FLIRT-ing with Zika: A Web Application to Predict the Movement of Infected Travelers Validated Against the Current Zika Virus Epidemic

Abstract

Introduction: Beginning in 2015, Zika virus rapidly spread throughout the Americas and has been linked to neurological and autoimmune diseases in adults and babies. Developing accurate tools to anticipate Zika spread is one of the first steps to mitigate further spread of the disease. When combined, air traffic data and network simulations can be used to create tools to predict where infectious disease may spread to and aid in the prevention of infectious diseases. Specific goals were to: 1) predict where travelers infected with the Zika Virus would arrive in the U.S.; and, 2) analyze and validate the open access web application’s (i.e., FLIRT) predictions using data collected after the prediction was made.Method: FLIRT was built to predict the flow and likely destinations of infected travelers through the air travel network. FLIRT uses a database of flight schedules from over 800 airlines, and can display direct flight traffic and perform passenger simulations between selected airports. FLIRT was used to analyze flights departing from five selected airports in locations where sustained Zika Virus transmission was occurring. FLIRT’s predictions were validated against Zika cases arriving in the U.S. from selected airports during the selected time periods. Kendall’s τ and Generalized Linear Models were computed for all permutations of FLIRT and case data to test the accuracy of FLIRT’s predictions.Results: FLIRT was found to be predictive of the final destinations of infected travelers in the U.S. from areas with ongoing transmission of Zika in the Americas from 01 February 2016 - 01 to April 2016, and 11 January 2016 to 11 March 2016 time periods. MIA-FLL, JFK-EWR-LGA, and IAH were top ranked at-risk metro areas, and Florida, Texas and New York were top ranked states at-risk for the future time period analyzed (11 March 2016 - 11 June 2016). For the 11 January 2016 to 11 March 2016 time period, the region-aggregated model indicated 7.24 (95% CI 6.85 – 7.62) imported Zika cases per 100,000 passengers, and the state-aggregated model suggested 11.33 (95% CI 10.80 – 11.90) imported Zika cases per 100,000 passengers.Discussion: The results from 01 February 2016 to 01 April 2016 and 11 January 2016 to 11 March 2016 time periods support that modeling air travel and passenger movement can be a powerful tool in predicting where infectious diseases will spread next. As FLIRT was shown to significantly predict distribution of Zika Virus cases in the past, there should be heightened biosurveillance and educational campaigns to medical service providers and the general public in these states, especially in the large metropolitan areas.

Digital Technology and Mobile Applications Impact on Zika and Ebola Epidemics Data Sharing and Emergency Response

“…A recent published paper on Zika epidemics have shown that the public showed more concern about the complications or consequences it had for women and babies, whereas WHO and CDC increased Zika epidemics guidelines and precautionary measures for women at child bearing information, awareness and active education. Whereas, another study showed such approach that tends to be episodic and ephemeral rather than coherent, comprehensive and sustained by all stakeholders over time [19,20]. Public authority announcements can give the importance of trust and credibility for information acceptance using Google Trends.…”

“…Keeping the existing community and public informed about updates and mitigation wider reach through SMS and internet-based applications, social media engagement and participation individuals from remote rural communities. Moreover, to sharing objective and true journalism on burial practices on Ebola spread, monitoring closed circuit and other mass media surveillance data and information access and uptake against Zika and Ebola epidemics in high-and low risk zones and cross-borders entries ports, patients, individuals and collective displacement tracing, tracking and monitoring [9,14,19,20].…”

“…Such patient or uncertified images of suffering and display of Ebola patients in the media also raises questions regarding informed consent, dignity and privacy. While certain organizations have cautioned people against putting themselves in danger to collect footage, many media organizations do not emphasize the importance of ethical practice, patient dignity, seeking informed consent process and ethical clearance [19,26].…”

“…Factors that were previously seen as barriers, such as information wider reach for all, real time health and epidemics literacy, online solutions and social mobilization and participation to the community have now being leveraged and optimized through advances digital technology access, acceptance and use. Previous studies have reported that the complexity level to prevent and respond to the Ebola and Zika virus epidemics events is due to the remoteness, underserved and culturally affected populations and weak health systems access and coverage inequities [9,10,19,20].…”

“…Nowadays, populations which were previously marginalized or particularly remotely vulnerable to infectious diseases and epidemics now have a voice in the global community and access to reliable healthcare advice and resources. These tools can assist in tracking and tracing of some major outbreaks with real time mapping that allows for quicker response, as demonstrated by HealthMap for the Ebola outbreak (http://www.healthmap.org/ en/) and Zika websites [9,10,19,20,34,35]. The HealthMap developed by a team of researchers, epidemiologists, and software designers at Boston Children's Hospital was used to detect Ebola and use for online informal sources, to monitor disease outbreak and real-time surveillance.…”