A Comparative Analysis of Influenza Vaccination Programs

The threat of avian influenza and the 2004-2005 influenza vaccine supply shortage in the United States has sparked a debate about optimal vaccination strategies to reduce the burden of morbidity and mortality caused by the influenza virus. We present a comparative analysis of two classes of suggested vaccination strategies: mortality-based strategies that target high risk populations and morbidity-based that target high prevalence populations. Applying the methods of contact network epidemiology to a model of disease transmission in a large urban population, we evaluate the efficacy of these strategies across a wide range of viral transmission rates and for two different age-specific mortality distributions. We find that the optimal strategy depends critically on the viral transmission level (reproductive rate) of the virus: morbidity-based strategies outperform mortality-based strategies for moderately transmissible strains, while the reverse is true for highly transmissible strains. These results hold for a range of mortality rates reported for prior influenza epidemics and pandemics. Furthermore, we show that vaccination delays and multiple introductions of disease into the community have a more detrimental impact on morbidity-based strategies than mortality-based strategies. If public health officials have reasonable estimates of the viral transmission rate and the frequency of new introductions into the community prior to an outbreak, then these methods can guide the design of optimal vaccination priorities. When such information is unreliable or not available, as is often the case, this study recommends mortality-based vaccination priorities

Mitigating Epidemics through Mobile Micro-measures

Epidemics of infectious diseases are among the largest threats to the quality of life and the economic and social well-being of developing countries. The arsenal of measures against such epidemics is well-established, but costly and insufficient to mitigate their impact. In this paper, we argue that mobile technology adds a powerful weapon to this arsenal, because (a) mobile devices endow us with the unprecedented ability to measure and model the detailed behavioral patterns of the affected population, and (b) they enable the delivery of personalized behavioral recommendations to individuals in real time. We combine these two ideas and propose several strategies to generate such recommendations from mobility patterns. The goal of each strategy is a large reduction in infections, with a small impact on the normal course of daily life. We evaluate these strategies over the Orange D4D dataset and show the benefit of mobile micro-measures, even if only a fraction of the population participates. These preliminary results demonstrate the potential of mobile technology to complement other measures like vaccination and quarantines against disease epidemics.Comment: Presented at NetMob 2013, Bosto

Pulsating-campaigns of human prophylaxis driven by risk perception palliate oscillations of direct contact transmitted diseases

Human behavioral responses play an important role in the impact of disease outbreaks and yet they are often overlooked in epidemiological models. Understanding to what extent behavioral changes determine the outcome of spreading epidemics is essential to design effective intervention policies. Here we explore, analytically, the interplay between the personal decision to protect oneself from infection and the spreading of an epidemic. We do so by coupling a decision game based on the perceived risk of infection with a Susceptible-Infected-Susceptible model. Interestingly, we find that the simple decision on whether to protect oneself is enough to modify the course of the epidemics, by generating sustained steady oscillations in the prevalence. We deem these oscillations detrimental, and propose two intervention policies aimed at modifying behavioral patterns to help alleviate them. Surprisingly, we find that pulsating campaigns, compared to continuous ones, are more effective in diminishing such oscillations.Comment: 19 pages, 6 figure

Surveillance guidelines for disease elimination: a case study of canine rabies

Surveillance is a critical component of disease control programmes but is often poorly resourced, particularly in developing countries lacking good infrastructure and especially for zoonoses which require combined veterinary and medical capacity and collaboration. Here we examine how successful control, and ultimately disease elimination, depends on effective surveillance. We estimated that detection probabilities of <0.1 are broadly typical of rabies surveillance in endemic countries and areas without a history of rabies. Using outbreak simulation techniques we investigated how the probability of detection affects outbreak spread, and outcomes of response strategies such as time to control an outbreak, probability of elimination, and the certainty of declaring freedom from disease. Assuming realistically poor surveillance (probability of detection <0.1), we show that proactive mass dog vaccination is much more effective at controlling rabies and no more costly than campaigns that vaccinate in response to case detection. Control through proactive vaccination followed by 2 years of continuous monitoring and vaccination should be sufficient to guarantee elimination from an isolated area not subject to repeat introductions. We recommend that rabies control programmes ought to be able to maintain surveillance levels that detect at least 5% (and ideally 10%) of all cases to improve their prospects of eliminating rabies, and this can be achieved through greater intersectoral collaboration. Our approach illustrates how surveillance is critical for the control and elimination of diseases such as canine rabies and can provide minimum surveillance requirements and technical guidance for elimination programmes under a broad-range of circumstances