Seasonal dynamics and thresholds governing recurrent epidemics

Driven by seasonality, many common recurrent infectious diseases are characterized by strong annual, biennial and sometimes irregular oscillations in the absence of vaccination programs. Using the seasonally forced SIR epidemic model, we are able to provide new insights into the dynamics of recurrent diseases and, in some cases, specific predictions about individual outbreaks. The analysis reveals a new threshold effect that gives clear conditions for the triggering of future disease outbreaks or their absence. The threshold depends critically on the susceptibility S ₀ of the population after an outbreak. We show that in the presence of seasonality, forecasts based on the susceptibility S ₀ are more reliable than those based on the classical reproductive number R ₀ from the conventional theory.      

Inferring Epidemiological Dynamics with Bayesian Coalescent Inference: The Merits of Deterministic and Stochastic Models

Estimation of epidemiological and population parameters from molecular sequence data has become central to the understanding of infectious disease dynamics. Various models have been proposed to infer details of the dynamics that describe epidemic progression. These include inference approaches derived from Kingman’s coalescent theory. Here, we use recently described coalescent theory for epidemic dynamics to develop stochastic and deterministic coalescent susceptible–infected–removed (SIR) tree priors. We implement these in a Bayesian phylogenetic inference framework to permit joint estimation of SIR epidemic parameters and the sample genealogy. We assess the performance of the two coalescent models and also juxtapose results obtained with a recently published birth–death-sampling model for epidemic inference. Comparisons are made by analyzing sets of genealogies simulated under precisely known epidemiological parameters. Additionally, we analyze influenza A (H1N1) sequence data sampled in the Canterbury region of New Zealand and HIV-1 sequence data obtained from known United Kingdom infection clusters. We show that both coalescent SIR models are effective at estimating epidemiological parameters from data with large fundamental reproductive number R₀ and large population size S₀. Furthermore, we find that the stochastic variant generally outperforms its deterministic counterpart in terms of error, bias, and highest posterior density coverage, particularly for smaller R₀ and S₀. However, each of these inference models is shown to have undesirable properties in certain circumstances, especially for epidemic outbreaks with R₀ close to one or with small effective susceptible populations.     

Epidemiological effects of seasonal oscillations in birth rates

Seasonal oscillations in birth rates are ubiquitous in human populations. These oscillations might play an important role in infectious disease dynamics because they induce seasonal variation in the number of susceptible individuals that enter populations. We incorporate seasonality of birth rate into the standard, deterministic susceptible-infectious-recovered (SIR) and susceptible-exposed-infectious-recovered (SEIR) epidemic models and identify parameter regions in which birth seasonality can be expected to have observable epidemiological effects. The SIR and SEIR models yield similar results if the infectious period in the SIR model is compared with the "infected period" (the sum of the latent and infectious periods) in the SEIR model. For extremely transmissible pathogens, large amplitude birth seasonality can induce resonant oscillations in disease incidence, bifurcations to stable multi-year epidemic cycles, and hysteresis. Typical childhood infectious diseases are not sufficiently transmissible for their asymptotic dynamics to be likely to exhibit such behaviour. However, we show that fold and period-doubling bifurcations generically occur within regions of parameter space where transients are phase-locked onto cycles resembling the limit cycles beyond the bifurcations, and that these phase-locking regions extend to arbitrarily small amplitude of seasonality of birth rates. Consequently, significant epidemiological effects of birth seasonality may occur in practice in the form of transient dynamics that are sustained by demographic stochasticity.     

Recurrent epidemics in small world networks

The effect of spatial correlations on the spread of infectious diseases was investigated using a stochastic susceptible-infective-recovered (SIR) model on complex networks. It was found that in addition to the reduction of the effective transmission rate, through the screening of infectives, spatial correlations have another major effect through the enhancement of stochastic fluctuations, which may become considerably larger than in the homogeneously mixed stochastic model. As a consequence, in finite spatially structured populations significant differences from the solutions of deterministic models are to be expected, since sizes even larger than those found for homogeneously mixed stochastic models are required for the effects of fluctuations to be negligible. Furthermore, time series of the (unforced) model provide patterns of recurrent epidemics with slightly irregular periods and realistic amplitudes, suggesting that stochastic models together with complex networks of contacts may be sufficient to describe the long-term dynamics of some diseases. The spatial effects were analysed quantitatively by modelling measles and pertussis, using a susceptible-exposed-infective-recovered (SEIR) model. Both the period and the spatial coherence of the epidemic peaks of pertussis are well described by the unforced model for realistic values of the parameters.     

Coalescent inference for infectious disease: meta-analysis of hepatitis C

Genetic analysis of pathogen genomes is a powerful approach to investigating the population dynamics and epidemic history of infectious diseases. However, the theoretical underpinnings of the most widely used, coalescent methods have been questioned, casting doubt on their interpretation. The aim of this study is to develop robust population genetic inference for compartmental models in epidemiology. Using a general approach based on the theory of metapopulations, we derive coalescent models under susceptible–infectious (SI), susceptible–infectious–susceptible (SIS) and susceptible–infectious–recovered (SIR) dynamics. We show that exponential and logistic growth models are equivalent to SI and SIS models, respectively, when co-infection is negligible. Implementing SI, SIS and SIR models in BEAST, we conduct a meta-analysis of hepatitis C epidemics, and show that we can directly estimate the basic reproductive number (R₀) and prevalence under SIR dynamics. We find that differences in genetic diversity between epidemics can be explained by differences in underlying epidemiology (age of the epidemic and local population density) and viral subtype. Model comparison reveals SIR dynamics in three globally restricted epidemics, but most are better fit by the simpler SI dynamics. In summary, metapopulation models provide a general and practical framework for integrating epidemiology and population genetics for the purposes of joint inference.     

Epidemic modelling: Aspects where stochasticity matters

Epidemic models are always simplifications of real world epidemics. Which real world features to include, and which simplifications to make, depend both on the disease of interest and on the purpose of the modelling. In the present paper we discuss some such purposes for which a stochastic model is preferable to a deterministic counterpart. The two main examples illustrate the importance of allowing the infectious and latent periods to be random when focus lies on the probability of a large epidemic outbreak and/or on the initial speed, or growth rate, of the epidemic. A consequence of the latter is that estimation of the basic reproduction number R₀ is sensitive to assumptions about the distributions of the infectious and latent periods when using data from the early stages of an outbreak, which we illustrate with data from the H1N1 influenza A pandemic. Some further examples are also discussed as are some practical consequences related to these stochastic aspects.     

Estimating the Probability of a Major Outbreak from the Timing of Early Cases: An Indeterminate Problem?

Conservation biologists, as well as veterinary and public health officials, would benefit greatly from being able to forecast whether outbreaks of infectious disease will be major. For values of the basic reproductive number (R ₀) between one and two, infectious disease outbreaks have a reasonable chance of either fading out at an early stage or, in the absence of intervention, spreading widely within the population. If it were possible to predict when fadeout was likely to occur, the need for costly precautionary control strategies could be minimized. However, the predictability of even simple epidemic processes remains largely unexplored. Here we conduct an examination of simulated data from the early stages of a fatal disease outbreak and explore how observable information might be useful for predicting major outbreaks. Specifically, would knowing the time of deaths for the first few cases allow us to predict whether an outbreak will be major? Using two approaches, trajectory matching and discriminant function analysis, we find that even in our best-case scenario (with accurate knowledge of epidemiological parameters, and precise times of death), it was not possible to reliably predict the outcome of a stochastic Susceptible-Exposed–Infectious-Recovered (SEIR) process.     

A tutorial introduction to Bayesian inference for stochastic epidemic models using Markov chain Monte Carlo methods

Recent Bayesian methods for the analysis of infectious disease outbreak data using stochastic epidemic models are reviewed. These methods rely on Markov chain Monte Carlo methods. Both temporal and non-temporal data are considered. The methods are illustrated with a number of examples featuring different models and datasets.     

Connectivity,reproduction number,and mobility interact to determine communities’ epidemiological superspreader potential in a metapopulation network

Disease epidemic outbreaks on human metapopulation networks are often driven by a small number of superspreader nodes, which are primarily responsible for spreading the disease throughout the network. Superspreader nodes typically are characterized either by their locations within the network, by their degree of connectivity and centrality, or by their habitat suitability for the disease, described by their reproduction number (R). Here we introduce a model that considers simultaneously the effects of network properties and R on superspreaders, as opposed to previous research which considered each factor separately. This type of model is applicable to diseases for which habitat suitability varies by climate or land cover, and for direct transmitted diseases for which population density and mitigation practices influences R. We present analytical models that quantify the superspreader capacity of a population node by two measures: probability-dependent superspreader capacity, the expected number of neighboring nodes to which the node in consideration will randomly spread the disease per epidemic generation, and time-dependent superspreader capacity, the rate at which the node spreads the disease to each of its neighbors. We validate our analytical models with a Monte Carlo analysis of repeated stochastic Susceptible-Infected-Recovered (SIR) simulations on randomly generated human population networks, and we use a random forest statistical model to relate superspreader risk to connectivity, R, centrality, clustering, and diffusion. We demonstrate that either degree of connectivity or R above a certain threshold are sufficient conditions for a node to have a moderate superspreader risk factor, but both are necessary for a node to have a high-risk factor. The statistical model presented in this article can be used to predict the location of superspreader events in future epidemics, and to predict the effectiveness of mitigation strategies that seek to reduce the value of R, alter host movements, or both.     

On the definition and utilization of heritable variation among hosts in reproduction ratio R0 for infectious diseases

Infectious diseases have a major role in evolution by natural selection and pose a worldwide concern in livestock. Understanding quantitative genetics of infectious diseases, therefore, is essential both for understanding the consequences of natural selection and for designing artificial selection schemes in agriculture. The basic reproduction ratio, R₀, is the key parameter determining risk and severity of infectious diseases. Genetic improvement for control of infectious diseases in host populations should therefore aim at reducing R₀. This requires definitions of breeding value and heritable variation for R₀, and understanding of mechanisms determining response to selection. This is challenging, as R₀ is an emergent trait arising from interactions among individuals in the population. Here we show how to define breeding value and heritable variation for R₀ for genetically heterogeneous host populations. Furthermore, we identify mechanisms determining utilization of heritable variation for R₀. Using indirect genetic effects, next-generation matrices and a SIR (Susceptible, Infected and Recovered) model, we show that an individual''s breeding value for R₀ is a function of its own allele frequencies for susceptibility and infectivity and of population average susceptibility and infectivity. When interacting individuals are unrelated, selection for individual disease status captures heritable variation in susceptibility only, yielding limited response in R₀. With related individuals, however, there is a secondary selection process, which also captures heritable variation in infectivity and additional variation in susceptibility, yielding substantially greater response. This shows that genetic variation in susceptibility represents an indirect genetic effect. As a consequence, response in R₀ increased substantially when interacting individuals were genetically related.     

Early real-time estimation of the basic reproduction number of emerging or reemerging infectious diseases in a community with heterogeneous contact pattern: Using data from Hong Kong 2009 H1N1 Pandemic Influenza as an illustrative example

Emerging and re-emerging infections such as SARS (2003) and pandemic H1N1 (2009) have caused concern for public health researchers and policy makers due to the increased burden of these diseases on health care systems. This concern has prompted the use of mathematical models to evaluate strategies to control disease spread, making these models invaluable tools to identify optimal intervention strategies. A particularly important quantity in infectious disease epidemiology is the basic reproduction number, R_0. Estimation of this quantity is crucial for effective control responses in the early phase of an epidemic. In our previous study, an approach for estimating the basic reproduction number in real time was developed. This approach uses case notification data and the structure of potential transmission contacts to accurately estimate R₀ from the limited amount of information available at the early stage of an outbreak. Based on this approach, we extend the existing methodology; the most recent method features intra- and inter-age groups contact heterogeneity. Given the number of newly reported cases at the early stage of the outbreak, with parsimony assumptions on removal distribution and infectivity profile of the diseases, experiments to estimate real time R₀ under different levels of intra- and inter-group contact heterogeneity using two age groups are presented. We show that the new method converges more quickly to the actual value of R₀ than the previous one, in particular when there is high-level intra-group and inter-group contact heterogeneity. With the age specific contact patterns, number of newly reported cases, removal distribution, and information about the natural history of the 2009 pandemic influenza in Hong Kong, we also use the extended model to estimate R₀ and age-specific R₀.     

Network-based analysis of stochastic SIR epidemic models with random and proportionate mixing

In this paper, we outline the theory of epidemic percolation networks and their use in the analysis of stochastic susceptible-infectious-removed (SIR) epidemic models on undirected contact networks. We then show how the same theory can be used to analyze stochastic SIR models with random and proportionate mixing. The epidemic percolation networks for these models are purely directed because undirected edges disappear in the limit of a large population. In a series of simulations, we show that epidemic percolation networks accurately predict the mean outbreak size and probability and final size of an epidemic for a variety of epidemic models in homogeneous and heterogeneous populations. Finally, we show that epidemic percolation networks can be used to re-derive classical results from several different areas of infectious disease epidemiology. In an Appendix, we show that an epidemic percolation network can be defined for any time-homogeneous stochastic SIR model in a closed population and prove that the distribution of outbreak sizes given the infection of any given node in the SIR model is identical to the distribution of its out-component sizes in the corresponding probability space of epidemic percolation networks. We conclude that the theory of percolation on semi-directed networks provides a very general framework for the analysis of stochastic SIR models in closed populations.     

Modeling the Transmission of Middle East Respirator Syndrome Corona Virus in the Republic of Korea

The 2015 epidemic of Middle East respiratory syndrome (MERS) in the Republic of Korea has been the largest outbreak outside Middle East. This epidemic had caused 185 laboratory-confirmed cases and 36 deaths in the Republic of Korea until September 2, 2015, which attracted public’s attention. Based on the detailed data of patients released by World Health Organization (WHO) and actual propagation of the epidemic, we construct two dynamical models to simulate the propagation processes from May 20 to June 8 and from June 9 to July 10, 2015, respectively and find that the basic reproduction number R ₀ reaches up to 4.422. The numerical analysis shows that the reasons of the outbreak spread quickly are lack of self-protection sense and targeted control measures. Through partial correction analysis, the parameters β ₁ and γ have strong correlations with R ₀, i.e., the infectivity and proportion of the asymptomatic infected cases have much influence on the spread of disease. By sensitivity analysis, strengthening self-protection ability of susceptible and quickly isolating or monitoring close contacts are effective measures to control the disease.     

The impact of network clustering and assortativity on epidemic behaviour

Epidemic models have successfully included many aspects of the complex contact structure apparent in real-world populations. However, it is difficult to accommodate variations in the number of contacts, clustering coefficient and assortativity. Investigations of the relationship between these properties and epidemic behaviour have led to inconsistent conclusions and have not accounted for their interrelationship. In this study, simulation is used to estimate the impact of social network structure on the probability of an SIR (susceptible-infective-removed) epidemic occurring and, if it does, the final size. Increases in assortativity and clustering coefficient are associated with smaller epidemics and the impact is cumulative. Derived values of the basic reproduction ratio (R₀) over networks with the highest property values are more than 20% lower than those derived from simulations with zero values of these network properties.     

Disease Surveillance on Complex Social Networks

As infectious disease surveillance systems expand to include digital, crowd-sourced, and social network data, public health agencies are gaining unprecedented access to high-resolution data and have an opportunity to selectively monitor informative individuals. Contact networks, which are the webs of interaction through which diseases spread, determine whether and when individuals become infected, and thus who might serve as early and accurate surveillance sensors. Here, we evaluate three strategies for selecting sensors—sampling the most connected, random, and friends of random individuals—in three complex social networks—a simple scale-free network, an empirical Venezuelan college student network, and an empirical Montreal wireless hotspot usage network. Across five different surveillance goals—early and accurate detection of epidemic emergence and peak, and general situational awareness—we find that the optimal choice of sensors depends on the public health goal, the underlying network and the reproduction number of the disease (R₀). For diseases with a low R₀, the most connected individuals provide the earliest and most accurate information about both the onset and peak of an outbreak. However, identifying network hubs is often impractical, and they can be misleading if monitored for general situational awareness, if the underlying network has significant community structure, or if R₀ is high or unknown. Taking a theoretical approach, we also derive the optimal surveillance system for early outbreak detection but find that real-world identification of such sensors would be nearly impossible. By contrast, the friends-of-random strategy offers a more practical and robust alternative. It can be readily implemented without prior knowledge of the network, and by identifying sensors with higher than average, but not the highest, epidemiological risk, it provides reasonably early and accurate information.     

The basic reproduction number and the probability of extinction for a dynamic epidemic model

We consider the spread of an epidemic through a population divided into n sub-populations, in which individuals move between populations according to a Markov transition matrix Σ and infectives can only make infectious contacts with members of their current population. Expressions for the basic reproduction number, R₀, and the probability of extinction of the epidemic are derived. It is shown that in contrast to contact distribution models, the distribution of the infectious period effects both the basic reproduction number and the probability of extinction of the epidemic in the limit as the total population size N → ∞. The interactions between the infectious period distribution and the transition matrix Σ mean that it is not possible to draw general conclusions about the effects on R₀ and the probability of extinction. However, it is shown that for n = 2, the basic reproduction number, R₀, is maximised by a constant length infectious period and is decreasing in ?, the speed of movement between the two populations.     

Networks, epidemics and vaccination through contact tracing

We consider a (social) network whose structure can be represented by a simple random graph having a pre-specified degree distribution. A Markovian susceptible-infectious-removed (SIR) epidemic model is defined on such a social graph. We then consider two real-time vaccination models for contact tracing during the early stages of an epidemic outbreak. The first model considers vaccination of each friend of an infectious individual (once identified) independently with probability ρ. The second model is related to the first model but also sets a bound on the maximum number an infectious individual can infect before being identified. Expressions are derived for the influence on the reproduction number of these vaccination models. We give some numerical examples and simulation results based on the Poisson and heavy-tail degree distributions where it is shown that the second vaccination model has a bigger advantage compared to the first model for the heavy-tail degree distribution.     

Analytic approximation of spatial epidemic models of foot and mouth disease

The effect of spatial heterogeneity in epidemic models has improved with computational advances, yet far less progress has been made in developing analytical tools for understanding such systems. Here, we develop two classes of second-order moment closure methods for approximating the dynamics of a stochastic spatial model of the spread of foot and mouth disease. We consider the performance of such ‘pseudo-spatial’ models as a function of R₀, the locality in disease transmission, farm distribution and geographically-targeted control when an arbitrary number of spatial kernels are incorporated. One advantage of mapping complex spatial models onto simpler deterministic approximations lies in the ability to potentially obtain a better analytical understanding of disease dynamics and the effects of control. We exploit this tractability by deriving analytical results in the invasion stages of an FMD outbreak, highlighting key principles underlying epidemic spread on contact networks and the effect of spatial correlations.