Modeling Biotic and Abiotic Drivers of Public Health Risk from West Nile Virus in Ohio, 2002-2006 DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Paul Angelo Rosile, MPH Graduate Program in Public Health The Ohio State University 2014 Dissertation Committee: Michael Bisesi, PhD, Advisor Song Liang, PhD, co-Advisor Jiyoung Lee, PhD Ningchuan Xiao, PhD Armando Hoet, DVM, PhD Von Sigler, PhD Copyright by Paul Angelo Rosile, MPH 2014 Abstract West Nile virus (WNV) disease in humans causes systemic febrile illness, meningoencephalitis, and death. The WNV, a reemerging pathogen, found its way to New York City, United States of America (U.S.), from the Mediterranean region in Europe in 1999 causing a countrywide epizootic and epidemic by 2003, and by 2012, leaving a reported 37,088 total human cases, 16,196 neuroinvasive cases, 1474 deaths, with an average case fatality rate of 10% in its wake. From 2002-2006, Ohio reported 669 human cases, 487 neuroinvasive cases, and 47 deaths, 5536 WNV positive mosquito pools, and 1328 WNV total positive dead birds. This study used captured data from this time frame to address the gap in translational research between mosquito control theoreticians and practitioners for better understanding, preventing, and controlling WNV transmission hazards and risks to humans, by developing a practical predictive model to be used in their mosquito control programs. Time-delayed indices were constructed as time periods relative to the week mosquitoes were trapped (weeks before and during the trapping week) to reach this goal. Temperature (T), weekly cumulative precipitation (CP), and the Palmer Index (PDI) informed these indices that estimated the temporal position of phases of the mosquito life cycle and the ecological conditions necessary for the development within these phases in ii relation to the trapping week. Descriptive statistical tools were used to characterize temporal and spatial patterns of: 1) T, CP, and the PDI relative to documented WNV mosquito infection; and, 2) reported human WNV disease, WNV positive bird deaths, mosquito infection rates (IRs), and mosquito density (abundance), by week, year and Ohio County, and within the broader context of the U.S.. Regression analyses were performed using these same indices as predictor variables with mosquito IRs as the outcome to determine the biological and meteorological drivers underlying WNV infections in mosquitoes, and using mosquito IRs as the predictor variable with human WNV case onsets as the outcome. A mathematical model (MM) was developed, evaluated and calibrated at the state and county levels using independent datasets from different years, by integrating functions containing the statistically significant meteorological drivers of WNV disease transmission, which resulted from the regression analysis and literature parameter values, into differential equations in order to gain insight into the biological processes fundamental to increased WNV infection in mosquitoes. The public health implications of this study should be realized with continued research on connecting the descriptive, statistical and mathematical model outcomes to real-life applications of mosquito vector control. The knowledge gained from continuing this translational research at the county level should improve the predictive capacity of the modeling in order to cost-effectively reduce WNV transmission hazards and public health risks. iii Dedication This document is dedicated to all those lives touched by West Nile virus and other vector-borne diseases. iv Acknowledgments I would like to thank my wife, Mary, and my twins, Paul Vinny and Michael, for their unwavering love, support, motivating memes and unselfishness during my doctoral program; my curriculum committee for requiring higher-level statistics as part of my coursework; my dissertation committee for their guidance and patience; the CPH Graduate Studies Committee for their administrative support; and to the mosquito control and public health professionals in Ohio who contributed the data that ensured the success of this research. Special thanks are given to Drs. Bisesi, Liang, and Weghorst, for being my technical and inspirational advisors. To the dedicated College of Public Health staff: Judy Dawson, Jennifer Wells, Erin Strawser, Dawn Williams, Kathy Renick, Susan Price, and Don Shymanski and the IS staff, which helped me in times of need. Special thanks to Feng Zhang for her GIS maps and to Juan Peng, Xin Huang, Di Cao, and Jess Ramey for their critical review of my statistical methods. To all of the West Nile virus researchers who contributed to the scientific literature and to vector control practitioners, thank you for your dedication to the prevention and control of WNV disease and for being prepared to research and to confront all emerging and reemerging vector-borne diseases. v Vita 1972................................................................Hubbard High School 1976................................................................B.S. Biology, Heidelberg University 1977-1979………………………………….. Registered Sanitarian, Seneca County General Health District 1977-1986…………………………………..Private sector employment in the food service industry, chef/co-owner Angelo’s Iron Gate Café, Tiffin, Ohio 1986-1990 ......................................................Registered Sanitarian, Franklin County General Health District 1990-1999 ......................................................Assistant Health Commissioner, Environmental Health Director, Delaware County/City Combined General Health District 1994................................................................M.P.H. The Ohio State University 1999-2012 ......................................................Assistant Health Commissioner, Environmental Health Director, Franklin County General Health District vi Publications Water Environment Research Foundation (WERF). (2012). Surveillance and Investigation of the Illness Reported by Neighbors of Biosolids Land Application and Other Soil Amendments, Pilot Testing. WERF and the International Water Association (IWA) Water Intelligence Online © IWA Publishing 2012. (Paul Rosile, PI, Song Liang, Tim Buckley, Kathleen Carr, and Jennifer Li) Silva HP, Rosile PA. Community environmental health assessment - The Delaware city- county health department experience, phase I - Issues identification. Journal of Environmental Health. 1999. 62(3): 9-15. Fields of Study Major Field: Public Health vii Table of Contents Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iv Acknowledgments................................................................................................................v Vita ..................................................................................................................................... vi Publications . ……………………………………………………………………………. vii Table of Contents………………………………………………………………………..viii List of Tables ................................................................................................................... xiv List of Figures ................................................................................................................. xvii Chapter 1: Introduction ........................................................................................................1 1.1 Significance, rationale, and innovation ..........................................................................1 1.2 Study framework and overall research objective ...........................................................7 1.3 Research questions .........................................................................................................8 1.3.1 Research question 1 ..............................................................................................8 1.3.2 Research question 2 ..............................................................................................9 1.3.3 Research question 3 ..............................................................................................9 1.4 Research hypotheses ......................................................................................................9 1.4.1 Research hypothesis 1 ...........................................................................................9 viii 1.4.2 Research hypothesis 2 .........................................................................................10 1.4.3 Research hypothesis 3 .........................................................................................11 1.5 Specific aims ................................................................................................................11 1.5.1 Specific aim 1 ......................................................................................................11 1.5.2 Specific aim 2 ......................................................................................................12 1.5.3 Specific aim 3 ......................................................................................................12 1.6 Organization of the dissertation ..................................................................................13 1.7 Background ..................................................................................................................14