1
|
Thinking clearly about social aspects of infectious disease transmission. Nature 2021; 595:205-213. [PMID: 34194045 DOI: 10.1038/s41586-021-03694-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023]
Abstract
Social and cultural forces shape almost every aspect of infectious disease transmission in human populations, as well as our ability to measure, understand, and respond to epidemics. For directly transmitted infections, pathogen transmission relies on human-to-human contact, with kinship, household, and societal structures shaping contact patterns that in turn determine epidemic dynamics. Social, economic, and cultural forces also shape patterns of exposure, health-seeking behaviour, infection outcomes, the likelihood of diagnosis and reporting of cases, and the uptake of interventions. Although these social aspects of epidemiology are hard to quantify and have limited the generalizability of modelling frameworks in a policy context, new sources of data on relevant aspects of human behaviour are increasingly available. Researchers have begun to embrace data from mobile devices and other technologies as useful proxies for behavioural drivers of disease transmission, but there is much work to be done to measure and validate these approaches, particularly for policy-making. Here we discuss how integrating local knowledge in the design of model frameworks and the interpretation of new data streams offers the possibility of policy-relevant models for public health decision-making as well as the development of robust, generalizable theories about human behaviour in relation to infectious diseases.
Collapse
|
2
|
Exploring the Benefits of Molecular Testing for Gonorrhoea Antibiotic Resistance Surveillance in Remote Settings. PLoS One 2015; 10:e0133202. [PMID: 26181042 PMCID: PMC4504484 DOI: 10.1371/journal.pone.0133202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/24/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Surveillance for gonorrhoea antimicrobial resistance (AMR) is compromised by a move away from culture-based testing in favour of more convenient nucleic acid amplification test (NAAT) tests. We assessed the potential benefit of a molecular resistance test in terms of the timeliness of detection of gonorrhoea AMR. METHODS AND FINDINGS An individual-based mathematical model was developed to describe the transmission of gonorrhoea in a remote Indigenous population in Australia. We estimated the impact of the molecular test on the time delay between first importation and the first confirmation that the prevalence of gonorrhoea AMR (resistance proportion) has breached the WHO-recommended 5% threshold (when a change in antibiotic should occur). In the remote setting evaluated in this study, the model predicts that when culture is the only available means of testing for AMR, the breach will only be detected when the actual prevalence of AMR in the population has already reached 8 - 18%, with an associated delay of ~43 - 69 months between first importation and detection. With the addition of a molecular resistance test, the number of samples for which AMR can be determined increases facilitating earlier detection at a lower resistance proportion. For the best case scenario, where AMR can be determined for all diagnostic samples, the alert would be triggered at least 8 months earlier than using culture alone and the resistance proportion will have only slightly exceeded the 5% notification threshold. CONCLUSIONS Molecular tests have the potential to provide more timely warning of the emergence of gonorrhoea AMR. This in turn will facilitate earlier treatment switching and more targeted treatment, which has the potential to reduce the population impact of gonorrhoea AMR.
Collapse
|
3
|
Porco TC, Gao D, Scott JC, Shim E, Enanoria WT, Galvani AP, Lietman TM. When does overuse of antibiotics become a tragedy of the commons? PLoS One 2012; 7:e46505. [PMID: 23236344 PMCID: PMC3517551 DOI: 10.1371/journal.pone.0046505] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 08/31/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Over-prescribing of antibiotics is considered to result in increased morbidity and mortality from drug-resistant organisms. A resulting common wisdom is that it would be better for society if physicians would restrain their prescription of antibiotics. In this view, self-interest and societal interest are at odds, making antibiotic use a classic "tragedy of the commons". METHODS AND FINDINGS We developed two mathematical models of transmission of antibiotic resistance, featuring de novo development of resistance and transmission of resistant organisms. We analyzed the decision to prescribe antibiotics as a mathematical game, by analyzing individual incentives and community outcomes. CONCLUSIONS A conflict of interest may indeed result, though not in all cases. Increased use of antibiotics by individuals benefits society under certain circumstances, despite the amplification of drug-resistant strains or organisms. In situations where increased use of antibiotics leads to less favorable outcomes for society, antibiotics may be harmful for the individual as well. For other scenarios, where a conflict between self-interest and society exists, restricting antibody use would benefit society. Thus, a case-by-case assessment of appropriate use of antibiotics may be warranted.
Collapse
Affiliation(s)
- Travis C. Porco
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- Center for Infectious Disease and Emergency Readiness, University of California, Berkeley, California, United States of America
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
| | - Daozhou Gao
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
| | - James C. Scott
- Department of Mathematics and Statistics, Colby College, Waterville, Maine, United States of America
| | - Eunha Shim
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Wayne T. Enanoria
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
- Center for Infectious Disease and Emergency Readiness, University of California, Berkeley, California, United States of America
| | - Alison P. Galvani
- School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Thomas M. Lietman
- Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, United States of America
- Institute for Global Health, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| |
Collapse
|