Ebola Model and Optimal Control with Vaccination Constraints

The Ebola virus disease is a severe viral haemorrhagic fever syndrome caused by Ebola virus. This disease is transmitted by direct contact with the body fluids of an infected person and objects contaminated with virus or infected animals, with a death rate close to 90% in humans. Recently, some mathematical models have been presented to analyse the spread of the 2014 Ebola outbreak in West Africa. In this paper, we introduce vaccination of the susceptible population with the aim of controlling the spread of the disease and analyse two optimal control problems related with the transmission of Ebola disease with vaccination. Firstly, we consider the case where the total number of available vaccines in a fixed period of time is limited. Secondly, we analyse the situation where there is a limited supply of vaccines at each instant of time for a fixed interval of time. The optimal control problems have been solved analytically. Finally, we have performed a number of numerical simulations in order to compare the models with vaccination and the model without vaccination, which has recently been shown to fit the real data. Three vaccination scenarios have been considered for our numerical simulations, namely: unlimited supply of vaccines; limited total number of vaccines; and limited supply of vaccines at each instant of time.Comment: This is a preprint of a paper whose final and definite form is with 'Journal of Industrial and Management Optimization' (JIMO), ISSN 1547-5816 (print), ISSN 1553-166X (online). Submitted February 2016; revised November 2016; accepted for publication March 201

Modeling spillover dynamics: understanding emerging pathogens of public health concern

The emergence of infectious diseases with pandemic potential is a major public health threat worldwide. The World Health Organization reports that about 60% of emerging infectious diseases are zoonoses, originating from spillover events. Although the mechanisms behind spillover events remain unclear, mathematical modeling offers a way to understand the intricate interactions among pathogens, wildlife, humans, and their shared environment. Aiming at gaining insights into the dynamics of spillover events and the outcome of an eventual disease outbreak in a population, we propose a continuous time stochastic modeling framework. This framework links the dynamics of animal reservoirs and human hosts to simulate cross-species disease transmission. We conduct a thorough analysis of the model followed by numerical experiments that explore various spillover scenarios. The results suggest that although most epidemic outbreaks caused by novel zoonotic pathogens do not persist in the human population, the rising number of spillover events can avoid long-lasting extinction and lead to unexpected large outbreaks. Hence, global efforts to reduce the impacts of emerging diseases should not only address post-emergence outbreak control but also need to prevent pandemics before they are established

Strategies for integrating literacy into a science classroom

A science reading course offers opportunities for students to develop their scientific literacy by delving into current topics in science through reading and writing. Due to the nature of the course, students could be enrolled for one semester or for the whole year. Through differentiation, Science Reading is accessible for a variety learning and interest levels. This creative component lays the groundwork for the development of a science reading course by providing examples of topics, methods, lesson activities, and assessments that could be incorporated into a Science Reading curriculum. The project recognizes the resources that are available to educators and includes a series of ideas or starting points for others to develop their own units or courses that embrace literacy in the science classroom

Exploring the integration of traditional and molecular epidemiological methods for infectious disease outbreaks

BACKGROUND: Understanding the transmission dynamics of infectious pathogens is critical to developing effective public health strategies. Traditionally, time consuming epidemiological methods were used, often limited by incomplete or inaccurate datasets. Novel phylogenetic techniques can determine transmission events, but have rarely been used in real-time outbreak settings to inform interventions and limit the impact of outbreaks. METHODS: I undertook a series of novel studies to explore the utility of combining phylogenetics with traditional epidemiological analysis to enhance the understanding of transmission dynamics. I investigated HIV in an endemic South African setting and Ebola in an acute outbreak in Sierra Leone. The strengths and limitations of this combined approach are explored, ethical issues investigated and recommendations made regarding the implications of this work for public health. RESULTS: Phylogenetics provides an exciting and synergistic tool to epidemiological analysis in outbreak investigation and control. These combined methods enable a more detailed understanding than is possible through either discipline alone. My key findings include: • Identification of infection source: Phylogenetics gives new insight into the role of external introductions (e.g. migrators) in driving and sustaining the high incidence of HIV. • Earlier identification of new emerging clusters: I identified a new cluster of HIV from around a mining community. This is one of the first examples of molecular methods detecting a previously unknown outbreak. • Identification of novel mechanisms of transmission: This work suggests that children may have been infected by playing in puddles contaminated with Ebola, a previously unrecognised route of transmission. CONCLUSION: The integration of these two methods facilitate sophisticated real-time techniques to maximise understanding of transmission dynamics, allowing faster and more effectively targeted interventions. Moving forwards, sequence data should be incorporated into standard outbreak investigation. This is critical at a time when infectious disease outbreaks have led to the some of the most significant global health threats of the recent past

Factors Affecting the Routine Immunization Activities During a Disease Outbreak, Epidemic and Covid-19 Pandemic in Africa

Background: The emerging disease outbreaks and pandemics affect immunization activities. In Africa, it has contributed to a significant decline in vaccination coverage and the provision of essential health services. The contributing factors which affect the immunization activities are unclear and vary as per the country's situation and response strategy to the emerging outbreaks and pandemics. Hence, we aimed to explore those factors related to disease outbreak, epidemic, and covid-19 pandemic affecting the delivery of immunization services in Africa. Methods: Our study is qualitative exploratory research, which included five countries selected using convenience sampling according to the regional classification of Africa by ACDC. Factors affecting routine immunization activities in the countries were identified through interviews with relevant stakeholders involved in vaccination services. The interviewees were selected using snowballing sampling, 4 participants from each country, twenty key informants ranking (routine immunization directors, national immunization officers, EPI officers, and some health workers and caregivers) were included for open-ended and semi-structured virtual in-depth interviews. Additionally, some parents were interviewed for their perceptions about vaccinating their children during the current pandemic. We also did a literature review on the impact of previous emerging disease outbreaks on routine immunization activities in the countries and the current situation of the COVID-19 pandemic. Supportive trend data based on measles vaccination coverage and disease rates based on WHO country reports over time were included. Data generated from the literature review and in-depth interviews were transcribed verbatim and analyzed using thematic analysis. We used the thematic framework to organize our findings; each country was identified according to the following variables: Country name, the current situation of covid-19, covid-19 impact on the following factors (health system, governance, and community), and the impact of a previous disease outbreak on the measles immunization coverage. Findings were grouped according to the country's perspective. We compared factors during previous outbreaks and covid-19 pandemics in Africa and addressed some interventions that can support immunization activities during disease x outbreak. Results: 40% of our participants emphasized that fear of infection was behind the interruption in the immunization activities during covid-19 pandemics. 35% agreed that movement restrictions limited many activities. Resource limitation and misinformation comes as an individual barrier representing 10-15%. Some of the addressed health system factors included: surveillance defect, human resource shortage, lack of training, infrastructure, and PPE inadequacy. On the community base: misinformation, vaccine hesitancy and refusal, and fear of infection were identified. Governance factors included: movement restriction, travel ban, closed health facilities, lockdown, and social distancing factors were addressed. Few gaps were identified, as providing the proper training to the health workers and the caregivers, community engagement, national planning, building a proper registry system with implementing the proper plans for fast service recovery after a pandemic. By fulfilling those gaps, we may be able to provide better access to routine immunization during a disease outbreak, epidemic, and pandemic. Conclusions: The study addressed the various factors affecting Africa’s routine immunization activities during disease outbreaks and pandemics. It also addressed the impact of a previous disease outbreak on the measles immunization coverage, which may predict the covid-19 impact on the immunization coverage. It is, therefore, essential for decision-makers to address those factors to ensure immunization coverage without any missed opportunities. Keywords: vaccination, outbreaks, covid-19, factors, Africa, misinformation, hesitancy.open석

Health communication management: the interface between culture and scientific communication in the management of Ebola in Liberia

The research questioned the efficacy of standard biomedical information sharing and communication processes in ensuring rapid and reliable behavioural changes in the control of epidemics, especially in high-context cultures. Information processing arousals and behaviour change motivations are subject to the level of interactions in the extrinsic and intrinsic elements of an information. Following, epidemic control can only be successful if relevant elements of a system’s values, norms, beliefs and practices for information processing are superimposed on scientific communication to create shared meanings. An empirical research approach in grounded theory underscore the data collection of this research with the data analogy utilising the MAXQDA Analytics Pro software. Ebola behavioural changes were identified to be enabled by the functional properties of community mobilisation as a structure and process for meaning making and behavioural motivation. A contextual health communication model dubbed the ecological collegial communication model has been modelled for epidemiological control as the output of the research. Specific to the methodology, a systematic qualitative and data analysis process in grounded theory was adopted for conducting the research and the dissertation writing. Commencing the process was the identification and analysis of the problem from the perspectives of the challenges to the Ebola communication management. This was comprehensively identified from the fundamentals of the process of communication to the communication itself and was assessed from the motivational factors underlying the behaviours within which the rationality of the behaviours could be understood for their inflexibility to change or their insensitivity to the Ebola messages. The mediations of the behavioural motivators in the cognitive processes to information processing were considered for their intrinsic and extrinsic values to arouse information processing and persuade change. To explore the interface between communication and culture in cognitive processes of information processing and decision making, literatures on behavioural theories, including anthropological theories from which the processes and determinants of behavioural enactment are predicted were reviewed in chapters two to four. Intention (also used interchangeably in this dissertation as motivation) was unanimously construed as proximal in determining behaviours in the literatures. However, intention was also construed to have linkages with other factors in the determination of behaviours.:Dedication ii Declaration iii Acknowledgements iv Table of contents v List of figures vi List of photos vii List of matrices vii List of tables vii List of appendices viii Abbreviations ix 1 Communication and culture of the 2014/2015 West Africa Ebola outbreak 1 1.1 Introduction 1 1.2 Conceptualisation of the research problem – the key factors of the Ebola outbreak 4 1.2.1 Structural violence 7 1.2.2 Communication deficiency 10 1.2.3 Cultural models (values and practices 20 1.2.3a Death and funerals 21 1.2.3b Caregiving 26 1.2.3c Reliance on traditional healers 31 1.3 Research objectives 37 1.4 Definitions 38 1.5 Questions formulation and research questions 42 1.6 Justification 52 1.7 Conclusion 58 2 Theoretical frameworks consistent with the 2014/2015 Ebola outbreak health communication approaches – A discourse 59 2.1 Introduction 59 2.2 Psychological/behaviour science models 60 2.2.1 Health belief model 61 2.2.2 Protection motivation theory 64 2.2.3 Theory of planned behavior /reasoned action 71 2.2.4 Social cognitive theory / social learning theory 76 2.3 Summary 79 3 Information processing/communication theories 81 3.1Introduction 81 3.2 Elaboration likelihood model 81 3.3 Activation model 86 3.4 Narrative theory and entertainment education 88 3.5 Summary 95 4 Ecological theories / framework 97 4.1 Introduction 97 4.2 The PEN-3 Model 98 4.2.1 Health education (cultural identity)100 4.2.2 Cultural appropriateness of health behavior (cultural empowerment) 101 4.3 Bioecological theory 103 4.4 Developmental process of Bronfenbrenner’s model in the framework of the 2014/2015 Ebola outbreak 108 4.5 Theoretical framework of this dissertation 119 5 Research process and methodologies 125 5.1 Introduction 125 5.2 Justification of the research methodology 128 5.3 Overview of Monteserrado County 134 5.4 Techniques/procedures 137 5.4.1 Archival materials/documents 138 5.4.2 Ethnographic/observations 139 5.4.3 Key informants/in-depth interviews 142 5.4.4 Focus group discussions 143 5.5 Data analysis 146 5.5.1 Codes 147 5.5.2 Qualitative analysis employed in the research 152 5.6 Role of the researcher 153 5.6.1 Origins of the project 153 5.6.2 The discourse - philosophical worldview 156 5.6.3 Concluding thoughts 157 6 Data analysis: cultural practices, health and communication in the Liberian context 160 6.1 Introduction 160 6.2 Ethnicity and religion 162 6.3 Social organization 171 6.4 Aspects of death and burial practices 179 6.5 Concept of health and health care 186 6.6 Communication and information sharing approach in Liberia 193 6.6.1Traditional communication and the town crier in Liberia 195 6.6.2 Contribution of Crusaders for Peace 201 6.6.3 Development of overarching Ebola communication messages 206 6.7 Conclusion 210 7 Data analysis: Socio-cultural patterns in Ebola perceptions, content of messages and behavioural outcomes 212 7.1 Introduction 212 7.2 Parent codes – summative description and discussions 214 7.3 Understanding the socio-cultural patterns in Ebola knowledge and behaviours: Perceptions of Ebola transmissions 226 7.4 Content and nature of Ebola messages in perceptions and behaviours 237 7.5 Conclusion 276 8 Data analysis: Understanding the motivators of Ebola behaviours – an analytical interrelationships model perspective 278 8.1 Introduction 278 8.2 Patterns of Ebola behaviours 279 8.3 Conclusion 317 9 Decoding: the interface between culture and communication in the Ebola communication management 319 9.1 Introduction 319 9.2 Contextual elements of effective communication – the interface 321 9.3 Cognitive heuristics to “…protect yourself…” 336 9.4 Processes of moderations of “protect yourself” in cognitions 339 9.5 Conclusion 343 10 Theoretical and conceptual inferences from empirical data and framework for a culturally appropriate communication 344 10.1 Introduction 344 10.2 Research questions 344 10.3 Epidemic control: The cultural model framework to persuasive communication for epidemic management 359 10.3.1 The composite conceptual analytical elements of the model 364 10.3.1a Model definition and assumptions 365 10.3.1b The ECCM – the interactive elements of a system 367 10.3.1c Pattern of communication in the ECCM 371 10.3.2 Summary 374 10.4 Processes of how to apply the ECCM 375 10.5 Limitations of the model 382 10.6 Conclusion 383 11 Conclusions and recommendations 385 11.1 Introduction 385 11.2 Key conclusions 385 11.3 Implications 387 11.3.1 Policy framework implications 387 11.3.2 Theoretical implications 390 11.4 Further research 393 11.4.1 Approach to communication 393 11.4.2 Cultural dynamics 396 11.4.3 Health perceptions 398 11.4.4 Ebola orphans and victims 398 11. 5 Research limitations 399 References 40

Integrating Mathematical Models of Behavior and Infectious Disease: Applications to Outbreak Dynamics and Control

This dissertation applies mathematical models from several disciplines to represent the complex interaction between human behavior and infectious disease transmission. We first use game theory and evolutionary dynamics to capture contact and risk behaviors such that they can be coupled to compartmental transmission models. We use this behavior-disease approach to model adaptive prophylaxis use during sexually transmitted infeciton (STI) outbreaks as well as burial practices during the 2014 Ebola outbreak using this framework. We then link rational decision theory and quantitative microbial risk assessment (QMRA) to investigate incomplete compliance with household water treatment (HWT) due to usability/efficacy trade-offs. Our analyses of these systems address theoretical and practical consequences of relaxing simplifying assumptions about behavior. We find that feedback between adaptive behavior and disease prevalence in our STI model lead to a range of dynamic outcomes including damped and sustained oscillations as well as complicating the interpretation of the basic reproductive number. For Ebola, our behavior-disease model gives both a superior fit to surveillance data and more accurate final-size forecasts than a reduced model without behavior change. In addition, our model predicts a shift to sanitary burial practices that corresponds to a change in the estimated reporting rate/population at risk and appears to have reduced the force of infection in the later phases of the outbreak. Finally, simulations and optimal risk-reduction solutions from our decision theoretic QMRA model suggest that current efficacy-focused HWT recommendations may be less effective at reducing the burden of diarrheal disease than interventions that prioritize usability and acceptance by the target population. Together, these results demonstrate the potential to improve infectious disease surveillance and control by modeling human behavioral factors that are often simplified or omitted. Such elements can explain the temporal patterns of outbreaks on short and long term scales while behavioral modeling can identify feedbacks that could be exploited to improve the uptake and sustainability of intervention policies.PhDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/133434/1/mhayash_1.pd