Burgio: GIS: Validità e Limiti della Nuova Epidemiologia

• 1. GIS and Epidemiology Ernesto Burgio Comitato Scientifico ISDE Italia exposure to electromagnetic fieldsvector-borne diseasessurveillance and monitoring ofwater borne diseases

2. A map of cholera deaths in London, 1840s Acontaminated water pump in Broad Street proved to be the source for the spread of cholera(Drawn by Dr John Snow about 1854; shown in Stamp, L. D. 1964,A Geography of Life and Death .). This redrafting leaves out someinteresting bits of evidencethat appeared on the original map , and in Tufte's version. For instance, there wasa building across the street from the pump that had no deaths at all .In1854 ,John Snow depicted acholera outbreakin Londonusing points to represent the locationsof some individual cases,possiblytheearliest use of the geographic method 3. High-risk areas can be identifiedusingGISandremote sensing technologiesthat would otherwise be difficult to detect using traditional methods. GISserves as a commonplatform for convergence ofmulti-disease surveillance activities . Public health resources, specific diseases and otherhealth events canbe mapped in relation to their surrounding environmentand existinghealth and social infrastructures .Such information when mapped together createsa powerful tool for monitoring and management of epidemics .. the diseases are classified aswater borne, vector borne, air borne, food borne..thevulnerable regions prone to these diseasesare identified by identifying thevector breeding sites, flow direction of the air, locating the places of stagnant water . By tracking the sources of diseases and themovement of contagions , thepopulations at riskwere identified 4. 1).. themapof BITS campus. It also shows the differenthostels , staff quarters, institute,wells, stagnant water bodies ,shopping centre 2) 2d view of theflow pattern of waterdependingon the elevation ofgroundat different sites 3)..flow direction of airtaken into considerationpoint vectorsand thevulnerable areas to thatparticular flow directionare identified 4..buffers created for the hostels, staff quarters, institute, market place and thevector breeding sites(theflight range of vectors are generally within 1km radiusfrom different vector sites..) environmental and seasonal changes prevent the survival of many vectors. 5. 6. 7. 8. Therangesof severalkey diseasesortheir vectorsare alreadychanging 9. West Nile

• The four species represented in the next four slides have tested positive for West Nile Virus in each of the past four years

• They are:Culex salinarius,Culex pipiens,Culex restuans ,and Aedes vexans .

College of African Wildlife Management 10. Culex pipiens Center for Food Security and Public HealthIowa State University 2004 Source: NASA at http://www.gsfc.nasa.gov/topstory/20020828phap.html 11. Culex restuans Center for Food Security and Public HealthIowa State University 2004 Source: NASA at http://www.gsfc.nasa.gov/topstory/20020828phap.html 12. Culex salinarius Center for Food Security and Public HealthIowa State University 2004 Source: NASA at http://www.gsfc.nasa.gov/topstory/20020828phap.html 13. Aedes vexans Center for Food Security and Public HealthIowa State University 2004 Source: NASA at http://www.gsfc.nasa.gov/topstory/20020828phap.html 14. West Nile

• NationalCumulative2007 HumanDisease Cases:3623

College of African Wildlife Management 15. Datasets used to model the temporal patterns ofcholera OUTBREAKS chlorophyll concentration In1998 , the National Aeronautics and Space Administration's ( NASA ) Center for Health Applications of Aerospace Related Technologies ( CHAART ) evaluatedcurrent and plannedsatellite sensor systemsas a first step in enabling human health scientists to determinedata relevant for theepidemiologic, entomologic, and ecologic aspects of their research , as well as developing remotesensing-basedmodels of transmission risk . .. howremote sensing data from different satellite systemscan becombined to characterize and map environmental variables in the Bay of Bengalthat areassociated with the temporal patternsof cholera outbreaksin Bangladesh Lobitz B, et al.Climate and infectiousdisease: Use of remote sensing for detectionofVibrio cholerae by indirect measurement . PNAS 2000;97:1438-43 .Sea surfacetemperaturedata Vibrio choleraeassociatedwithinland water Plankton blooms(cold water upwellingin marine environment) 16. 17. H5N1 Wild Bird Flu Outbreaks February 2006 18. 19. 20. The maximum clade credibility (MCC) tree of H1N1pdm with CTMC spatial reconstruction. Lineages are coloured according to the highest posterior probability for location (these probabilities are shown when > 0.5).The blue band represents the 95% credible interval for the time of the most recent common ancestor. 21. http://flutracker.rhizalabs.com/ 22. La correlazione tra gli eventi stata chiarita ? 23. Counter Bioterrorism 2002PanicoaPalermo 24. (in genere vengono paragonatedue popolazioni)

• laltra un po meno ( id estpi distante dallimpianto ma comunqueesposta agli stessi inquinanti(per via diretta o da fonti diffuse,in primisil traffico veicolareo per via indiretta attraverso lacatena alimentare)

• una molto esposta .. ( id estdirettamente esposta alle emissioni dellimpianto)

N il discorso cambia di molto se si paragonano lincidenza locale di una o pi patologie (prevalentementeneoplastiche )..e lecosiddette patologie attese ,chesono a loro volta il fruttodi una esposizione massiccia e progressiva agli stessi inquinanti (e la cui incidenza aumenta nel tempo di pari passo allinquinamento); 25. analisi peranelli(Km dalla fonte) invece che perlivelli (concentrazioni) 26. 11.. le popolazioni (periodi, aree,...)esposteenon espostesonomescolateinvece che confrontate.. 12.. non si analizzano lesottopopolazionipi fragilied esposte:donne residenti ,bambini .. 13.. Lapopolazione di riferimentotroppo diversada quella studiata.. 14.. Lapopolazione di riferimentotroppo similea quella studiata.. a list of 15 points oriented to show the reason whywe cannot take for grantedthat the studied population is ingood health even if the scientific documentation has given some indicationsabout it.. 15.. si prende in considerazioneun singolo inquinante(es. amianto o benzene odiossineometalli pesantioNO2 ) e/o unasingola fonte(es. un singolo camino).. 27. Il grafico riporta ilrischio di morte per tumore polmonare standardizzato per et (SMR)di gruppi di lavoratori di una fabbrica per la produzione dicromati . I gruppi sono differenti per mansione, durata dellesposizione e latenza.LSMR passa da 131 a 322, raggiungendo anche lasignificativit statisticaescludendo quei lavoratori, a partire dagliimpiegati , che non erano presumibilmente a contatto con il cromo o lo erano stati pertroppo breve tempo. Lerrata inclusione nel gruppo esposto di tutti i lavoratori ha prodotto una vistosa sottostima del rischio ( diluition effect ). IlRapporto Standardizzato di Mortalit (SMR) esprime il rapporto tra decessiosservati e decessi attesi , cio il numero di deceduti (per singola causa o gruppo di cause) che si sarebbero dovuti verificare se la popolazione in studio (quella dei lavoratori esposti) avesse subto la mortalit (per singola causa o gruppo di cause) della popolazione di riferimento. Lasignificativit statistica al 95% (p