A stochastic SIR model with contact-tracing: large population limits and statistical inference

This paper is devoted to the presentation and study of a specific stochastic epidemic model accounting for the effect of contact-tracing on the spread of an infectious disease. Precisely, one considers here the situation in which individuals identified as infected by the public health detection system may contribute to detecting other infectious individuals by providing information related to persons with whom they have had possibly infectious contacts. The control strategy, which consists of examining each individual who has been able to be identified on the basis of the information collected within a certain time period, is expected to efficiently reinforce the standard random-screening-based detection and considerably ease the epidemic. In the novel modelling of the spread of a communicable infectious disease considered here, the population of interest evolves through demographic, infection and detection processes, in a way that its temporal evolution is described by a stochastic Markov process, of which the component accounting for the contact-tracing feature is assumed to be valued in a space of point measures. For adequate scalings of the demographic, infection and detection rates, it is shown to converge to the weak deterministic solution of a PDE system, as a parameter n, interpreted as the population size, roughly speaking, becomes larger. From the perspective of the analysis of infectious disease data, this approximation result may serve as a key tool for exploring the asymptotic properties of standard inference methods such as maximum likelihood estimation. We state preliminary statistical results in this context. Eventually, relations of the model with the available data of the HIV epidemic in Cuba, in which country a contact-tracing detection system has been set up since 1986, is investigated and numerical applications are carried out.     

Probability of a Disease Outbreak in Stochastic Multipatch Epidemic Models

Environmental heterogeneity, spatial connectivity, and movement of individuals play important roles in the spread of infectious diseases. To account for environmental differences that impact disease transmission, the spatial region is divided into patches according to risk of infection. A system of ordinary differential equations modeling spatial spread of disease among multiple patches is used to formulate two new stochastic models, a continuous-time Markov chain, and a system of stochastic differential equations. An estimate for the probability of disease extinction is computed by approximating the Markov chain model with a multitype branching process. Numerical examples illustrate some differences between the stochastic models and the deterministic model, important for prevention of disease outbreaks that depend on the location of infectious individuals, the risk of infection, and the movement of individuals.     

Common source epidemics I: A stochastic model

A discrete time stochastic model is formulated for the spread of a disease which is transmitted to an uninfected but susceptible individual through an environmental source and not through contact (either direct or indirect) with infected individuals. The model incorporates both exposure and infection components. The exposure component includes consideration of the introduction of an infectious agent into the environment and the subsequent diffusion of the agent. It also includes time and location patterns for visits by individuals in the target population to the affected environment. The infection component incorporates physiological responses of exposed individuals to the infectious agent. The goal of the model is to provide a method for developing a predicted epidemic curve. Comments are given on an application of the model to the study of an outbreak of toxoplasmosis in Atlanta, Georgia, in 1977. This work was partially supported by BRSG Grant S07 RR0731 awarded by the Biomedical Research Support Grant Program, Division of Research Resources, National Institutes of Health.     

Control of emerging infectious diseases using responsive imperfect vaccination and isolation

This paper is concerned with a stochastic model for the spread of an SEIR (susceptible --> exposed (= latent) --> infective --> removed) epidemic among a population partitioned into households, featuring different rates of infection for within and between households. The model incorporates responsive vaccination and isolation policies, based upon the appearance of diagnosed cases in households. Different models for imperfect vaccine response are considered. A threshold parameter R*, which determines whether or not a major epidemic can occur, and the probability of a major epidemic are obtained for different infectious and latent period distributions. Simpler expressions for these quantities are obtained in the limiting case of infinite within-household infection rate. Numerical studies suggest that the choice of infectious period distribution and whether or not latent individuals are vaccine-sensitive have a material influence on the spread of the epidemic, while, for given vaccine efficacy, the choice of vaccine action model is less influential. They also suggest that an effective isolation policy has a more significant impact than vaccination. The results show that R* alone is not sufficient to summarise the potential for an epidemic.     

An age-dependent epidemic model with application to measles

A combined epidemic-demographic model is developed which models the spread of an infectious disease throughout a population of constant size. The model allows for births, deaths, temporary or permanent immunity, and immunization. The relationship of this model to previously studied epidemic and demographic models is illustrated. An advantage of this model is that all epidemic and demographic parameters may be estimated. The stability of the equilibrium point corresponding to the elimination of the disease is studied and a threshold value is found which indicates whether the disease will die out or remain endemic in the population. The application of the model to measles indicates that immunization levels needed to reduce the incidence to near zero may not be as high as previously predicted.     

Spatial heterogeneity, social structure and disease dynamics of animal populations

Social groupings, population dynamics and population movements of animals all give rise to spatio-temporal variations in population levels. These variations may be of crucial importance when considering the spread of infectious diseases since infection levels do not increase unless there is a sufficient pool of susceptible individuals. This paper explores the impact of social groupings on the potential for an endemic disease to develop in a spatially explicit model system. Analysis of the model demonstrates that the explicit inclusion of space allows asymmetry between groups to arise when this was not possible in the equivalent spatially homogeneous system. Moreover, differences in movement behaviours for susceptible and infected individuals gives rise to different spatial profiles for the populations. These profiles were not observed in previous work on an epidemic system. The results are discussed in an ecological context with reference to furious and dumb strains of infectious diseases.     

A rigorous approach to investigating common assumptions about disease transmission

Changing scale, for example, the ability to move seamlessly from an individual-based model to a population-based model, is an important problem in many fields. In this paper, we introduce process algebra as a novel solution to this problem in the context of models of infectious disease spread. Process algebra allows us to describe a system in terms of the stochastic behaviour of individuals, and is a technique from computer science. We review the use of process algebra in biological systems, and the variety of quantitative and qualitative analysis techniques available. The analysis illustrated here solves the changing scale problem: from the individual behaviour we can rigorously derive equations to describe the mean behaviour of the system at the level of the population. The biological problem investigated is the transmission of infection, and how this relates to individual interactions.     

Stochastic epidemics in dynamic populations: quasi-stationarity and extinction

Empirical evidence shows that childhood diseases persist in large communities whereas in smaller communities the epidemic goes extinct (and is later reintroduced by immigration). The present paper treats a stochastic model describing the spread of an infectious disease giving life-long immunity, in a community where individuals die and new individuals are born. The time to extinction of the disease starting in quasi-stationarity (conditional on non-extinction) is exponentially distributed. As the population size grows the epidemic process converges to a diffusion process. Properties of the limiting diffusion are used to obtain an approximate expression for τ, the mean-parameter in the exponential distribution of the time to extinction for the finite population. The expression is used to study how τ depends on the community size but also on certain properties of the disease/community: the basic reproduction number and the means and variances of the latency period, infectious period and life-length. Effects of introducing a vaccination program are also discussed as is the notion of the critical community size, defined as the size which distinguishes between the two qualitatively different behaviours. Received: 14 February 2000 / Revised version: 5 June 2000 / Published online: 24 November 2000     

A Novel Statistical Model to Estimate Host Genetic Effects Affecting Disease Transmission

There is increasing recognition that genetic diversity can affect the spread of diseases, potentially affecting plant and livestock disease control as well as the emergence of human disease outbreaks. Nevertheless, even though computational tools can guide the control of infectious diseases, few epidemiological models can simultaneously accommodate the inherent individual heterogeneity in multiple infectious disease traits influencing disease transmission, such as the frequently modeled propensity to become infected and infectivity, which describes the host ability to transmit the infection to susceptible individuals. Furthermore, current quantitative genetic models fail to fully capture the heritable variation in host infectivity, mainly because they cannot accommodate the nonlinear infection dynamics underlying epidemiological data. We present in this article a novel statistical model and an inference method to estimate genetic parameters associated with both host susceptibility and infectivity. Our methodology combines quantitative genetic models of social interactions with stochastic processes to model the random, nonlinear, and dynamic nature of infections and uses adaptive Bayesian computational techniques to estimate the model parameters. Results using simulated epidemic data show that our model can accurately estimate heritabilities and genetic risks not only of susceptibility but also of infectivity, therefore exploring a trait whose heritable variation is currently ignored in disease genetics and can greatly influence the spread of infectious diseases. Our proposed methodology offers potential impacts in areas such as livestock disease control through selective breeding and also in predicting and controlling the emergence of disease outbreaks in human populations.     

Modelling the effect of urbanization on the transmission of an infectious disease

This paper models the impact of urbanization on infectious disease transmission by integrating a CA land use development model, population projection matrix model and CA epidemic model in S-Plus. The innovative feature of this model lies in both its explicit treatment of spatial land use development, demographic changes, infectious disease transmission and their combination in a dynamic, stochastic model. Heuristically-defined transition rules in cellular automata (CA) were used to capture the processes of both land use development with urban sprawl and infectious disease transmission. A population surface model and dwelling distribution surface were used to bridge the gap between urbanization and infectious disease transmission. A case study is presented involving modelling influenza transmission in Southampton, a dynamically evolving city in the UK. The simulation results for Southampton over a 30-year period show that the pattern of the average number of infection cases per day can depend on land use and demographic changes. The modelling framework presents a useful tool that may be of use in planning applications.     

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.     

An SEIS epidemic model with transport-related infection

In this paper, an SEIS epidemic model is proposed to study the effect of transport-related infection on the spread and control of infectious disease. New result implies that traveling of the exposed (means exposed but not yet infectious) individuals can bring disease from one region to other regions even if the infectious individuals are inhibited from traveling among regions. It is shown that transportation among regions will change the disease dynamics and break infection out even if infectious diseases will go to extinction in each isolated region without transport-related infection. In addition, our analysis shows that transport-related infection intensifies the disease spread if infectious diseases break out to cause an endemic situation in each region, in the sense of that both the absolute and relative size of patients increase. This suggests that it is very essential to strengthen restrictions of passengers once we know infectious diseases appeared.     

Extinction thresholds in deterministic and stochastic epidemic models

The basic reproduction number, ?(0), one of the most well-known thresholds in deterministic epidemic theory, predicts a disease outbreak if ?(0)>1. In stochastic epidemic theory, there are also thresholds that predict a major outbreak. In the case of a single infectious group, if ?(0)>1 and i infectious individuals are introduced into a susceptible population, then the probability of a major outbreak is approximately 1-(1/?(0))( i ). With multiple infectious groups from which the disease could emerge, this result no longer holds. Stochastic thresholds for multiple groups depend on the number of individuals within each group, i ( j ), j=1, …, n, and on the probability of disease extinction for each group, q ( j ). It follows from multitype branching processes that the probability of a major outbreak is approximately [Formula: see text]. In this investigation, we summarize some of the deterministic and stochastic threshold theory, illustrate how to calculate the stochastic thresholds, and derive some new relationships between the deterministic and stochastic thresholds.     

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.     

Transmissible cancer in Tasmanian devils: localized lineage replacement and host population response

Tasmanian devil facial tumour disease (DFTD) is a clonally transmissible cancer threatening the Tasmanian devil (Sarcophilus harrisii) with extinction. Live cancer cells are the infectious agent, transmitted to new hosts when individuals bite each other. Over the 18 years since DFTD was first observed, distinct genetic and karyotypic sublineages have evolved. In this longitudinal study, we investigate the associations between tumour karyotype, epidemic patterns and host demographic response to the disease. Reduced host population effects and low DFTD infection rates were associated with high prevalence of tetraploid tumours. Subsequent replacement by a diploid variant of DFTD coincided with a rapid increase in disease prevalence, population decline and reduced mean age of the population. Our results suggest a role for tumour genetics in DFTD transmission dynamics and epidemic outcome. Future research, for this and other highly pathogenic emerging infectious diseases, should focus on understanding the evolution of host and pathogen genotypes, their effects on susceptibility and tolerance to infection, and their implications for designing novel genetic management strategies. This study provides evidence for a rapid localized lineage replacement occurring within a transmissible cancer epidemic and highlights the possibility that distinct DFTD genetic lineages may harbour traits that influence pathogen fitness.     

The initialization and sensitivity of multigroup models for the transmission of HIV

We study two multigroup mathematical models of the spread of HIV. In the differential infectivity model, the infected population is divided into groups according to their infectiousness, and HIV is primarily spread by a small, highly infectious, group of superspreaders. In the staged-progression model, every infected individual goes through a series of infection stages and the virus is primarily spread by individuals in an initial highly infectious stage or in the late stages of the disease. We demonstrate the importance of choosing appropriate initial conditions, and define a new approach to distributing the initial population among the subgroups so as to minimize the artificial transients in the solutions due to unbalanced initial conditions. We demonstrate that the rate of removal in and out of a population is an important, yet often neglected, effect. We also illustrate the importance of distinguishing between the number of partners a person has and the number of contacts per partner. By assuming that people with many partners have fewer contacts per partner than people with few partners, we found that the epidemic is less sensitive to the partner acquisition rate than one might expect. However, because the probability of transmission of HIV per contact is low, the epidemic is very sensitive to the number of contacts per partner. Modeling this distinction is particularly important when estimating the impact of programs which encourage people to have fewer sexual partners.     

Pathogen adaptation under imperfect vaccination: implications for pertussis

Mass vaccination campaigns have drastically reduced the burden of infectious diseases. Unfortunately, in recent years several infectious diseases have re-emerged. Pertussis poses a well-known example. Inspired by pertussis, we study, by means of an epidemic model, the population and evolutionary dynamics of a pathogen population under the pressure of vaccination. A distinction is made between infection in immunologically naive individuals (primary infection) and infection in individuals whose immune system has been primed by vaccination or infection (secondary infection). The results show that (i) vaccination with an imperfect vaccine may not succeed in reducing the infection pressure if the transmissibility of secondary infections is higher than that of primary infections; (ii) pathogen strains that are able to evade the immunity induced by vaccination can only spread if escape mutants incur no or only a modest fitness cost and (iii) the direction of evolution depends crucially on the distribution of the different types of susceptibles in the population. We discuss the implications of these results for the design and use of vaccines that provide temporary immunity.     

The Modeling of Global Epidemics: Stochastic Dynamics and Predictability

The global spread of emergent diseases is inevitably entangled with the structure of the population flows among different geographical regions. The airline transportation network in particular shrinks the geographical space by reducing travel time between the world's most populated areas and defines the main channels along which emergent diseases will spread. In this paper, we investigate the role of the large-scale properties of the airline transportation network in determining the global propagation pattern of emerging diseases. We put forward a stochastic computational framework for the modeling of the global spreading of infectious diseases that takes advantage of the complete International Air Transport Association 2002 database complemented with census population data. The model is analyzed by using for the first time an information theory approach that allows the quantitative characterization of the heterogeneity level and the predictability of the spreading pattern in presence of stochastic fluctuations. In particular we are able to assess the reliability of numerical forecast with respect to the intrinsic stochastic nature of the disease transmission and travel flows. The epidemic pattern predictability is quantitatively determined and traced back to the occurrence of epidemic pathways defining a backbone of dominant connections for the disease spreading. The presented results provide a general computational framework for the analysis of containment policies and risk forecast of global epidemic outbreaks. On leave from CEA-Centre d'Etudes de Bruyères-Le-Chatel, France.     

Coexistence of multiple pathogen strains in stochastic epidemic models with density-dependent mortality

Stochastic differential equations that model an SIS epidemic with multiple pathogen strains are derived from a system of ordinary differential equations. The stochastic model assumes there is demographic variability. The dynamics of the deterministic model are summarized. Then the dynamics of the stochastic model are compared to the deterministic model. In the deterministic model, there can be either disease extinction, competitive exclusion, where only one strain persists, or coexistence, where more than one strain persists. In the stochastic model, all strains are eventually eliminated because the disease-free state is an absorbing state. However, if the population size and the initial number of infected individuals are sufficiently large, it may take a long time until all strains are eliminated. Numerical simulations of the stochastic model show that coexistence cases predicted by the deterministic model are an unlikely occurrence in the stochastic model even for short time periods. In the stochastic model, either disease extinction or competitive exclusion occur. The initial number of infected individuals, the basic reproduction numbers, and other epidemiological parameters are important determinants of the dominant strain in the stochastic epidemic model.