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Abstract ObjectivesWest Nile virus (WNV) is the most common mosquito-borne disease in the United States. Predicting the location and timing of outbreaks would allow targeting of disease prevention and mosquito control activities. Our objective was to develop software (ArboMAP) for routine WNV forecasting using public health surveillance data and meteorological observations. Materials and MethodsArboMAP was implemented using an R markdown script for data processing, modeling, and report generation. A Google Earth Engine application was developed to summarize and download weather data. Generalized additive models were used to make county-level predictions of WNV cases. ResultsArboMAP minimized the number of manual steps required to make weekly forecasts, generated information that was useful for decision-makers, and has been tested and implemented in multiple public health institutions. Discussion and ConclusionRoutine prediction of mosquito-borne disease risk is feasible and can be implemented by public health departments using ArboMAP. 

Meteorological data for public health surveillanceMichael Wimberly, Professor from the University of Oklahoma, walks us through integrating meteorological data for public health surveillance and disease forecasting. Public health surveillance involves the collection, analysis, interpretation, and dissemination of health-related data to plan, implement, and evaluate public health practices. The resulting information supports the detection of emerging health threats, planning interventions, and evaluating policies and programs to protect and improve population health. 

Revolutionising disease detection: The emergence of non-invasive VOC breathomicsBreathomics marks a revolutionary approach to disease detection by analyzing the chemical composition of exhaled breath. As the world recovers from the recent global health crises, the detection and management of pandemic diseases like COVID-19, RSV, and flu have come to the forefront. The COVID-19 pandemic alone has affected over 96 million people in the US, with a devastating count of more than a million fatalities. Similarly, respiratory syncytial virus (RSV) and influenza (flu) collectively burden the healthcare system with millions of cases annually, leading to hundreds of thousands of hospitalizations and tens of thousands of deaths. These staggering statistics underscore an urgent need for diagnostic methods that are not only swift and accurate but also non- invasive to facilitate rapid, widespread testing. Enter Breathomics—a revolutionary approach that analyzes the chemical composition of exhaled breath to detect diseases. 

A comprehensive approach to integrated one health surveillance and responseSurveillance data plays a crucial role in understanding and responding to emerging infectious diseases; here, we learn why adopting a One Health surveillance approach to EIDs can help to protect human, animal, and environmental health. Over 75% of emerging infectious diseases (EIDs) affecting humans are zoonotic diseases with animal hosts, which can be transmitted by waterborne, foodborne, vector-borne, or air-borne pathways. (7) Early detection is important and allows for a rapid response through preventive and control measures. However, early detection of EIDs is hindered by several obstacles, such as climate change, which can alter habitats, leading to shifts in the distribution of disease- carrying vectors like mosquitoes and ticks. This can result in diseases such as malaria, dengue fever, and Lyme disease becoming more common in areas with established transmission or spreading to new areas entirely. (4) Environmental changes such as deforestation and urbanization disrupt ecosystems, increasing the likelihood of zoonotic disease spillover from wildlife to humans. In addition to working at the interface of these changes, detection and tracking of EIDs also requires sharing and standardization of complex data and integrating processes across different regions and health systems. 

Wastewater surveillance for infectious disease preparednessThe University of Oklahoma Wastewater Based Epidemiology (OU WBE) team highlights successes from their three years of wastewater surveillance in Oklahoma & how this surveillance approach can be used as next-level monitoring for infectious disease preparedness. The OU WBE team, founded by Bradley Stevenson, Jason Vogel, and Katrin Gaardbo Kuhn in response to the COVID-19 pandemic in Summer 2020, has expanded to one of the most extensive wastewater monitoring networks in the world with a team that has included over 50 faculty, students and staff. In a paper published in 1942, Drs. James Trask and John Paul described a study to detect poliovirus in wastewater samples collected in New York and New Haven. They concluded, “It is likely that the periodic sampling of sewage for pathogenic viruses or bacteria may be a method of epidemiological value”. (1) Since then, wastewater surveillance has been used to detect sporadic outbreaks or clusters of various infectious pathogens, reaching new levels of routine utilization during the COVID-19 pandemic.(2) 

This clinical study presents a comprehensive investigation into the utility of breath analysis as a non-invasive method for the early detection of lung cancer. The study enrolled 14 lung cancer patients, 14 non-lung cancer controls with diverse medical conditions, and 3 tuberculosis (TB) patients for biomarker discovery. Matching criteria including age, gender, smoking history, and comorbidities were strictly followed to ensure reliable comparisons. A systematic breath sampling protocol utilizing a BIO-VOC sampler was employed, followed by VOC analysis using Thermal Desorption–Gas Chromatography–Mass Spectrometry (TD-GC/MS). The resulting VOC profiles were subjected to stringent statistical analysis, including Orthogonal Projections to Latent Structures—Discriminant Analysis (OPLS-DA), Kruskal–Wallis test, and Receiver Operating Characteristic (ROC) analysis. Notably, 13 VOCs exhibited statistically significant differences between lung cancer patients and controls. The combination of eight VOCs (hexanal, heptanal, octanal, benzaldehyde, undecane, phenylacetaldehyde, decanal, and benzoic acid) demonstrated substantial discriminatory power with an area under the curve (AUC) of 0.85, a sensitivity of 82%, and a specificity of 76% in the discovery set. Validation in an independent cohort yielded an AUC of 0.78, a sensitivity of 78%, and a specificity of 64%. Further analysis revealed that elevated aldehyde levels in lung cancer patients’ breath could be attributed to overactivated Alcohol Dehydrogenase (ADH) pathways in cancerous tissues. Addressing methodological challenges, this study employed a matching of physiological and pathological confounders, controlled room air samples, and standardized breath sampling techniques. Despite the limitations, this study’s findings emphasize the potential of breath analysis as a diagnostic tool for lung cancer and suggest its utility in differentiating tuberculosis from lung cancer. However, further research and validation are warranted for the translation of these findings into clinical practice. 

During the COVID-19 pandemic, wastewater surveillance was widely used to monitor temporal and geographical infection trends. Using this as a foundation, a statewide program for routine wastewater monitoring of gastrointestinal pathogens was established in Oklahoma. The results from 18 months of surveillance showed that wastewater concentrations of Salmonella, Campylobacter, and norovirus exhibit similar seasonal patterns to those observed in reported human cases (F = 4–29, p < 0.05) and that wastewater can serve as an early warning tool for increases in cases, offering between one- and two-weeks lead time. Approximately one third of outbreak alerts in wastewater correlated in time with confirmed outbreaks of Salmonella or Campylobacter and our results further indicated that several outbreaks are likely to go undetected through the traditional surveillance approach currently in place. Better understanding of the true distribution and burden of gastrointestinal infections ultimately facilitates better disease prevention and control and reduces the overall socioeconomic and healthcare related impact of these pathogens. In this respect, wastewater represents a unique opportunity for monitoring infections in real-time, without the need for individual human testing. With increasing demands for sustainable and low-cost disease surveillance, the usefulness of wastewater as a long-term method for tracking infectious disease transmission is likely to become even more pronounced. 

Applying data science advances in disease surveillance and control Dr. David S. Ebert and Dr. Aaron Wendelboe explain how a cohesive, multidisciplinary, and multi-tiered approach can support a more predictive model in disease surveillance and control. Public health disease surveillance is being conducted in countless settings, including healthcare, vertebrate and invertebrate animals, wastewater, air quality, transportation, and commercial activities, but, attaining the goal of early disease detection has been somewhat elusive. For instance, one of the few key shortcoming of public health preparedness efforts is the insufficient collaboration between multidisciplinary experts, such as data scientists, computer engineers, anthropologists, social scientists, and systems engineers. To address these gaps in knowledge and preparedness, we are responding in a multi-tiered approach with a One Health perspective that will be economically feasible and sustainable. The authors have also engaged a broad set of stakeholders, created broad multidisciplinary teams, are combining relevant data sources in innovative ways that will serve as early indicators, are using advanced technologies for early diagnosis, and advancing analytic methods to maintain high specificity for true event identification.