Spatio-temporal waves and targeted vaccination in recurrent epidemic network models

The success of an infectious disease to invade a population is strongly controlled by the population''s specific connectivity structure. Here, a network model is presented as an aid in understanding the role of social behaviour and heterogeneous connectivity in determining the spatio-temporal patterns of disease dynamics. We explore the controversial origins of long-term recurrent oscillations believed to be characteristic of diseases that have a period of temporary immunity after infection. In particular, we focus on sexually transmitted diseases such as syphilis, where this controversy is currently under review. Although temporary immunity plays a key role, it is found that, in realistic small-world networks, the social and sexual behaviour of individuals also has a great influence in generating long-term cycles. The model generates circular waves of infection with unusual spatial dynamics that depend on focal areas that act as pacemakers in the population. Eradication of the disease can be efficiently achieved by eliminating the pacemakers with a targeted vaccination scheme. A simple difference equation model is derived, which captures the infection dynamics of the network model and gives insights into their origins and their eradication through vaccination. Illustrative videos may be found in the electronic supplementary material.     

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.     

A simple criterion to design optimal non-pharmaceutical interventions for mitigating epidemic outbreaks

For mitigating the COVID-19 pandemic, much emphasis is made on implementing non-pharmaceutical interventions to keep the reproduction number below one. However, using that objective ignores that some of these interventions, like bans of public events or lockdowns, must be transitory and as short as possible because of their significant economic and societal costs. Here, we derive a simple and mathematically rigorous criterion for designing optimal transitory non-pharmaceutical interventions for mitigating epidemic outbreaks. We find that reducing the reproduction number below one is sufficient but not necessary. Instead, our criterion prescribes the required reduction in the reproduction number according to the desired maximum of disease prevalence and the maximum decrease of disease transmission that the interventions can achieve. We study the implications of our theoretical results for designing non-pharmaceutical interventions in 16 cities and regions during the COVID-19 pandemic. In particular, we estimate the minimal reduction of each region’s contact rate necessary to control the epidemic optimally. Our results contribute to establishing a rigorous methodology to design optimal non-pharmaceutical intervention policies for mitigating epidemic outbreaks.     

Evidence of strategic periodicities in collective conflict dynamics

We analyse the timescales of conflict decision-making in a primate society. We present evidence for multiple, periodic timescales associated with social decision-making and behavioural patterns. We demonstrate the existence of periodicities that are not directly coupled to environmental cycles or known ultraridian mechanisms. Among specific biological and socially defined demographic classes, periodicities span timescales between hours and days. Our results indicate that these periodicities are not driven by exogenous or internal regularities but are instead driven by strategic responses to social interaction patterns. Analyses also reveal that a class of individuals, playing a critical functional role, policing, have a signature timescale of the order of 1 h. We propose a classification of behavioural timescales analogous to those of the nervous system, with high frequency, or α-scale, behaviour occurring on hour-long scales, through to multi-hour, or β-scale, behaviour, and, finally γ periodicities observed on a timescale of days.     

Disease control across urban–rural gradients

Controlling the regional re-emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after its initial spread in ever-changing personal contact networks and disease landscapes is a challenging task. In a landscape context, contact opportunities within and between populations are changing rapidly as lockdown measures are relaxed and a number of social activities re-activated. Using an individual-based metapopulation model, we explored the efficacy of different control strategies across an urban–rural gradient in Wales, UK. Our model shows that isolation of symptomatic cases or regional lockdowns in response to local outbreaks have limited efficacy unless the overall transmission rate is kept persistently low. Additional isolation of non-symptomatic infected individuals, who may be detected by effective test-and-trace strategies, is pivotal to reducing the overall epidemic size over a wider range of transmission scenarios. We define an ‘urban–rural gradient in epidemic size'' as a correlation between regional epidemic size and connectivity within the region, with more highly connected urban populations experiencing relatively larger outbreaks. For interventions focused on regional lockdowns, the strength of such gradients in epidemic size increased with higher travel frequencies, indicating a reduced efficacy of the control measure in the urban regions under these conditions. When both non-symptomatic and symptomatic individuals are isolated or regional lockdown strategies are enforced, we further found the strongest urban–rural epidemic gradients at high transmission rates. This effect was reversed for strategies targeted at symptomatic individuals only. Our results emphasize the importance of test-and-trace strategies and maintaining low transmission rates for efficiently controlling SARS-CoV-2 spread, both at landscape scale and in urban areas.     

Effects of heterogeneity in infection-exposure history and immunity on the dynamics of a protozoan parasite

Infection systems where traits of the host, such as acquired immunity, interact with the infection process can show complex dynamic behaviour with counter-intuitive results. In this study, we consider the traits ‘immune status’ and ‘exposure history’, and our aim is to assess the influence of acquired individual heterogeneity in these traits. We have built an individual-based model of Eimeria acervulina infections, a protozoan parasite with an environmental stage that causes coccidiosis in chickens. With the model, we simulate outbreaks of the disease under varying initial contaminations. Heterogeneity in the traits arises stochastically through differences in the dose and frequency of parasites that individuals pick up from the environment. We find that the relationship between the initial contamination and the severity of an outbreak has a non-monotonous ‘wave-like’ pattern. This pattern can be explained by an increased heterogeneity in the host population caused by the infection process at the most severe outbreaks. We conclude that when dealing with these types of infection systems, models that are used to develop or evaluate control measures cannot neglect acquired heterogeneity in the host population traits that interact with the infection process.     

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.     

Modelling behavioural contagion

The last decade has seen much work on quantitative understanding of human behaviour, with online social interaction offering the possibility of more precise measurement of behavioural phenomena than was previously possible. A parsimonious model is proposed that incorporates several observed features of behavioural contagion not seen in existing epidemic model schemes, leading to metastable behavioural dynamics.     

Modelling seasonal influenza: the role of weather and punctuated antigenic drift

Seasonal influenza appears as annual oscillations in temperate regions of the world, yet little is known as to what drives these annual outbreaks and what factors are responsible for their inter-annual variability. Recent studies suggest that weather variables, such as absolute humidity, are the key drivers of annual influenza outbreaks. The rapid, punctuated, antigenic evolution of the influenza virus is another major factor. We present a new framework for modelling seasonal influenza based on a discrete-time, age-of-infection, epidemic model, which allows the calculation of the model''s likelihood function in closed form. This framework may be used to perform model inference and parameter estimation rigorously. The modelling approach allows us to fit 11 years of Israeli influenza data, with the best models fitting the data with unusually high correlations in which r > 0.9. We show that using actual weather to modulate influenza transmission rate gives better results than using the inter-annual means of the weather variables, providing strong support for the role of weather in shaping the dynamics of influenza. This conclusion remains valid even when incorporating a more realistic depiction of the decay of immunity at the population level, which allows for discrete changes in immunity from year to year.     

Demographic buffering: titrating the effects of birth rate and imperfect immunity on epidemic dynamics

Host demography can alter the dynamics of infectious disease. In the case of perfectly immunizing infections, observations of strong sensitivity to demographic variation have been mechanistically explained through analysis of the susceptible–infected–recovered (SIR) model that assumes lifelong immunity following recovery from infection. When imperfect immunity is incorporated into this framework via the susceptible–infected–recovered–susceptible (SIRS) model, with individuals regaining full susceptibility following recovery, we show that rapid loss of immunity is predicted to buffer populations against the effects of demographic change. However, this buffering is contrary to the dependence on demography recently observed for partially immunizing infections such as rotavirus and respiratory syncytial virus. We show that this discrepancy arises from a key simplification embedded in the SIR(S) framework, namely that the potential for differential immune responses to repeat exposures is ignored. We explore the minimum additional immunological information that must be included to reflect the range of observed dependencies on demography. We show that including partial protection and lower transmission following primary infection is sufficient to capture more realistic reduced levels of buffering, in addition to changes in epidemic timing, across a range of partially and fully immunizing infections. Furthermore, our results identify key variables in this relationship, including R₀.     

Triple contagion: a two-fears epidemic model

We present a differential equations model in which contagious disease transmission is affected by contagious fear of the disease and contagious fear of the control, in this case vaccine. The three contagions are coupled. The two fears evolve and interact in ways that shape distancing behaviour, vaccine uptake, and their relaxation. These behavioural dynamics in turn can amplify or suppress disease transmission, which feeds back to affect behaviour. The model reveals several coupled contagion mechanisms for multiple epidemic waves. Methodologically, the paper advances infectious disease modelling by including human behavioural adaptation, drawing on the neuroscience of fear learning, extinction and transmission.     

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.     

Predictability in a highly stochastic system: final size of measles epidemics in small populations

A standard assumption in the modelling of epidemic dynamics is that the population of interest is well mixed, and that no clusters of metapopulations exist. The well-known and oft-used SIR model, arguably the most important compartmental model in theoretical epidemiology, assumes that the disease being modelled is strongly immunizing, directly transmitted and has a well-defined period of infection, in addition to these population mixing assumptions. Childhood infections, such as measles, are prime examples of diseases that fit the SIR-like mechanism. These infections have been well studied for many systems with large, well-mixed populations with endemic infection. Here, we consider a setting where populations are small and isolated. The dynamics of infection are driven by stochastic extinction–recolonization events, producing large, sudden and short-lived epidemics before rapidly dying out from a lack of susceptible hosts. Using a TSIR model, we fit prevaccination measles incidence and demographic data in Bornholm, the Faroe Islands and four districts of Iceland, between 1901 and 1965. The datasets for each of these countries suffer from different levels of data heterogeneity and sparsity. We explore the potential for prediction of this model: given historical incidence data and up-to-date demographic information, and knowing that a new epidemic has just begun, can we predict how large it will be? We show that, despite a lack of significant seasonality in the incidence of measles cases, and potentially severe heterogeneity at the population level, we are able to estimate the size of upcoming epidemics, conditioned on the first time step, to within reasonable confidence. Our results have potential implications for possible control measures for the early stages of new epidemics in small populations.     

Fluid fragmentation shapes rain-induced foliar disease transmission

Plant diseases represent a growing threat to the global food supply. The factors contributing to pathogen transmission from plant to plant remain poorly understood. Statistical correlations between rainfalls and plant disease outbreaks were reported; however, the detailed mechanisms linking the two were relegated to a black box. In this combined experimental and theoretical study, we focus on the impact dynamics of raindrops on infected leaves, one drop at a time. We find that the deposition range of most of the pathogen-bearing droplets is constrained by a hydrodynamical condition and we quantify the effect of leaf size and compliance on such constraint. Moreover, we identify and characterize two dominant fluid fragmentation scenarios as responsible for the dispersal of most pathogen-bearing droplets emitted from infected leaves: (i) the crescent-moon ejection is driven by the direct interaction between the impacting raindrop and the contaminated sessile drop and (ii) the inertial detachment is driven by the motion imparted to the leaf by the raindrop, leading to catapult-like droplet ejections. We find that at first, decreasing leaf size or increasing compliance reduces the range of pathogen-bearing droplets and the subsequent epidemic onset efficiency. However, this conclusion only applies for the crescent moon ejection. Above a certain compliance threshold a more effective mechanism of contaminated fluid ejection, the inertial detachment, emerges. This compliance threshold is determined by the ratio between the leaf velocity and the characteristic velocity of fluid fragmentation. The inertial detachment mechanism enhances the range of deposition of the larger contaminated droplets and suggests a change in epidemic onset pattern and a more efficient potential of infection of neighbouring plants. Dimensionless parameters and scaling laws are provided to rationalize our observations. Our results link for the first time the mechanical properties of foliage with the onset dynamics of foliar epidemics through the lens of fluid fragmentation. We discuss how the reported findings can inform the design of mitigation strategies acting at the early stage of a foliar disease outbreak.     

Constructing the effect of alternative intervention strategies on historic epidemics.

Data from historical epidemics provide a vital and sometimes under-used resource from which to devise strategies for future control of disease. Previous methods for retrospective analysis of epidemics, in which alternative interventions are compared, do not make full use of the information; by using only partial information on the historical trajectory, augmentation of control may lead to predictions of a paradoxical increase in disease. Here we introduce a novel statistical approach that takes full account of the available information in constructing the effect of alternative intervention strategies in historic epidemics. The key to the method lies in identifying a suitable mapping between the historic and notional outbreaks, under alternative control strategies. We do this by using the Sellke construction as a latent process linking epidemics. We illustrate the application of the method with two examples. First, using temporal data for the common human cold, we show the improvement under the new method in the precision of predictions for different control strategies. Second, we show the generality of the method for retrospective analysis of epidemics by applying it to a spatially extended arboreal epidemic in which we demonstrate the relative effectiveness of host culling strategies that differ in frequency and spatial extent. Some of the inferential and philosophical issues that arise are discussed along with the scope of potential application of the new method.     

Incorporating individual health-protective decisions into disease transmission models: a mathematical framework

It is anticipated that the next generation of computational epidemic models will simulate both infectious disease transmission and dynamic human behaviour change. Individual agents within a simulation will not only infect one another, but will also have situational awareness and a decision algorithm that enables them to modify their behaviour. This paper develops such a model of behavioural response, presenting a mathematical interpretation of a well-known psychological model of individual decision making, the health belief model, suitable for incorporation within an agent-based disease-transmission model. We formalize the health belief model and demonstrate its application in modelling the prevalence of facemask use observed over the course of the 2003 Hong Kong SARS epidemic, a well-documented example of behaviour change in response to a disease outbreak.     

Analytical approximation for invasion and endemic thresholds,and the optimal control of epidemics in spatially explicit individual-based models

Computer simulations of individual-based models are frequently used to compare strategies for the control of epidemics spreading through spatially distributed populations. However, computer simulations can be slow to implement for newly emerging epidemics, delaying rapid exploration of different intervention scenarios, and do not immediately give general insights, for example, to identify the control strategy with a minimal socio-economic cost. Here, we resolve this problem by applying an analytical approximation to a general epidemiological, stochastic, spatially explicit SIR(S) model where the infection is dispersed according to a finite-ranged dispersal kernel. We derive analytical conditions for a pathogen to invade a spatially explicit host population and to become endemic. To derive general insights about the likely impact of optimal control strategies on invasion and persistence: first, we distinguish between ‘spatial'' and ‘non-spatial'' control measures, based on their impact on the dispersal kernel; second, we quantify the relative impact of control interventions on the epidemic; third, we consider the relative socio-economic cost of control interventions. Overall, our study shows a trade-off between the two types of control interventions and a vaccination strategy. We identify the optimal strategy to control invading and endemic diseases with minimal socio-economic cost across all possible parameter combinations. We also demonstrate the necessary characteristics of exit strategies from control interventions. The modelling framework presented here can be applied to a wide class of diseases in populations of humans, animals and plants.