Epidemics with general generation interval distributions

The importance of the generation interval in investigating dynamics and control of new SARS-CoV-2 variants

Inferring the relative strength (i.e. the ratio of reproduction numbers) and relative speed (i.e. the difference between growth rates) of new SARS-CoV-2 variants is critical to predicting and controlling the course of the current pandemic. Analyses of new variants have primarily focused on characterizing changes in the proportion of new variants, implicitly or explicitly assuming that the relative speed remains fixed over the course of an invasion. We use a generation-interval-based framework to challenge this assumption and illustrate how relative strength and speed change over time under two idealized interventions: a constant-strength intervention like idealized vaccination or social distancing, which reduces transmission rates by a constant proportion, and a constant-speed intervention like idealized contact tracing, which isolates infected individuals at a constant rate. In general, constant-strength interventions change the relative speed of a new variant, while constant-speed interventions change its relative strength. Differences in the generation-interval distributions between variants can exaggerate these changes and modify the effectiveness of interventions. Finally, neglecting differences in generation-interval distributions can bias estimates of relative strength.

The effect of the definition of 'pandemic' on quantitative assessments of infectious disease outbreak risk

In the early stages of an outbreak, the term 'pandemic' can be used to communicate about infectious disease risk, particularly by those who wish to encourage a large-scale public health response. However, the term lacks a widely accepted quantitative definition. We show that, under alternate quantitative definitions of 'pandemic', an epidemiological metapopulation model produces different estimates of the probability of a pandemic. Critically, we show that using different definitions alters the projected effects of key parameters-such as inter-regional travel rates, degree of pre-existing immunity, and heterogeneity in transmission rates between regions-on the risk of a pandemic. Our analysis provides a foundation for understanding the scientific importance of precise language when discussing pandemic risk, illustrating how alternative definitions affect the conclusions of modelling studies. This serves to highlight that those working on pandemic preparedness must remain alert to the variability in the use of the term 'pandemic', and provide specific quantitative definitions when undertaking one of the types of analysis that we show to be sensitive to the pandemic definition.

Will an outbreak exceed available resources for control? Estimating the risk from invading pathogens using practical definitions of a severe epidemic

Forecasting whether or not initial reports of disease will be followed by a severe epidemic is an important component of disease management. Standard epidemic risk estimates involve assuming that infections occur according to a branching process and correspond to the probability that the outbreak persists beyond the initial stochastic phase. However, an alternative assessment is to predict whether or not initial cases will lead to a severe epidemic in which available control resources are exceeded. We show how this risk can be estimated by considering three practically relevant potential definitions of a severe epidemic; namely, an outbreak in which: (i) a large number of hosts are infected simultaneously; (ii) a large total number of infections occur; and (iii) the pathogen remains in the population for a long period. We show that the probability of a severe epidemic under these definitions often coincides with the standard branching process estimate for the major epidemic probability. However, these practically relevant risk assessments can also be different from the major epidemic probability, as well as from each other. This holds in different epidemiological systems, highlighting that careful consideration of how to classify a severe epidemic is vital for accurate epidemic risk quantification.

A primer on the use of probability generating functions in infectious disease modeling

We explore the application of probability generating functions (PGFs) to invasive processes, focusing on infectious disease introduced into large populations. Our goal is to acquaint the reader with applications of PGFs, moreso than to derive new results. PGFs help predict a number of properties about early outbreak behavior while the population is still effectively infinite, including the probability of an epidemic, the size distribution after some number of generations, and the cumulative size distribution of non-epidemic outbreaks. We show how PGFs can be used in both discrete-time and continuous-time settings, and discuss how to use these results to infer disease parameters from observed outbreaks. In the large population limit for susceptible-infected-recovered (SIR) epidemics PGFs lead to survival-function based models that are equivalent to the usual mass-action SIR models but with fewer ODEs. We use these to explore properties such as the final size of epidemics or even the dynamics once stochastic effects are negligible. We target this primer at biologists and public health researchers with mathematical modeling experience who want to learn how to apply PGFs to invasive diseases, but it could also be used in an applications-based mathematics course on PGFs. We include many exercises to help demonstrate concepts and to give practice applying the results. We summarize our main results in a few tables. Additionally we provide a small python package which performs many of the relevant calculations.

A generating function approach to HIV transmission with dynamic contact rates

The basic reproduction number, R₀, is often defined as the average number of infections generated by a newly infected individual in a fully susceptible population. The interpretation, meaning, and derivation of R₀ are controversial. However, in the context of mean field models, R₀ demarcates the epidemic threshold below which the infected population approaches zero in the limit of time. In this manner, R₀ has been proposed as a method for understanding the relative impact of public health interventions with respect to disease eliminations from a theoretical perspective. The use of R₀ is made more complex by both the strong dependency of R₀ on the model form and the stochastic nature of transmission. A common assumption in models of HIV transmission that have closed form expressions for R₀ is that a single individual's behavior is constant over time. In this paper we derive expressions for both R₀ and probability of an epidemic in a finite population under the assumption that people periodically change their sexual behavior over time. We illustrate the use of generating functions as a general framework to model the effects of potentially complex assumptions on the number of transmissions generated by a newly infected person in a susceptible population. We find that the relationship between the probability of an epidemic and R₀ is not straightforward, but, that as the rate of change in sexual behavior increases both R₀ and the probability of an epidemic also decrease.

Early estimation of the reproduction number in the presence of imported cases: pandemic influenza H1N1-2009 in New Zealand

We analyse data from the early epidemic of H1N1-2009 in New Zealand, and estimate the reproduction number . We employ a renewal process which accounts for imported cases, illustrate some technical pitfalls, and propose a novel estimation method to address these pitfalls. Explicitly accounting for the infection-age distribution of imported cases and for the delay in transmission dynamics due to international travel, was estimated to be (95% confidence interval: ). Hence we show that a previous study, which did not account for these factors, overestimated . Our approach also permitted us to examine the infection-age at which secondary transmission occurs as a function of calendar time, demonstrating the downward bias during the beginning of the epidemic. These technical issues may compromise the usefulness of a well-known estimator of - the inverse of the moment-generating function of the generation time given the intrinsic growth rate. Explicit modelling of the infection-age distribution among imported cases and the examination of the time dependency of the generation time play key roles in avoiding a biased estimate of , especially when one only has data covering a short time interval during the early growth phase of the epidemic.

Pandemic influenza: Modelling and public health perspectives

We describe the application of mathematical models in the study of disease epidemics with particular focus on pandemic influenza. We outline the general mathematical approach and the complications arising from attempts to apply it for disease outbreak management in a real public health context.

Outbreak properties of epidemic models: the roles of temporal forcing and stochasticity on pathogen invasion dynamics

Despite temporally forced transmission driving many infectious diseases, analytical insight into its role when combined with stochastic disease processes and non-linear transmission has received little attention. During disease outbreaks, however, the absence of saturation effects early on in well-mixed populations mean that epidemic models may be linearised and we can calculate outbreak properties, including the effects of temporal forcing on fade-out, disease emergence and system dynamics, via analysis of the associated master equations. The approach is illustrated for the unforced and forced SIR and SEIR epidemic models. We demonstrate that in unforced models, initial conditions (and any uncertainty therein) play a stronger role in driving outbreak properties than the basic reproduction number R0, while the same properties are highly sensitive to small amplitude temporal forcing, particularly when R0 is small. Although illustrated for the SIR and SEIR models, the master equation framework may be applied to more realistic models, although analytical intractability scales rapidly with increasing system dimensionality. One application of these methods is obtaining a better understanding of the rate at which vector-borne and waterborne infectious diseases invade new regions given variability in environmental drivers, a particularly important question when addressing potential shifts in the global distribution and intensity of infectious diseases under climate change.