Standard models for disease dynamics mostly assume that parameters affecting disease transmission and spread are constant during the course of an outbreak. Although seasonal outbreaks of some infectious diseases might be driven by internal nonlinear dynamics, recent studies on seasonal outbreaks in wildlife (Altizer et al. 2006) and the age-old observation that some illnesses follow a clear seasonal pattern (Dowell 2001) suggest that there is more to the story than this. Even measles, the paradigm example of nonlinear disease dynamics, exhibits an element of seasonal forcing (Grenfell et al. 2002).
The temporal forcing addressed in the above studies is relatively slow, generally on the order of months or years. For emerging diseases, however, one suspects that disease parameters will change rapidly. And not due to the changing of seasons, but rather to a change in society--our increased effectiveness at controlling the disease as we learn about it.
In a
new paper in the open access journal
PLoS One, we explored this idea using SARS as a model system. First, we considered a variation of a model developed by David Kendall in the 1940's, the "non-homogeneous birth-death process", which we interpreted as a stochastic version of of the familar S-I epidemic. We studied two special cases of this model. Both assumed that the effect of "societal learning" was on the rate at which symptomatic infectious individuals were removed from the population, but they differed in how this process was represented. In the first model, we supposed that removal rate increased according to a constant, but unknown, factor. In the second model we supposed that this constant factor obtained initially, but with diminishing returns over time as control options are used up and further accelerating removal of infectious persons becomes increasingly difficult. This latter process we called "relaxation".
Interestingly, unlike most realistic disease models, which are highly computational, this model is analytically tractable. When we investigated the resulting formulas for the distribution of the duration of outbreak and the expected epidemic size, we found that the effect of relaxation was determined by its interaction with the basic societal learning rate. However, in most cases, where the basic learning rate is relatively high to begin with, the effect of relaxation was swamped by the basic learning effect. In sum, what the model suggested was common sense--tackling a disease outbreak early on is one of the most important factors determining control. What might be a little surprising is the relatively large size some outbreaks will achieve, even when very effective controls are implemented very early.
To take this idea to the next step, we fit our basic and relaxation models to weekly data on SARS in Singapore. SARS had already been shown to exhibit this kind of external forcing (Lipsitch et al. 2003), but it was not clear if a really simple model, like the one we developed, could do a very good job at recapturing the observed outbreak size. Two results emerged from this analysis. First, the simple model from Kendall did a pretty good job of predicting the final outbreak size. The actual outbreak of 238 cases was pretty near the expectation based on the model (278 cases) and well within the interval representing 95% of simulation runs (56 cases at the low end and 611 cases at the high end). Second, perhaps remarkably, the statistical analysis produced no evidence for relaxation over the 8 week duration of the epidemic studied here.
One lesson this analysis reinforces is that the magnitude of response to an outbreak at the very beginning can be a crucial factor determining its ultimate size. There may also be a technical quantitative lesson here, however. Forecasting epidemic size at the start of an outbreak is a notoriously difficult thing to do, mostly because it's so hard to know how effective the response will be. If estimates of the learning rate, such as obtained here, turn out to be relatively transportable between populations, then these could be incorporated into forecasts from the very beginning. Of course, ultimately the parameters determining infectious contact rates depend on the society in which the disease emerges and will differ among populations. What is necessary for forecasting is only that learning rate be relatively well conserved--not exactly. Whether this is so is an outstanding empirical question.
Altizer, S., Dobson, A., Hosseini, P.,
Hudson, P., Pascual, M., and Rohani, P.
2006. Seasonality and population dynamics: infectious diseases as case studies.
Ecology Letters. 9:467-484.
Dowell, S.F. 2001. Seasonal variation in host susceptibility and cycles of certain infectious diseases.
Emerging Infectious Diseases 7:369-374.
Grenfell, B. T., Bjornstad, O. N. & Finkenstädt, B. F. 2002. Dynamics of measles epidemics. II. Scaling noise, determinism and predictability with the time series SIR model.
Ecological Monographs 72:185-202.
Lipsitch, M. 2003. Transmission dynamics and control of severe acute respiratory syndrome.
Science 300:1966-1970.
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