Multiregion contact systems for modelling STD epidemics

A metapopulation modelling framework for gonorrhoea and other sexually transmitted infections in heterosexual populations

Gonorrhoea continues to be a public health problem in the UK, and is the second most common bacterial sexually transmitted infection (STI) after chlamydia. In the UK, gonorrhoea is disproportionately concentrated in epidemiologically distinct subpopulations, with much higher incidence rates in young people, some ethnic minorities and inner city subpopulations. The original model of STI transmission proposed by Hethcote and Yorke explained some of these features through the concept of the 'core group'. Since then, several authors have modified the original model approach to include multiple sexual activity classes, but found this modelling approach to be inadequate when applied to low-prevalence settings such as the UK. We present a metapopulation framework for modelling gonorrhoea and other STIs. The model proposes that the epidemiology of gonorrhoea is largely driven by subpopulations with higher than average concentrations of individuals with high sexual risk activity. We show how this conceptualization of gonococcal epidemiology overcomes key limitations associated with some of the prior efforts to model gonorrhoea. We also use the model to explain several epidemiological features of gonorrhoea, such as its asymmetric distribution across subpopulations, and the contextual risk experienced by members of at-risk subpopulations. Finally, we extend the model to explain the distribution of other STIs, using chlamydia as an example of a more ubiquitous bacterial STI.

Mathematical tools for planning effective intervention scenarios for sexually transmitted diseases

BACKGROUND

We studied the dynamics of sexually transmitted diseases in structured populations, deriving analogies from the theory of metapopulations.

GOAL

The goal was to study the impact of potential interventions, such as reducing the probability of transmission (e.g., by condom use), reducing the duration of infectiousness (e.g., by early diagnosis and treatment), or reducing the number of new contacts.

STUDY DESIGN

A structured SIS model was used for the study.

RESULTS

We extended the concept of core groups to the concept of nodal epidemiologic contribution (NEC) by considering the contribution that an individual in a particular (social, spatial, or other such) group makes to a target quantity, such as the threshold condition for disease persistence, the equilibrium prevalence, or the number of disease transmissions in the long term. The measures for NEC derived here are analogous to patch values in metapopulation theory, which measure the contributions of particular habitat patches to various-aspects of metapopulation dynamics.

CONCLUSION

Our results highlight that intervention measures should be targeted especially promptly if the goal is the complete eradication of the disease, as the variance in the contributions made by the individuals is the highest for this case.