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Dengue fever and other febrile mosquito-borne diseases place considerable health and economic burdens on small island nations in the Caribbean. Here, we used two methods of cluster detection to find potential hotspots of transmission of dengue and chikungunya in Barbados, and to assess the impact of input surveillance data and methodology on observed patterns of risk. Using Moran’s I and spatial scan statistics, we analyzed the geospatial and temporal distribution of disease cases and rates across Barbados for dengue fever in 2013–2016, and a chikungunya outbreak in 2014. During years with high numbers of dengue cases, hotspots for cases were found with Moran’s I in the south and central regions in 2013 and 2016, respectively. Using smoothed disease rates, clustering was detected in all years for dengue. Hotspots suggesting higher rates were not detected via spatial scan statistics, but coldspots suggesting lower than expected rates of disease activity were found in southwestern Barbados during high case years of dengue. No significant spatiotemporal structure was found in cases during the chikungunya outbreak. Spatial analysis of surveillance data is useful in identifying outbreak hotspots, potentially complementing existing early warning systems. We caution that these methods should be used in a manner appropriate to available data and reflecting explicit public health goals—managing for overall case numbers or targeting anomalous rates for further investigation.

Sea surface temperature conditions in the central-eastern tropical Pacific indicated a mild El Niño event in October 2018, which continued throughout the spring of 2019. The global El Niño Southern Oscillation (ENSO) forecast consensus was that these generally weak warm patterns would persist at least until the end of the summer. El Niño and its impact on local climatic conditions in southern coastal Ecuador influence the inter-annual transmission of dengue fever in the region. In this study, we use an ENSO model to issue forecasts of El Niño for the year 2019, which are then used to predict local climate variables, precipitation and minimum temperature, in the city of Machala, Ecuador. All these forecasts are incorporated in a dengue transmission model, specifically developed and tested for this area, to produce out-of-sample predictions of dengue risk. Predictions are issued at the beginning of January 2019 for the whole year, thus providing the longest forecast lead time of 12 months. Preliminary results indicated that the mild El Niño event did not provide the optimum climate conditions for dengue transmission, with the model predicting a very low probability of a dengue outbreak during the typical peak season in Machala in 2019. This is contrary to 2016, when a large El Niño event resulted in excess rainfall and warmer temperatures in the region, and a dengue outbreak occurred 3 months earlier than expected. This event was successfully predicted using a similar prediction framework to the one applied here. With the present study, we continue our efforts to build and test a climate service tool to issue early warnings of dengue outbreaks in the region.

Climate drives population dynamics through multiple mechanisms, which can lead to seemingly context-dependent effects of climate on natural populations. For climate-sensitive diseases, such as dengue, chikungunya, and Zika, climate appears to have opposing effects in different contexts. Here we show that a model, parameterized with laboratory measured climate-driven mosquito physiology, captures three key epidemic characteristics across ecologically and culturally distinct settings in Ecuador and Kenya: the number, timing, and duration of outbreaks. The model generates a range of disease dynamics consistent with observed Aedes aegypti abundances and laboratory-confirmed arboviral incidence with variable accuracy (28–85% for vectors, 44–88% for incidence). The model predicted vector dynamics better in sites with a smaller proportion of young children in the population, lower mean temperature, and homes with piped water and made of cement. Models with limited calibration that robustly capture climate-virus relationships can help guide intervention efforts and climate change disease projections., The effects of climate on vector-borne disease systems are highly context-dependent. Here, the authors incorporate laboratory-measured physiological traits of the mosquito Aedes aegypti into climate-driven mechanistic models to predict number, timing, and duration of outbreaks in Ecuador and Kenya.

Urban flooding is a major problem in many coastal cities around the world, mainly caused by factors such as poor urban planning, outdated sewer capacity or high frequent extreme events. In developing countries such as Ecuador, lack of monitoring, financial constraints and absence of proper policies exacerbate flooding problems. The use of the Stormwater Management Model (SWMM) helped to identify zones that are flooded even with a 2-year precipitation event at Duran city. Since there are no flood monitoring stations across the study area, model calibration was performed against unofficial records (people complaints, media photographs, and water marks on walls). Model results fairly agreed with those unofficial record. However, a validation process is not achievable yet due to lack of enough flood data even in flood prone areas. To further increase city resilience, authorities and stakeholders should engage in climate actions to raise flood hazard-risk awareness, monitoring hydro-meteorological factors, complement drainage operations with nature-based solutions, and improve hydrodynamic modelling to develop a flood early warning system for the city.

Urban Heat Island (UHI) research has been increasingly impacting science during the last decades. As most of humanity is living in cities, urban climatology is a consolidating field that attract more and more interest with time. Higher temperature in cities are involved in many processes and have impacts on energy needs, thermal comfort, public health and air pollution. Especially in tropical climates, where temperature and humidity ranges are high per se, the impact of urbanization processes can be even deeper. Despite of the high urbanization rates and the climate in which most populated cities of Latin-America are placed, there are only few studies that estimates UHI intensities and proposes mitigation strategies conducted in the region up to now. Here we will briefly look at the most important studies on UHI for tropical cities, then we will describe the pioneer studies that we conducted in the cities of Guayaquil and Duran, Ecuador.

Small island developing states in the Caribbean are among the most vulnerable countries on the planet to climate variability and climate change. In the last 3 decades, the Caribbean region has undergone frequent and intense heat waves, storms, floods, and droughts. This has had a detrimental impact on population health and well-being, including an increase in infectious disease outbreaks. Recent advances in climate science have enhanced our ability to anticipate hydrometeorological hazards and associated public health challenges. Here, we discuss progress towards bridging the gap between climate science and public health decision-making in the Caribbean to build health system resilience to extreme climatic events. We focus on the development of climate services to help manage mosquito-transmitted disease epidemics. There are numerous areas of ongoing biological research aimed at better understanding the direct and indirect impacts of climate change on the transmission of mosquito-borne diseases. Here, we emphasise additional factors that affect our ability to operationalise this biological understanding. We highlight a lack of financial resources, technical expertise, data sharing, and formalised partnerships between climate and health communities as major limiting factors to developing sustainable climate services for health. Recommendations include investing in integrated climate, health and mosquito surveillance systems, building regional and local human resource capacities, and designing national and regional cross-sectoral policies and national action plans. This will contribute towards achieving the Sustainable Development Goals (SDGs) and maximising regional development partnerships and co-benefits for improved health and well-being in the Caribbean., This Perspective article discusses progress towards bridging the gap between climate science and public health decision-making, highlighting the importance of multi-institutional and interdisciplinary collaborations to develop early warning systems for arboviral diseases in the Caribbean.

Between October 2018 - May 2019, sea surface temperature conditions in the central-eastern tropical Pacific indicated a mild El Niño event. In May 2019, the global El Niño Southern Oscillation (ENSO) forecast consensus was that these generally weak warm patterns will persist at least until the end of the northern hemisphere summer. El Niño and its impact on local climatic conditions in southern coastal Ecuador influence the inter-annual transmission of dengue fever in the region. In this study, we use an ENSO model to issue forecasts of El Niño for the year 2019, which are then used to predict local climate variables, precipitation and minimum temperature, in the city of Machala, Ecuador. All these forecasts are incorporated in a dengue transmission model, specifically developed and tested for this area, to produce out-of-sample predictions of dengue risk. Predictions are issued at the beginning of January 2019 for the whole year, thus providing the longest forecast lead time of 12 months. Preliminary results indicate that the mild and ongoing El Niño event did not provide the optimum climate conditions for dengue transmission, with the model predicting a very low probability of a dengue outbreak during the typical peak season in Machala in 2019. This is contrary to 2016, when a large El Niño event resulted in excess rainfall and warmer temperatures in the region, and a dengue outbreak occurred 3 months earlier than expected. This event was successfully predicted using a similar prediction framework to the one applied here. With the present study, we continue our efforts to build and test a climate service tool to issue early warnings of dengue outbreaks in the region.

Here we report the findings from the first two years of an arbovirus surveillance study conducted in Machala, Ecuador, a dengue endemic region (2014-2015). Patients with suspected dengue virus (DENV) infections (index cases, n=324) were referred from five Ministry of Health clinical sites. A subset of DENV positive index cases (n = 44) were selected, and individuals from the index household and four neighboring homes within 200-meters were recruited (n = 400). Individuals who entered the study, other than index cases, are referred to as associates. In 2014, 70.9% of index cases and 35.6% of associates had acute or recent DENV infections. In 2015, 28.3% of index cases and 12.8% of associates had acute or recent DENV infections. For every DENV infection captured by passive surveillance, we detected an additional three acute or recent DENV infections in associates. Of associates with acute DENV infections, 68% reported dengue-like symptoms, with the highest prevalence of symptomatic acute infections in children under 10 years of age. The first chikungunya virus (CHIKV) infections were detected on epidemiological week 12 in 2015. 43.1% of index cases and 3.5% of associates had acute CHIKV infections. No Zika virus infections were detected. Phylogenetic analyses of isolates of DENV from 2014 revealed genetic relatedness and shared ancestry of DENV1, DENV2 and DENV4 genomes from Ecuador with those from Venezuela and Colombia, indicating presence of viral flow between Ecuador and surrounding countries. Enhanced surveillance studies, such as this, provide high-resolution data on symptomatic and inapparent infections across the population.

Climate change presents complex and wide‐reaching threats to human health. A variable and changing climate can amplify and unmask ecological and socio‐political weaknesses and increase the risk of adverse health outcomes in socially vulnerable regions. When natural disasters occur in such areas, underlying climatic conditions may amplify the public health crisis. We describe an emerging epidemic of Zika virus (ZIKV) in Ecuador following the 2016 earthquake, which coincided with an exceptionally strong El Niño event. We hypothesize that the trigger of a natural disaster during anomalous climate conditions and underlying social vulnerabilities were force multipliers contributing to a dramatic increase in ZIKV cases postearthquake., Key Points When natural disasters occur in areas made vulnerable by climate change, the effects are multipliedClimate change makes vulnerable regions even more vulnerable and plays a role in the root cause of the eventual impacts of natural disastersMultisectoral coordination is needed to implement surveillance and response systems to detect and protect vulnerable communities

Barbados is a Caribbean island country of approximately 285,000 people, with a thriving tourism industry. In 2015, Zika spread rapidly throughout the Americas, and its proliferation through the Caribbean islands followed suit. Barbados reported its first confirmed autochthonous Zika transmission to the Pan American Health Organization in January 2016, a month before the global public health emergency was declared. After detection of suspected Zika cases on Barbados in 2015, 926 individuals were described as suspected cases, and 147 laboratory-confirmed cases were reported through December 2016, the end of the most recent epidemiological year. In this short report, we describe the epidemiological characteristics of 926 clinical case records that were originally suspected as cases of Zika, and which were subsequently sent for testing and confirmation; 147 were found positive for Zika, using reverse transcription-polymerase chain reaction methods, another 276 tested negative, and the remaining 503 were either pending results or still in the suspected category. Women were represented at about twice the rate of men in case records where gender was reported (71.9%), and confirmed cases (78.2%), and 19 of the confirmed positive cases were children under the age of 10.

ObjectiveTo detect potential hotspots of transmission of dengue and chikungunya in Barbados, and assess impact of input surveillance data and methodology on observed patterns of risk.MethodsUsing two methods of cluster detection, Moran’s I and spatial scan statistics, we analyzed the geospatial and temporal distribution of disease cases and rates across Barbados for dengue fever in 2013–2016, and a 2014 chikungunya outbreak.ResultsDuring years with high numbers of dengue cases, hotspots for cases were found with Moran’s I in south and central regions in 2013 and 2016, respectively. Using smoothed disease rates, clustering was detected every year for dengue. Hotspots were not detected via spatial scan statistics, but coldspots suggesting lower rates of disease activity were found in southwestern Barbados during high case years of dengue.ConclusionsSpatial analysis of surveillance data is useful in identifying outbreak hotspots, complementing existing early warning systems. We caution that these methods should be used in a manner appropriate to available data, and reflecting explicit public health goals – managing for overall case numbers, or targeting anomalous rates for further investigation.

Background Small island developing states (SIDS) in the Caribbean region are challenged with managing the health outcomes of a changing climate. Health and climate sectors have partnered to co-develop climate services to improve the management of emerging arboviral diseases such as dengue fever, for example, through the development of climate-driven early warning systems. The objective of this study was to identify health and climate stakeholder perceptions and needs in the Caribbean, with respect to the development of climate services for arboviruses. Methods Stakeholders included public decision makers and practitioners from the climate and health sectors at the regional (Caribbean) level and from the countries of Dominica and Barbados. From April to June 2017, we conducted interviews (n = 41), surveys (n = 32), and national workshops with stakeholders. Survey responses were tabulated, and audio recordings were transcribed and analyzed using qualitative coding to identify responses by research topic, country/region, and sector. Results Health practitioners indicated that their jurisdiction is currently experiencing an increased risk of arboviral diseases associated with climate variability, and most anticipated that this risk will increase in the future. National health sectors reported financial limitations and a lack of technical expertise in geographic information systems (GIS), statistics, and modeling, which constrained their ability to implement climate services for arboviruses. National climate sectors were constrained by a lack of personnel. Stakeholders highlighted the need to strengthen partnerships with the private sector, academia, and civil society. They identified a gap in local research on climate-arbovirus linkages, which constrained the ability of the health sector to make informed decisions. Strategies to strengthen the climate-health partnership included a top-down approach by engaging senior leadership, multi-lateral collaboration agreements, national committees on climate and health, and shared spaces of dialogue. Mechanisms for mainstreaming climate services for health operations to control arboviruses included climatic-health bulletins and an online GIS platform that would allow for regional data sharing and the generation of spatiotemporal epidemic forecasts. Stakeholders identified a 3-month forecast of arboviral illness as the optimal time frame for an epidemic forecast. Conclusions These findings support the creation of interdisciplinary and intersectoral ‘communities of practice’ and the co-design of climate services for the Caribbean public health sector. By fostering the effective use of climate information within health policy, research and practice, nations will have greater capacity to adapt to a changing climate., Author summary Small island nations in the Caribbean are highly vulnerable to climate change, whose effects include increased frequency and severity of droughts and increased intensity of tropical storms and hurricanes. Extreme weather and climate events affect directly or indirectly most dimensions of human well being, including mental and physical health, food, housing, freshwater, and livelihoods. Climate-driven early warning systems (EWS) to predict epidemics of dengue fever and other mosquito-borne diseases can help nations to adapt to changing climate conditions. In this study we assessed climate and health sector stakeholder perceptions and needs to inform the development of a dengue EWS. Stakeholders identified capacity limitations (financial resources, trained personnel), and the need for local research on climate-arbovirus linkages to inform decision makers. They identified six key strategies for strengthening the partnership between the climate-health sectors, and they assessed the viability of public health actions that could be take in response to short (2 week), medium (3 month) and long-term (1 year) forecasts of dengue fever epidemics. The results of this study contribute to Caribbean efforts to develop climate services for health, a key adaptation strategy to reduce the health impacts of climate change.

Insecticide resistance (IR) can undermine efforts to control vectors of public health importance. Aedes aegypti is the main vector of resurging diseases in the Americas such as yellow fever and dengue, and recently emerging chikungunya and Zika fever, which have caused unprecedented epidemics in the region. Vector control remains the primary intervention to prevent outbreaks of Aedes-transmitted diseases. In many high-risk regions, like southern Ecuador, we have limited information on IR. In this study, Ae. aegypti IR was measured across four cities in southern Ecuador using phenotypic assays and genetic screening for alleles associated with pyrethroid IR. Bottle bioassays showed significant inter-seasonal variation in resistance to deltamethrin, a pyrethroid commonly used by the Ministry of Health, and alpha-cypermethrin, as well as between-city differences in deltamethrin resistance. There was also a significant difference in phenotypic response to the organophosphate, Malathion, between two cities during the second sampling season. Frequencies of the resistant V1016I genotype ranged from 0.13 to 0.68. Frequencies of the resistant F1534C genotype ranged from 0.63 to 1.0, with sampled populations in Machala and Huaquillas at fixation for the resistant genotype in all sampled seasons. In Machala and Portovelo, there were statistically significant inter-seasonal variation in genotype frequencies for V1016I. Resistance levels were highest in Machala, a city with hyperendemic dengue transmission and historically intense insecticide use. Despite evidence that resistance alleles conferred phenotypic resistance to pyrethroids, there was not a precise correspondence between these indicators. For the F1534C gene, 17.6% of homozygous mutant mosquitoes and 70.8% of heterozygotes were susceptible, while for the V1016I gene, 45.6% homozygous mutants and 55.6% of heterozygotes were susceptible. This study shows spatiotemporal variability in IR in Ae. aegypti populations in southern coastal Ecuador, and provides an initial examination of IR in this region, helping to guide vector control efforts for Ae. aegypti., Author summary Mosquito control is the primary method of managing the spread of many diseases transmitted by the yellow fever mosquito (Aedes aegypti). Throughout much of Latin America the transmission of diseases like dengue fever and Zika fever pose a serious risk to public health. The rise of insecticide resistance (IR) is a major threat to established vector control programs, which may fail if commonly used insecticides are rendered ineffective. Public health authorities in southern coastal Ecuador, a high-risk region for diseases vectored by Ae. aegypti, previously had limited information on the status of IR in local populations of mosquitoes. Here, we present the first assessment of IR in adult Ae. aegypti to insecticides (deltamethrin, Malathion, and alpha-cypermethrin) routinely used in public health vector control in four cities along Ecuador’s southern coast. Observed patterns of IR differed between cities and seasons of mosquito sampling, suggesting that IR status may fluctuate in space and time. The highest overall resistance was detected in Machala, a city with hyperendemic dengue transmission and a long history of intense insecticide use. Monitoring for IR is an integral component of vector control services, where alternative management strategies are deployed when IR is detected.

Background: Populations in coastal cities are exposed to increasing risk of flooding, resulting in rising damages to health and assets. Local adaptation measures, such as early warning systems for floods (EWSFs), are urgently needed to reduce the risk and impact of flood events. The aim of this study was to assess community perceptions and self-reported actions in response to flooding in a tropical coastal city to inform flood risk reduction policies and programs.Methods: This qualitative case study was conducted in flood-prone areas in Machala, Ecuador, a coastal city exposed to seasonal floods and extreme floods during El Niño events. Adult community members from three periurban sites were invited to participate. Focus groups discussions (11 focus groups in total) were held with community members (n=65 people) from September to November 2014 to assess perceptions of flood exposure, sensitivity, adaptive capacity, and current alert systems. Focus groups discussions were audio recorded, transcribed, and coded by topic; participatory maps were field validated, georeferenced, and digitized using GIS software. Results: Community members identified the presence of annual flooding during the rainy season, as well as greater than normal flood events (depths ranging from 0.5 to 3 meters), which recurred every 3-4 years in some communities. The deepest floods occurred during the 1982 and 1997/1998 El Niño events. Community members perceived that exposure to flooding depended on the rainfall coinciding with high ocean tides, and geographic proximity to blocked drainage areas, canals, and low local elevation. Participants reported that children were the most sensitive group due to increased susceptibility to skin infections and mosquito borne diseases (i.e., dengue fever). Other sensitive groups included the elderly, physically handicapped people, low-income families, and recent migrants. They identified persistent social-ecological vulnerabilities that increased flood risk and exposure in the urban periphery, such as inadequate access to garbage collection, homes settled in precarious low-lying geographies, economic barriers, lack of political access, and lack of social mobilization. In addition, communities expressed a lack of social capital (e.g. political voice), despite the existence of formalized community councils. Key neighborhood resources with respect to flooding included green areas, schools, nurseries, fire stations, health clinics, police stations, a retention wall (berm), and an emergency meeting place. Challenges for adaptive capacity existed primarily in actions related to the preparation and recovery stages of flooding. Despite the presence of an official flood warning system, community member relied on informal communication channels via social media. Conclusions: The flood vulnerability assessment framework and participatory research process utilized here can potentially inform studies in other flood-prone regions to guide the development of EWSFs and other climate change adaptation policies and actions.

BackgroundSmall island developing states (SIDS) in the Caribbean region are challenged with managing the health outcomes of a changing climate. Health and climate sectors have partnered to co-develop climate services to improve the management of these diseases, for example, through the development of climate-driven early warning systems. The objective of this study was to identify health and climate stakeholder perceptions and needs in the Caribbean, with respect to the development of climate services for arboviruses (e.g. dengue, chikungunya, and Zika).MethodsStakeholders included public decision makers and practitioners from the climate and health sectors at the regional (Caribbean) level and from the countries of Dominica and Barbados. From April to June 2017, we conducted interviews (n=41), surveys (n=32), and national workshops with stakeholders. Survey responses were tabulated and audio recordings were transcribed and analyzed using qualitative coding to identify responses by research topic, country/region, and sector.ResultsHealth practitioners indicated that their jurisdiction is currently experiencing an increased risk of diseases transmitted byAe. aegyptidue to climate variability, and most anticipated that this risk will increase in the future. National health sectors reported financial limitations and a lack of technical expertise in geographic information systems (GIS), statistics, and modeling, which constrained their ability to implement climate services for arboviruses. National climate sectors were constrained by a lack of personnel. Stakeholders highlighted the need to strengthen partnerships with the private sector, academia, and civil society. They identified a gap in local research on climate-arbovirus linkages, which constrained the ability of the health sector to make informed decisions. Strategies to strengthen the climate-health partnership included a top-down approach by engaging senior leadership, multi-lateral collaboration agreements, national committees on climate and health, and shared spaces of dialogue. Mechanisms for mainstreaming climate services for health operations to control arboviruses included climate-health bulletins and an online GIS platform that would allow for regional data sharing and the generation of spatiotemporal epidemic forecasts.ConclusionsThese findings support the creation of interdisciplinary and intersectoral communities of practices and the co-design of climate services for the Caribbean public health sector. By fostering the effective use of climate information within health policy, research and practice, nations will have greater capacity to adapt to a changing climate.

Dengue fever is an emerging infectious disease in the Gal&aacute, pagos Islands of Ecuador, with the first cases reported in 2002 and subsequent periodic outbreaks. We report results of a 2014 pilot study conducted in Puerto Ayora (PA) on Santa Cruz Island, and Puerto Baquerizo Moreno (PB) on San Cristobal Island. To assess the socio-ecological risk factors associated with dengue and mosquito vector presence at the household level, we conducted 100 household surveys (50 on each island) in neighborhoods with prior reported dengue cases. Adult mosquitoes were collected inside and outside the home, larval indices were determined through container surveys, and heads of households were interviewed to determine demographics, self-reported prior dengue infections, housing conditions, and knowledge, attitudes, and practices regarding dengue. Multi-model selection methods were used to derive best-fit generalized linear regression models of prior dengue infection, and Aedes aegypti presence. We found that 24% of PB and 14% of PA respondents self-reported a prior dengue infection, and more PB homes than PA homes had Ae. aegypti. The top-ranked model for prior dengue infection included several factors related to human movement, household demographics, access to water quality issues, and dengue awareness. The top-ranked model for Ae. aegypti presence included housing conditions, mosquito control practices, and dengue risk perception. This is the first study of dengue risk and Ae. aegypti presence in the Gal&aacute, pagos Islands.

20 pages, 7 figures, 3 tables, supplemental material https://www.frontiersin.org/articles/10.3389/fmars.2019.00145/full#supplementary-material, Among marine phytoplankton, dinoflagellates are a key component in marine ecosystems as primary producers. Some species synthesize toxins, associated with human seafood poisoning, and mortality in marine organisms. Thus, there is a large necessity to understand the role of environmental variables in dinoflagellates spatial-temporal patterns in response to future climate scenarios. In that sense, a monthly four-year (2013–2017) monitoring was taken to evaluate dinoflagellates abundances and physical-chemical parameters in the water column at different depths. Sampling sites were established at 10 miles in four locations within the Ecuadorian coast. A total of 102 taxa were identified, corresponding to 8 orders, 22 families, and 31 genera. Eight potentially harmful genera were registered but no massive blooms were detected. The most frequent dinoflagellates were Gymnodinium sp. and Gyrodinium sp. Environmental variables showed different mixing layer thickness and a conspicuous and deepening thermocline/oxycline/halocline and nutricline depending on annual and seasonal oceanographic fluctuations. This study confirms that seasonal and spatial distribution of the environmental variables are linked to the main current systems on the Eastern Tropical Pacific, thus the warm Panama current lead to a less dinoflagellates abundance in the north of Ecuador (Esmeraldas), while the Equatorial Upwelling and the cold nutrient-rich Humboldt Current influence dinoflagellates abundance at the central (Manta, La Libertad) and South of Ecuador (Puerto Bolivar), respectively. Inter-annual variability of dinoflagellates abundance is associated with ENSO and upwelling conditions. Climate change scenarios predict an increase in water surface temperature and extreme events frequency in tropical areas, so it is crucial to involve policy-makers and stakeholders in the implementation of future laws involving long-term monitoring and sanitary programs, not covered at present, This research has been developed as an international and inter-institutional collaboration among different research institutes and universities. We would like to acknowledge the following projects and institutional support: Project “Oceanic Early Warning System,” funded by National Secretary of Science and Technology (SENESCYT) and INOCAR, Project T2-DI-2014 “Climate Variability and Harmful Algae Bloom Interaction and their impact on human health on the coast of Ecuador,” funded by the Escuela Superior Politecnica del Litoral (ESPOL)

Mangroves are the dominant coastal vegetation in tropical estuaries and host a large diversity of brachyuran crabs. Crab larvae have adapted to dynamic hydrological conditions in estuaries using several physiological and behavioral strategies. Changes in crab larval assemblages can be monitored in time in order to detect ecological changes occurring within estuaries. For this study, we sampled quarterly crab larval assemblages in two sub-estuaries (Salado and Churute) of the Gulf of Guayaquil (GG) during 2016–2017. The largest community dissimilarities occurred between sub-estuaries, with Salado having higher morphological diversity and larval densities than Churute. Temporal patterns were only evident within each sub-estuary, and in relation to total and individual morpho-species density values. Ocypodidae larvae were dominant across samples; with zoea I of the red mangrove crab (Ucides occidentalis) showing maximal density values during spring tides. Hydrological parameters (i.e., turbidity, conductivity, salinity and temperature) contributed to only 19% of the variability in biota, demonstrating that crab larvae are physiologically adapted to a wide range of water conditions. This study established an ecological baseline for future studies using crab larval assemblages in the assessment of ecological changes occurring in mangrove tidal creeks of the GG. However, longer time-series monitoring data and description of new species and stages of crab larvae are necessary to better assess potential future changes.

Duran is a coastal city located in the Guayas Estuary region in which 24% of urban sectors suffers from the effects of chronic flooding. This study seeks to assess the causes of Duran&rsquo, s vulnerability by considering exposure, population sensitivity and adaptive capacity to establish alternatives to reduce its vulnerability to flooding. An operational framework is proposed based on the vulnerability definition of the Intergovernmental Panel on Climate Change (IPCC) and applying a census-based Index of Vulnerability, a geographic information system and local knowledge of urban development. A Principal Component and equal weighting analysis were applied as well as a spatial clustering to explore the spatial vulnerability across the city. A total of 34% of the city area is mapped as having high and very high vulnerability, mostly occupied by informal settlements (e.g., 288 hectares). Underlying factors were poor quality housing, lack of city services and low adaptive capacity of the community. However, some government housing programs (e.g., El Recreo), with better housing and adaptive capacity were also highly vulnerable. Limited urban planning governance has led to the overloading of storm water and drainage infrastructure which cause chronic flooding. Understanding the underlying causes of vulnerability is critical in order develop integrated strategies that increase city resilience to climate change.

This article is a review of the science goals and activities initiated within the framework of the Pollution and its Impacts on the South American Cryosphere (PISAC) initiative. Air pollution associated with biomass burning and urban emissions affects extensive areas of South America. We focus on black carbon (BC) aerosol and its impacts on air quality, water availability, and climate, with an emphasis on the Andean cryosphere. BC is one of the key short-lived climate pollutants that is a topic of growing interest for near-term mitigation of these issues. Limited scientific evidence indicates that the Andean cryosphere has already responded to climate change with receding glaciers and snow cover, which directly affect water resources, agriculture, and energy production in the Andean region of South America. Despite the paucity of systematic observations along the Andes, a few studies have detected BC on snow and glaciers in the Andes. These, in addition to existing and projected emissions and weather patterns, suggest a possible contribution of BC to the observed retreat of the Andean cryosphere. Here we provide an overview of the current understanding of these issues from scientific and policy perspectives, and propose strategic expansions to the relevant measurement infrastructure in the region.

Urban Heat Island (UHI) is a phenomenon that is affecting cities across the world. In tropical climates, an increased UHI intensity can cause a significant rise in heat stress probability, both indoors and outdoors. A general increase in the air-conditioning energy consumption of buildings should also be expected as a consequence. This paper evaluates the case of Duran, Ecuador. It estimated, through a spatial distribution analysis, urban morphology parameters, properties of materials, and anthropogenic heat emissions in the streets. Twenty-eight urban, randomly selected samples were classified using the k-means clustering technique, which resulted in four preliminary clusters. Exploratory UHI simulations were carried out in the Urban Weather Generator tool (UWG) using the four clusters to investigate the relevance of the main UHI driving factors through a sensitivity analysis. Urban samples were weighted, considering the sensitivity analysis, for better classifying the driving factors. Results indicate that Duran city is strongly affected by UHI, especially in informal settlements with high anthropogenic heat release. The urban temperatures obtained by the model were compared to the experimental measurements in different locations in the city. Besides, the building cooling needs were simulated by using the TRNSYS v. 17 tool for residential and commercial buildings of the city, showing that UHI is increasing cooling-related energy consumption in a 30–70 % for residential buildings and a 10–20 % for commercial buildings. Finally, general mitigation strategies and policy implications to reduce the UHI intensity are proposed, and a set of scenarios is tested for the cluster with the highest UHI intensity.

The ocean is intrinsically linked to human health as it provides food and wellbeing, yet shifts in its dynamics can pose climate-ecological risks, such as harmful algal blooms (HABs) that can impact the health and economy of coastal communities. For decades, Ecuadorian coastal communities have witnessed seasonal algal blooms, events that are driven by factors including complex ocean-climate interactions, nutrient availability, and ecological variables. However, little is known about the risk perceived by coastal populations regarding such events. Understanding how specific groups of people in specific places perceive HABs risks is critical for communicating, promoting, and regulating public health measures. This study assessed the knowledge, attitudes, and practices of fishermen, restaurant owners, and coastal authorities in relation to harmful algal blooms, or ‘red tide’ events, in coastal Ecuador. Methods utilized in this study include a non-probabilistic sampling approach for the two studied populations: coastal communities comprised of fishermen and restaurant owners (N1=181), and authorities comprised of coastal officials in the sectors of health, and environment and risk management (N2=20). Using contingency tables, chi-square test, Cramer’s V correlation statistic, and multiple correspondence analysis, this study compared the responses of these two groups, coastal communities, and authorities, to determine whether the principal activity or livelihood, affected risk perception in each group. This project implemented four workshops to interact with coastal stakeholders and more deeply understand risk perception within studied populations. Results demonstrated that principal activity indeed influenced risk perception of red tides and that fishermen, restaurant owners, and health authorities had limited knowledge and low-risk perception of red tide impacts on human health. Recommendations produced from this research include tailored workshops and improved communication between authorities and coastal communities to enhance algal bloom monitoring and coastal management during future red tide events.

Summary Background El Nino and its effect on local meteorological conditions potentially influences interannual variability in dengue transmission in southern coastal Ecuador. El Oro province is a key dengue surveillance site, due to the high burden of dengue, seasonal transmission, co-circulation of all four dengue serotypes, and the recent introduction of chikungunya and Zika. In this study, we used climate forecasts to predict the evolution of the 2016 dengue season in the city of Machala, following one of the strongest El Nino events on record. Methods We incorporated precipitation, minimum temperature, and Nino3·4 index forecasts in a Bayesian hierarchical mixed model to predict dengue incidence. The model was initiated on Jan 1, 2016, producing monthly dengue forecasts until November, 2016. We accounted for misreporting of dengue due to the introduction of chikungunya in 2015, by using active surveillance data to correct reported dengue case data from passive surveillance records. We then evaluated the forecast retrospectively with available epidemiological information. Findings The predictions correctly forecast an early peak in dengue incidence in March, 2016, with a 90% chance of exceeding the mean dengue incidence for the previous 5 years. Accounting for the proportion of chikungunya cases that had been incorrectly recorded as dengue in 2015 improved the prediction of the magnitude of dengue incidence in 2016. Interpretation This dengue prediction framework, which uses seasonal climate and El Nino forecasts, allows a prediction to be made at the start of the year for the entire dengue season. Combining active surveillance data with routine dengue reports improved not only model fit and performance, but also the accuracy of benchmark estimates based on historical seasonal averages. This study advances the state-of-the-art of climate services for the health sector, by showing the potential value of incorporating climate information in the public health decision-making process in Ecuador. Funding European Union FP7, Royal Society, and National Science Foundation.

Dengue fever, a mosquito-borne viral disease, is an ongoing public health problem in Ecuador and throughout the tropics, yet we have a limited understanding of the disease transmission dynamics in these regions. The objective of this study was to characterize the spatial dynamics and social-ecological risk factors associated with a recent dengue outbreak in Guayaquil, Ecuador. We examined georeferenced dengue cases (n = 4,248) and block-level census data variables to identify potential social-ecological variables associated with the presence and burden of dengue fever in Guayaquil in 2012. We applied LISA and Moran’s I tests to analyze hotspots of dengue cases and used multimodel selection in R computing language to identify covariates associated with dengue incidence at the census zone level. Significant hotspots of dengue transmission were found near the North Central and Southern portions of Guayaquil. Significant risk factors for presence of dengue included poor housing conditions (e.g., poor condition of ceiling, floors, and walls), access to paved roads, and receipt of remittances. Counterintuitive positive correlations with dengue presence were observed with several municipal services such as garbage collection and access to piped water. Risk factors for the increased burden of dengue included poor housing conditions, garbage collection, receipt of remittances, and sharing a property with more than one household. Social factors such as education and household demographics were negatively correlated with increased dengue burden. Our findings elucidate underlying differences with dengue presence and burden and indicate the potential to develop dengue vulnerability and risk maps to inform disease prevention and control - information that is also relevant for emerging epidemics of chikungunya and zika.HighlightsIn 2012, Guayaquil, Ecuador had a large outbreak of dengue casesDengue case presence and burden exhibited spatial heterogeneity at the census block levelSocial-ecological drivers of case presence and burden differed in this outbreak, highlighting the need to model both types of epidemiological dataAccess to municipal resources such as garbage collection and piped water had counterintuitive relationships with dengue presence, but poor housing, garbage collection and remittances correlated to dengue burden.Our findings inform risk mapping and vector control and surveillance allocation, relevant to this and other concurrent emergent epidemics such as chikungunya and zika

More than half of the world population is at risk of vector-borne diseases including dengue fever, chikungunya, zika, yellow fever, leishmaniasis, chagas disease, and malaria, with highest incidences in tropical regions. In Ecuador, vector-borne diseases are present from coastal and Amazonian regions to the Andes Mountains; however, a detailed characterization of the distribution of their vectors has never been carried out. We estimate the distribution of 14 vectors of the above vector-borne diseases under present-day and future climates. Our results consistently suggest that climate warming is likely threatening some vector species with extinction, locally or completely. These results suggest that climate change could reduce the burden of specific vector species. Other vector species are likely to shift and constrain their geographic range to the highlands in Ecuador potentially affecting novel areas and populations. These forecasts show the need for development of early prevention strategies for vector species currently absent in areas projected as suitable under future climate conditions. Informed interventions could reduce the risk of human exposure to vector species with distributional shifts, in response to current and future climate changes. Based on the mixed effects of future climate on human exposure to disease vectors, we argue that research on vector-borne diseases should be cross-scale and include climatic, demographic, and landscape factors, as well as forces facilitating disease transmission at fine scales.

Background The epidemiology of ambulatory acute respiratory tract infections (ARTI) caused by influenza viruses and respiratory syncytial virus (RSV) in young children is not well described in Ecuador. The seasonality of these infections vary across and within tropical countries experiencing different climates. Understanding trends that differ from one region to the next is needed to optimize implementation of effective preventive measures. Methods This 5-year prospective study compares the epidemiology of ARTI caused by influenza and RSV in children from Machala (6 m) and Quito (2,832 m), Ecuador. Children < 5 years presenting with ARTI for ≤7 days are eligible. Demographic and clinical data are gathered and a nasopharyngeal sample is collected for diagnostic testing using the Biofire FilmArray® respiratory panel platform that allows for the detection of 17 viruses. Results Between July 2018 and March 2019, we enrolled 446 subjects; 322 from Machala and 124 from Quito. Eighteen percent of the samples from Quito and 9% from Machala were positive for influenza viruses, while RSV accounted for 4% of the samples from Quito and 5% of those from Machala. The influenza B season at both elevations lasted 14 weeks, but started 5 weeks earlier in Machala (weeks 29–42 vs. weeks 34–47). Influenza B seasonal activity preceded influenza A at both sites. In Machala, the influenza A season began 6 weeks after the influenza B season (weeks 48–4), but overlapped with the influenza B season in Quito (weeks 45–2). In Machala, RSV was detected during the first week of surveillance (2018, week 29) but did not re-emerge to cause sustained activity until 2019, week 6. The RSV season began in Quito in 2018 during week 47, with sustained activity through the time of this report, 2019, week 12. Conclusion The 2018–2019 seasonal epidemiology of ARTI caused by influenza viruses and RSV differed between Ecuadorean children living close to sea level and those living at high elevation. Patterns of seasonal activity observed throughout the 5-year study period will facilitate decision-making regarding the optimal timing and duration for implementing existing and emerging prevention measures. Disclosures All authors: No reported disclosures.

This paper explores whether the health risks related to air pollution and temperature extremes are spatially and socioeconomically differentiated within three Latin American cities: Bogota, Colombia, Mexico City, Mexico, and Santiago, Chile. Based on a theoretical review of three relevant approaches to risk analysis (risk society, environmental justice, and urban vulnerability as impact), we hypothesize that health risks from exposure to air pollution and temperature in these cities do not necessarily depend on socio-economic inequalities. To test this hypothesis, we gathered, validated, and analyzed temperature, air pollution, mortality and socioeconomic vulnerability data from the three study cities. Our results show the association between air pollution levels and socioeconomic vulnerabilities did not always correlate within the study cities. Furthermore, the spatial differences in socioeconomic vulnerabilities within cities do not necessarily correspond with the spatial distribution of health impacts. The present study improves our understanding of the multifaceted nature of health risks and vulnerabilities associated with global environmental change. The findings suggest that health risks from atmospheric conditions and pollutants exist without boundaries or social distinctions, even exhibiting characteristics of a boomerang effect (i.e., affecting rich and poor alike) on a smaller scale such as areas within urban regions. We used human mortality, a severe impact, to measure health risks from air pollution and extreme temperatures. Public health data of better quality (e.g., morbidity, hospital visits) are needed for future research to advance our understanding of the nature of health risks related to climate hazards.

This paper examines the opportunities and challenges faced by “ Ad aptation to the Health Impacts of A ir P ollution and Climate E x t remes in Latin American Cities” (ADAPTE). ADAPTE is an issue-driven research endeavor that integrates different disciplinary domains to explore the complex nature of urban vulnerability/adaptive capacity to weather and air pollution in Buenos Aires, Bogota, Mexico City and Santiago. The paper also critically reflects on some of the possible challenges to be encountered, along with the benefits to be gleaned, when doing issue-driven research that seeks to be scientifically robust and socially relevant and is defined by such attributes as integration of heterogeneous research domains, interactivity and reflexivity. ADAPTE's efforts to integrate concepts, methods and data from different disciplines were fundamental in the design of a conceptual framework on urban vulnerability. The integrating research question and the use of quantitative and qualitative methods allowed ADAPTE to shed a slightly different light on the nature and interconnections between the different dimensions of urban vulnerability. However, it has proven difficult for us to fully explore the dynamics of urban vulnerability as well as the issues of scale and context. A set of cultural and communication challenges has arisen, not only from the diverse conceptualization approaches, methods, differing terminologies and mechanisms for analyzing and presenting results that ADAPTE has attempted to integrate, but also from institutional and interpersonal issues affecting team interactions.

En este trabajo realizamos una exploración inicial sobre medidas de adaptación implementadas en nuestra región frente a Eventos Hidrometeorológicos Extremos (EHE) en zonas rurales, identificando tanto experiencias positivas como negativas. Estas medidas son extraídas de estudios de casos realizados en sitios seleccionados en Argentina, Brasil, Chile, Colombia y Ecuador; describiendo las experiencias de diferentes actores y organizaciones sociales. Se utilizaron tanto fuentes primarias (expertos, involucrados/afectados) como secundarias (bases de datos, artículos científicos, publicaciones oficiales, notas de prensa, etc.). El primer desafío encontrado fue la definición de EHE; en primer lugar, puesto que la misma cambia si se la enfoca desde el punto de vista meteorológico o hidrológico; en segundo lugar no existe acuerdo en la definición de valores límites para caracterizar estos eventos dentro de la región, dadas sus características socio-ambientales; y en tercer lugar en muchos de los sitios donde se realizó este estudio no existen registros lo suficientemente largos y confiables para poder cuantificar los EHE. En vista de lo anterior decidimos utilizar una definición “empírica” de EHE, dejando que sean los actores sociales que vivieron la experiencia los que determinen cuando ocurrió un evento de esa naturaleza. A pesar de las diferencias en la vulnerabilidad y los impactos sobre los paisajes rurales que se encuentran en cada estudio de caso, esta investigación sugiere que la gestión integrada de los paisajes a nivel comunitario permite a los productores agrícolas adoptar medidas de adaptación a su debido tiempo y preparar a las comunidades rurales para enfrentarse y responder ante la ocurrencia de EHE. Esto ilustra la importancia de mantener paisajes multifuncionales, donde los agroecosistemas se combinan con ecosistemas para amortiguar el impacto negativo de los EHE, principalmente a través de procesos de regulación hídrica. Finalmente entre las lecciones aprendidas más importantes se identificaron las siguientes: La demanda de una adecuada transferencia de la información; la necesidad de promoción del capital social; la importancia de tener un Estado desempeñando un rol proactivo; la relevancia de tener una prensa que oriente y no escandalice; y la necesidad de contar con mecanismos óptimos para estimación de costos.

Background Dengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines. Methods A 37-item questionnaire of dengue knowledge, attitudes, and practices was developed and administered to dengue healthcare providers in Machala, Ecuador. Survey focus areas included: “Demographics,” “Infection and Prevention of Dengue,” “Dengue Diagnosis and the WHO Dengue Guide,” “Laboratory Testing,” “Treatment of Dengue,” and “Opinions Regarding Dengue.” Results A total of 76 healthcare providers participated in this study, of which 82 % were medical doctors and 14 % were nurses. Fifty-eight percent of healthcare professionals practiced in ambulatory clinics and 34 % worked in a hospital. Eighty-nine percent of respondents were familiar with the 2009 WHO Dengue Guidelines, and, within that group, 97 % reported that the WHO Dengue Guide was helpful in dengue diagnosis and clinical management. Knowledge gaps identified included Aedes aegypti mosquito feeding habits and dengue epidemiology. Individuals with greater dengue-related knowledge were more likely to consider dengue a major health problem. Only 22 % of respondents correctly reported that patients with comorbidities and dengue without warning signs require hospital admission, and 25 % of providers reported never admitting patients with dengue to the hospital. Twenty percent of providers reported rarely (≤25 % of cases) obtaining laboratory confirmation of dengue infection. Providers reported patient presumptive self-medication as an ongoing problem. Thirty-one percent of healthcare providers reported inadequate access to resources needed to diagnose and treat dengue. Conclusion Participants demonstrated a high level of knowledge of dengue symptoms and treatment, but additional training regarding prevention, diagnosis, and admission criteria is needed. Interventions should not only focus on increasing knowledge, but also encourage review of the WHO Dengue Guidelines, avoidance of presumptive self-medication, and recognition of dengue as a major health problem. This study provided an assessment tool that effectively captured healthcare providers’ knowledge and identified critical gaps in practice. Electronic supplementary material The online version of this article (doi:10.1186/s40794-016-0024-y) contains supplementary material, which is available to authorized users.

Within a GIS environment, we combine field measures of mangrove diameter, mangrove species distribution, and mangrove density with remotely sensed measures of mangrove location and mangrove canopy cover to estimate the mangrove carbon holdings of northern Ecuador. We find that the four northern estuaries of Ecuador contain approximately 7,742,999 t (plus or minus 15.47 percent) of standing carbon. Of particular high carbon holdings are the Rhizophora mangle dominated mangrove stands found in-and-around the Cayapas-Mataje Ecological Reserve in northern Esmeraldas Province, Ecuador and certain stands of Rhizophora mangle in-and-around the Isla Corazon y Fragata Wildlife Refuge in central Manabi Province, Ecuador. Our field driven mangrove carbon estimate is higher than all but one of the comparison models evaluated. We find that basic latitudinal mangrove carbon models performed at least as well, if not better, than the more complex species based allometric models in predicting standing carbon levels. In addition, we find that improved results occur when multiple models are combined as opposed to relying any one single model for mangrove carbon estimates. The high level of carbon contained in these mangrove forests, combined with the future atmospheric carbon sequestration potential they offer, makes it a necessity that they are included in any future payment for ecosystem services strategy aimed at utilizing forest systems to reduce CO2 emissions and mitigate predicted CO2 driven temperature increases., Comment: 52 pages, 7 figures, 5 figures, final author copy

Background In Ecuador, dengue virus (DENV) infections transmitted by the Aedes aegypti mosquito are among the greatest public health concerns in urban coastal communities. Community- and household-level vector control is the principal means of controlling disease outbreaks. This study aimed to assess the impact of knowledge, attitudes, and practices (KAPs) and social-ecological factors on the presence or absence of DENV infections in the household. Methods In 2014 and 2015, individuals with DENV infections from sentinel clinics in Machala, Ecuador, were invited to participate in the study, as well as members of their household and members of four neighboring households located within 200 meters. We conducted diagnostic testing for DENV on all study participants; we surveyed heads of households (HOHs) regarding demographics, housing conditions and KAPs. We compared KAPs and social-ecological factors between households with (n = 139) versus without (n = 80) DENV infections, using bivariate analyses and multivariate logistic regression models with and without interactions. Results Significant risk factors in multivariate models included proximity to abandoned properties, interruptions in piped water, and shaded patios (p, Author summary Dengue, chikungunya and Zika viruses are transmitted to people primarily by the Aedes aegypti mosquitoes in tropical and subtropical regions. Diseases transmitted by the Ae. aegypti mosquito are a growing public health concern. Mosquito control is the principal means of preventing and controlling disease outbreaks. In this study, we compared the characteristics of households with and without DENV infections in the city of Machala, Ecuador. We found that risk factors for DENV infection included proximity to abandoned properties, interruptions in the piped water supply, and a highly shaded patio. Protective factors included the use of mosquito bed nets, fumigation inside the home, and piped water inside the home. These findings can be used to inform targeted interventions by the public health sector at the household and community levels.

Large-scale changes in land use are occurring in many tropical regions, with significant impacts on nitrogen and phosphorus biogeochemistry. In this study we examine the relationships between land use, anthropogenic nutrient inputs, and riverine nutrient exports in a major agricultural watershed of the Pacific coast of South America, the Guayas River basin of Ecuador. We present comprehensive nutrient budgets for nitrogen (N) and phosphorous (P) for the Guayas River basin and 10 sub-watersheds. We quantify the four major anthropogenic nutrient fluxes into and out of the region: N and P fertilizer application, N fixation by leguminous crops, net import/export of N and P in agricultural products (food and feed), and atmospheric deposition. We also estimate inputs of N from biological N fixation in forests and of P from weathering sources in soils and bedrock. The sum of these sources represents net inputs of N and P to each watershed region. Overall, synthetic fertilizers are the largest input to the Guayas Basin for N (53%) and P (57%), and the largest outputs are N and P in crops. Losses of N and P in river export account for 14–38% of total N and P inputs, and there is significant accumulation of N and P, or unmeasured forms of N and P export, in most of the sub-basins. Nutrient balances are indicative of the sustainability of land use practices in a region, where a negative balance of N or P indicates nutrient depletion and subsequent loss of soil fertility, yield, and economic viability. Although the nutrient balance of the entire Guayas Basin is positive, there are negative or near zero balances in two sub-watersheds with extensive banana, coffee and permanent crops. In these basins, degradation of soil quality may be occurring due to these net nutrient losses. Our data show that nutrients are leaving the basin primarily as export crops, with riverine losses of nutrients smaller than crop exports. Nonetheless, there is a direct relationship between nutrient inputs and river outputs, suggesting that agricultural management practices in the basin may have direct impacts on N and P delivery to the highly productive Guayas estuary.