Prioritisation of pathways for targeted risk assessment

Risk analysis of pathways for transboundary infectious disease spread is critical to target interventions and surveillance, but comprehensive analysis of all pathways is not feasible – the detailed data requirements and time to complete are prohibitive. Risk is also dynamic due to increasing globalisation and the influence of drivers of disease emergence. Therefore, our aim is to provide a transparent framework for rapid, accurate prioritisation of pathways for targeted risk analysis of transboundary infectious disease spread at regional level. We combine methods from network analysis, risk assessment and participatory epidemiology, and demonstrate the framework in the context of rabies spread between selected countries in south-east Asia and Oceania. Animal health experts from seven countries participated in the pathway prioritisation exercise. Pathways were defined in spreadsheets. Parameters associated with pathways were collected and included counts of travelers, the probability of inspection at borders, and probability of carrying a dog. These were used to estimate the number of dogs travelling on each pathway annually. Network methods were used to visualise pathways as weighted edges and countries as nodes. Proportional piling methods (‘jellybean maps’) were used to investigate border regions and routes in more detail. Network maps illustrated regional pathways of high priority for risk assessment, and countries which were more likely to be exporters or importers of dogs. Jellybean maps provided a record of information about border region movements and promoted discussion about social drivers of dog movement, as well as relative volumes of dog movements. This framework promoted cross-border discussion about disease risk. The tools are not disease or region specific and participants quickly identified potential for use in other contexts. This framework does not require specialist knowledge for implementation and provides practical, accessible and dynamic pathway assessment tools to prioritise risk analysis at a regional level.