Health Organization. http://www.who.int/mediacentre/factsheets/fs117/en/ (Accessed on 31st March 2017)
  3. Global diffusion of eHealth: making universal health coverage achievable. Report of the third global survey on eHealth. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO.: http://apps.who.int/iris/bitstream/10665/252529/1/9789241511780-eng.pdf?ua=1
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