TY - JOUR AU - Schmidt, Chris AU - Phippard, Alba AU - Olsen, Jennifer M. AU - Wirt, Kathy AU - Riviera, Andrea AU - Crawley, Adam AU - Waterman, Steve AU - Ernst, Kacey PY - 2017/05/02 Y2 - 2024/03/29 TI - Kidenga: Public engagement for detection and prevention of Aedes -borne viral diseases JF - Online Journal of Public Health Informatics JA - OJPHI VL - 9 IS - 1 SE - Communicable Disease Surveillance Use Cases for Human, Animal, and Zoonotic Diseases DO - 10.5210/ojphi.v9i1.7694 UR - https://ojphi.org/ojs/index.php/ojphi/article/view/7694 SP - AB - <div style="left: 86.4px; top: 341.528px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.08175);" data-canvas-width="61.227199999999996">Objective</div><div style="left: 100.8px; top: 355.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.993919);" data-canvas-width="119.20400000000001">(1) Early detection of</div><div style="left: 219.998px; top: 355.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.956137);" data-canvas-width="32.4768">Aedes</div><div style="left: 252.471px; top: 355.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.995964);" data-canvas-width="211.52624">-borne arboviral disease; (2) improved</div><div style="left: 86.4px; top: 371.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.953383);" data-canvas-width="47.510239999999996">data on</div><div style="left: 133.888px; top: 371.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.974915);" data-canvas-width="64.36063999999999">Ae. aegypti</div><div style="left: 198.22px; top: 371.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.917744);" data-canvas-width="30.4844">and</div><div style="left: 228.69px; top: 371.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.99452);" data-canvas-width="81.40144">Ae. albopictus</div><div style="left: 310.06px; top: 371.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.970948);" data-canvas-width="156.01512000000002">distribution in the United</div><div style="left: 86.4px; top: 387.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00153);" data-canvas-width="325.59759999999994">States (U.S.); and (3) education of clinicians and the public.</div><div style="left: 86.4px; top: 418.328px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.11862);" data-canvas-width="79.3288">Introduction</div><div style="left: 100.8px; top: 432.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01129);" data-canvas-width="363.76192">Zika, chikungunya, and dengue have surged in the Americas over</div><div style="left: 86.4px; top: 448.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.991782);" data-canvas-width="377.55503999999996">the past several years and pose serious health threats in regions of the</div><div style="left: 86.4px; top: 464.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03675);" data-canvas-width="66.4904">U.S. where</div><div style="left: 152.896px; top: 464.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00018);" data-canvas-width="62.628">Ae. aegypti</div><div style="left: 215.508px; top: 464.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.07496);" data-canvas-width="28.3968">and</div><div style="left: 243.911px; top: 464.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01242);" data-canvas-width="79.424">Ae. albopictus</div><div style="left: 323.318px; top: 464.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.04081);" data-canvas-width="141.79359999999997">mosquito vectors occur.</div><div style="left: 86.4px; top: 480.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.969557);" data-canvas-width="60.7104">Ae. aegypti</div><div style="left: 147.099px; top: 480.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.980299);" data-canvas-width="316.63656000000003">have been detected up to 6 months of the year or longer in</div><div style="left: 86.4px; top: 496.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02003);" data-canvas-width="378.3968799999998">parts of Arizona, Florida, and Texas where mosquito surveillance is</div><div style="left: 86.4px; top: 512.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.990955);" data-canvas-width="377.42175999999995">regularly conducted. However, many areas in the U.S. lack basic data</div><div style="left: 86.4px; top: 528.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02659);" data-canvas-width="378.4172800000003">on vector presence or absence. The Zika, dengue, and chikungunya</div><div style="left: 86.4px; top: 544.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01397);" data-canvas-width="378.21055999999993">viruses range in pathogenicity, but all include asymptomatic or mild</div><div style="left: 86.4px; top: 560.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.964354);" data-canvas-width="378.9911999999996">presentations for which individuals may not seek care. Traditional</div><div style="left: 86.4px; top: 576.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01523);" data-canvas-width="378.37784000000005">passive surveillance systems rely on confirmatory laboratory testing</div><div style="left: 86.4px; top: 592.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.988209);" data-canvas-width="377.4135999999999">and may not detect emergent disease until there is high morbidity in a</div><div style="left: 86.4px; top: 608.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00417);" data-canvas-width="377.96848">community or severe disease presentation. Participatory surveillance</div><div style="left: 86.4px; top: 624.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02153);" data-canvas-width="378.42544000000015">is an approach to disease detection that allows the public to directly</div><div style="left: 86.4px; top: 640.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.967253);" data-canvas-width="378.7599999999998">report symptoms electronically and provides rapid visualization of</div><div style="left: 86.4px; top: 656.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.0172);" data-canvas-width="378.36424000000005">aggregated data to the user and public health agencies. Several such</div><div style="left: 86.4px; top: 672.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.993135);" data-canvas-width="379.9567999999999">systems have been shown to be sensitive, accurate, and timelier</div><div style="left: 86.4px; top: 688.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03151);" data-canvas-width="380.98767999999995">than traditional surveillance. We developed Kidenga, a mobile</div><div style="left: 86.4px; top: 704.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.972849);" data-canvas-width="379.15168000000006">phone app and participatory surveillance system, to address some</div><div style="left: 86.4px; top: 720.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.974561);" data-canvas-width="379.4127999999999">of the challenges in early detection of day-biting mosquitoes and</div><div style="left: 86.4px; top: 736.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.950131);" data-canvas-width="32.27279999999999">Aedes</div><div style="left: 118.696px; top: 736.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.982642);" data-canvas-width="344.72736000000003">-borne arboviruses and to enhance dissemination of information</div><div style="left: 86.4px; top: 752.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00159);" data-canvas-width="125.80000000000001">to at-risk communities.</div><div style="left: 86.4px; top: 783.128px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.07381);" data-canvas-width="55.9096">Methods</div><div style="left: 100.8px; top: 797.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00167);" data-canvas-width="365.8943999999999">Kidenga sends a weekly push notification prompting users to</div><div style="left: 86.4px; top: 813.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.981769);" data-canvas-width="379.3720000000001">report symptoms, travel history, and day-biting mosquito activity.</div><div style="left: 86.4px; top: 829.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.980564);" data-canvas-width="377.30479999999994">If an individual reports through Kidenga that they or a family member</div><div style="left: 86.4px; top: 845.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03471);" data-canvas-width="378.65119999999996">have had symptoms consistent with Zika, dengue, or chikungunya,</div><div style="left: 86.4px; top: 861.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.97985);" data-canvas-width="377.3564800000001">they receive an email with educational information about the diseases,</div><div style="left: 86.4px; top: 877.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.985032);" data-canvas-width="376.9716">prevention strategies, and treatment/testing information for clinicians.</div><div style="left: 86.4px; top: 893.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02895);" data-canvas-width="378.82663999999994">Upon registration, users can opt in to have additional follow-up via</div><div style="left: 86.4px; top: 909.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.953632);" data-canvas-width="379.27544000000006">email. At any time, users may also view maps of aggregated user</div><div style="left: 86.4px; top: 925.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00248);" data-canvas-width="377.7998399999999">reports, confirmed case counts by county from public health partners</div><div style="left: 86.4px; top: 941.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.969741);" data-canvas-width="83.38160000000002">(in pilot areas),</div><div style="left: 169.816px; top: 941.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.946128);" data-canvas-width="32.136799999999994">Aedes</div><div style="left: 201.967px; top: 941.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.978142);" data-canvas-width="261.5551999999999">distribution maps, information about prevention</div><div style="left: 86.4px; top: 957.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03161);" data-canvas-width="378.67024">and control strategies, and news on the diseases and vectors from a</div><div style="left: 86.4px; top: 973.481px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02413);" data-canvas-width="378.58727999999996">curated newsfeed. Users in select pilot areas may also receive press</div><div style="left: 86.4px; top: 989.481px; font-size: 13.6px; font-family: serif; transform: scaleX(0.991835);" data-canvas-width="377.49247999999994">releases issued by their state or local public health department related</div><div style="left: 86.4px; top: 1005.48px; font-size: 13.6px; font-family: serif; transform: scaleX(0.962072);" data-canvas-width="379.3448">to the diseases and their vectors. University of Arizona owns and</div><div style="left: 86.4px; top: 1021.48px; font-size: 13.6px; font-family: serif; transform: scaleX(0.954763);" data-canvas-width="379.27952">maintains the app and its data. Local and state health departments</div><div style="left: 86.4px; top: 1037.48px; font-size: 13.6px; font-family: serif; transform: scaleX(0.999268);" data-canvas-width="377.73999999999995">that want more detailed information on user symptoms and mosquito</div><div style="left: 86.4px; top: 1053.48px; font-size: 13.6px; font-family: serif; transform: scaleX(0.94673);" data-canvas-width="379.0075199999997">activity may request and monitor the data at no cost. A marketing</div><div style="left: 86.4px; top: 1069.48px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00651);" data-canvas-width="380.54567999999966">campaign to recruit a broad user base is being implemented in</div><div style="left: 86.4px; top: 1085.48px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00763);" data-canvas-width="155.61120000000005">Arizona, Texas, and Florida.</div><div style="left: 86.4px; top: 1115.93px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.0848);" data-canvas-width="49.123200000000004">Results</div><div style="left: 100.8px; top: 1130.28px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02388);" data-canvas-width="364.2283999999999">Kidenga was developed with significant input from public health</div><div style="left: 86.4px; top: 1146.28px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01741);" data-canvas-width="270.9528">stakeholders and launched in September 2016</div><div style="left: 357.228px; top: 1146.28px; font-size: 13.6px; font-family: serif;">,</div><div style="left: 360.829px; top: 1146.28px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00446);" data-canvas-width="106.12079999999997">accompanied by</div><div style="left: 86.4px; top: 1162.28px; font-size: 13.6px; font-family: serif; transform: scaleX(0.967644);" data-canvas-width="378.9775999999999">English and Spanish radio public service announcements in select</div><div style="left: 489.6px; top: 339.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.961014);" data-canvas-width="378.81575999999967">Arizona markets, press releases, and a social marketing campaign.</div><div style="left: 489.6px; top: 355.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.03752);" data-canvas-width="381.37663999999967">A Spanish version of the app is under development. We will</div><div style="left: 489.6px; top: 371.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00099);" data-canvas-width="380.29135999999994">describe the results of user registration and survey submissions,</div><div style="left: 489.6px; top: 387.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.990398);" data-canvas-width="379.6195200000002">challenges identified during development and deployment of this</div><div style="left: 489.6px; top: 403.881px; font-size: 13.6px; font-family: serif; transform: scaleX(0.974401);" data-canvas-width="379.3991999999999">novel surveillance system, plans for data use and evaluation, and</div><div style="left: 489.6px; top: 419.881px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00152);" data-canvas-width="229.28240000000002">collaborations with public health partners.</div><div style="left: 489.6px; top: 450.328px; font-size: 13.6px; font-family: sans-serif; transform: scaleX(1.10338);" data-canvas-width="81.6136">Conclusions</div><div style="left: 504px; top: 464.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.959377);" data-canvas-width="364.9152">The utility of Kidenga as a surveillance system will depend on</div><div style="left: 489.6px; top: 480.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.0336);" data-canvas-width="378.55599999999987">broad and consistent participation among diverse user populations,</div><div style="left: 489.6px; top: 496.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.993013);" data-canvas-width="377.49384">particularly in low-risk areas; strategies to integrate health reports for</div><div style="left: 489.6px; top: 512.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.02111);" data-canvas-width="378.6280799999999">high-risk populations who may not have smartphones; validation of</div><div style="left: 489.6px; top: 528.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01044);" data-canvas-width="378.09087999999997">data and development of sensitive and specific algorithms for taking</div><div style="left: 489.6px; top: 544.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.04361);" data-canvas-width="379.0727999999999">public health action, and buy-in from public health departments to</div><div style="left: 489.6px; top: 560.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.01235);" data-canvas-width="378.11127999999985">use the data and advocate for this novel surveillance tool. Kidenga’s</div><div style="left: 489.6px; top: 576.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.978831);" data-canvas-width="230.79200000000012">secondary function as an education tool on</div><div style="left: 720.384px; top: 576.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.950131);" data-canvas-width="32.27279999999999">Aedes</div><div style="left: 752.66px; top: 576.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.976247);" data-canvas-width="114.18831999999996">-borne viruses is less</div><div style="left: 489.6px; top: 592.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.04955);" data-canvas-width="378.9231999999998">dependent upon a large user base and can be evaluated separately.</div><div style="left: 489.6px; top: 608.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.977101);" data-canvas-width="336.8719999999998">Participatory surveillance systems that specifically monitor</div><div style="left: 826.579px; top: 608.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.968149);" data-canvas-width="32.8848">Aedes</div><div style="left: 859.471px; top: 608.681px; font-size: 13.6px; font-family: serif;">-</div><div style="left: 489.6px; top: 624.681px; font-size: 13.6px; font-family: serif; transform: scaleX(0.973789);" data-canvas-width="379.3720000000002">borne pathogens are relatively new, and the challenges associated</div><div style="left: 489.6px; top: 640.681px; font-size: 13.6px; font-family: serif; transform: scaleX(1.00207);" data-canvas-width="356.17039999999986">with their early detection may differ from those of other diseases.</div> ER -