Discovery of a missing disease spreader

This study presents a method to discover an outbreak of an infectious disease in a region for which data are missing, but which is at work as a disease spreader. Node discovery for the spread of an infectious disease is defined as discriminating between the nodes which are neighboring to a missing disease spreader node, and the rest, given a dataset on the number of cases. The spread is described by stochastic differential equations. A perturbation theory quantifies the impact of the missing spreader on the moments of the number of cases. Statistical discriminators examine the mid-body or tail-ends of the probability density function, and search for the disturbance from the missing spreader. They are tested with computationally synthesized datasets, and applied to the SARS outbreak and flu pandemic.Comment: in pres

Understanding HIV/AIDS in the African Context

This book of readings is intended for courses in Global Health. The editors asked Prof. Stillwaggon to contribute a chapter summarizing her years of work on the spread of HIV/AIDS in populations among whom bacterial, fungal, parasitic, and viral diseases are extremely common, particularly in sub-Saharan Africa. Her work has demonstrated that differences in behavior cannot explain differences in HIV rates between world regions

Optimal treatment allocations in space and time for on-line control of an emerging infectious disease

A key component in controlling the spread of an epidemic is deciding where, whenand to whom to apply an intervention.We develop a framework for using data to informthese decisionsin realtime.We formalize a treatment allocation strategy as a sequence of functions, oneper treatment period, that map up-to-date information on the spread of an infectious diseaseto a subset of locations where treatment should be allocated. An optimal allocation strategyoptimizes some cumulative outcome, e.g. the number of uninfected locations, the geographicfootprint of the disease or the cost of the epidemic. Estimation of an optimal allocation strategyfor an emerging infectious disease is challenging because spatial proximity induces interferencebetween locations, the number of possible allocations is exponential in the number oflocations, and because disease dynamics and intervention effectiveness are unknown at outbreak.We derive a Bayesian on-line estimator of the optimal allocation strategy that combinessimulation–optimization with Thompson sampling.The estimator proposed performs favourablyin simulation experiments. This work is motivated by and illustrated using data on the spread ofwhite nose syndrome, which is a highly fatal infectious disease devastating bat populations inNorth America

Pandemic Influenza: Ethics, Law, and the Public\u27s Health

Highly pathogenic Influenza (HPAI) has captured the close attention of policy makers who regard pandemic influenza as a national security threat. Although the prevalence is currently very low, recent evidence that the 1918 pandemic was caused by an avian influenza virus lends credence to the theory that current outbreaks could have pandemic potential. If the threat becomes a reality, massive loss of life and economic disruption would ensue. Therapeutic countermeasures (e.g., vaccines and antiviral medications) and public health interventions (e.g., infection control, social separation, and quarantine) form the two principal strategies for prevention and response, both of which present formidable legal and ethical challenges that have yet to receive sufficient attention. In part II, we examine the major medical countermeasures being being considered as an intervention for an influenza pandemic. In this section, we will evaluate the known effectiveness of these interventions and analyze the ethical claims relating to distributive justice in the allocation of scarce resources. In part III, we will discuss public health interventions, exploring the hard tradeoffs between population health on the one hand and personal (e.g., autonomy, privacy, and liberty) and economic (e.g., trade, tourism, and business) interests on the other. This section will focus on the ethical and human rights issues inherent in population-based interventions. Pandemics can be deeply socially divisive, and the political response to these issues not only impacts public health preparedness, but also reflects profoundly on the kind of society we aspire to be

PocketCare: Tracking the Flu with Mobile Phones using Partial Observations of Proximity and Symptoms

Mobile phones provide a powerful sensing platform that researchers may adopt to understand proximity interactions among people and the diffusion, through these interactions, of diseases, behaviors, and opinions. However, it remains a challenge to track the proximity-based interactions of a whole community and then model the social diffusion of diseases and behaviors starting from the observations of a small fraction of the volunteer population. In this paper, we propose a novel approach that tries to connect together these sparse observations using a model of how individuals interact with each other and how social interactions happen in terms of a sequence of proximity interactions. We apply our approach to track the spreading of flu in the spatial-proximity network of a 3000-people university campus by mobilizing 300 volunteers from this population to monitor nearby mobile phones through Bluetooth scanning and to daily report flu symptoms about and around them. Our aim is to predict the likelihood for an individual to get flu based on how often her/his daily routine intersects with those of the volunteers. Thus, we use the daily routines of the volunteers to build a model of the volunteers as well as of the non-volunteers. Our results show that we can predict flu infection two weeks ahead of time with an average precision from 0.24 to 0.35 depending on the amount of information. This precision is six to nine times higher than with a random guess model. At the population level, we can predict infectious population in a two-week window with an r-squared value of 0.95 (a random-guess model obtains an r-squared value of 0.2). These results point to an innovative approach for tracking individuals who have interacted with people showing symptoms, allowing us to warn those in danger of infection and to inform health researchers about the progression of contact-induced diseases

The Impact of the Criminalization of HIV Non-Disclosure on the Health and Human Rights of “Black” Communities

The criminalization of HIV non-disclosure has become a hot topic for discussion and debate amongst human rights advocates, HIV/AIDS service providers, and people infected and affected by HIV/AIDS. This paper explores the inherent problems with HIV non-disclosure laws. These laws are ambiguous and pose a serious threat to public health policy and programming by obstructing the fundamental human rights of people infected and affected by HIV/AIDS. Using a human rights framework, this paper explores the impact of non-disclosure laws on the health and rights of African, Caribbean, and Black-Canadian communities and proposes ways to address the shortcomings of HIV non-disclosure laws and inadequate social policies

Cities and population health.

A majority of the world's population will live in urban areas by 2007 and cities are exerting growing influence on the health of both urban and non-urban residents. Although there long has been substantial interest in the associations between city living and health, relatively little work has tried to understand how and why cities affect population health. This reflects both the number and complexity of determinants and of the absence of a unified framework that integrates the multiple factors that influence the health of urban populations. This paper presents a conceptual framework for studying how urban living affects population health. The framework rests on the assumption that urban populations are defined by size, density, diversity, and complexity, and that health in urban populations is a function of living conditions that are in turn shaped by municipal determinants and global and national trends. The framework builds on previous urban health research and incorporates multiple determinants at different levels. It is intended to serve as a model to guide public health research and intervention

Emerging Infectious Disease leads to Rapid Population Decline of Common British Birds

Emerging infectious diseases are increasingly cited as threats to wildlife, livestock and humans alike. They can threaten geographically isolated or critically endangered wildlife populations; however, relatively few studies have clearly demonstrated the extent to which emerging diseases can impact populations of common wildlife species. Here, we report the impact of an emerging protozoal disease on British populations of greenfinch Carduelis chloris and chaffinch Fringilla coelebs, two of the most common birds in Britain. Morphological and molecular analyses showed this to be due to Trichomonas gallinae. Trichomonosis emerged as a novel fatal disease of finches in Britain in 2005 and rapidly became epidemic within greenfinch, and to a lesser extent chaffinch, populations in 2006. By 2007, breeding populations of greenfinches and chaffinches in the geographic region of highest disease incidence had decreased by 35% and 21% respectively, representing mortality in excess of half a million birds. In contrast, declines were less pronounced or absent in these species in regions where the disease was found in intermediate or low incidence. Also, populations of dunnock Prunella modularis, which similarly feeds in gardens, but in which T. gallinae was rarely recorded, did not decline. This is the first trichomonosis epidemic reported in the scientific literature to negatively impact populations of free-ranging non-columbiform species, and such levels of mortality and decline due to an emerging infectious disease are unprecedented in British wild bird populations. This disease emergence event demonstrates the potential for a protozoan parasite to jump avian host taxonomic groups with dramatic effect over a short time period

When Terrorism Threatens Health: How Far are Limitations on Personal and Ecomonic Liberties Justified

The government is engaged in a homeland-security project to safeguard the population\u27s health from potential terrorist attacks. This project is politically charged because it affords the state enhanced powers to restrict personal and economic liberties. Just as governmental powers relating to intelligence, law enforcement, and criminal justice curtail individual interests, so too do public health powers