The differential infectivity and staged progression models for the transmission of HIV

Recent studies of HIV RNA in infected individuals show that viral levels vary widely between individuals and within the same individual over time. Individuals with higher viral loads during the chronic phase tend to develop AIDS more rapidly. If RNA levels are correlated with infectiousness, these variations explain puzzling results from HIV transmission studies and suggest that a small subset of infected people may be responsible for a disproportionate number of infections. We use two simple models to study the impact of variations in infectiousness. In the first model, we account for different levels of virus between individuals during the chronic phase of infection, and the increase in the average time from infection to AIDS that goes along with a decreased viral load. The second model follows the more standard hypothesis that infected individuals progress through a series of infection stages, with the infectiousness of a person depending upon his current disease stage. We derive and compare threshold conditions for the two models and find explicit formulas of their endemic equilibria. We show that formulas for both models can be put into a standard form, which allows for a clear interpretation. We define the relative impact of each group as the fraction of infections being caused by that group. We use these formulas and numerical simulations to examine the relative importance of different stages of infection and different chronic levels of virus to the spreading of the disease. The acute stage and the most infectious group both appear to have a disproportionate effect, especially on the early epidemic. Contact tracing to identify super-spreaders and alertness to the symptoms of acute HIV infection may both be needed to contain this epidemic.     

Household epidemic models with varying infection response

This paper is concerned with SIR (susceptible → infected → removed) household epidemic models in which the infection response may be either mild or severe, with the type of response also affecting the infectiousness of an individual. Two different models are analysed. In the first model, the infection status of an individual is predetermined, perhaps due to partial immunity, and in the second, the infection status of an individual depends on the infection status of its infector and on whether the individual was infected by a within- or between-household contact. The first scenario may be modelled using a multitype household epidemic model, and the second scenario by a model we denote by the infector-dependent-severity household epidemic model. Large population results of the two models are derived, with the focus being on the distribution of the total numbers of mild and severe cases in a typical household, of any given size, in the event that the epidemic becomes established. The aim of the paper is to investigate whether it is possible to determine which of the two underlying explanations is causing the varying response when given final size household outbreak data containing mild and severe cases. We conduct numerical studies which show that, given data on sufficiently many households, it is generally possible to discriminate between the two models by comparing the Kullback–Leibler divergence for the two fitted models to these data.     

The effect of contact heterogeneity and multiple routes of transmission on final epidemic size

Heterogeneity in the number of potentially infectious contacts amongst members of a population increases the basic reproduction ratio (R(0)) and markedly alters disease dynamics compared to traditional mean-field models. Most models describing transmission on contact networks only account for one specific route of transmission. However, for many infectious diseases multiple routes of transmission exist. The model presented here captures transmission through a well defined network of contacts, complemented by mean-field type transmission amongst the nodes of the network that accounts for alternative routes of transmission. The impact of these combined transmission mechanisms on the final epidemic size is investigated analytically. The analytic predictions for the purely mean-field case and the transmission through the network-only case are confirmed by individual-based network simulations. There is a critical transmission potential above which an increased contribution of the mean-field type transmission increases the final epidemic size while an increased contribution of the transmission through the network decreases it. Below the critical transmission potential the opposite effect is observed.     

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.     

Pair-level approximations to the spatio-temporal dynamics of epidemics on asymmetric contact networks

The process of infection during an epidemic can be envisaged as being transmitted via a network of routes represented by a contact network. Most differential equation models of epidemics are mean-field models. These contain none of the underlying spatial structure of the contact network. By extending the mean-field models to pair-level, some of the spatial structure can be contained in the model. Some networks of transmission such as river or transportation networks are clearly asymmetric, whereas others such as airborne infection can be regarded as symmetric. Pair-level models have been developed to describe symmetric contact networks. Here we report on work to develop a pair-level model that is also applicable to asymmetric contact networks. The procedure for closing the model at the level of pairs is discussed in detail. The model is compared against stochastic simulations of epidemics on asymmetric contact networks and against the predictions of the symmetric model on the same networks. DEFRA funded project FC1153     

Deterministic epidemic models on contact networks: correlations and unbiological terms

The relationship between system-level and subsystem-level master equations is investigated and then utilised for a systematic and potentially automated derivation of the hierarchy of moment equations in a susceptible-infectious-removed (SIR) epidemic model. In the context of epidemics on contact networks we use this to show that the approximate nature of some deterministic models such as mean-field and pair-approximation models can be partly understood by the identification of implicit anomalous terms. These terms describe unbiological processes which can be systematically removed up to and including the nth order by nth order moment closure approximations. These terms lead to a detailed understanding of the correlations in network-based epidemic models and contribute to understanding the connection between individual-level epidemic processes and population-level models. The connection with metapopulation models is also discussed. Our analysis is predominantly made at the individual level where the first and second order moment closure models correspond to what we term the individual-based and pair-based deterministic models, respectively. Matlab code is included as supplementary material for solving these models on transmission networks of arbitrary complexity.     

Building epidemiological models from R0: an implicit treatment of transmission in networks

Simple deterministic models are still at the core of theoretical epidemiology despite the increasing evidence for the importance of contact networks underlying transmission at the individual level. These mean-field or 'compartmental' models based on homogeneous mixing have made, and continue to make, important contributions to the epidemiology and the ecology of infectious diseases but fail to reproduce many of the features observed for disease spread in contact networks. In this work, we show that it is possible to incorporate the important effects of network structure on disease spread with a mean-field model derived from individual level considerations. We propose that the fundamental number known as the basic reproductive number of the disease, R0, which is typically derived as a threshold quantity, be used instead as a central parameter to construct the model from. We show that reliable estimates of individual level parameters can replace a detailed knowledge of network structure, which in general may be difficult to obtain. We illustrate the proposed model with small world networks and the classical example of susceptible-infected-recovered (SIR) epidemics.     

Congruent epidemic models for unstructured and structured populations: analytical reconstruction of a 2003 SARS outbreak

Both the threat of bioterrorism and the natural emergence of contagious diseases underscore the importance of quantitatively understanding disease transmission in structured human populations. Over the last few years, researchers have advanced the mathematical theory of scale-free networks and used such theoretical advancements in pilot epidemic models. Scale-free contact networks are particularly interesting in the realm of mathematical epidemiology, primarily because these networks may allow meaningfully structured populations to be incorporated in epidemic models at moderate or intermediate levels of complexity. Moreover, a scale-free contact network with node degree correlation is in accord with the well-known preferred mixing concept. The present author describes a semi-empirical and deterministic epidemic modeling approach that (a) focuses on time-varying rates of disease transmission in both unstructured and structured populations and (b) employs probability density functions to characterize disease progression and outbreak controls. Given an epidemic curve for a historical outbreak, this modeling approach calls for Monte Carlo calculations (that define the average new infection rate) and solutions to integro-differential equations (that describe outbreak dynamics in an aggregate population or across all network connectivity classes). Numerical results are obtained for the 2003 SARS outbreak in Taiwan and the dynamical implications of time-varying transmission rates and scale-free contact networks are discussed in some detail.     

A note on generation times in epidemic models

The time between the infection of a primary case and one of its secondary cases is called a generation time. The distribution (and mean) of the generation times is derived for a rather general class of epidemic models. The relation to assumptions on distributions of latency times and infectious times or more generally on random time varying infectiousness, is investigated. Serial times, defined as the times between occurrence of observable events in the progress of an infectious disease (e.g., the onset of clinical symptoms), are also considered.     

The Effect of Time Distribution Shape on a Complex Epidemic Model

In elaborating a model of the progress of an epidemic, it is necessary to make assumptions about the distributions of latency times and infectious times. In many models, the often implicit assumption is that these times are independent and exponentially distributed. We explore the effects of altering the distribution of latency and infectious times in a complex epidemic model with regional divisions connected by a travel intensity matrix. We show a delay in spread with more realistic latency times. More realistic infectiousness times lead to faster epidemics. The effects are similar but accentuated when compared to a purely homogeneous mixing model.     

Exact epidemic models on graphs using graph-automorphism driven lumping

The dynamics of disease transmission strongly depends on the properties of the population contact network. Pair-approximation models and individual-based network simulation have been used extensively to model contact networks with non-trivial properties. In this paper, using a continuous time Markov chain, we start from the exact formulation of a simple epidemic model on an arbitrary contact network and rigorously derive and prove some known results that were previously mainly justified based on some biological hypotheses. The main result of the paper is the illustration of the link between graph automorphisms and the process of lumping whereby the number of equations in a system of linear differential equations can be significantly reduced. The main advantage of lumping is that the simplified lumped system is not an approximation of the original system but rather an exact version of this. For a special class of graphs, we show how the lumped system can be obtained by using graph automorphisms. Finally, we discuss the advantages and possible applications of exact epidemic models and lumping.     

Contact intervals, survival analysis of epidemic data, and estimation of R(0)

We argue that the time from the onset of infectiousness to infectious contact, which we call the "contact interval," is a better basis for inference in epidemic data than the generation or serial interval. Since contact intervals can be right censored, survival analysis is the natural approach to estimation. Estimates of the contact interval distribution can be used to estimate R(0) in both mass-action and network-based models. We apply these methods to 2 data sets from the 2009 influenza A(H1N1) pandemic.     

Moment Approximation of Infection Dynamics in a Population of Moving Hosts

The modelling of contact processes between hosts is of key importance in epidemiology. Current studies have mainly focused on networks with stationary structures, although we know these structures to be dynamic with continuous appearance and disappearance of links over time. In the case of moving individuals, the contact network cannot be established. Individual-based models (IBMs) can simulate the individual behaviours involved in the contact process. However, with very large populations, they can be hard to simulate and study due to the computational costs. We use the moment approximation (MA) method to approximate a stochastic IBM with an aggregated deterministic model. We illustrate the method with an application in animal epidemiology: the spread of the highly pathogenic virus H5N1 of avian influenza in a poultry flock. The MA method is explained in a didactic way so that it can be reused and extended. We compare the simulation results of three models: 1. an IBM, 2. a MA, and 3. a mean-field (MF). The results show a close agreement between the MA model and the IBM. They highlight the importance for the models to capture the displacement behaviours and the contact processes in the study of disease spread. We also illustrate an original way of using different models of the same system to learn more about the system itself, and about the representation we build of it.     

Modeling epidemic spread with awareness and heterogeneous transmission rates in networks

During an epidemic outbreak in a human population, susceptibility to infection can be reduced by raising awareness of the disease. In this paper, we investigate the effects of three forms of awareness (i.e., contact, local, and global) on the spread of a disease in a random network. Connectivity-correlated transmission rates are assumed. By using the mean-field theory and numerical simulation, we show that both local and contact awareness can raise the epidemic thresholds while the global awareness cannot, which mirrors the recent results of Wu et al. The obtained results point out that individual behaviors in the presence of an infectious disease has a great influence on the epidemic dynamics. Our method enriches mean-field analysis in epidemic models.     

A Simulation Study Comparing Epidemic Dynamics on Exponential Random Graph and Edge-Triangle Configuration Type Contact Network Models

We compare two broad types of empirically grounded random network models in terms of their abilities to capture both network features and simulated Susceptible-Infected-Recovered (SIR) epidemic dynamics. The types of network models are exponential random graph models (ERGMs) and extensions of the configuration model. We use three kinds of empirical contact networks, chosen to provide both variety and realistic patterns of human contact: a highly clustered network, a bipartite network and a snowball sampled network of a “hidden population”. In the case of the snowball sampled network we present a novel method for fitting an edge-triangle model. In our results, ERGMs consistently capture clustering as well or better than configuration-type models, but the latter models better capture the node degree distribution. Despite the additional computational requirements to fit ERGMs to empirical networks, the use of ERGMs provides only a slight improvement in the ability of the models to recreate epidemic features of the empirical network in simulated SIR epidemics. Generally, SIR epidemic results from using configuration-type models fall between those from a random network model (i.e., an Erdős-Rényi model) and an ERGM. The addition of subgraphs of size four to edge-triangle type models does improve agreement with the empirical network for smaller densities in clustered networks. Additional subgraphs do not make a noticeable difference in our example, although we would expect the ability to model cliques to be helpful for contact networks exhibiting household structure.     

Covariation between the physiological and behavioral components of pathogen transmission: host heterogeneity determines epidemic outcomes

Although heterogeneity in contact rate, physiology, and behavioral response to infection have all been empirically demonstrated in host–pathogen systems, little is known about how interactions between individual variation in behavior and physiology scale‐up to affect pathogen transmission at a population level. The objective of this study is to evaluate how covariation between the behavioral and physiological components of transmission might affect epidemic outcomes in host populations. We tested the consequences of contact rate covarying with susceptibility, infectiousness, and infection status using an individual‐based, dynamic network model where individuals initiate and terminate contacts with conspecifics based on their behavioral predispositions and their infection status. Our results suggest that both heterogeneity in physiology and subsequent covariation of physiology with contact rate could powerfully influence epidemic dynamics. Overall, we found that 1) individual variability in susceptibility and infectiousness can reduce the expected maximum prevalence and increase epidemic variability; 2) when contact rate and susceptibility or infectiousness negatively covary, it takes substantially longer for epidemics to spread throughout the population, and rates of epidemic spread remained suppressed even for highly transmissible pathogens; and 3) reductions in contact rate resulting from infection‐induced behavioral changes can prevent the pathogen from reaching most of the population. These effects were strongest for theoretical pathogens with lower transmissibility and for populations where the observed variation in contact rate was higher, suggesting that such heterogeneity may be most important for less infectious, more chronic diseases in wildlife. Understanding when and how variability in pathogen transmission should be modelled is a crucial next step for disease ecology.     

Disease contact tracing in random and clustered networks

The efficacy of contact tracing, be it between individuals (e.g. sexually transmitted diseases or severe acute respiratory syndrome) or between groups of individuals (e.g. foot-and-mouth disease; FMD), is difficult to evaluate without precise knowledge of the underlying contact structure; i.e. who is connected to whom? Motivated by the 2001 FMD epidemic in the UK, we determine, using stochastic simulations and deterministic 'moment closure' models of disease transmission on networks of premises (nodes), network and disease properties that are important for contact tracing efficiency. For random networks with a high average number of connections per node, little clustering of connections and short latency periods, contact tracing is typically ineffective. In this case, isolation of infected nodes is the dominant factor in determining disease epidemic size and duration. If the latency period is longer and the average number of connections per node small, or if the network is spatially clustered, then the contact tracing performs better and an overall reduction in the proportion of nodes that are removed during an epidemic is observed.     

Duplication models for biological networks.

Are biological networks different from other large complex networks? Both large biological and nonbiological networks exhibit power-law graphs (number of nodes with degree k, N(k) approximately k(-beta)), yet the exponents, beta, fall into different ranges. This may be because duplication of the information in the genome is a dominant evolutionary force in shaping biological networks (like gene regulatory networks and protein-protein interaction networks) and is fundamentally different from the mechanisms thought to dominate the growth of most nonbiological networks (such as the Internet). The preferential choice models used for nonbiological networks like web graphs can only produce power-law graphs with exponents greater than 2. We use combinatorial probabilistic methods to examine the evolution of graphs by node duplication processes and derive exact analytical relationships between the exponent of the power law and the parameters of the model. Both full duplication of nodes (with all their connections) as well as partial duplication (with only some connections) are analyzed. We demonstrate that partial duplication can produce power-law graphs with exponents less than 2, consistent with current data on biological networks. The power-law exponent for large graphs depends only on the growth process, not on the starting graph.