Epidemic cycles driven by host behaviour

Host immunity and demographics (the recruitment of susceptibles via birthrate) have been demonstrated to be a key determinant of the periodicity of measles, pertussis and dengue epidemics. However, not all epidemic cycles are from pathogens inducing sterilizing immunity or are driven by demographics. Many sexually transmitted infections are driven by sexual behaviour. We present a mathematical model of disease transmission where individuals can disconnect and reconnect depending on the infectious status of their contacts. We fit the model to historic syphilis (Treponema pallidum) and gonorrhea (Neisseria gonorrhoeae) incidence in the USA and explore potential intervention strategies against syphilis. We find that cycles in syphilis incidence can be driven solely by changing sexual behaviour in structured populations. Our model also explains the lack of similar cycles in gonorrhea incidence even if the two infections share the same propagation pathways. Our model similarly illustrates how sudden epidemic outbreaks can occur on time scales smaller than the characteristic demographic time scale of the population and that weaker infections can lead to more violent outbreaks. Behaviour also appears to be critical for control strategies as we found a bigger sensitivity to behavioural interventions than antibiotic treatment. Thus, behavioural interventions may play a larger role than previously thought, especially in the face of antibiotic resistance and low intervention efficacies.     

Decreasing stochasticity through enhanced seasonality in measles epidemics

Seasonal changes in the environment are known to be important drivers of population dynamics, giving rise to sustained population cycles. However, it is often difficult to measure the strength and shape of seasonal forces affecting populations. In recent years, statistical time-series methods have been applied to the incidence records of childhood infectious diseases in an attempt to estimate seasonal variation in transmission rates, as driven by the pattern of school terms. In turn, school-term forcing was used to show how susceptible influx rates affect the interepidemic period. In this paper, we document the response of measles dynamics to distinct shifts in the parameter regime using previously unexplored records of measles mortality from the early decades of the twentieth century. We describe temporal patterns of measles epidemics using spectral analysis techniques, and point out a marked decrease in birth rates over time. Changes in host demography alone do not, however, suffice to explain epidemiological transitions. By fitting the time-series susceptible–infected–recovered model to measles mortality data, we obtain estimates of seasonal transmission in different eras, and find that seasonality increased over time. This analysis supports theoretical work linking complex population dynamics and the balance between stochastic and deterministic forces as determined by the strength of seasonality.     

Likelihood-based estimation of continuous-time epidemic models from time-series data: application to measles transmission in London

We present a new statistical approach to analyse epidemic time-series data. A major difficulty for inference is that (i) the latent transmission process is partially observed and (ii) observed quantities are further aggregated temporally. We develop a data augmentation strategy to tackle these problems and introduce a diffusion process that mimics the susceptible-infectious-removed (SIR) epidemic process, but that is more tractable analytically. While methods based on discrete-time models require epidemic and data collection processes to have similar time scales, our approach, based on a continuous-time model, is free of such constraint. Using simulated data, we found that all parameters of the SIR model, including the generation time, were estimated accurately if the observation interval was less than 2.5 times the generation time of the disease. Previous discrete-time TSIR models have been unable to estimate generation times, given that they assume the generation time is equal to the observation interval. However, we were unable to estimate the generation time of measles accurately from historical data. This indicates that simple models assuming homogenous mixing (even with age structure) of the type which are standard in mathematical epidemiology miss key features of epidemics in large populations.     

The effect of population structure on the emergence of drug resistance during influenza pandemics.

The spread of H5N1 avian influenza and the recent high numbers of confirmed human cases have raised international concern about the possibility of a new pandemic. Therefore, antiviral drugs are now being stockpiled to be used as a first line of defence. The large-scale use of antivirals will however exert a strong selection pressure on the virus, and may lead to the emergence of drug-resistant strains. A few mathematical models have been developed to assess the emergence of drug resistance during influenza pandemics. These models, however, neglected the spatial structure of large populations and the stochasticity of epidemic and demographic processes. To assess the impact of population structure and stochasticity, we modify and extend a previous model of influenza epidemics into a metapopulation model which takes into account the division of large populations into smaller units, and develop deterministic and stochastic versions of the model. We find that the dynamics in a fragmented population is less explosive, and, as a result, prophylaxis will prevent more infections and lead to fewer resistant cases in both the deterministic and stochastic model. While in the deterministic model the final level of resistance during treatment is not affected by fragmentation, in the stochastic model it is. Our results enable us to qualitatively extrapolate the prediction of deterministic, homogeneous-mixing models to more realistic scenarios.     

Characterizing the dynamics of rubella relative to measles: the role of stochasticity

Rubella is a completely immunizing and mild infection in children. Understanding its behaviour is of considerable public health importance because of congenital rubella syndrome, which results from infection with rubella during early pregnancy and may entail a variety of birth defects. The recurrent dynamics of rubella are relatively poorly resolved, and appear to show considerable diversity globally. Here, we investigate the behaviour of a stochastic seasonally forced susceptible–infected–recovered model to characterize the determinants of these dynamics and illustrate patterns by comparison with measles. We perform a systematic analysis of spectra of stochastic fluctuations around stable attractors of the corresponding deterministic model and compare them with spectra from full stochastic simulations in large populations. This approach allows us to quantify the effects of demographic stochasticity and to give a coherent picture of measles and rubella dynamics, explaining essential differences in the recurrent patterns exhibited by these diseases. We discuss the implications of our findings in the context of vaccination and changing birth rates as well as the persistence of these two childhood infections.     

Parameter estimation and prediction for the course of a single epidemic outbreak of a plant disease.

Many epidemics of plant diseases are characterized by large variability among individual outbreaks. However, individual epidemics often follow a well-defined trajectory which is much more predictable in the short term than the ensemble (collection) of potential epidemics. In this paper, we introduce a modelling framework that allows us to deal with individual replicated outbreaks, based upon a Bayesian hierarchical analysis. Information about 'similar' replicate epidemics can be incorporated into a hierarchical model, allowing both ensemble and individual parameters to be estimated. The model is used to analyse the data from a replicated experiment involving spread of Rhizoctonia solani on radish in the presence or absence of a biocontrol agent, Trichoderma viride. The rate of primary (soil-to-plant) infection is found to be the most variable factor determining the final size of epidemics. Breakdown of biological control in some replicates results in high levels of primary infection and increased variability. The model can be used to predict new outbreaks of disease based upon knowledge from a 'library' of previous epidemics and partial information about the current outbreak. We show that forecasting improves significantly with knowledge about the history of a particular epidemic, whereas the precision of hindcasting to identify the past course of the epidemic is largely independent of detailed knowledge of the epidemic trajectory. The results have important consequences for parameter estimation, inference and prediction for emerging epidemic outbreaks.     

Introduction of rubella-containing-vaccine to Madagascar: implications for roll-out and local elimination

Few countries in Africa currently include rubella-containing vaccination (RCV) in their immunization schedule. The Global Alliance for Vaccines Initiative (GAVI) recently opened a funding window that has motivated more widespread roll-out of RCV. As countries plan RCV introductions, an understanding of the existing burden, spatial patterns of vaccine coverage, and the impact of patterns of local extinction and reintroduction for rubella will be critical to developing effective programmes. As one of the first countries proposing RCV introduction in part with GAVI funding, Madagascar provides a powerful and timely case study. We analyse serological data from measles surveillance systems to characterize the epidemiology of rubella in Madagascar. Combining these results with data on measles vaccination delivery, we develop an age-structured model to simulate rubella vaccination scenarios and evaluate the dynamics of rubella and the burden of congenital rubella syndrome (CRS) across Madagascar. We additionally evaluate the drivers of spatial heterogeneity in age of infection to identify focal locations where vaccine surveillance should be strengthened and where challenges to successful vaccination introduction are expected. Our analyses indicate that characteristics of rubella in Madagascar are in line with global observations, with an average age of infection near 7 years, and an impact of frequent local extinction with reintroductions causing localized epidemics. Modelling results indicate that introduction of RCV into the routine programme alone may initially decrease rubella incidence but then result in cumulative increases in the burden of CRS in some regions (and transient increases in this burden in many regions). Deployment of RCV with regular supplementary campaigns will mitigate these outcomes. Results suggest that introduction of RCV offers a potential for elimination of rubella in Madagascar, but also emphasize both that targeted vaccination is likely to be a lynchpin of this success, and the public health vigilance that this introduction will require.     

Multifractal signatures of infectious diseases

Incidence of infection time-series data for the childhood diseases measles, chicken pox, rubella and whooping cough are described in the language of multifractals. We explore the potential of using the wavelet transform maximum modulus (WTMM) method to characterize the multiscale structure of the observed time series and of simulated data generated by the stochastic susceptible-exposed-infectious-recovered (SEIR) epidemic model. The singularity spectra of the observed time series suggest that each disease is characterized by a unique multifractal signature, which distinguishes that particular disease from the others. The wavelet scaling functions confirm that the time series of measles, rubella and whooping cough are clearly multifractal, while chicken pox has a more monofractal structure in time. The stochastic SEIR epidemic model is unable to reproduce the qualitative singularity structure of the reported incidence data: it is too smooth and does not appear to have a multifractal singularity structure. The precise reasons for the failure of the SEIR epidemic model to reproduce the correct multiscale structure of the reported incidence data remain unclear.     

Complexity and anisotropy in host morphology make populations less susceptible to epidemic outbreaks

One of the challenges in epidemiology is to account for the complex morphological structure of hosts such as plant roots, crop fields, farms, cells, animal habitats and social networks, when the transmission of infection occurs between contiguous hosts. Morphological complexity brings an inherent heterogeneity in populations and affects the dynamics of pathogen spread in such systems. We have analysed the influence of realistically complex host morphology on the threshold for invasion and epidemic outbreak in an SIR (susceptible–infected–recovered) epidemiological model. We show that disorder expressed in the host morphology and anisotropy reduces the probability of epidemic outbreak and thus makes the system more resistant to epidemic outbreaks. We obtain general analytical estimates for minimally safe bounds for an invasion threshold and then illustrate their validity by considering an example of host data for branching hosts (salamander retinal ganglion cells). Several spatial arrangements of hosts with different degrees of heterogeneity have been considered in order to separately analyse the role of shape complexity and anisotropy in the host population. The estimates for invasion threshold are linked to morphological characteristics of the hosts that can be used for determining the threshold for invasion in practical applications.     

Beyond R0: heterogeneity in secondary infections and probabilistic epidemic forecasting

The basic reproductive number, R₀, is one of the most common and most commonly misapplied numbers in public health. Often used to compare outbreaks and forecast pandemic risk, this single number belies the complexity that different epidemics can exhibit, even when they have the same R₀. Here, we reformulate and extend a classic result from random network theory to forecast the size of an epidemic using estimates of the distribution of secondary infections, leveraging both its average R₀ and the underlying heterogeneity. Importantly, epidemics with lower R₀ can be larger if they spread more homogeneously (and are therefore more robust to stochastic fluctuations). We illustrate the potential of this approach using different real epidemics with known estimates for R₀, heterogeneity and epidemic size in the absence of significant intervention. Further, we discuss the different ways in which this framework can be implemented in the data-scarce reality of emerging pathogens. Lastly, we demonstrate that without data on the heterogeneity in secondary infections for emerging infectious diseases like COVID-19 the uncertainty in outbreak size ranges dramatically. Taken together, our work highlights the critical need for contact tracing during emerging infectious disease outbreaks and the need to look beyond R₀.     

Inferring pandemic growth rates from sequence data

Using sequence data to infer population dynamics is playing an increasing role in the analysis of outbreaks. The most common methods in use, based on coalescent inference, have been widely used but not extensively tested against simulated epidemics. Here, we use simulated data to test the ability of both parametric and non-parametric methods for inference of effective population size (coded in the popular BEAST package) to reconstruct epidemic dynamics. We consider a range of simulations centred on scenarios considered plausible for pandemic influenza, but our conclusions are generic for any exponentially growing epidemic. We highlight systematic biases in non-parametric effective population size estimation. The most prominent such bias leads to the false inference of slowing of epidemic spread in the recent past even when the real epidemic is growing exponentially. We suggest some sampling strategies that could reduce (but not eliminate) some of the biases. Parametric methods can correct for these biases if the infected population size is large. We also explore how some poor sampling strategies (e.g. that over-represent epidemiologically linked clusters of cases) could dramatically exacerbate bias in an uncontrolled manner. Finally, we present a simple diagnostic indicator, based on coalescent density and which can easily be applied to reconstructed phylogenies, that identifies time-periods for which effective population size estimates are less likely to be biased. We illustrate this with an application to the 2009 H1N1 pandemic.     

Partially observed epidemics in wildlife hosts: modelling an outbreak of dolphin morbillivirus in the northwestern Atlantic,June 2013–2014

Morbilliviruses cause major mortality in marine mammals, but the dynamics of transmission and persistence are ill understood compared to terrestrial counterparts such as measles; this is especially true for epidemics in cetaceans. However, the recent outbreak of dolphin morbillivirus in the northwestern Atlantic Ocean can provide new insights into the epidemiology and spatio-temporal spread of this pathogen. To deal with uncertainties surrounding the ecology of this system (only stranded animals were observed), we develop a statistical framework that can extract key information about the underlying transmission process given only sparse data. Our self-exciting Poisson process model suggests that individuals are infectious for at most 24 days and can transfer infection up to two latitude degrees (220 km) within this time. In addition, the effective reproduction number is generally below one, but reaches 2.6 during a period of heightened stranding numbers near Virginia Beach, Virginia, in summer 2013. Network analysis suggests local movements dominate spatial spread, with seasonal migration facilitating wider dissemination along the coast. Finally, a low virus transmission rate or high levels of pre-existing immunity can explain the lack of viral spread into the Gulf of Mexico. More generally, our approach illustrates novel methodologies for analysing very indirectly observed epidemics.     

Noise, nonlinearity and seasonality: the epidemics of whooping cough revisited

Understanding the mechanisms that generate oscillations in the incidence of childhood infectious diseases has preoccupied epidemiologists and population ecologists for nearly two centuries. This body of work has generated simple yet powerful explanations for the epidemics of measles and chickenpox, while the dynamics of other infectious diseases, such as whooping cough, have proved more challenging to decipher. A number of authors have, in recent years, proposed that the noisy and somewhat irregular epidemics of whooping cough may arise due to stochasticity and its interaction with nonlinearity in transmission and seasonal variation in contact rates. The reason underlying the susceptibility of whooping cough dynamics to noise and the precise nature of its transient dynamics remain poorly understood. Here we use household data on the incubation period in order to parametrize more realistic distributions of the latent and infectious periods. We demonstrate that previously reported phenomena result from transients following the interaction between the stable annual attractor and unstable multiennial solutions.     

Role of high-dose exposure in transmission hot zones as a driver of SARS-CoV-2 dynamics

Epidemiological data about SARS-CoV-2 spread indicate that the virus is not transmitted uniformly in the population. The transmission tends to be more effective in select settings that involve exposure to relatively high viral dose, such as in crowded indoor settings, assisted living facilities, prisons or food processing plants. To explore the effect on infection dynamics, we describe a new mathematical model where transmission can occur (i) in the community at large, characterized by low-dose exposure and mostly mild disease, and (ii) in so-called transmission hot zones, characterized by high-dose exposure that can be associated with more severe disease. The model yields different types of epidemiological dynamics, depending on the relative importance of hot zone and community transmission. Interesting dynamics occur if the rate of virus release/deposition from severely infected people is larger than that of mildly infected individuals. Under this assumption, we find that successful infection spread can hinge upon high-dose hot zone transmission, yet the majority of infections are predicted to occur in the community at large with mild disease. In this regime, residual hot zone transmission can account for continued virus spread during community lockdowns, and the suppression of hot zones after community interventions are relaxed can cause a prolonged lack of infection resurgence following the reopening of society. This gives rise to the notion that targeted interventions specifically reducing virus transmission in the hot zones have the potential to suppress overall infection spread, including in the community at large. Epidemiological trends in the USA and Europe are interpreted in light of this model.     

Modelling the spread of American foulbrood in honeybees

We investigate the spread of American foulbrood (AFB), a disease caused by the bacterium Paenibacillus larvae, that affects bees and can be extremely damaging to beehives. Our dataset comes from an inspection period carried out during an AFB epidemic of honeybee colonies on the island of Jersey during the summer of 2010. The data include the number of hives of honeybees, location and owner of honeybee apiaries across the island. We use a spatial SIR model with an underlying owner network to simulate the epidemic and characterize the epidemic using a Markov chain Monte Carlo (MCMC) scheme to determine model parameters and infection times (including undetected ‘occult’ infections). Likely methods of infection spread can be inferred from the analysis, with both distance- and owner-based transmissions being found to contribute to the spread of AFB. The results of the MCMC are corroborated by simulating the epidemic using a stochastic SIR model, resulting in aggregate levels of infection that are comparable to the data. We use this stochastic SIR model to simulate the impact of different control strategies on controlling the epidemic. It is found that earlier inspections result in smaller epidemics and a higher likelihood of AFB extinction.     

Applications of percolation theory to fungal spread with synergy

There is increasing interest in the use of the percolation paradigm to analyse and predict the progress of disease spreading in spatially structured populations of animals and plants. The wider utility of the approach has been limited, however, by several restrictive assumptions, foremost of which is a strict requirement for simple nearest-neighbour transmission, in which the disease history of an individual is influenced only by that of its neighbours. In a recent paper, the percolation paradigm has been generalized to incorporate synergistic interactions in host infectivity and susceptibility, and the impact of these interactions on the invasive dynamics of an epidemic has been demonstrated. In the current paper, we elicit evidence that such synergistic interactions may underlie transmission dynamics in real-world systems by first formulating a model for the spread of a ubiquitous parasitic and saprotrophic fungus through replicated populations of nutrient sites and subsequently fitting and testing the model using data from experimental microcosms. Using Bayesian computational methods for model fitting, we demonstrate that synergistic interactions are necessary to explain the dynamics observed in the replicate experiments. The broader implications of this work in identifying disease-control strategies that deflect epidemics from invasive to non-invasive regimes are discussed.     

Plug-and-play inference for disease dynamics: measles in large and small populations as a case study

Statistical inference for mechanistic models of partially observed dynamic systems is an active area of research. Most existing inference methods place substantial restrictions upon the form of models that can be fitted and hence upon the nature of the scientific hypotheses that can be entertained and the data that can be used to evaluate them. In contrast, the so-called plug-and-play methods require only simulations from a model and are thus free of such restrictions. We show the utility of the plug-and-play approach in the context of an investigation of measles transmission dynamics. Our novel methodology enables us to ask and answer questions that previous analyses have been unable to address. Specifically, we demonstrate that plug-and-play methods permit the development of a modelling and inference framework applicable to data from both large and small populations. We thereby obtain novel insights into the nature of heterogeneity in mixing and comment on the importance of including extra-demographic stochasticity as a means of dealing with environmental stochasticity and model misspecification. Our approach is readily applicable to many other epidemiological and ecological systems.     

Bayesian data assimilation provides rapid decision support for vector-borne diseases

Predicting the spread of vector-borne diseases in response to incursions requires knowledge of both host and vector demographics in advance of an outbreak. Although host population data are typically available, for novel disease introductions there is a high chance of the pathogen using a vector for which data are unavailable. This presents a barrier to estimating the parameters of dynamical models representing host–vector–pathogen interaction, and hence limits their ability to provide quantitative risk forecasts. The Theileria orientalis (Ikeda) outbreak in New Zealand cattle demonstrates this problem: even though the vector has received extensive laboratory study, a high degree of uncertainty persists over its national demographic distribution. Addressing this, we develop a Bayesian data assimilation approach whereby indirect observations of vector activity inform a seasonal spatio-temporal risk surface within a stochastic epidemic model. We provide quantitative predictions for the future spread of the epidemic, quantifying uncertainty in the model parameters, case infection times and the disease status of undetected infections. Importantly, we demonstrate how our model learns sequentially as the epidemic unfolds and provide evidence for changing epidemic dynamics through time. Our approach therefore provides a significant advance in rapid decision support for novel vector-borne disease outbreaks.