The effectiveness of backward contact tracing in networks

Discovering and isolating infected individuals is a cornerstone of epidemic control. Because many infectious diseases spread through close contacts, contact tracing is a key tool for case discovery and control. However, although contact tracing has been performed widely, the mathematical understanding of contact tracing has not been fully established and it has not been clearly understood what determines the efficacy of contact tracing. Here, we reveal that, compared with "forward" tracing---tracing to whom disease spreads, "backward" tracing---tracing from whom disease spreads---is profoundly more effective. The effectiveness of backward tracing is due to simple but overlooked biases arising from the heterogeneity in contacts. Using simulations on both synthetic and high-resolution empirical contact datasets, we show that even at a small probability of detecting infected individuals, strategically executed contact tracing can prevent a significant fraction of further transmissions. We also show that---in terms of the number of prevented transmissions per isolation---case isolation combined with a small amount of contact tracing is more efficient than case isolation alone. By demonstrating that backward contact tracing is highly effective at discovering super-spreading events, we argue that the potential effectiveness of contact tracing has been underestimated. Therefore, there is a critical need for revisiting current contact tracing strategies so that they leverage all forms of biases. Our results also have important consequences for digital contact tracing because it will be crucial to incorporate the capability for backward and deep tracing while adhering to the privacy-preserving requirements of these new platforms.Comment: 15 pages, 4 figure

The impact of prior information on estimates of disease transmissibility using Bayesian tools

The basic reproductive number (R₀) and the distribution of the serial interval (SI) are often used to quantify transmission during an infectious disease outbreak. In this paper, we present estimates of R₀ and SI from the 2003 SARS outbreak in Hong Kong and Singapore, and the 2009 pandemic influenza A(H1N1) outbreak in South Africa using methods that expand upon an existing Bayesian framework. This expanded framework allows for the incorporation of additional information, such as contact tracing or household data, through prior distributions. The results for the R₀ and the SI from the influenza outbreak in South Africa were similar regardless of the prior information (R0 = 1.36-1.46, μ = 2.0-2.7, μ = mean of the SI). The estimates of R₀ and μ for the SARS outbreak ranged from 2.0-4.4 and 7.4-11.3, respectively, and were shown to vary depending on the use of contact tracing data. The impact of the contact tracing data was likely due to the small number of SARS cases relative to the size of the contact tracing sample

Ebola Contact Tracing Study data

The collection contains four datasets captured in the Ebola Contact Tracing Study: [1] 'summary_data_cases' contains details of the 41 confirmed Ebola cases included in the study; [2] 'app_data_contacts' contains details of the 646 Ebola contacts registered on the Ebola Contact Tracing App (ECT) smartphone app. These originate from 18 Ebola cases (16 were laboratory confirmed and 2 were “secret burials” that were not confirmed); [3] 'paper_data_contacts' describes 408 Ebola contacts who were identified from 25 Ebola cases for monitoring using the standard paper-based system for contact tracing; and [4] 'main_analysis_dataset' contains information on 804 Ebola contacts and their contact tracing monitoring status collected using both the ECT app and paper-based system

Enhancing Bayesian risk prediction for epidemics using contact tracing

Contact tracing data collected from disease outbreaks has received relatively little attention in the epidemic modelling literature because it is thought to be unreliable: infection sources might be wrongly attributed, or data might be missing due to resource contraints in the questionnaire exercise. Nevertheless, these data might provide a rich source of information on disease transmission rate. This paper presents novel methodology for combining contact tracing data with rate-based contact network data to improve posterior precision, and therefore predictive accuracy. We present an advancement in Bayesian inference for epidemics that assimilates these data, and is robust to partial contact tracing. Using a simulation study based on the British poultry industry, we show how the presence of contact tracing data improves posterior predictive accuracy, and can directly inform a more effective control strategy.Comment: 40 pages, 9 figures. Submitted to Biostatistic

The impact of contact tracing in clustered populations

The tracing of potentially infectious contacts has become an important part of the control strategy for many infectious diseases, from early cases of novel infections to endemic sexually transmitted infections. Here, we make use of mathematical models to consider the case of partner notification for sexually transmitted infection, however these models are sufficiently simple to allow more general conclusions to be drawn. We show that, when contact network structure is considered in addition to contact tracing, standard “mass action” models are generally inadequate. To consider the impact of mutual contacts (specifically clustering) we develop an improvement to existing pairwise network models, which we use to demonstrate that ceteris paribus, clustering improves the efficacy of contact tracing for a large region of parameter space. This result is sometimes reversed, however, for the case of highly effective contact tracing. We also develop stochastic simulations for comparison, using simple re-wiring methods that allow the generation of appropriate comparator networks. In this way we contribute to the general theory of network-based interventions against infectious disease