Effects of heterogeneous and clustered contact patterns on infectious disease dynamics

The spread of infectious diseases fundamentally depends on the pattern of contacts between individuals. Although studies of contact networks have shown that heterogeneity in the number of contacts and the duration of contacts can have far-reaching epidemiological consequences, models often assume that contacts are chosen at random and thereby ignore the sociological, temporal and/or spatial clustering of contacts. Here we investigate the simultaneous effects of heterogeneous and clustered contact patterns on epidemic dynamics. To model population structure, we generalize the configuration model which has a tunable degree distribution (number of contacts per node) and level of clustering (number of three cliques). To model epidemic dynamics for this class of random graph, we derive a tractable, low-dimensional system of ordinary differential equations that accounts for the effects of network structure on the course of the epidemic. We find that the interaction between clustering and the degree distribution is complex. Clustering always slows an epidemic, but simultaneously increasing clustering and the variance of the degree distribution can increase final epidemic size. We also show that bond percolation-based approximations can be highly biased if one incorrectly assumes that infectious periods are homogeneous, and the magnitude of this bias increases with the amount of clustering in the network. We apply this approach to model the high clustering of contacts within households, using contact parameters estimated from survey data of social interactions, and we identify conditions under which network models that do not account for household structure will be biased.     

An intuitive formulation for the reproductive number for the spread of diseases in heterogeneous populations

The thresholds for mathematical epidemiology models specify the critical conditions for an epidemic to grow or die out. The reproductive number can provide significant insight into the transmission dynamics of a disease and can guide strategies to control its spread. We define the mean number of contacts, the mean duration of infection, and the mean transmission probability appropriately for certain epidemiological models, and construct a simplified formulation of the reproductive number as the product of these quantities. When the spread of the epidemic depends strongly upon the heterogeneity of the populations, the epidemiological models must account for this heterogeneity, and the expressions for the reproductive number become correspondingly more complex. We formulate several models with different heterogeneous structures and demonstrate how to define the mean quantities for an explicit expression for the reproductive number. In complex heterogeneous models, it seems necessary to define the reproductive number for each structured subgroup or cohort and then use the average of these reproductive numbers weighted by their heterogeneity to estimate the reproductive number for the total population.     

Susceptible-infected-recovered epidemics in dynamic contact networks

Contact patterns in populations fundamentally influence the spread of infectious diseases. Current mathematical methods for epidemiological forecasting on networks largely assume that contacts between individuals are fixed, at least for the duration of an outbreak. In reality, contact patterns may be quite fluid, with individuals frequently making and breaking social or sexual relationships. Here, we develop a mathematical approach to predicting disease transmission on dynamic networks in which each individual has a characteristic behaviour (typical contact number), but the identities of their contacts change in time. We show that dynamic contact patterns shape epidemiological dynamics in ways that cannot be adequately captured in static network models or mass-action models. Our new model interpolates smoothly between static network models and mass-action models using a mixing parameter, thereby providing a bridge between disparate classes of epidemiological models. Using epidemiological and sexual contact data from an Atlanta high school, we demonstrate the application of this method for forecasting and controlling sexually transmitted disease outbreaks.     

EpiFire: An open source C++ library and application for contact network epidemiology

ABSTRACT: BACKGROUND: Contact network models have become increasingly common in epidemiology, but we lack a flexible programming framework for the generation and analysis of epidemiological contact networks and for the simulation of disease transmission through such networks. RESULTS: Here we present EpiFire, an applications programming interface and graphical user interface implemented in C++, which includes a fast and efficient library for generating, analyzing and manipulating networks. Network-based percolation and chain-binomial simulations of susceptible-infected-recovered disease transmission, as well as traditional non-network mass-action simulations, can be performed using EpiFire. CONCLUSIONS: EpiFire provides an open-source programming interface for the rapid development of network models with a focus in contact network epidemiology. EpiFire also provides a point-and-click interface for generating networks, conducting epidemic simulations, and creating figures. This interface is particularly useful as a pedagogical tool.     

Social encounter networks: characterizing Great Britain

A major goal of infectious disease epidemiology is to understand and predict the spread of infections within human populations, with the intention of better informing decisions regarding control and intervention. However, the development of fully mechanistic models of transmission requires a quantitative understanding of social interactions and collective properties of social networks. We performed a cross-sectional study of the social contacts on given days for more than 5000 respondents in England, Scotland and Wales, through postal and online survey methods. The survey was designed to elicit detailed and previously unreported measures of the immediate social network of participants relevant to infection spread. Here, we describe individual-level contact patterns, focusing on the range of heterogeneity observed and discuss the correlations between contact patterns and other socio-demographic factors. We find that the distribution of the number of contacts approximates a power-law distribution, but postulate that total contact time (which has a shorter-tailed distribution) is more epidemiologically relevant. We observe that children, public-sector and healthcare workers have the highest number of total contact hours and are therefore most likely to catch and transmit infectious disease. Our study also quantifies the transitive connections made between an individual''s contacts (or clustering); this is a key structural characteristic of social networks with important implications for disease transmission and control efficacy. Respondents'' networks exhibit high levels of clustering, which varies across social settings and increases with duration, frequency of contact and distance from home. Finally, we discuss the implications of these findings for the transmission and control of pathogens spread through close contact.     

The impact of imitation on vaccination behavior in social contact networks

Previous game-theoretic studies of vaccination behavior typically have often assumed that populations are homogeneously mixed and that individuals are fully rational. In reality, there is heterogeneity in the number of contacts per individual, and individuals tend to imitate others who appear to have adopted successful strategies. Here, we use network-based mathematical models to study the effects of both imitation behavior and contact heterogeneity on vaccination coverage and disease dynamics. We integrate contact network epidemiological models with a framework for decision-making, within which individuals make their decisions either based purely on payoff maximization or by imitating the vaccination behavior of a social contact. Simulations suggest that when the cost of vaccination is high imitation behavior may decrease vaccination coverage. However, when the cost of vaccination is small relative to that of infection, imitation behavior increases vaccination coverage, but, surprisingly, also increases the magnitude of epidemics through the clustering of non-vaccinators within the network. Thus, imitation behavior may impede the eradication of infectious diseases. Calculations that ignore behavioral clustering caused by imitation may significantly underestimate the levels of vaccination coverage required to attain herd immunity.     

Epidemic growth rate and household reproduction number in communities of households,schools and workplaces

In this paper we present a novel and coherent modelling framework for the characterisation of the real-time growth rate in SIR models of epidemic spread in populations with social structures of increasing complexity. Known results about homogeneous mixing and multitype models are included in the framework, which is then extended to models with households and models with households and schools/workplaces. Efficient methods for the exact computation of the real-time growth rate are presented for the standard SIR model with constant infection and recovery rates (Markovian case). Approximate methods are described for a large class of models with time-varying infection rates (non-Markovian case). The quality of the approximation is assessed via comparison with results from individual-based stochastic simulations. The methodology is then applied to the case of influenza in models with households and schools/workplaces, to provide an estimate of a household-to-household reproduction number and thus asses the effort required to prevent an outbreak by targeting control policies at the level of households. The results highlight the risk of underestimating such effort when the additional presence of schools/workplaces is neglected. Our framework increases the applicability of models of epidemic spread in socially structured population by linking earlier theoretical results, mainly focused on time-independent key epidemiological parameters (e.g. reproduction numbers, critical vaccination coverage, epidemic final size) to new results on the epidemic dynamics.     

Epidemic progression on networks based on disease generation time

We investigate the time evolution of disease spread on a network and present an analytical framework using the concept of disease generation time. Assuming a susceptible–infected–recovered epidemic process, this network-based framework enables us to calculate in detail the number of links (edges) within the network that are capable of producing new infectious nodes (individuals), the number of links that are not transmitting the infection further (non-transmitting links), as well as the number of contacts that individuals have with their neighbours (also known as degree distribution) within each epidemiological class, for each generation period. Using several examples, we demonstrate very good agreement between our analytical calculations and the results of computer simulations.     

Evaluating the Adequacy of Gravity Models as a Description of Human Mobility for Epidemic Modelling

Gravity models have a long history of use in describing and forecasting the movements of people as well as goods and services, making them a natural basis for disease transmission rates over distance. In agent-based micro-simulations, gravity models can be directly used to represent movement of individuals and hence disease. In this paper, we consider a range of gravity models as fits to movement data from the UK and the US. We examine the ability of synthetic networks generated from fitted models to match those from the data in terms of epidemic behaviour; in particular, times to first infection. For both datasets, best fits are obtained with a two-piece ‘matched’ power law distance distribution. Epidemics on synthetic UK networks match well those on data networks across all but the smallest nodes for a range of aggregation levels. We derive an expression for time to infection between nodes in terms of epidemiological and network parameters which illuminates the influence of network clustering in spread across networks and suggests an approximate relationship between the log-likelihood deviance of model fit and the match times to infection between synthetic and data networks. On synthetic US networks, the match in epidemic behaviour is initially poor and sensitive to the initially infected node. Analysis of times to infection indicates a failure of models to capture infrequent long-range contact between large nodes. An assortative model based on node population size captures this heterogeneity, considerably improving the epidemiological match between synthetic and data networks.     

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.     

Network epidemic models with two levels of mixing

The study of epidemics on social networks has attracted considerable attention recently. In this paper, we consider a stochastic SIR (susceptible-->infective-->removed) model for the spread of an epidemic on a finite network, having an arbitrary but specified degree distribution, in which individuals also make casual contacts, i.e. with people chosen uniformly from the population. The behaviour of the model as the network size tends to infinity is investigated. In particular, the basic reproduction number R(0), that governs whether or not an epidemic with few initial infectives can become established is determined, as are the probability that an epidemic becomes established and the proportion of the population who are ultimately infected by such an epidemic. For the case when the infectious period is constant and all individuals in the network have the same degree, the asymptotic variance and a central limit theorem for the size of an epidemic that becomes established are obtained. Letting the rate at which individuals make casual contacts decrease to zero yields, heuristically, corresponding results for the model without casual contacts, i.e. for the standard SIR network epidemic model. A deterministic model that approximates the spread of an epidemic that becomes established in a large population is also derived. The theory is illustrated by numerical studies, which demonstrate that the asymptotic approximations work well, even for only moderately sized networks, and that the degree distribution and the inclusion of casual contacts can each have a major impact on the outcome of an epidemic.     

Network theory and SARS: predicting outbreak diversity

Many infectious diseases spread through populations via the networks formed by physical contacts among individuals. The patterns of these contacts tend to be highly heterogeneous. Traditional "compartmental" modeling in epidemiology, however, assumes that population groups are fully mixed, that is, every individual has an equal chance of spreading the disease to every other. Applications of compartmental models to Severe Acute Respiratory Syndrome (SARS) resulted in estimates of the fundamental quantity called the basic reproductive number R0--the number of new cases of SARS resulting from a single initial case--above one, implying that, without public health intervention, most outbreaks should spark large-scale epidemics. Here we compare these predictions to the early epidemiology of SARS. We apply the methods of contact network epidemiology to illustrate that for a single value of R0, any two outbreaks, even in the same setting, may have very different epidemiological outcomes. We offer quantitative insight into the heterogeneity of SARS outbreaks worldwide, and illustrate the utility of this approach for assessing public health strategies.     

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.     

Epidemic threshold and network structure: The interplay of probability of transmission and of persistence in small-size directed networks

A growing number of studies are investigating the effect of contact structure on the dynamics of epidemics in large-scale complex networks. Whether findings thus obtained apply also to networks of small size, and thus to many real-world biological applications, is still an open question. We use numerical simulations of disease spread in directed networks of 100 individual nodes with a constant number of links. We show that, no matter the type of network structure (local, small-world, random and scale-free), there is a linear threshold determined by the probability of infection transmission between connected nodes and the probability of infection persistence in an infected node. The threshold is significantly lower for scale-free networks compared to local, random and small-world ones only if super-connected nodes have a higher number of links both to and from other nodes. The starting point, the node at which the epidemic starts, does not affect the threshold conditions, but has a marked influence on the final size of the epidemic in all kinds of network. There is evidence that contact structure has an influence on the average final size of an epidemic across all starting nodes, with significantly lower values in scale-free networks at equilibrium. Simulations in scale-free networks show a distinctive time-series pattern, which, if found in a real epidemic, can be used to infer the underlying network structure. The findings have relevance also for meta-population ecology and species conservation.     

Deterministic epidemic models with explicit household structure

For a wide range of airborne infectious diseases, transmission within the family or household is a key mechanism for the spread and persistence of infection. In general, household-based transmission is relatively strong but only involves a limited number of individuals in contact with each infectious person. In contrast, transmission outside the household can be characterised by many contacts but a lower probability of transmission. Here we develop a relatively simple dynamical model that captures these two transmission regimes. We compare the dynamics of such models for a range of household sizes, whilst constraining all models to have equal early growth rate so that all models fit to the same early incidence observations of an epidemic. Finally we consider the use of prophylactic vaccination, responsive vaccination, or antivirals to combat epidemic spread and focus on whether it is optimal to target controls at entire households or to treat individuals independently.     

Simulated epidemics in an empirical spatiotemporal network of 50,185 sexual contacts

Sexual contact patterns, both in their temporal and network structure, can influence the spread of sexually transmitted infections (STI). Most previous literature has focused on effects of network topology; few studies have addressed the role of temporal structure. We simulate disease spread using SI and SIR models on an empirical temporal network of sexual contacts in high-end prostitution. We compare these results with several other approaches, including randomization of the data, classic mean-field approaches, and static network simulations. We observe that epidemic dynamics in this contact structure have well-defined, rather high epidemic thresholds. Temporal effects create a broad distribution of outbreak sizes, even if the per-contact transmission probability is taken to its hypothetical maximum of 100%. In general, we conclude that the temporal correlations of our network accelerate outbreaks, especially in the early phase of the epidemics, while the network topology (apart from the contact-rate distribution) slows them down. We find that the temporal correlations of sexual contacts can significantly change simulated outbreaks in a large empirical sexual network. Thus, temporal structures are needed alongside network topology to fully understand the spread of STIs. On a side note, our simulations further suggest that the specific type of commercial sex we investigate is not a reservoir of major importance for HIV.     

Network frailty and the geometry of herd immunity

The spread of infectious disease through communities depends fundamentally on the underlying patterns of contacts between individuals. Generally, the more contacts one individual has, the more vulnerable they are to infection during an epidemic. Thus, outbreaks disproportionately impact the most highly connected demographics. Epidemics can then lead, through immunization or removal of individuals, to sparser networks that are more resistant to future transmission of a given disease. Using several classes of contact networks-Poisson, scale-free and small-world-we characterize the structural evolution of a network due to an epidemic in terms of frailty (the degree to which highly connected individuals are more vulnerable to infection) and interference (the extent to which the epidemic cuts off connectivity among the susceptible population that remains following an epidemic). The evolution of the susceptible network over the course of an epidemic differs among the classes of networks; frailty, relative to interference, accounts for an increasing component of network evolution on networks with greater variance in contacts. The result is that immunization due to prior epidemics can provide greater community protection than random vaccination on networks with heterogeneous contact patterns, while the reverse is true for highly structured populations.     

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.     

Individual risk perception and empirical social structures shape the dynamics of infectious disease outbreaks

The dynamics of a spreading disease and individual behavioral changes are entangled processes that have to be addressed together in order to effectively manage an outbreak. Here, we relate individual risk perception to the adoption of a specific set of control measures, as obtained from an extensive large-scale survey performed via Facebook—involving more than 500,000 respondents from 64 countries—showing that there is a “one-to-one” relationship between perceived epidemic risk and compliance with a set of mitigation rules. We then develop a mathematical model for the spreading of a disease—sharing epidemiological features with COVID-19—that explicitly takes into account non-compliant individual behaviors and evaluates the impact of a population fraction of infectious risk-deniers on the epidemic dynamics. Our modeling study grounds on a wide set of structures, including both synthetic and more than 180 real-world contact patterns, to evaluate, in realistic scenarios, how network features typical of human interaction patterns impact the spread of a disease. In both synthetic and real contact patterns we find that epidemic spreading is hindered for decreasing population fractions of risk-denier individuals. From empirical contact patterns we demonstrate that connectivity heterogeneity and group structure significantly affect the peak of hospitalized population: higher modularity and heterogeneity of social contacts are linked to lower peaks at a fixed fraction of risk-denier individuals while, at the same time, such features increase the relative impact on hospitalizations with respect to the case where everyone correctly perceive the risks.