Challenges and Opportunities in Epidemiology​​

A Survey on Digital Epidemiology: Networks and Models

David Pastor-Escuredo and Luis E. Olmos

LifeD Lab, Spain; UCL, UK; UNICEF, Facultad de Ciencias Básicas, Universidad de Medellin


Epidemiology has recently witnessed great advances based on computational models. Its scope and impact are getting wider thanks to the new data sources feeding analytical frameworks and models. Besides traditional variables considered in epidemiology, large-scale social patterns can now be integrated in real time with multi-source data, bridging the gap between different scales. In a hyper-connected world, models and analysis of interactions and social behaviors are key to understanding and stopping outbreaks. Big Data, along with apps, is enabling validating and refining models with real-world data at scale, as well as new applications and frameworks to map and track diseases in real time or optimize the necessary resources and interventions, such as testing and vaccination strategies. Digital epidemiology is positioning itself as a discipline necessary to control epidemics and implement actionable protocols and policies. In this review, we address the research areas configuring current digital epidemiology: transmission and propagation models and descriptions based on human networks and contact tracing, mobility analysis, and spatiotemporal propagation of infectious diseases and infodemic, which comprise the study of information and knowledge propagation. Digital epidemiology has the potential to create new operational mechanisms for prevention and mitigation, monitoring the evolution of epidemics, assessing their impact, and evaluating pharmaceutical and non-pharmaceutical measures to fight the outbreaks. Epidemics have to be approached through the lens of complexity science, as they require systemic solutions. Opportunities and challenges to tackle epidemics more effectively and with a human-centered vision are discussed here.

Annarosa Floreani, Daniela Gabbia, and Sara De Martin


IgG4-related disease (IgG4-RD) is a rare condition characterized by immune-mediated fibro-inflammation affecting various organs (liver, pancreas, heart, kidney, and brain, among others) with peculiar histopathologic features. Few epidemiological data have been published so far, although a dramatic increase in the number of patients diagnosed with IgG4-RD has been recorded in the last few years. The clinical manifestations of IgG4-RD frequently involve the liver and pancreas. Specifically, a crucial challenge in differential diagnosis is IgG4-related sclerosing cholangitis, which is frequently accompanied by pancreatic involvement. Inflammatory alterations of the liver parenchyma have also been described, with a new nosology of IgG4-autoimmune hepatitis. Type 1 autoimmune pancreatitis is the pancreatic manifestation of IgG4-RD. The first-ever epidemiological study to estimate the point prevalence of IgG4-related sclerosing cholangitis was recently conducted in Japan. Moreover, several demographic studies on IgG4-RD involving the liver and pancreas have been published in other countries, although the majority of them are cohort studies and data on incidence and prevalence are lacking. This review aims to update the recent epidemiological and clinical knowledge of IgG4-RD involving the liver and pancreas, focusing also on the risk of malignancy.

Rifat Erdem Togrol


Today, multiple sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. 2020 statistical survey figures show that it affects 2.8 million people worldwide. This figure corresponds to an average of 1/3000 people, a figure that is likely to rise further. Globally, the median estimated prevalence of MS is approximately 36 per 100,000, according to international data, with 2.9 million people living with MS in the world in 2023. Regionally, the estimated median prevalence of MS is highest in Europe and the Americas. Regional differences in incidence generally run parallel to prevalence. A median prevalence and incidence were reported for the Eastern Mediterranean area and the Middle East, but in the last decades, this has tended to change. Also, the incidence has increased in the Mediterranean islands, but not all. Its prevalence increased from 40 per 100,000 to 100 per 100,000 in Turkey, while in Greece, Cyprus, the Basra Gulf, and the Middle East in general, a similarly increasing trend was observed in recent years. The highest prevalence rates were reported in Iran (148.06 per 100,000), and higher incidence rates were estimated at 6.88 per 100,000 in Kuwait. The same increase can be seen in some parts of Russia and Western Asia. In fact, the increasing trend in incidence can be seen even in the Far East, in China and Japan, where the prevalence and incidence were originally low. The gender distribution of MS in the region is also tending to change in recent years, with more females having MS. Of the various risk factors cited for multiple sclerosis, migration seems to be an important risk factor for the region, although there are some exceptions.

Helin Gosalia, Diana Y. Wei, and Peter J. Goadsby


Cluster headache is a primary headache disorder and is the most prevalent of the trigeminal autonomic cephalalgias. Cluster headaches significantly impact those affected, necessitating early diagnosis and management. Despite unique clinical features, such as patients experiencing attacks in a circannual pattern and often with a circadian rhythm within bouts, cluster headache patients are often misdiagnosed, mismanaged, and have a delay in diagnosis. Preclinical, neuroimaging, and clinical studies have advanced our understanding of cluster headache pathophysiology. The trigeminovascular system, the trigeminal autonomic reflex, and the hypothalamus are all involved in the pathophysiology of cluster headaches. As our understanding of the pathophysiology of cluster headaches has evolved, new therapeutic options, such as calcitonin gene-related peptide monoclonal antibodies, non-invasive vagal nerve stimulation, and sphenopalatine ganglion stimulation, have proven to have efficacy in the treatment of cluster headaches. Herein, we aim to review developments to aid readers in their understanding of this debilitating disorder. 

Robert Drury


Throughout the history of science, technological innovation has facilitated an improved understanding of our human nature and characteristics and our complex relationships with our environment. In medical history, such innovations have allowed a more accurate and nuanced ability to intervene in promoting health and preventing and treating disease and disorder. Of course, the ability to correctly apprehend the meaning of the observations that are available to us through innovative breakthroughs is dependent on the conceptual adequacy of our endeavor. This conceptual adequacy has shown evolutionary progress and broadening, partially achieving the goal of consilience articulated by the evolutionary biologist EO Wilson (1). The aim of this paper is to explore this expanding base and then describe an exemplar of our greater ability to understand and intervene in the pursuit of global health. The scope of inquiry ranges from individual remotely obtained data to global health evaluation by advanced computational methods, with the objective of clarifying the conceptual, methodological, and operational aspects of such a systemic approach.

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