Kidenga: Public engagement for detection and prevention of Aedes -borne viral diseases
Authors: Schmidt Chris , Phippard Alba , Olsen Jennifer M. , Wirt Kathy , Riviera Andrea , Crawley Adam , Waterman Steve , Ernst Kacey 
Published: May 2017

Objective(1) Early detection ofAedes-borne arboviral disease; (2) improveddata onAe. aegyptiandAe. albopictusdistribution in the UnitedStates (U.S.); and (3) education of clinicians and the public.IntroductionZika, chikungunya, and dengue have surged in the Americas overthe past several years and pose serious health threats in regions of theU.S. whereAe. aegyptiandAe. albopictusmosquito vectors occur.Ae. aegyptihave been detected up to 6 months of the year or longer inparts of Arizona, Florida, and Texas where mosquito surveillance isregularly conducted. However, many areas in the U.S. lack basic dataon vector presence or absence. The Zika, dengue, and chikungunyaviruses range in pathogenicity, but all include asymptomatic or mildpresentations for which individuals may not seek care. Traditionalpassive surveillance systems rely on confirmatory laboratory testingand may not detect emergent disease until there is high morbidity in acommunity or severe disease presentation. Participatory surveillanceis an approach to disease detection that allows the public to directlyreport symptoms electronically and provides rapid visualization ofaggregated data to the user and public health agencies. Several suchsystems have been shown to be sensitive, accurate, and timelierthan traditional surveillance. We developed Kidenga, a mobilephone app and participatory surveillance system, to address someof the challenges in early detection of day-biting mosquitoes andAedes-borne arboviruses and to enhance dissemination of informationto at-risk communities.MethodsKidenga sends a weekly push notification prompting users toreport symptoms, travel history, and day-biting mosquito activity.If an individual reports through Kidenga that they or a family memberhave had symptoms consistent with Zika, dengue, or chikungunya,they receive an email with educational information about the diseases,prevention strategies, and treatment/testing information for clinicians.Upon registration, users can opt in to have additional follow-up viaemail. At any time, users may also view maps of aggregated userreports, confirmed case counts by county from public health partners(in pilot areas),Aedesdistribution maps, information about preventionand control strategies, and news on the diseases and vectors from acurated newsfeed. Users in select pilot areas may also receive pressreleases issued by their state or local public health department relatedto the diseases and their vectors. University of Arizona owns andmaintains the app and its data. Local and state health departmentsthat want more detailed information on user symptoms and mosquitoactivity may request and monitor the data at no cost. A marketingcampaign to recruit a broad user base is being implemented inArizona, Texas, and Florida.ResultsKidenga was developed with significant input from public healthstakeholders and launched in September 2016,accompanied byEnglish and Spanish radio public service announcements in selectArizona markets, press releases, and a social marketing campaign.A Spanish version of the app is under development. We willdescribe the results of user registration and survey submissions,challenges identified during development and deployment of thisnovel surveillance system, plans for data use and evaluation, andcollaborations with public health partners.ConclusionsThe utility of Kidenga as a surveillance system will depend onbroad and consistent participation among diverse user populations,particularly in low-risk areas; strategies to integrate health reports forhigh-risk populations who may not have smartphones; validation ofdata and development of sensitive and specific algorithms for takingpublic health action, and buy-in from public health departments touse the data and advocate for this novel surveillance tool. Kidenga’ssecondary function as an education tool onAedes-borne viruses is lessdependent upon a large user base and can be evaluated separately.Participatory surveillance systems that specifically monitorAedes-borne pathogens are relatively new, and the challenges associatedwith their early detection may differ from those of other diseases.