A Novel Approach to Modeling Epidemic Vulnerability, Applied to Aedes aegypti -Vectored Diseases in Perú

Background: A proactive approach to preventing and responding to emerging infectious diseases is critical to global health security. We present a three-stage approach to modeling the spatial distribution of outbreak vulnerability to Aedes aegypti-vectored diseases in Peru. Methods: Extending a framework developed for modeling hemorrhagic fever vulnerability in Africa, we modeled outbreak vulnerability in three stages: index case potential (stage 1), outbreak receptivity (stage 2), and epidemic potential (stage 3), stratifying scores on season and El Nino events. Subsequently, we evaluated the validity of these scores using dengue surveillance data and spatial models.  Findings: We found high validity for stage 1 and 2 scores, but not stage 3 scores. Vulnerability was highest in Selva Baja and Costa, and in summer and during El Nino events, with index case potential (stage 1) being high in both regions but outbreak receptivity (stage 2) being generally high in Selva Baja only. Interpretation: Stage 1 and 2 scores are well-suited to predicting outbreaks of Ae aegypti-vectored diseases in this setting, however stage 3 scores appear better suited to diseases with direct human-to-human transmission. To prevent such outbreaks, measures to detect index cases should be targeted to both Selva Baja and Costa, while Selva Baja should be prioritized for healthcare system strengthening. Successful extension of this framework from hemorrhagic fevers in Africa to an arbovirus in Latin America indicates its broad utility for outbreak and pandemic preparedness and response activities. Funding: JM: NIH/NIEHS T32 ES015459-09 CWM: NOAA NA18OAR4310342 PMR, LAF: University of Washington Population Health Initiative Declaration of Interests: The authors declare no competing interests.