A framework to support the decision-making process for modelling of communicable diseases

Thesis (MEng)--Stellenbosch University, 2019.ENGLISH ABSTRACT: Infectious disease outbreaks have the potential to disrupt and strain the global health care system, even more so when a localised disease outbreak propagates rapidly to a large area. Such a disease outbreak is referred to as a pandemic disease outbreak. Pandemic outbreaks often inspire global collaboration between researchers and modelling practitioners with a view to devise strategies, disease propagation models and actions on how to address the outbreak. Modelling of infectious disease is a complex endeavour. The literature on the available modelling approaches and general application to disease modelling is well documented in the literature. What is, however, less evident, especially to a modelling practitioner with less rigorous modelling experience, is the selection and consideration of modelling considerations based on the specific context of the disease outbreak. To address this challenge, a modelling support framework is designed in this research project, with a view to formalise the most salient universal modelling steps and assist novice modelling practitioners in the consideration and selection of appropriate approaches for modelling infectious diseases. The research consists of three phases, namely the design and execution of a structured literature review, analysis of the findings of the literature review, and the construction of a modelling support and guidance framework. During the first phase of the research, the chain of infection is used as an overarching metaphor to guide the process in identifying relevant considerations, disease characteristics and contextual factors which may potentially affect disease propagation, and this is used as the basis for determining the scope of the structured literature review. The review is designed to construct a sufficiently detailed dataset which is well representative of the various modelling approaches as applied in literature. The 283 identified literature pieces are methodically analysed and the relevant modelling considerations, disease characteristics and contextual factors from each of the pieces are captured to the dataset. During the second phase of the research the dataset is analysed. The modelling considerations are analysed in relation to the disease transmission mode, and the relationship between modelling considerations are also analysed. In general, the selection of modelling approaches and considerations were not reducible to a single factor. This suggests that numerous factors must be considered in the model decision making process, and additionally, it highlights the importance of contextualising the disease outbreak. The third phase of the research consists of the framework construction. Both the first and the second phases of the research are used to inform and guide the framework construction. The framework is constructed with two goals in mind, namely to inform modelling considerations from a holistic viewpoint and to aid in the selection of the relevant modelling considerations. The framework use is verified with an illustrative case study and validated with semi-structured interviews that are conducted with external subject matter experts with a background in engineering and health care modelling.AFRIKAANSE OPSOMMING: Die uitbreek van ’n aansteeklike siekte het die potensiaal om die globale gesondheidsorgsisteem te ontwrig en onder geweldige druk te plaas, des te meer wanneer so ’n gelokaliseerde uitbreking spoedig na ’n groter area versprei. Sulke siekte-uitbrekings staan bekend as pandemiese siektes. Die ontstaan van pandemiese uitbrekings van siektes lei tipies tot wêreldwye samewerking tussen navorsers en modelleerders. Die doel van samewerking hou verband met die skep van strategieë, modelle wat siekte-oordrag modelleer en aksieplanne om die uitbreking te bestuur. Die modellering van aansteeklike siektes is ’n komplekse onderneming. Beskikbare modellerings-benaderings en die generiese gebruik daarvan om siektes te modelleer is goed opgeteken in die literatuur. Wat minder ooglopend is van hierdie benaderings, veral vir die modelleerder met elementêre modelleringskennis, is die oorweging en selektering van modelleringelemente gebaseer op die spesifieke kontekstuele omstandighede van die siekte-uitbreking. Om hierdie uitdaging aan te pak word daar in hierdie navorsingsprojek ’n ondersteuningsraamwerk vir modellering geskep. Die doel hiervan is die formalisering van die belangrikste modellerings-stappe en om onervare modelleerders te ondersteun in die oorweging en selektering van toepaslike benaderings om aansteeklike siektes te modelleer. Die navorsing bestaan uit drie fases, naamlik die ontwerp en uitvoering van ’n gestruktureerde literatuuroorsig, ’n analise van die bevindinge van die literatuuroorsig, en die opstel van ’n raamwerk wat ondersteuning en raadgewing ten opsigte van modellering bied. As deel van die eerste fase van die navorsing, word die ketting van infeksie as ’n oorhoofse metafoor gebruik. Hierdie metafoor word gebruik om relevante oorwegings, siekte-eienskappe en kontekstuele faktore te identifiseer wat die potensiaal het om die verspreiding van siektes te beïnvloed. Dit word ook as die basis gebruik om die bestek van die gestruktureerde literatuuroorsig te bepaal. Die gestruktureerde literatuuroorsig is ontwerp om ’n gedetailleerde datastel op te stel wat ’n goeie verteenwoordiging is van die verskeie modelleringsbenaderings soos dit in die literatuur toegepas is. Die geïdentifiseerde 283 literatuurstukke is stapsgewys geanaliseer en die relevante modelleringsbenaderings, siekte-eienskappe en kontekstuele faktore van die literatuurstukke is in die datastel opgeneem. As deel van die tweede fase van die navorsing word die datastel geanaliseer. Die modelleringsoorwegings is geanaliseer met betrekking tot die siekte-oordragsmetode en die verhoudings tussen ander modelleringsoorwegings. Oor die algemeen is daar bevind dat die keuse van ’n modelleringsbenadering of -oorweging nie reduseerbaar is tot die oorweging van ’n enkele faktor nie. Die afleiding is dus dat verskeie faktore in ag geneem moet word in die seleksieproses van ’n modelleringsbenadering, en dat die belangrikheid van die kontekstualisering van ’n siekte-uitbreking benadruk moet word. As deel van die derde fase van die navorsing is die raamwerk opgestel. Beide die eerste en tweede fases van die navorsing is gebruik om die opstelproses van die raamwerk te lei en die opstelkeuses in te lig. Die raamwerk is opgestel met twee verwagte uitkomstes, naamlik om die modellerings-oorwegings vanuit ’n holistiese oogpunt in te lig, sowel as om die selektering van relevante modelleringsoorwegings te ondersteun. Die gebruik van die raamwerk is geverifieer met behulp van ’n verduidelikende gevallestudie. Die validasie is voltooi met behulp van semi-gestruktureerde onderhoude met eksterne vakgebied-kenners met ’n agtergrond in die ingenieurswese en gesondheidssorg-modelleringsvelde

The Anthropology of Epidemics

Over the past decades, infectious disease epidemics have come to increasingly pose major global health challenges to humanity. The Anthropology of Epidemics approaches epidemics as total social phenomena: processes and events which encompass and exercise a transformational impact on social life whilst at the same time functioning as catalysts of shifts and ruptures as regards human/non-human relations. Bearing a particular mark on subject areas and questions which have recently come to shape developments in anthropological thinking, the volume brings epidemics to the forefront of anthropological debate, as an exemplary arena for social scientific study and analysis

Forecasting influenza in Europe and globally: the role of absolute humidity and human travel, and the potential for use in public health decision making

Influenza causes substantial morbidity and mortality yearly in both temperate and tropical regions, as well as sporadic and potentially severe pandemics. Although vaccines for seasonal influenza exist, most options for controlling influenza outbreaks are reactive in nature. Sufficiently accurate and well-calibrated forecasts, on the other hand, could allow public health practitioners, medical professionals, and the public to respond to unfolding influenza outbreaks proactively. For example, hospitals could prepare additional beds for a predicted surge, and public health experts could redouble vaccination efforts. Recently, skillful forecasts have been developed for a range of infectious diseases, including influenza, but this work has been limited to only a few countries. In this dissertation, we explore the potential for generating accurate influenza forecasts using a publicly-available dataset of country-level epidemiologic and virologic surveillance data. In Chapter 2, we use a combined model-inference system to generate retrospective forecasts for 64 countries in both temperate and tropical climates. We show that forecast accuracy is significantly better in countries with temperate climates, and that inclusion of environmental forcing, specifically modulation of viral transmissibility due to variability of absolute humidity conditions, also improves forecast accuracy in temperate climates. In Chapter 3, we develop a metapopulation model of twelve European countries using data on international air travel and commuting. We find that this model is unable to produce more skillful forecasts than those produced for individual countries in isolation. We make recommendations for improvements in data collection and reporting that may increase the success of similar modeling efforts in the future. In Chapter 4, we assess the performance of real-time forecasts generated for 37 countries over two influenza seasons and discuss the potential for their use in public health decision making. Finally, in Chapter 5 we describe the results of a small survey of public health practitioners in the United States. We find that the majority of respondents desire more effective communication between modelers and public health practitioners, and we discuss the importance of regular and improved communication in advancing the practical use of forecasts as public health decision making tools. This dissertation advances the science of influenza forecasting by demonstrating that skillful retrospective and real-time forecasts can be generated for many countries where previous forecasting efforts are either minimal or absent. However, it is vital that data quality issues be addressed if further progress is to be made. Future work should focus in particular on climatic drivers of influenza in the tropics and subtropics, on the role of human travel at various spatial scales, and on the development of regional and local forecasting capacity. Additionally, dedicated collaboration between modelers and public health practitioners will be instrumental for motivating and informing the use of forecasts in combating influenza outbreaks

The Anthropology of Epidemics

Over the past decades, infectious disease epidemics have come to increasingly pose major global health challenges to humanity. The Anthropology of Epidemics approaches epidemics as total social phenomena: processes and events which encompass and exercise a transformational impact on social life whilst at the same time functioning as catalysts of shifts and ruptures as regards human/non-human relations. Bearing a particular mark on subject areas and questions which have recently come to shape developments in anthropological thinking, the volume brings epidemics to the forefront of anthropological debate, as an exemplary arena for social scientific study and analysis

The Governance of Disease Outbreaks

This edited volume is directed at experts in international law, practitioners in international institutions, and other experts who would like to familiarize themselves with the legal framework of infectious disease governance. Using the West African Ebola crisis as a case study, this book is part of a larger collaborative project on international health governance. Project partners are the Forschungsstätte der Evangelischen Studiengemeinschaft e.V. - Institute for Interdisciplinary Research and the Max Planck Institute for Comparative Public Law and International Law (MPIL). The authors explain the context and substantive legal framework of the Ebola crisis, while also highlighting its human rights aspects, institutional law (such as the debate on the securitization of health), and the limits to a purely legal approach to the subject. The authors are experts in public international law, public health, political science, and anthropology. With contributions by: Elif Askin, Susan L. Erikson, André den Exter, Robert Frau, Wolfgang Hein, Bonnie Kaiser, Hunter Keys, Michael Marx, Edefe Ojomo, Ilja Richard Pavone, Mateja Steinbrück Platise, Christian R. Thauer, Leonie Vierck, Pedro A. Villarreal, A. Katarina Weilert. Der Sammelband richtet sich an ein Fachpublikum von Völkerrechtlern, Praktikern in internationalen Institutionen und anderen Experten, die sich mit den rechtlichen Rahmenbedingungen der internationalen Governance ansteckender Krankheiten vertraut machen möchten. Fallbeispiel ist die Ebola-Krise in Westafrika. Der Band geht aus einem breiter angelegten Heidelberger Kooperationsprojekt zur „International Health Governance“ der Forschungsstätte der Evangelischen Studiengemeinschaft e.V. - Institut für interdisziplinäre Forschung (FEST) und des Max-Planck-Instituts für ausländisches öffentliches Recht und Völkerrecht (MPIL) hervor. Die Autoren beleuchten Kontext und materiellen Rechtsrahmen des Themas, auch unter Hervorhebung menschenrechtlicher Bezüge, institutionelles Recht („Gesundheit als Sicherheitsrisiko?“) sowie die Grenzen eines genuin rechtlichen Ansatzes. Die Autoren sind den Disziplinen Völkerrecht, Public Health, Politikwissenschaften und Anthropologie zuzuordnen. Mit Beiträgen von: Elif Askin, Susan L. Erikson, André den Exter, Robert Frau, Wolfgang Hein, Bonnie Kaiser, Hunter Keys, Michael Marx, Edefe Ojomo, Ilja Richard Pavone, Mateja Steinbrück Platise, Christian R. Thauer, Leonie Vierck, Pedro A. Villarreal, A. Katarina Weilert

Crisis and emergency risk communication. 2012 edition

In 2002, the Centers for Disease Control and Prevention (CDC) decided to fill a critical training gap and resource need and developed the Crisis and Emergency Risk Communication manual. When it was written, the central role of crisis communication in public health responses to crises was beginning to be recognized. Since that time, thousands, perhaps tens of thousands, of health, emergency management, and government professionals have been trained using the original CERC Manual and associated materials in the United States, Canada, Europe, and many other locations. While CERC principles are timeless, new information has been developed, new examples have emerged, and new understandings have been created. Crisis communication is by definition a very dynamic field, and for any work to maintain its state-of-the art relevance, revisions and updates are required.This revision, Crisis and Emergency Risk Communication: 2012 Edition is an effort to update and, in some cases, expand the original CERC manual. All revisions were informed by two principles. First, the revisions were grounded in the research literature. Second, we worked to develop and present the material in a practical, applications-oriented framework. We are grateful to our advisory board for helping ensure that the principles reflect state-of-the-art knowledge.1. Introduction to crisis and emergency risk communication -- 2. Psychology of a crisis -- 3. Messages and audiences -- 4. Crisis communication plans -- 5. The spokesperson -- 6. Working with the media -- 7. Stakeholder and partner communication -- 8. Other communication channels -- 9. CERC, social media, and mobile media devices -- 10. Terrorism and bioterrorism communication challenges -- 11. Human resources for CERC -- 12. Understanding roles of federal, state, and local community health partners -- 13. Media and public health law -- Acronyms -- Epidemiology terms \u2013 Indexes.OtherPublic Health Preparedness and ResponseCurrentPublic Health Preparedness and ResponseOthe

Emerging Communication Technologies and Public Health Information Dissemination

Health promotion is a critical constituent of the public health system. Its primary objective is the empowerment of individuals and communities in the interest of positively influencing health behaviours and outcomes. One of the main ways in which successful health promotion is achieved is by the dissemination of relevant health information to individuals and communities. As global health costs rise to match the demands of an increasing and ageing population, such delivery of cost-effective public health information is explored. The recent advances in communication technologies have led to the development of social digital platforms (Web 2.0), with unprecedented opportunities for the extensive dissemination of relevant health information. The widespread uptake of social networking sites (SNS) presents a novel platform for public health promotion and management that can verily overcome the issues faced by current public health initiatives while reaching global populations of health consumers. This thesis aims to provide an exploratory analysis of the current landscape of health information communication across SNS, primarily through the platform Twitter. The research will address literature gaps in this cross-disciplinary field of health and communication sciences found for various SNS user-types, analyse and characterise the types of health information being disseminated across such platforms, as well as examine SNS activity during public health events. Public health officials and Web 2.0 platform developers can utilise findings from this thesis to address limitations of online public health-related communication insofar as they can assist with: a) advising plans for better engagement of information disseminated during health events; b) developing future applications and technologies that are appropriate for disadvantaged groups; c) identifying information dissemination strategies for authoritative health bodies and organizations to effectively reach populations