Optimal control of vaccination in a vector-borne reaction-diffusion model applied to Zika virus

Computing optimal drug dosing regarding efficacy and safety: the enhanced OptiDose method in NONMEM

Recently, an optimal dosing algorithm (OptiDose) was developed to compute the optimal drug doses for any pharmacometrics model for a given dosing scenario. In the present work, we enhance the OptiDose concept to compute optimal drug dosing with respect to both efficacy and safety targets. Usually, these are not of equal importance, but one is a top priority, that needs to be satisfied, whereas the other is a secondary target and should be achieved as good as possible without failing the top priority target. Mathematically, this leads to state-constrained optimal control problems. In this paper, we elaborate how to set up such problems and transform them into classical unconstrained optimal control problems which can be solved in NONMEM. Three different optimal dosing tasks illustrate the impact of the proposed enhanced OptiDose method.

A Coupled Spatial-Network Model: A Mathematical Framework for Applications in Epidemiology

There is extensive evidence that network structure (e.g., air transport, rivers, or roads) may significantly enhance the spread of epidemics into the surrounding geographical area. A new compartmental modeling framework is proposed which couples well-mixed (ODE in time) population centers at the vertices, 1D travel routes on the graph's edges, and a 2D continuum containing the rest of the population to simulate how an infection spreads through a population. The edge equations are coupled to the vertex ODEs through junction conditions, while the domain equations are coupled to the edges through boundary conditions. A numerical method based on spatial finite differences for the edges and finite elements in the 2D domain is described to approximate the model, and numerical verification of the method is provided. The model is illustrated on two simple and one complex example geometries, and a parameter study example is performed. The observed solutions exhibit exponential decay after a certain time has passed, and the cumulative infected population over the vertices, edges, and domain tends to a constant in time but varying in space, i.e., a steady state solution.

Vaccination for communicable endemic diseases: optimal allocation of initial and booster vaccine doses

For some communicable endemic diseases (e.g., influenza, COVID-19), vaccination is an effective means of preventing the spread of infection and reducing mortality, but must be augmented over time with vaccine booster doses. We consider the problem of optimally allocating a limited supply of vaccines over time between different subgroups of a population and between initial versus booster vaccine doses, allowing for multiple booster doses. We first consider an SIS model with interacting population groups and four different objectives: those of minimizing cumulative infections, deaths, life years lost, or quality-adjusted life years lost due to death. We solve the problem sequentially: for each time period, we approximate the system dynamics using Taylor series expansions, and reduce the problem to a piecewise linear convex optimization problem for which we derive intuitive closed-form solutions. We then extend the analysis to the case of an SEIS model. In both cases vaccines are allocated to groups based on their priority order until the vaccine supply is exhausted. Numerical simulations show that our analytical solutions achieve results that are close to optimal with objective function values significantly better than would be obtained using simple allocation rules such as allocation proportional to population group size. In addition to being accurate and interpretable, the solutions are easy to implement in practice. Interpretable models are particularly important in public health decision making.

Qualitative analysis and chaotic behavior of respiratory syncytial virus infection in human with fractional operator

Respiratory syncytial virus (RSV) is the cause of lung infection, nose, throat, and breathing issues in a population of constant humans with super-spreading infected dynamics transmission in society. This research emphasizes on examining a sustainable fractional derivative-based approach to the dynamics of this infectious disease. We proposed a fractional order to establish a set of fractional differential equations (FDEs) for the time-fractional order RSV model. The equilibrium analysis confirmed the existence and uniqueness of our proposed model solution. Both sensitivity and qualitative analysis were employed to study the fractional order. We explored the Ulam-Hyres stability of the model through functional analysis theory. To study the influence of the fractional operator and illustrate the societal implications of RSV, we employed a two-step Lagrange polynomial represented in the generalized form of the Power-Law kernel. Also, the fractional order RSV model is demonstrated with chaotic behaviors which shows the trajectory path in a stable region of the compartments. Such a study will aid in the understanding of RSV behavior and the development of prevention strategies for those who are affected. Our numerical simulations show that fractional order dynamic modeling is an excellent and suitable mathematical modeling technique for creating and researching infectious disease models.

Optimal control applied to Zika virus epidemics in Colombia and Puerto Rico

Zika virus (ZIKV) is a mostly non-lethal disease in humans transmitted by mosquitoes or humans that can produce severe brain defects such as microcephaly in babies and Guillain-Barré syndrome in elderly adults. The use of optimal control strategies involving information campaigns about insect repellents and condoms alongside an available safe and effective vaccine can prevent the number of infected humans with ZIKV. A system of nonlinear ordinary differential equations is formulated for the transmission dynamics of ZIKV in the presence of three control strategies to evaluate the impact of various scenarios during a ZIKV epidemic. In addition, we estimate parameters using weekly incidence data from previous ZIKV outbreaks in Colombia and Puerto Rico to capture the dynamics of an epidemic in each country when control measures are available. The basic reproduction number, R0, of each country is calculated using estimated parameters (without the controls). The vector-borne transmission threshold (Rv) is dominant in both countries , but the sexual transmission threshold (Rd) in Colombia is considerably higher than in Puerto Rico. Numerical simulations for Colombia show that the most effective strategies are to use three controls since the start of the outbreak. However, for Puerto Rico only information campaigns about mosquito repellents and vaccination are the most effective ways to mitigate the epidemic.

The effect of governance structures on optimal control of two-patch epidemic models

Infectious diseases continue to pose a significant threat to the health of humans globally. While the spread of pathogens transcends geographical boundaries, the management of infectious diseases typically occurs within distinct spatial units, determined by geopolitical boundaries. The allocation of management resources within and across regions (the "governance structure") can affect epidemiological outcomes considerably, and policy-makers are often confronted with a choice between applying control measures uniformly or differentially across regions. Here, we investigate the extent to which uniform and non-uniform governance structures affect the costs of an infectious disease outbreak in two-patch systems using an optimal control framework. A uniform policy implements control measures with the same time varying rate functions across both patches, while these measures are allowed to differ between the patches in a non-uniform policy. We compare results from two systems of differential equations representing transmission of cholera and Ebola, respectively, to understand the interplay between transmission mode, governance structure and the optimal control of outbreaks. In our case studies, the governance structure has a meaningful impact on the allocation of resources and burden of cases, although the difference in total costs is minimal. Understanding how governance structure affects both the optimal control functions and epidemiological outcomes is crucial for the effective management of infectious diseases going forward.

Dynamics and optimal control of a stochastic Zika virus model with spatial diffusion

Zika is an infectious disease with multiple transmission routes, which is related to severe congenital disabilities, especially microcephaly, and has attracted worldwide concern. This paper aims to study the dynamic behavior and optimal control of the disease. First, we establish a stochastic reaction-diffusion model (SRDM) for Zika virus, including human-mosquito transmission, human-human sexual transmission, and vertical transmission of mosquitoes, and prove the existence, uniqueness, and boundedness of the global positive solution of the model. Then, we discuss the sufficient conditions for disease extinction and the existence of a stationary distribution of positive solutions. After that, three controls, i.e. personal protection, treatment of infected persons, and insecticides for spraying mosquitoes, are incorporated into the model and an optimal control problem of Zika is formulated to minimize the number of infected people, mosquitoes, and control cost. Finally, some numerical simulations are provided to explain and supplement the theoretical results obtained.

Reframing Optimal Control Problems for Infectious Disease Management in Low-Income Countries

Optimal control theory can be a useful tool to identify the best strategies for the management of infectious diseases. In most of the applications to disease control with ordinary differential equations, the objective functional to be optimized is formulated in monetary terms as the sum of intervention costs and the cost associated with the burden of disease. We present alternate formulations that express epidemiological outcomes via health metrics and reframe the problem to include features such as budget constraints and epidemiological targets. These alternate formulations are illustrated with a compartmental cholera model. The alternate formulations permit us to better explore the sensitivity of the optimal control solutions to changes in available budget or the desired epidemiological target. We also discuss some limitations of comprehensive cost assessment in epidemiology.

Propagation thresholds in a diffusive epidemic model with latency and vaccination

This paper studies the propagation thresholds in a diffusive epidemic model with latency and vaccination. When the initial condition satisfies proper exponential decaying behavior, we present the spatial expansion feature of the infected. Different leftward and rightward spreading speeds are obtained with respect to different decaying initial values. Moreover, the convergence in the sense of compact open topology is also studied when the spreading speeds are finite. Finally, we show that the minimal spreading speed is the minimal wave speed of traveling wave solutions, which also presents the precisely asymptotic behavior of traveling wave solutions for the infected branch at the disease-free side. Here, the asymptotic behavior plays an important role that distinguishes the minimal spreading speed from all possible spreading speeds. From the definition of possible spreading speeds, we may find some factors affecting the spatial expansion ability, which includes that the vaccination could decrease the spatial expansion ability of the disease.

Computing optimal drug dosing with OptiDose: implementation in NONMEM

Determining a drug dosing recommendation with a PKPD model can be a laborious and complex task. Recently, an optimal dosing algorithm (OptiDose) was developed to compute the optimal doses for any pharmacometrics/PKPD model for a given dosing scenario. In the present work, we reformulate the underlying optimal control problem and elaborate how to solve it with standard commands in the software NONMEM. To demonstrate the potential of the OptiDose implementation in NONMEM, four relevant but substantially different optimal dosing tasks are solved. In addition, the impact of different dosing scenarios as well as the choice of the therapeutic goal on the computed optimal doses are discussed.

MODEL FOR TRANSMISSION AND OPTIMAL CONTROL OF ANTHRAX INVOLVING HUMAN AND ANIMAL POPULATION

Anthrax is a disease caused by Bacillus anthracis, commonly affects animals as well as humans health. In this paper, a nonlinear deterministic anthrax model involving human and animal is proposed and analyzed. The reproduction number [Formula: see text] and equilibrium points are explored to study the dynamic behavior of the disease. The existence and stability of equilibrium points are discussed. For [Formula: see text], the disease-free equilibrium [Formula: see text] is globally stable. However, it is unstable when [Formula: see text] and a locally stable endemic equilibrium point [Formula: see text] exists. The model is then extended to optimal control model considering human vaccination, animal vaccination and proper removal of carcass. The vaccination class of human and animal population appears separately in a model. The existence and characterization of optimal control are discussed. The numerical simulations are carried out for the choice of parametric values and initial conditions. These illustrate scavengers in the suspected area which eat infected dead body of animals contributing to the effort of reducing the expansion of disease. In addition, numerical comparison analysis with four distinct control strategies is carried out. Our findings show that each control technique has its own influence on reducing the total number of infections in the human and animal populations. The cumulative impact of all control measures is found to be extremely effective in lowering the prevalence of the disease.

Sequential allocation of vaccine to control an infectious disease

The problem of optimally allocating a limited supply of vaccine to control a communicable disease has broad applications in public health and has received renewed attention during the COVID-19 pandemic. This allocation problem is highly complex and nonlinear. Decision makers need a practical, accurate, and interpretable method to guide vaccine allocation. In this paper we develop simple analytical conditions that can guide the allocation of vaccines over time. We consider four objectives: minimize new infections, minimize deaths, minimize life years lost, or minimize quality-adjusted life years lost due to death. We consider an SIR model with interacting population groups. We approximate the model using Taylor series expansions, and develop simple analytical conditions characterizing the optimal solution to the resulting problem for a single time period. We develop a solution approach in which we allocate vaccines using the analytical conditions in each time period based on the state of the epidemic at the start of the time period. We illustrate our method with an example of COVID-19 vaccination, calibrated to epidemic data from New York State. Using numerical simulations, we show that our method achieves near-optimal results over a wide range of vaccination scenarios. Our method provides a practical, intuitive, and accurate tool for decision makers as they allocate limited vaccines over time, and highlights the need for more interpretable models over complicated black box models to aid in decision making.

Set-Valued Control to COVID-19 Spread with Treatment and Limitation of Vaccination Resources

In this paper, we consider an SEIR model that describes the dynamics of the COVID-19 pandemic. Subject to this model with vaccination and treatment as controls, we formulate a control problem that aims to reduce the number of infectious individuals to zero. The novelty of this work consists of considering a more realistic control problem by adding mixed constraints to take into account the limited vaccines supply. Furthermore, to solve this problem, we use a set-valued approach combining a Lyapunov function defined in the sense of viability theory with some results from the set-valued analysis. The expressions of the control variables are given via continuous selection of an adequately designed feedback map. The main result of our study shows that even though there are limits of vaccination resources, the combination of treatment and vaccination strategies can significantly reduce the number of exposed and infectious individuals. Some numerical simulations are proposed to show the efficiency of our set-valued approach and to validate our theoretical results.

Optimal allocation of limited vaccine to minimize the effective reproduction number

We examine the problem of allocating a limited supply of vaccine for controlling an infectious disease with the goal of minimizing the effective reproduction number Re. We consider an SIR model with two interacting populations and develop an analytical expression that the optimal vaccine allocation must satisfy. With limited vaccine supplies, we find that an all-or-nothing approach is optimal. For certain special cases, we determine the conditions under which the optimal Re is below 1. We present an example of vaccine allocation for COVID-19 and show that it is optimal to vaccinate younger individuals before older individuals to minimize Re if less than 59% of the population can be vaccinated. The analytical conditions we develop provide a simple means of determining the optimal allocation of vaccine between two population groups to minimize Re.

Optimal control for colistin dosage selection

Optimization of antibiotic administration helps minimizing cases of bacterial resistance. Dosages are often selected by trial and error using a pharmacokinetic (PK) model. However, this is limited to the range of tested dosages, restraining possible treatment choices, especially for the loading doses. Colistin is a last-resort antibiotic with a narrow therapeutic window; therefore, its administration should avoid subtherapeutic or toxic concentrations. This study formulates an optimal control problem for dosage selection of colistin based on a PK model, minimizing deviations of colistin concentration to a target value and allowing a specific dosage optimization for a given individual. An adjoint model was used to provide the sensitivity of concentration deviations to dose changes. A three-compartment PK model was adopted. The standard deviation between colistin plasma concentrations and a target set at 2 mg/L was minimized for some chosen treatments and sample patients. Significantly lower deviations from the target concentration are obtained for shorter administration intervals (e.g. every 8 h) compared to longer ones (e.g. every 24 h). For patients with normal or altered renal function, the optimal loading dose regimen should be divided into two or more administrations to attain the target concentration quickly, with a high first loading dose followed by much lower ones. This regimen is not easily obtained by trial and error, highlighting advantages of the method. The present method is a refined optimization of antibiotic dosage for the treatment of infections. Results for colistin suggest significant improvement in treatment avoiding subtherapeutic or toxic concentrations.

Forecasting the Effects of the New SARS-CoV-2 Variant in Europe

Due to the emergence of a new SARS-CoV-2 variant, we use a previous model to simulate the behaviour of this new SARS-CoV-2 variant. The analysis and simulations are performed for Europe, in order to provide a global analysis of the pandemic. In this context, numerical results are obtained in the first 100 days of the pandemic assuming an infectivity of 70%, 56%, and 35%, respectively, higher for the new SAR-CoV-2 variant, as compared with the real data.

Spatial connectivity in mosquito-borne disease models: a systematic review of methods and assumptions

Spatial connectivity plays an important role in mosquito-borne disease transmission. Connectivity can arise for many reasons, including shared environments, vector ecology and human movement. This systematic review synthesizes the spatial methods used to model mosquito-borne diseases, their spatial connectivity assumptions and the data used to inform spatial model components. We identified 248 papers eligible for inclusion. Most used statistical models (84.2%), although mechanistic are increasingly used. We identified 17 spatial models which used one of four methods (spatial covariates, local regression, random effects/fields and movement matrices). Over 80% of studies assumed that connectivity was distance-based despite this approach ignoring distant connections and potentially oversimplifying the process of transmission. Studies were more likely to assume connectivity was driven by human movement if the disease was transmitted by an Aedes mosquito. Connectivity arising from human movement was more commonly assumed in studies using a mechanistic model, likely influenced by a lack of statistical models able to account for these connections. Although models have been increasing in complexity, it is important to select the most appropriate, parsimonious model available based on the research question, disease transmission process, the spatial scale and availability of data, and the way spatial connectivity is assumed to occur.

Optimal allocation of limited vaccine to control an infectious disease: Simple analytical conditions

When allocating limited vaccines to control an infectious disease, policy makers frequently have goals relating to individual health benefits (e.g., reduced morbidity and mortality) as well as population-level health benefits (e.g., reduced transmission and possible disease eradication). We consider the optimal allocation of a limited supply of a preventive vaccine to control an infectious disease, and four different allocation objectives: minimize new infections, deaths, life years lost, or quality-adjusted life years (QALYs) lost due to death. We consider an SIR model with n interacting populations, and a single allocation of vaccine at time 0. We approximate the model dynamics to develop simple analytical conditions characterizing the optimal vaccine allocation for each objective. We instantiate the model for an epidemic similar to COVID-19 and consider n=2 population groups: one group (individuals under age 65) with high transmission but low mortality and the other group (individuals age 65 or older) with low transmission but high mortality. We find that it is optimal to vaccinate younger individuals to minimize new infections, whereas it is optimal to vaccinate older individuals to minimize deaths, life years lost, or QALYs lost due to death. Numerical simulations show that the allocations resulting from our conditions match those found using much more computationally expensive algorithms such as exhaustive search. Sensitivity analysis on key parameters indicates that the optimal allocation is robust to changes in parameter values. The simple conditions we develop provide a useful means of informing vaccine allocation decisions for communicable diseases.

La Crosse virus spread within the mosquito population in Knox County, TN

In Appalachia, La Crosse virus (LACV) is a leading pediatric arbovirus and public health concern for children under 16 years. LACV is transmitted via the bite of an infected Aedes mosquito. Thus, it is imperative to understand the dynamics of the local vector population in order to assess risk and transmission. Using entomological data collected from Knox County, Tennessee in 2013, we formulate an environmentally-driven system of ordinary differential equations to model mosquito population dynamics over a single season. Further, we include infected compartments to represent LACV transmission within the mosquito population. Findings suggest that the model, with dependence on degree days and accumulated precipitation, can closely describe field data. This model confirms the need to include these environmental variables when planning control strategies.

Global Dynamics of a Reaction-Diffusion Model of Zika Virus Transmission with Seasonality

In this paper, we propose a periodic reaction-diffusion model of Zika virus with seasonal and spatial heterogeneous structure in host and vector population. We introduce the basic reproduction ratio [Formula: see text] for this model and show that the disease-free periodic solution is globally asymptotically stable if [Formula: see text], while the system admits a globally asymptotically stable positive periodic solution if [Formula: see text]. Numerically, we study the Zika transmission in Rio de Janeiro Municipality, Brazil, and investigate the effects of some model parameters on [Formula: see text]. We find that the neglect of seasonality underestimates the value of [Formula: see text] and the maximum carrying capacity affects the spread of Zika virus.

MODELING ZIKA TRANSMISSION DYNAMICS: PREVENTION AND CONTROL

The Zika virus (ZIKV) epidemic is depicted to have high spatial diversity and slow growth, attributable to the dynamics of the mosquito vector and mobility of the human populations. In an effort to understand the transmission dynamics of Zika virus, we formulate a new compartmental epidemic model with a system of seven differential equations and 11 parameters incorporating the decaying transmission rate and study the impact of protection measure on basic public health. We do not fit the model to the observed pattern of spread, rather we use parameter values estimated in the past and examine the extent to which the designed model prediction agrees with the pattern of spread seen in Brazil, via reaction–diffusion modeling. Our work includes estimation of key epidemiological parameters such as basic reproduction number ([Formula: see text], and gives a rough estimate of how many individuals can be typically infected during an outbreak if it occurs in India. We used partial rank correlation coefficient method for global sensitivity analysis to identify the most influential model parameters. Using optimal control theory and Pontryagin’s maximum principle, a control model has been proposed and conditions for the optimal control are determined for the deterministic model of Zika virus. The control functions for the strategies (i) vector-to-human contact reduction and (ii) vector elimination are introduced into the system. Numerical simulations are also performed. This work aimed at understanding the potential extent and timing of the ZIKV epidemic can be used as a template for the analysis of future mosquito-borne epidemics.

Applying optimal control theory to a spatial simulation model of sudden oak death: ongoing surveillance protects tanoak while conserving biodiversity

Sudden oak death has devastated tree populations across California. However, management might still slow disease spread at local scales. We demonstrate how to unambiguously characterize effective, local management strategies using a detailed, spatially explicit simulation model of spread in a single forest stand. This pre-existing, parameterized simulation is approximated here by a carefully calibrated, non-spatial model, explicitly constructed to be sufficiently simple to allow optimal control theory (OCT) to be applied. By lifting management strategies from the approximate model to the detailed simulation, effective time-dependent controls can be identified. These protect tanoak-a culturally and ecologically important species-while conserving forest biodiversity within a limited budget. We also consider model predictive control, in which both the approximating model and optimal control are repeatedly updated as the epidemic progresses. This allows management which is robust to both parameter uncertainty and systematic differences between simulation and approximate models. Including the costs of disease surveillance then introduces an optimal intensity of surveillance. Our study demonstrates that successful control of sudden oak death is likely to rely on adaptive strategies updated via ongoing surveillance. More broadly, it illustrates how OCT can inform effective real-world management, even when underpinning disease spread models are highly complex.