Rubella vaccination in India: Identifying broad consequences of vaccine introduction and key knowledge gaps

Rubella virus infection typically presents as a mild illness in children; however, infection during pregnancy may cause the birth of an infant with congenital rubella syndrome (CRS). As of February 2017, India began introducing rubella-containing vaccine (RCV) into the public-sector childhood vaccination programme. Low-level RCV coverage among children over several years can result in an increase in CRS incidence by increasing the average age of infection without sufficiently reducing rubella incidence. We evaluated the impact of RCV introduction on CRS incidence across India's heterogeneous demographic and epidemiological contexts. We used a deterministic age-structured model that reflects Indian states' rural and urban area-specific demography and vaccination coverage levels to simulate rubella dynamics and estimate CRS incidence with and without RCV introduction to the public sector. Our analysis suggests that current low-level private-sector vaccination has already slightly increased the burden of CRS in India. We additionally found that the effect of public-sector RCV introduction depends on the basic reproductive number, R0, of rubella. If R0 is five, a value empirically estimated from an array of settings, CRS incidence post-RCV introduction will likely decrease. However, if R0 is seven or nine, some states may experience short-term or annual increases in CRS, even if a long-term total reduction in cases (30 years) is expected. Investment in population-based serological surveys and India's fever/rash surveillance system will be key to monitoring the success of the vaccination programme

Uncertainty Principle for Control of Ensembles of Oscillators Driven by Common Noise

We discuss control techniques for noisy self-sustained oscillators with a focus on reliability, stability of the response to noisy driving, and oscillation coherence understood in the sense of constancy of oscillation frequency. For any kind of linear feedback control--single and multiple delay feedback, linear frequency filter, etc.--the phase diffusion constant, quantifying coherence, and the Lyapunov exponent, quantifying reliability, can be efficiently controlled but their ratio remains constant. Thus, an "uncertainty principle" can be formulated: the loss of reliability occurs when coherence is enhanced and, vice versa, coherence is weakened when reliability is enhanced. Treatment of this principle for ensembles of oscillators synchronized by common noise or global coupling reveals a substantial difference between the cases of slightly non-identical oscillators and identical ones with intrinsic noise.Comment: 10 pages, 5 figure

Experimental support of the scaling rule for demographic stochasticity

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73613/1/j.1461-0248.2006.00903.x.pd

Phocine distemper Virus: Current knowledge and future directions

Phocine distemper virus (PDV) was first recognized in 1988 following a massive epidemic in harbor and grey seals in north-western Europe. Since then, the epidemiology of infection in North Atlantic and Arctic pinnipeds has been investigated. In the western North Atlantic endemic infection in harp and grey seals predates the European epidemic, with relatively small, localized mortality events occurring primarily in harbor seals. By contrast, PDV seems not to have become established in European harbor seals following the 1988 epidemic and a second event of similar magnitude and extent occurred in 2002. PDV is a distinct species within the Morbillivirus genus with minor sequence variation between outbreaks over time. There is now mounting evidence of PDV-like viruses in the North Pacific/Western Arctic with serological and molecular evidence of infection in pinnipeds and sea otters. However, despite the absence of associated mortality in the region, there is concern that the virus may infect the large Pacific harbor seal and northern elephant seal populations or the endangered Hawaiian monk seals. Here, we review the current state of knowledge on PDV with particular focus on developments in diagnostics, pathogenesis, immune response, vaccine development, phylogenetics and modeling over the past 20 years

Measles metapopulation dynamics: A gravity model for epidemiological coupling and dynamics

10.1086/422341American Naturalist1642267-281AMNT

Modeling the potential impact of typhoid conjugate vaccines

Mathematical modeling of the transmission dynamics of Salmonella Typhi allows for an evaluation of the potential impact of vaccination and a quantification of the expected direct and indirect effects of vaccines under a variety of scenarios regarding vaccine efficacy and program implementation. We developed an age-structured compartmental model that reflects the natural history and immune response to infection with Salmonella Typhi. We fit our model to data on culture-confirmed cases of typhoid fever from a variety of settings in South Asia in order to estimate important model parameters, such as the basic reproductive number (R0). We then evaluated the potential impact of routine vaccination and/or vaccination campaigns targeted at different age groups. We parameterized the vaccine efficacy and duration of protection based on data for Vi-polysaccharide and Vi-conjugate vaccines. Our model was able to reproduce the incidence pattern and age distribution of typhoid cases in Vellore, India; Kathmandu, Nepal; and Dhaka, Bangladesh for different values of R0 in these settings. Vaccination was predicted to confer substantial indirect protection in the short term, leading to a decrease in the incidence of typhoid. However, waning of vaccine-induced immunity could lead to a rebound in typhoid incidence 5-15 years after vaccine introduction. Model predictions for the overall and indirect effects of typhoid vaccination and prospects for elimination depend strongly on the role of chronic carriers in transmission. Elucidating the role of chronic carriers in transmission in different settings is a pivotal area for future epidemiological research. Our results suggest that is unlikely that typhoid can be eliminated from high incidence endemic settings through vaccination alone

Experimental evolution of parasite life-history traits in Strongyloides ratti (Nematoda)

Evolutionary ecology predicts that parasite life-history traits, including a parasite's survivorship and fecundity within a host, will evolve in response to selection and that their evolution will be constrained by trade-offs between traits. Here, we test these predictions using a nematode parasite of rats, Strongyloides ratti, as a model. We performed a selection experiment by passage of parasite progeny from either early in an infection (‘fast’ lines) or late in an infection (‘slow’ lines). We found that parasite fecundity responded to selection but that parasite survivorship did not. We found a trade-off mediated via conspecific density-dependent constraints; namely, that fast lines exhibit higher density-independent fecundity than slow lines, but fast lines suffered greater reduction in fecundity in the presence of density-dependent constraints than slow lines. We also found that slow lines both stimulate a higher level of IgG1, which is a marker for a Th2-type immune response, and show less of a reduction in fecundity in response to IgG1 levels than for fast lines. Our results confirm the general prediction that parasite life-history traits can evolve in response to selection and indicate that such evolutionary responses may have significant implications for the epidemiology of infectious disease

Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa

Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (?50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered

Inferring the inter-host transmission of influenza A virus using patterns of intra-host genetic variation

Influenza A viruses (IAVs) cause acute, highly transmissible infections in a wide range of animal species. Understanding how these viruses are transmitted within and between susceptible host populations is critical to the development of effective control strategies. While viral gene sequences have been used to make inferences about IAV transmission dynamics at the epidemiological scale, their utility in accurately determining patterns of inter-host transmission in the short-term—i.e. who infected whom—has not been strongly established. Herein, we use intra-host sequence data from the viral HA1 (hemagglutinin) gene domain from two transmission studies employing different IAV subtypes in their natural hosts—H3N8 in horses and H1N1 in pigs—to determine how well these data recapitulate the known pattern of inter-host transmission. Although no mutations were fixed over the course of either experimental transmission chain, we show that some minor, transient alleles can provide evidence of host-to-host transmission and, importantly, can be distinguished from those that cannot