Bi-directional communication platforms, participatory surveillance and social listening: Lessons and challenges from the Zika pandemic Presented by Dr. Kacey Ernst University of Arizona
Zika Pandemic: Overview
Specific Zika Pandemic Challenges Challenge Aedes aegypti highly invasive, exploits small often cryptic sources. Requires vigilance. High level of asymptomatic and mild cases. Rapid emergence to new locations. High degree of uncertainty about transmission risk, rapidly evolving scientific evidence. Role of Communication Community and household level engagement to remove water sources is essential to reducing risk. Syndromic reporting of community members to identify clusters of syndromes consistent with Zika infection. Identify and relay when and where first cases originate and areas with highest risk for future emergence. Communication streams must be fluid and timely to provide new information as it develops and dispel rumors.
Social listening during the Zika pandemic Variable Number of posts (%) Most popular post Useful information 162 (81) 21 (12) WHO Live press briefing on Zika virus * Misleading/misguiding information 10 reasons why Zika virus fear is another fraudulent medical hoax and vaccine industry funding scam Total views 43,000 535,000 (178,000 + 357,000) Total shares 964 15,300 + 4,300 Average shares for all posts 200 740 Fig. 1. The number of Zika vaccine tweets and tweets with pseudo-scientific claims coincides about the Zika vaccine for 7 day periods for the first 120 days of 2016. [Dredze et. al. 2016] Table 1. Facebook (Facebook Inc, Menlo Park, CA) posts about the Zika virus pandemic with the most popular post characteristics. [Sharma et. al. 2016]
Bi-Directional Information Exchange to Detect and Control Disease Spread Public provides weekly geobased symptom and mosquito data Experts provide up-todate advice Objectives Kidenga V1.0 participator surveillance and education/ communication exchange Rapidly identify clusters of potential transmission Provide education to the public Obtain information on daybiting mosquitoes Kidenga sponsored by University of Arizona with support from the Centers for Disease Control, Skoll Global Threats Fund
Public Health Benefit and Impact of Coupled Bi-directional Communication and Participatory Surveillance Empowered, aware and educated community takes more actions consistent with CDC and partner guidance Early detection and early response by public health to rapidly reduce vector populations in focal areas Reduce contacts with infectious vectors and flatten the epidemic curve Kidenga, mobile crowd-sourcing surveillance for mosquito-borne diseases.
Approach may need to differ for emerging and established threats Novel pathogen Ex. Zika virus Challenges Rumors will be high Media attention will be high Uncertainty from science and public health experts high Opportunities Risk behaviors may be more readily modifiable Emergence of est. pathogen into new area Ex. Dengue outbreak in Florida Challenges Uncertainty from science and public health experts moderate Opportunities Lessons available from other areas Seasonal pandemic Ex. Dengue in Puerto Rico Challenges Message fatigue Complacency Opportunities Well-established best practices for community engagement in control/prevention Lower levels of uncertainty Knowledge base higher (maybe)
Develop synergies among communication modalities Challenges Rumor monitoring Health concern prioritization Penetration and acceptance of communication platform and surveillance Bi-directional communication platforms Address rumors and health concerns Provide tailored risk awareness from participatory surveillance Enhance engagement Link exposure and syndromic field data with social media feeds Cohort seeds for social media dissemination of more accurate information Populations equivalent? (benefit?) Timeliness of analysis and integration Social listening Participatory surveillance
Key Opportunity: Educate, entertain, and collect data Context: Communication platforms must engage and educate to have a sustained impact Gap: Individuals may lose interest. Target: Educational games Rationale: 70% of teachers reported increasing student engagement with games [Ash et. al. 2012]. Children act as health messengers to family [Ayi et. al. 2010]. Educational game mock-up: Hunting for mosquitoes in a virtual world or a real one
Key Opportunity: Precision Messaging Context: Personalized health messaging may bemore effective [Kreuter et. al. 2000]. Gap: Current messaging may not effectively reach those at highest risk. Target: Develop shareable spatially and temporally targeted messaging. Rationale: Social media platforms currently used to target marketing based on profiles Transmission risk is clustered geographic targeting Disseminate through communication platforms Expected Outcomes: Increased health action Sharing highly relevant content with friends messaging Geographically targeted weatherbased warnings to motivate action
Key Challenge: Evaluation Context: Ultimate goal of bi-directional communication and participatory surveillance motivating action. Gap: Typically risk communication is evaluated on comprehension, appear, attitude change Target: Behavior changes and risk reduction evaluation Strategies: Incorporate action into the interaction Geo-tag mosquito habitat and treat it Report symptoms Use secondary data to evaluate ultimate outcomes Traps set for weekly monitoring of mosquitoes in Maricopa County, AZ, potential to randomize and geographically target and examine ultimate impact of Ae. aegypti indices reduction
Key Challenge: Ethics of participatory surveillance Context: Community-based surveillance falls between standard regulatory oversight bodies IRB HIPAA FDA Gap: Balance of public health action and privacy; when to provide public health with user information Target: Develop process to address current gap
Key Challenge and Opportunity: Public Health Collaborations Collaborations can be challenged by: Logistics in data and information exchange Determining when and how data should be used for public health action Reliability Accuracy Consistency in public health messaging Collaborations provide an opportunity for: Transparency Rapid dissemination of critical and accurate information for prevention and control Provision of early alerts and risk information
ACKNOWLEDGEMENTS University of Arizona James Romine Andrea Rivera Chris Schmidt Htay Hla Nirav Merchant Centers for Disease Control and Prevention Alba Phippard Steve Waterman Heather Joseph Project director Kathy Wirt SkollGlobal Threats Fund Jennifer Olsen Adam Crawley Jessica Shao Funding for the development and marketing of Kidenga provided by: CDC and Skoll Global Threats Fund
References 1. Dredze M., Broniatowski DA, Hilyard KM, Zika vaccine misconceptions: A social media analysis. Vaccine, Volume 34, Issue 30, 2016, 3441 3442. 2. Sharma M, Yadav K, Yadav N, Ferdinand KC. Zika virus pandemic-analysis of Facebook as a social media health information platform. Am J Infect Control. 2016 Oct 21. pii: S0196-6553(16)30918-X. doi: 10.1016/j.ajic.2016.08.022. [Epub ahead of print] 3. Ash K., Digital Gaming in Classrooms Seen Gaining Popularity. Education week. 2012. Vol. 31, Issue 30, Pages 12-13. 4. Ayi I, Nonaka D, Adjovu JK, Hanafusa S, Jimba M, Bosompem KM, Mizoue T, Takeuchi T, Boakye DA, Kobayashi J. School-based participatory health education for malaria control in Ghana: engaging children as health messengers. Malaria Journal. 2010;9(1):1-12. doi: 10.1186/1475-2875-9-98. 5. Kreuter MW, Farrell D, Olevitch L, Brennan L. Tailoring health messages: Customizing communication with computer technology.mahwah, NJ: Erlbaum; 2000.