High above our planet, satellites are engaged in a floating ballet.
A few dance along Earth's orbit to track global weather systems. Some partner with locations on Earth to exchange television, GPS or phone data. And still others are choreographed to point into deep space to record other planets and distant galaxies.
A West Virginia University professor in a groundbreaking move is using satellite data to predict something much less celestial the outbreak of disease in order to save lives.
A Growing Disease
After nearly three years of war, Yemen is in the midst of what
United Nations agencies have deemed the world’s "worst humanitarian crisis."
Ongoing hostilities, dilapidated infrastructure, famine and a crippled economy have
plunged the war-torn country on the southern tip of the Arabian Peninsula into
the largest cholera outbreak in history.
In December 2017, the International Committee of the Red Cross announced that the
number of suspected cholera cases in Yemen had reached 1 million in less than nine
In contrast, Haiti, which suffered devastating levels of cholera after a 2010 earthquake
that leveled the island nation, reached 700,000 cases over the course of three
"The escalation of the disease in Haiti, but especially in Yemen, is astonishing," said
Antar Jutla, assistant professor in the Benjamin M. Statler College of Engineering
and Mineral Resources, "particularly because cholera is an illness that is 100-percent
preventable and treatable."
Jutla, a professor of civil and environmental engineering, studies hydroepidemiology,
which he describes as the "nexus of hydroclimate, the environment and human health."
He was recently awarded the prestigious CAREER award from the National Science
Foundation to support this work.
Jutla became interested in this work as a doctoral student and National Oceanic and
Atmospheric postdoctoral fellow at the University of Maryland. It was there that
we began working with Rita Colwell, distinguished professor in Maryland’s cell
biology and molecular genetics department.
Colwell, who is former director of the National Science Foundation and former president
of the American Association for the Advancement of Science, is one of the foremost
experts on cholera and pioneered work on the environmental factors that affect
the spread of the disease.
As a researcher in Colwell’s lab, Jutla saw the impact that the work could have when
viewed through the lens of civil engineering and infrastructure.
"Antar proved to be a brilliant research scientist with a capacity to absorb new
information from diverse disciplinary fields, a talent that has allowed him to
become an expert in climate-related infectious disease processes," Colwell said.
Although it remains a burgeoning field, Jutla recognizes the urgency of the work.
"There aren’t a lot of us doing this type of work yet," he said. "But we have an
opportunity to understand how these different factors create conditions favorable
for the proliferation of water-related diseases like cholera and what their impact
will be on society.
"If we can ensure safe drinking water and sanitation facilities, we can control this
Antar Jutla uses The Cave to project maps on a large screen in his research to predict where cholera outbreaks will occur (SCOTT LITUCHY PHOTO).
The Worth of WaterFor those living in industrialized nations, cholera may
be recognized only as the disease that derailed a party of settlers on the Oregon
Trail, the popular video game about migration to the Western United States.
But for millions of people around the world, cholera is not a pixelated game changer.
It is a real, persistent and devastating illness.
Cholera is an acute infection in the intestine that causes diarrhea and can rapidly
escalate to death from dehydration if left untreated. A waterborne illness, it
is spread via water contaminated by fecal bacteria and becomes abundant in areas
with inadequate sanitation systems and drinking water.
"When the British scientist John Snow discovered cholera in the 1800s, indications
showed a strong association between the disease and the environment under certain
circumstances," Jutla said. "I am looking at interactions between cholera bacteria
and things like temperature, precipitation, organic matter and salinity in water
through the lens of civil engineering."
Cholera outbreaks occur in two forms.
Endemic cholera happens along coastal regions on a seasonal basis. Environmental
conditions such as warm temperatures and chlorophyll levels can spur the growth
of bacteria already in existence in ocean waters. Often the disease is contained
because communities are prepared for the regular pattern of outbreaks.
Epidemic cholera, like what happened in Yemen, is a sudden disease outbreak
in inland regions with characteristic high mortality and morbidity rates. In these
cases, communities are often unprepared to handle the outbreak.
"If the right conditions occur, the disease spreads quickly, and it is dangerous
because communities are caught off guard," Jutla said. "On top of that, there is
often a pre-existing breakdown in civil infrastructure or a new one caused by extreme
events, which results in limited access to clean water, food, medical centers and
Using sophisticated modeling, monitoring and surveillance tools combined with datasets
and environmental and biological processes, Jutla and a team of researchers from
the University of Maryland and University of Rhode Island developed predictive
models for cholera outbreaks.
The only thing they needed was the empirical data to populate their algorithms.
A girl drinks water alleged to contain the bacterium Vibrio cholera on the outskirts
of Sanaa, Yemen (ASSOCIATED PRESS PHOTO).
A View From AboveJutla’s team was interested in monitoring cholera "trigger
conditions" to observe the risk of the disease in regions like Yemen.
"We are linking satellite information with microbiological information and disease
data to analyze conditions that are favorable for cholera," Jutla said. "The result
is a comprehensive database and validations that can be used to produce risk maps
at least four weeks in advance, enough time for countries to mobilize resources."
To do this, the team had to collect specific variables on things like population
density and migration, but in Yemen they were faced with a particular challenge:
the team had little to no access to the country’s population data.
With the ongoing volatility in the country and increased level of instability in
the infrastructure, the datasets in question were in constant flux. Even if the
team could have obtained the appropriate data, there was no guarantee that it would
have been accurate.
"The use of NASA satellite data was especially important in Yemen since we didn’t
have boots on the ground," Jutla said.
The team collected observation data such as temperature, precipitation, water availability
and land from satellites that keep watch over Earth.
Using the algorithms that they had previously built and validated with data collected
from parts of South Asia and Africa, the team processed the satellite data from
Yemen and calculated the risk of outbreak.
They predicted that the western regions of Yemen had a high risk of cholera outbreak
in large part due to sudden wet conditions that preceded warm temperatures.
When these two environmental conditions fall in sequence, then the hydrological risk
of growth of bacteria increases dramatically. If you add a condition under which
humans interact with water, such as a natural disaster or civil unrest, an outbreak
While Jutla and his graduate student, Rakibul Khan, checked their models, the World
Health Organization reported a major outbreak that closely mirrored the research
"At that point, we decided to take a deeper look into the data from Yemen, because
as a scientist, your first reaction is that there is a flaw in your algorithm,"
But as he and Khan combed through their work, they found that risk of cholera was,
in fact, high.
"On the scientific side of what we do, we were pleasantly surprised at the predictive
power of the model," Jutla said.
"But on the human side, we were very concerned about the impact of this infection
on children and elderly in Yemen. We knew if the infection had triggered, then
transmission was going to follow given societal conditions in the country."
That interest pushes the team to improve their models. Their primary focus is to
refine and validate the product so that the information can inform decision-making.
Currently the team is using NASA resources and funds from the West Virginia Space
Grant Consortium to gather, process and analyze data for public use. Eventually
they would like to have simulation tools robust enough to mimic the ease and clarity
of pollen counts in weather predictions.
A boy walks beside a sewage swamp covered with waste tires near a well in Sanaa,
Yemen (ASSOCIATED PRESS PHOTO).
The Power of PredictionIn the case of cholera, which can ravage the body in
a matter of hours, preparation can mean the difference between saving a life and
For Jutla, the ultimate objective is to produce "actionable knowledge" that will
reduce the incidence of water-related disease and death.
"Ultimately, you want to get the information in the hands of decision-makers — government
agencies, local authorities, foundations and humanitarian aid organizations," Jutla
With timely and accurate notification, cities can deploy educational campaigns about
safe drinking and sanitation habits, stock up on and distribute oral rehydration
treatments and antibiotics (particularly pediatric antibiotics), mobilize health
professionals, and inform policy and intervention strategies related to sanitation
infrastructure and access to clean drinking water in vulnerable regions.
Yemen is still in dire need of humanitarian aid. The extreme events from war in the
country have been major contributors to the spread of cholera, highlighting the
critical need for stable infrastructure for water and health in order to stop the
spread of the disease.
But government and aid groups report that nearly all those with the disease who have
access to healthcare services survive. Cholera is easily treatable by treating
those affected with an oral rehydration solution, a combination of sugar and salts
mixed with water. Antibiotics and vaccines are also available.
Hope is on the horizon.
As Jutla and the team continue to refine their algorithms and datasets, they know
that it is a race to beat the next cholera outbreak.
"Africa is the new homeland of cholera," Jutla said. "Many countries on the continent
endure frequent extreme events, mass migration of human population and stresses
on availability of safe water."
As seen in Yemen, these are the ingredients for a new epidemic.
Jutla also continues to help lead the growth of the field. In fall 2017, he and his
colleagues completed a workshop in Bangladesh — the first of its kind — to develop
a cholera warning system using remote sensing data from satellites.
"This was the flagship program," Jutla said. "The goal was to promote the use of
these observations in public health decisions, from improving prevention efforts
and raising disease awareness to water and sanitation management."
In addition, Jutla has been asked to speak at national and international conferences
and other academic institutions that are looking to establish similar programs.
There is a great opportunity at hand — development of a unique and innovative civil
infrastructure — which is directly tied to the mission of civil and environmental
"When I began this work, I realized it was about how engineers think about disease,"
Jutla said. "But it is larger than that. It is engineering, computer science, microbiology,
medicine, public health and policy rolled into one.
"All of it is necessary to solve the biggest challenges facing the world today."