Aerial Dispersal and Multiple-Scale Spread of Epidemic Disease

Disease spread has traditionally been described as a traveling wave of constant velocity. However, aerially dispersed pathogens capable of long-distance dispersal often have dispersal gradients with extended tails that could result in acceleration of the epidemic front. We evaluated empirical data with a simple model of disease spread that incorporates logistic growth in time with an inverse power function for dispersal. The scale invariance of the power law dispersal function implies its applicability at any spatial scale; indeed, the model successfully described epidemics ranging over six orders of magnitude, from experimental field plots to continental-scale epidemics of both plant and animal diseases. The distance traveled by epidemic fronts approximately doubled per unit time, velocity increased linearly with distance (slope ~½), and the exponent of the inverse power law was approximately 2. We found that it also may be possible to scale epidemics to account for initial outbreak focus size and the frequency of susceptible hosts. These relationships improve understanding of the geographic spread of emerging diseases, and facilitate the development of methods for predicting and preventing epidemics of plants, animals, and humans caused by pathogens that are capable of long-distance dispersal.     

HIV/AIDS in Asia： The Shape of Epidemics and Their Molecular Epidemiology

The Asia-Pacific region is a home to 60% of the population in the world and to approximately one quarter of people with HIV/AIDS. Close to a million of people has been infected and a half million people died of AIDS annually in Asia,becoming the second largest epicenter of global AIDS epidemic. Molecular epidemiology has been useful tool to track a course of HIV spread. In-depth knowledge from the studies on molecular epidemiology elucidates the dynamics of HIV spread and the interrelationship of epidemics in the different regions in Asia.     

Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics

Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics is discussed. Optimal effect of school closure is observed when this measure is taken at the start of the epidemic or pandemic and for a sufficiently long time. School closure during high morbidity among schoolchildren, in the middle (at the peak) and by the end of epidemic or pandemic does not influence significantly the spread of influenza or morbidity. Significant economic losses and other negative consequences of school closure are noted. School closure may be the most appropriate during the emergence of influenza pandemic when the pandemic vaccine is not yet available, however timely mass immunization of schoolchildren against influenza may be a more appropriate measure than school closure for the reduction of influenza morbidity and spread during seasonal influenza epidemics.     

Revealing the True Incidence of Pandemic A(H1N1)pdm09 Influenza in Finland during the First Two Seasons — An Analysis Based on a Dynamic Transmission Model

The threat of the new pandemic influenza A(H1N1)pdm09 imposed a heavy burden on the public health system in Finland in 2009-2010. An extensive vaccination campaign was set up in the middle of the first pandemic season. However, the true number of infected individuals remains uncertain as the surveillance missed a large portion of mild infections. We constructed a transmission model to simulate the spread of influenza in the Finnish population. We used the model to analyse the two first years (2009-2011) of A(H1N1)pdm09 in Finland. Using data from the national surveillance of influenza and data on close person-to-person (social) contacts in the population, we estimated that 6% (90% credible interval 5.1 – 6.7%) of the population was infected with A(H1N1)pdm09 in the first pandemic season (2009/2010) and an additional 3% (2.5 – 3.5%) in the second season (2010/2011). Vaccination had a substantial impact in mitigating the second season. The dynamic approach allowed us to discover how the proportion of detected cases changed over the course of the epidemic. The role of time-varying reproduction number, capturing the effects of weather and changes in behaviour, was important in shaping the epidemic.     

HIV/AIDS in Asia: The shape of epidemics and their molecular epidemiology

The Asia-Pacific region is a home to 60% of the population in the world and to approximately one quarter of people with HIV/AIDS. Close to a million of people has been infected and a half million people died of AIDS annually in Asia, becoming the second largest epicenter of global AIDS epidemic. Molecular epidemiology has been useful tool to track a course of HIV spread. In-depth knowledge from the studies on molecular epidemiology elucidates the dynamics of HIV spread and the interrelationship of epidemics in the different regions in Asia. Foundation items: Grant support from Ministry of Health, Labour and Welfare and Ministry of Education, Science and Technology in Japan; Japanese Foundation for AIDS Prevention.     

Genesis of the novel epidemic Vibrio cholerae O139 strain: evidence for horizontal transfer of genes involved in polysaccharide synthesis.

Only Vibrio cholerae strains of serotype O1 are known to cause epidemics, while non-O1 strains are associated with sporadic cases of cholera. It was therefore unexpected that the recent cholera epidemic in Asia was caused by a non-O1 strain with the serotype O139. We provide evidence that O139 arose from a strain closely related to the causative agent of the present cholera pandemic, V. cholerae O1 El Tor, by acquisition of novel DNA which was inserted into, and replaced part of, the O antigen gene cluster of the recipient strain. Part of the novel DNA was sequenced and two open reading frames (otnA and otnB) were observed, the products of which showed homology to proteins involved in capsule and O antigen synthesis, respectively. This suggests that the otnAB DNA determines the distinct antigenic properties of the O139 cell surface. The otnAB DNA was not detected in O1 strains, but was present in two non-O1 V. cholerae strains with serotypes O69 and O141. In the O69 and O139 strains the otnAB genes were located proximate to the putative insertion sequence (IS) element rfbQRS, which is associated with O antigen synthesis genes in O1 strains, and may have played a role in the insertion of the otnAB DNA in the recipient chromosome. Our results suggest that the O139 strain arose by horizontal gene transfer between a non-O1 and an O1 strain. The acquired DNA has altered the antigenic properties of the recipient O1 strain, providing a selective advantage in a region where a large part of the population is immune to O1 strains.(ABSTRACT TRUNCATED AT 250 WORDS)     

Microevolution and epidemic spread of serogroup A Neisseria meningitidis – a review

An extensive and representative strain collection of serogroup A Neisseria meningitidis was established. These bacteria were obtained from different endemic and epidemic/pandemic sources and include strains from diseased patients and healthy carriers. The genetic relationships of the bacteria were defined by multi-locus enzyme electrophoresis and sequence polymorphisms of genetically variable antigens have been analyzed in closely-related groupings. The results are interpreted as reflecting a balance of recombination events, which disrupt clonal relationships, and sequential bottlenecks, which purify the bacterial population of genetic variants during epidemic spread.     

Comparison of influenza outbreaks in the Republic of Kazakhstan and Russia induced by 2009 yearly new variant of A(H1N1) influenza virus

The aim of the work is the comparison of the epidemiology of influenza and acute respiratory virus infections(ARVI)in the Republic of Kazakhstan with the corresponding influenza epidemic in Russia induced by influenza pandemic virus A/California/07/2009 in 2009. Data on influenza and ARVI from the Republic of Kazakhstan and Federal Center of influenza was collected and investigated over the course of several weeks from hospitalized patients with the same diagnosis among all population and in age groups on 16 territories of Kazakhstan and in 49 major cities of Russia. The epidemic in Kazakhstan resembled the Russian epidemic in terms of its abnormally early beginning,expression of monoaetiology,the spread of the epidemic into all territories and start of the epidemics among adult population. High percentage of hospitalized people and lethal outcome were registered in this epidemic. Similarity of epidemic process character in corresponding border-line territories of both countries was found out.     

Molecular epidemiological analysis of the spread of human immunodeficiency virus (HIV) infection in the Novosibirsk region

The dynamics of the spread of individual subtypes of type 1 HIV (HIV-1), circulating in the Novosibirsk region during the epidemic rise of HIV infection was under study. The epidemic of HIV-1 in Novosibirsk has a pattern similar to that in Russia as a whole. At the initial stage of epidemics multiple sources of virus determine the heterogeneity of the isolated subtypes of HIV-1. Then the parenteral route of HIV transmission, connected with the intravenous use of narcotic drugs, becomes dominant. Recently the spread of HIV-1 from the group of intravenous drug users to other groups of the population has been observed. In the circulation of HIV-1 among drug users the leading role was shown to belong to subtype A, which ensures its rapid spread and dominating role in the epidemic process. Further spread of the HIV-1 epidemic is expected to proceed in parallel to the spread of viral hepatitis, sexually transmitted diseases and drug addiction. Thus, HIV-1, subtype A, may be assumed to be dominant in the Novosibirsk region in the nearest future.     

Shaping the phylogenetic tree of influenza by cross-immunity

Cross-immunity among related strains can account for the selection producing the slender phylogenetic tree of influenza A and B in humans. Using a model of seasonal influenza epidemics with drift (Andreasen, 2003. Dynamics of annual influenza A epidemics with immuno-selection. J. Math. Biol. 46, 504-536), and assuming that two mutants arrive in the host population sequentially, we determine the threshold condition for the establishment of the second mutant in the presence of partial cross-protection caused by the first mutant and their common ancestors. For fixed levels of cross-protection, the chance that the second mutant establishes increases with rho the basic reproduction ratio and some temporary immunity may be necessary to explain the slenderness of flu's phylogenetic tree. In the presence of moderate levels of temporary immunity, an asymmetric situation can arise in the season after the two mutants were introduced and established: if the offspring of the new mutant arrives before the offspring of the resident type, then the mutant-line may produce a massive epidemic suppressing the original lineage. However, if the original lineage arrives first then both strains may establish and the phylogenetic tree may bifurcate.     

Global disease spread: statistics and estimation of arrival times

We study metapopulation models for the spread of epidemics in which different subpopulations (cities) are connected by fluxes of individuals (travelers). This framework allows one to describe the spread of a disease on a large scale and we focus here on the computation of the arrival time of a disease as a function of the properties of the seed of the epidemics and of the characteristics of the network connecting the various subpopulations. Using analytical and numerical arguments, we introduce an easily computable quantity which approximates this average arrival time. We show on the example of a disease spread on the world-wide airport network that this quantity predicts with a good accuracy the order of arrival of the disease in the various subpopulations in each realization of epidemic scenario, and not only for an average over realizations. Finally, this quantity might be useful in the identification of the dominant paths of the disease spread.     

Surveys of Respiratory Virus Antibodies in an Arctic Indian Population

A study was undertaken to determine the etiological agents responsible for epidemics in a small and relatively isolated Arctic community.Three serological surveys were carried out over a four-year period employing complement fixation tests. Clinical information from the resident nurse was also available.The results indicated that of the two clinical epidemics of “influenza” which occurred during the period of study one was due to influenza virus type A; the other was unidentified. However, influenza virus type B affected approximately 30% of the population at some time during a two-year period without being clinically recognized. An epidemic affecting mainly children, which was clinically considered to be whooping cough, was probably caused by an adenovirus. A mumps epidemic with a high attack rate for all age groups which had occurred a few months prior to the first survey was confirmed. Sendai virus and psittacosis virus are probably endemic in this community.     

The Role of China in the Global Spread of the Current Cholera Pandemic

Epidemics and pandemics of cholera, a severe diarrheal disease, have occurred since the early 19th century and waves of epidemic disease continue today. Cholera epidemics are caused by individual, genetically monomorphic lineages of Vibrio cholerae: the ongoing seventh pandemic, which has spread globally since 1961, is associated with lineage L2 of biotype El Tor. Previous genomic studies of the epidemiology of the seventh pandemic identified three successive sub-lineages within L2, designated waves 1 to 3, which spread globally from the Bay of Bengal on multiple occasions. However, these studies did not include samples from China, which also experienced multiple epidemics of cholera in recent decades. We sequenced the genomes of 71 strains isolated in China between 1961 and 2010, as well as eight from other sources, and compared them with 181 published genomes. The results indicated that outbreaks in China between 1960 and 1990 were associated with wave 1 whereas later outbreaks were associated with wave 2. However, the previously defined waves overlapped temporally, and are an inadequate representation of the shape of the global genealogy. We therefore suggest replacing them by a series of tightly delineated clades. Between 1960 and 1990 multiple such clades were imported into China, underwent further microevolution there and then spread to other countries. China was thus both a sink and source during the pandemic spread of V. cholerae, and needs to be included in reconstructions of the global patterns of spread of cholera.     

The spatial spread and final size of the deterministic non-reducible n-type epidemic

A model has been formulated in [6] to describe the spatial spread of an epidemic involving n types of individual, and the possible wave solutions at different speeds were investigated. The final size and pandemic theorems are now established for such an epidemic. The results are relevant to the measles, host-vector, carrier-borne epidemics, rabies and diseases involving an intermediate host. Diseases in which some of the population is vaccinated, and models that divide the population into several strata are also covered.     

Validation of the Modes of Transmission Model as a Tool to Prioritize HIV Prevention Targets: A Comparative Modelling Analysis

Background

The static Modes of Transmission (MOT) model predicts the annual fraction of new HIV infections acquired across subgroups (MOT metric), and is used to focus HIV prevention. Using synthetic epidemics via a dynamical model, we assessed the validity of the MOT metric for identifying epidemic drivers (behaviours or subgroups that are sufficient and necessary for HIV to establish and persist), and the potential consequence of MOT-guided policies.

Methods and Findings

To generate benchmark MOT metrics for comparison, we simulated three synthetic epidemics (concentrated, mixed, and generalized) with different epidemic drivers using a dynamical model of heterosexual HIV transmission. MOT metrics from generic and complex MOT models were compared against the benchmark, and to the contribution of epidemic drivers to overall HIV transmission (cumulative population attributable fraction over t years, PAF_t). The complex MOT metric was similar to the benchmark, but the generic MOT underestimated the fraction of infections in epidemic drivers. The benchmark MOT metric identified epidemic drivers early in the epidemics. Over time, the MOT metric did not identify epidemic drivers. This was not due to simplified MOT models or biased parameters but occurred because the MOT metric (irrespective of the model used to generate it) underestimates the contribution of epidemic drivers to HIV transmission over time (PAF_5–30). MOT-directed policies that fail to reach epidemic drivers could undermine long-term impact on HIV incidence, and achieve a similar impact as random allocation of additional resources.

Conclusions

Irrespective of how it is obtained, the MOT metric is not a valid stand-alone tool to identify epidemic drivers, and has limited additional value in guiding the prioritization of HIV prevention targets. Policy-makers should use the MOT model judiciously, in combination with other approaches, to identify epidemic drivers.     

Emerged HA and NA mutants of the pandemic influenza H1N1 viruses with increasing epidemiological significance in Taipei and Kaohsiung, Taiwan, 2009-10

The 2009 influenza pandemic provided an opportunity to observe dynamic changes of the hemagglutinin (HA) and neuraminidase (NA) of pH1N1 strains that spread in two metropolitan areas -Taipei and Kaohsiung. We observed cumulative increases of amino acid substitutions of both HA and NA that were higher in the post–peak than in the pre-peak period of the epidemic. About 14.94% and 3.44% of 174 isolates had one and two amino acids changes, respective, in the four antigenic sites. One unique adaptive mutation of HA2 (E374K) was first detected three weeks before the epidemic peak. This mutation evolved through the epidemic, and finally emerged as the major circulated strain, with significantly higher frequency in the post-peak period than in the pre-peak (64.65% vs 9.28%, p<0.0001). E374K persisted until ten months post-nationwide vaccination without further antigenic changes (e.g. prior to the highest selective pressure). In public health measures, the epidemic peaked at seven weeks after oseltamivir treatment was initiated. The emerging E374K mutants spread before the first peak of school class suspension, extended their survival in high-density population areas before vaccination, dominated in the second wave of class suspension, and were fixed as herd immunity developed. The tempo-spatial spreading of E374K mutants was more concentrated during the post–peak (p = 0.000004) in seven districts with higher spatial clusters (p<0.001). This is the first study examining viral changes during the naïve phase of a pandemic of influenza through integrated virological/serological/clinical surveillance, tempo-spatial analysis, and intervention policies. The vaccination increased the percentage of E374K mutants (22.86% vs 72.34%, p<0.001) and significantly elevated the frequency of mutations in Sa antigenic site (2.36% vs 23.40%, p<0.001). Future pre-vaccination public health efforts should monitor amino acids of HA and NA of pandemic influenza viruses isolated at exponential and peak phases in areas with high cluster cases.     

Strain replacement in an epidemic model with super-infection and perfect vaccination

Several articles in the recent literature discuss the complexities of the impact of vaccination on competing subtypes of one micro-organism. Both with competing virus strains and competing serotypes of bacteria, it has been established that vaccination has the potential to switch the competitive advantage from one of the pathogen subtypes to the other resulting in pathogen replacement. The main mechanism behind this process of substitution is thought to be the differential effectiveness of the vaccine with respect to the two competing micro-organisms. In this article, we show that, if the disease dynamics is regulated by super-infection, strain substitution may indeed occur even with perfect vaccination. In fact we discuss a two-strain epidemic model in which the first strain can infect individuals already infected by the second and, as far as vaccination is concerned, we consider a best-case scenario in which the vaccine provides perfect protection against both strains. We find out that if the reproduction number of the first strain is smaller than the reproduction number of the second strain and the first strain dominates in the absence of vaccination then increasing vaccination levels promotes coexistence which allows the first strain to persist in the population even if its vaccine-dependent reproduction number is below one. Further increase of vaccination levels induces the domination of the second strain in the population. Thus the second strain replaces the first strain. Large enough vaccination levels lead to the eradication of the disease.     

Epidemic dynamics and antigenic evolution in a single season of influenza A

We use a mathematical model to study the evolution of influenza A during the epidemic dynamics of a single season. Classifying strains by their distance from the epidemic-originating strain, we show that neutral mutation yields a constant rate of antigenic evolution, even in the presence of epidemic dynamics. We introduce host immunity and viral immune escape to construct a non-neutral model. Our population dynamics can then be framed naturally in the context of population genetics, and we show that departure from neutrality is governed by the covariance between a strain's fitness and its distance from the original epidemic strain. We quantify the amount of antigenic evolution that takes place in excess of what is expected under neutrality and find that this excess amount is largest under strong host immunity and long epidemics.     

Partnership dynamics and strain competition

Models of epidemic spread that include partnership dynamics within the host population have demonstrated that finite length partnerships can limit the spread of pathogens. Here the influence of partnerships on strain competition is investigated. A simple epidemic and partnership formation model is used to demonstrate that, in contrast to standard epidemiological models, the constraint introduced by partnerships can influence the success of pathogen strains. When partnership turnover is slow, strains must have a long infectious period in order to persist, a requirement of much less importance when partnership turnover is rapid. By introducing a trade-off between transmission rate and infectious period it is shown that populations with different behaviours can favour different strains. Implications for control measures based on behavioural modifications are discussed, with such measures perhaps leading to the emergence of new strains.     

A recombinant HIV-1 strain causing an epidemic among injection drug addicts in Kaliningrad

The analysis of the genetic structure of HIV causing the epidemic in Kaliningrad Province. A new recombinant virus of subtype A/B was detected with the use of the polymerase chain reaction, the cloning of amplified fragments, sequencing and the phylogenetic analysis of the obtained data. The results thus obtained indicate that the epidemic in Kaliningrad was caused by a recombinant strain, and not due to co-infection caused by two HIV strains of different subtypes. The study of HIV-1 DNA revealed the divergence between the samples was extremely low, which was characteristic of epidemics connected with the transmission of the virus in the process of the intravenous use of narcotic drugs.