Transmission potential of the novel avian influenza A(H7N9) infection in mainland China

Effect of avian influenza scare on transmission of zoonotic avian influenza: A case study of influenza A (H7N9)

Avian influenza scare is a human psychological factor that asserts both positive and negative effects on the transmission of zoonotic avian influenza. In order to study the dichotomous effect of avian influenza scare on disease transmission, taking H7N9 avian influenza as a typical case, a two-patch epidemic model is proposed. The global dynamics and the threshold criteria are established by LaSalle invariant principle and the theory of asymptotic autonomous system. To mitigate the negative effects and curb illegal poultry trade, a game-theoretic model is adopted to explore the optimal policy of culling subsidies to reasonably compensate stakeholders for their economic losses resulting from the scare. The optimal policy of culling subsidy is found to heavily depend on the penalty of illegal poultry trade, the stakeholders' income, the intensity of control measures, and the prevalence level of the disease. The negative effect of avian influenza scare on disease transmission is considerably more significant than the positive effect. In order to avoid a widespread outbreak of zoonotic avian influenza across the region, a comprehensive national global control strategy is essential and effective, even in the presence of the negative effect of the avian influenza scare.

Transmission dynamics and optimal control of H7N9 in China

H7N9 avian influenza is a highly pathogenic zoonotic disease. In order to control the disease, many strategies have been adopted in China such as poultry culling, the closure of live poultry markets (LPMs), the vaccination of poultry, and the treatment for humans. Due to the limited resource, it is of paramount significance to achieve the optimal control. In this paper, an epidemic model incorporating the selective culling rate is formulated to investigate the transmission mechanism of H7N9. The threshold dynamics and bifurcation analyses of the model are well investigated. Furthermore, the problem of optimal control is explored in line with Pontryagin’s Maximum Principle, with consideration given to the comprehensive measures. The numerical simulations suggest that the vaccination of poultry and the closure of LPMs are the two most economical and effective measures.

Vector-host epidemic model with direct transmission in random environment

This paper studies a stochastic vector-host epidemic model with direct transmission in random environment, governed by a system of stochastic differential equations with regime-switching diffusion. We first examine the existence and uniqueness of a positive global solution. Then, we investigate stability properties of the solution, including almost sure and pth moment exponential stability and stochastic asymptotic stability. Moreover, we study conditions for the existence and uniqueness of a stationary distribution. Numerical simulations are presented to illustrate the theoretical results.

Modeling a stochastic avian influenza model under regime switching and with human-to-human transmission

In this paper, we investigate the stochastic avian influenza model with human-to-human transmission, which is disturbed by both white and telegraph noises. First, we show that the solution of the stochastic system is positive and global. Furthermore, by using stochastic Lyapunov functions, we establish sufficient conditions for the existence of a unique ergodic stationary distribution. Then we obtain the conditions for extinction. Finally, numerical simulations are employed to demonstrate the analytical results.

Mathematically modeling spillovers of an emerging infectious zoonosis with an intermediate host

Modeling the behavior of zoonotic pandemic threats is a key component of their control. Many emerging zoonoses, such as SARS, Nipah, and Hendra, mutated from their wild type while circulating in an intermediate host population, usually a domestic species, to become more transmissible among humans, and this transmission route will only become more likely as agriculture and trade intensifies around the world. Passage through an intermediate host enables many otherwise rare diseases to become better adapted to humans, and so understanding this process with accurate mathematical models is necessary to prevent epidemics of emerging zoonoses, guide policy interventions in public health, and predict the behavior of an epidemic. In this paper, we account for a zoonotic disease mutating in an intermediate host by introducing a new mathematical model for disease transmission among three species. We present a model of these disease dynamics, including the equilibria of the system and the basic reproductive number of the pathogen, finding that in the presence of biologically realistic interspecies transmission parameters, a zoonotic disease with the capacity to mutate in an intermediate host population can establish itself in humans even if its R₀ in humans is less than 1. This result and model can be used to predict the behavior of any zoonosis with an intermediate host and assist efforts to protect public health.

A two-thresholds policy for a Filippov model in combating influenza

This work designs a two-thresholds policy for a Filippov model in combating influenza, so as to estimate when and whether to take control strategies, including the media coverage, antiviral treatment of infected individuals and vaccination of susceptible population. By introducing two tolerance thresholds [Formula: see text] and [Formula: see text] of susceptible and infected individuals, the two-thresholds policy is designed as: a vaccination program is implemented when the number of susceptible individuals is above [Formula: see text]; an antiviral treatment strategy is taken and the mass media begins to report information about influenza when the infection number is larger than [Formula: see text]; no control strategies are required in other cases. Furthermore, the global dynamics of the model are analyzed by varying these two thresholds, including the existence and dynamics of sliding mode, and the existence and global stability of equilibrium. It is shown that the model solutions ultimately converge to a pseudoequilibrium or a pseudoattractor on the switching surface, or a real equilibrium. The obtained results indicate that, by choosing susceptible and infected thresholds properly, the infection number can be remained below or at an acceptable level.

Comparison of methods to Estimate Basic Reproduction Number (R 0) of influenza, Using Canada 2009 and 2017-18 A (H1N1) Data

Background

The basic reproduction number (R ₀) has a key role in epidemics and can be utilized for preventing epidemics. In this study, different methods are used for estimating R ₀'s and their vaccination coverage to find the formula with the best performance.

Materials and Methods

We estimated R ₀ for cumulative cases count data from April 18 to July 6, 2009 and 35-2017 to 34-2018 weeks in Canada: maximum likelihood (ML), exponential growth rate (EG), time-dependent reproduction numbers (TD), attack rate (AR), gamma-distributed generation time (GT), and the final size of the epidemic. Gamma distribution with mean and standard deviation 3.6 ± 1.4 is used as GT.

Results

The AR method obtained a R _{0 (}95% confidence interval [CI]) value of 1.116 (1.1163, 1.1165) and an EG (95%CI) value of 1.46 (1.41, 1.52). The R ₀ (95%CI) estimate was 1.42 (1.27, 1.57) for the obtained ML, 1.71 (1.12, 2.03) for the obtained TD, 1.49 (1.0, 1.97) for the gamma-distributed GT, and 1.00 (0.91, 1.09) for the final size of the epidemic. The minimum and maximum vaccination coverage were related to AR and TD methods, respectively, where the TD method has minimum mean squared error (MSE). Finally, the R ₀ (95%CI) for 2018 data was 1.52 (1.11, 1.94) by TD method, and vaccination coverage was estimated as 34.2%.

Conclusion

For the purposes of our study, the estimation of TD was the most useful tool for computing the R ₀, because it has the minimum MSE. The estimation R ₀ > 1 indicating that the epidemic has occurred. Thus, it is required to vaccinate at least 41.5% to prevent and control the next epidemic.

Virus-induced pathogenesis, vaccine development, and diagnosis of novel H7N9 avian influenza A virus in humans: a systemic literature review

H7N9 avian influenza virus (AIV) caused human infections in 2013 in China. Phylogenetic analyses indicate that H7N9 AIV is a novel reassortant strain with pandemic potential. We conducted a systemic review regarding virus-induced pathogenesis, vaccine development, and diagnosis of H7N9 AIV infection in humans. We followed PRISMA guidelines and searched PubMed, Web of Science, and Google Scholar to identify relevant articles published between January 2013 and December 2018. Pathogenesis data indicated that H7N9 AIV belongs to low pathogenic avian influenza, which is mostly asymptomatic in avian species; however, H7N9 induces high mortality in humans. Sporadic human infections have recently been reported, caused by highly pathogenic avian influenza viruses detected in poultry. H7N9 AIVs resistant to adamantine and oseltamivir cause severe human infection by rapidly inducing progressive acute community-acquired pneumonia, multiorgan dysfunction, and cytokine dysregulation; however, mechanisms via which the virus induces severe syndromes remain unclear. An H7N9 AIV vaccine is lacking; designs under evaluation include synthesized peptide, baculovirus-insect system, and virus-like particle vaccines. Molecular diagnosis of H7N9 AIVs is suggested over conventional assays, for biosafety reasons. Several advanced or modified diagnostic assays are under investigation and development. We summarized virus-induced pathogenesis, vaccine development, and current diagnostic assays in H7N9 AIVs.

Identifying Risk Factors Of A(H7N9) Outbreak by Wavelet Analysis and Generalized Estimating Equation

Five epidemic waves of A(H7N9) occurred between March 2013 and May 2017 in China. However, the potential risk factors associated with disease transmission remain unclear. To address the spatial–temporal distribution of the reported A(H7N9) human cases (hereafter referred to as “cases”), statistical description and geographic information systems were employed. Based on long-term observation data, we found that males predominated the majority of A(H7N9)-infected individuals and that most males were middle-aged or elderly. Further, wavelet analysis was used to detect the variation in time-frequency between A(H7N9) cases and meteorological factors. Moreover, we formulated a Poisson regression model to explore the relationship among A(H7N9) cases and meteorological factors, the number of live poultry markets (LPMs), population density and media coverage. The main results revealed that the impact factors of A(H7N9) prevalence are manifold, and the number of LPMs has a significantly positive effect on reported A(H7N9) cases, while the effect of weekly average temperature is significantly negative. This confirms that the interaction of multiple factors could result in a serious A(H7N9) outbreak. Therefore, public health departments adopting the corresponding management measures based on both the number of LPMs and the forecast of meteorological conditions are crucial for mitigating A(H7N9) prevalence.

Global Dynamics of an Avian Influenza A(H7N9) Epidemic Model with Latent Period and Nonlinear Recovery Rate

An SEIR type of compartmental model with nonlinear incidence and recovery rates was formulated to study the combined impacts of psychological effect and available resources of public health system especially the number of hospital beds on the transmission and control of A(H7N9) virus. Global stability of the disease-free and endemic equilibria is determined by the basic reproduction number as a threshold parameter and is obtained by constructing Lyapunov function and second additive compound matrix. The results obtained reveal that psychological effect and available resources do not change the stability of the steady states but can indeed diminish the peak and the final sizes of the infected. Our studies have practical implications for the transmission and control of A(H7N9) virus.

Contact reductions from live poultry market closures limit the epidemic of human infections with H7N9 influenza

An early steep increase in the number of humans infected with avian influenza A(H7N9) virus was observed in China, raising great public concern domestically and internationally. Little is known about the dynamics of the transmission contacts between poultry and human populations, although such understanding is essential for developing effective strategies to control this zoonosis. In this study, we evaluated the effects of contact reductions from live poultry markets (LPMs) closures on the transmission of H7N9 virus during epidemics in Guangdong Province, China. A mathematical model of the poultry-to-person transmission dynamics of H7N9 virus was constructed. The parameters in the model were estimated from publicly available data on confirmed cases of human infection and information on LPMs closure during 2013-2017. By fitting the model, we measured the time-dependent contact quantity of the susceptible population to LPMs. The results showed that periodic intervention strategies can greatly reduce the magnitude of outbreaks, and the earlier interventions for policy are implemented, the smaller is the outbreak. The control efforts for LPMs to decrease the contact quantity are critical in preventing epidemics in the long term. This model should provide important insights for the development of a national intervention strategy for the long-term control of avian influenza virus epidemics.

AVIAN INFLUENZA A H7N9 VIRUS HAS BEEN ESTABLISHED IN CHINA

In March 2013, a novel avian-origin influenza A H7N9 virus was identified among human patients in China and a total of 124 human cases with 24 related deaths were confirmed by May 2013. From November 2013 to July 2017, H7N9 broke out four more times in China. A deterministic model is proposed to study the transmission dynamics of the avian influenza A H7N9 virus between wild and domestic birds and from birds to humans, and is applied to simulate the open data on numbers of the infected human cases and related deaths reported from March to May 2013 and from November 2013 to June 2014 by the Chinese Center for Disease Control and Prevention. The basic reproduction number [Formula: see text] is estimated and sensitivity analysis of [Formula: see text] in terms of model parameters is performed. Taking into account the fact that it broke out again from November 2014 to June 2015, from November 2015 to July 2016, and from October 2016 to July 2017, we believe that H7N9 virus has been well established in birds and will likely cause regular outbreaks in humans again in the future. Control measures for the future spread of H7N9 include (i) reducing the transmission opportunities between wild birds and domestic birds, (ii) closing or monitoring the retail live-poultry markets in the infected areas, and (iii) culling the infected domestic birds in the epidemic regions.

A Filippov model describing the effects of media coverage and quarantine on the spread of human influenza

Mass-media reports on an epidemic or pandemic have the potential to modify human behaviour and affect social attitudes. Here we construct a Filippov model to evaluate the effects of media coverage and quarantine on the transmission dynamics of influenza. We first choose a piecewise smooth incidence rate to represent media reports being triggered once the number of infected individuals exceeds a certain critical level [Formula: see text] . Further, if the number of infected cases increases and exceeds another larger threshold value [Formula: see text] ( [Formula: see text] ), we consider that the incidence rate tends to a saturation level due to the protection measures taken by individuals; meanwhile, we begin to quarantine susceptible individuals when the number of susceptible individuals is larger than a threshold value S_c. Then, for each susceptible threshold value S_c, the global properties of the Filippov model with regard to the existence and stability of all possible equilibria and sliding-mode dynamics are examined, as we vary the infected threshold values [Formula: see text] and [Formula: see text] . We show generically that the Filippov system stabilizes at either the endemic equilibrium of the subsystem or the pseudoequilibrium on the switching surface or the endemic equilibrium [Formula: see text] depending on the choice of the threshold values. The findings suggest that proper combinations of infected and susceptible threshold values can maintain the number of infected individuals either below a certain threshold level or at a previously given level.

ANALYSIS OF AVIAN INFLUENZA A (H7N9) MODEL BASED ON THE LOW PATHOGENICITY IN POULTRY

The avian influenza A (H7N9) virus is one subtype of influenza viruses, which has previously been isolated only in birds. Recently, an outbreak of a new avian influenza (H7N9) in China has resulted in numerous infections and high mortality in the humans. The H7N9 virus is low pathogenic in poultry and high pathogenic in human and that is critically different from other avian influenza viruses. An increasing number of the new H7N9 cases and the high mortality have caused a serious global concern. Here, based on the reported data, we propose and analyze an SE-SEIS avian–human influenza model. We prove the global stability results for both the disease-free equilibrium point and the endemic equilibrium point by using a general Bendixson–Dulac theorem. Our reported theoretical results of this paper are expected to help in exploring the development of efficient methods to controlling the spread of avian influenza A(H7N9).

Seasonality of Influenza A(H7N9) Virus in China-Fitting Simple Epidemic Models to Human Cases

Background

Three epidemic waves of influenza A(H7N9) (hereafter ‘H7N9’) human cases have occurred between March 2013 and July 2015 in China. However, the underlying transmission mechanism remains unclear. Our main objective is to use mathematical models to study how seasonality, secular changes and environmental transmission play a role in the spread of H7N9 in China.

Methods

Data on human cases and chicken cases of H7N9 infection were downloaded from the EMPRES-i Global Animal Disease Information System. We modelled on chicken-to-chicken transmission, assuming a constant ratio of 10⁻⁶ human case per chicken case, and compared the model fit with the observed human cases. We developed three different modified Susceptible-Exposed-Infectious-Recovered-Susceptible models: (i) a non-periodic transmission rate model with an environmental class, (ii) a non-periodic transmission rate model without an environmental class, and (iii) a periodic transmission rate model with an environmental class. We then estimated the key epidemiological parameters and compared the model fit using Akaike Information Criterion and Bayesian Information Criterion.

Results

Our results showed that a non-periodic transmission rate model with an environmental class provided the best model fit to the observed human cases in China during the study period. The estimated parameter values were within biologically plausible ranges.

Conclusions

This study highlighted the importance of considering secular changes and environmental transmission in the modelling of human H7N9 cases. Secular changes were most likely due to control measures such as Live Poultry Markets closures that were implemented during the initial phase of the outbreaks in China. Our results suggested that environmental transmission via viral shedding of infected chickens had contributed to the spread of H7N9 human cases in China.

Interpreting the transmissibility of the avian influenza A(H7N9) infection from 2013 to 2015 in Zhejiang Province, China

Three epidemic waves of human influenza A(H7N9) were documented in several different provinces in China between 2013 and 2015. With limited understanding of the potential for human-to-human transmission, it was difficult to implement control measures efficiently or to inform the public adequately about the application of interventions. In this study, the human-to-human transmission rate for the epidemics that occurred between 2013 and 2015 in Zhejiang Province, China, was analysed. The reproduction number (R), a key indicator of transmission intensity, was estimated by fitting the number of infections from poultry to humans and from humans to humans into a mathematical model. The posterior mean R for human-to-human transmission was estimated to be 0·27, with a 95% credible interval of 0·14–0·44 for the first wave, whereas the posterior mean Rs decreased to 0·15 in the second and third waves. Overall, these estimates indicate that a human H7N9 pandemic is unlikely to occur in Zhejiang. The reductions in the viral transmissibility and the number of poultry-transmitted infections after the first epidemic may be attributable to the various intervention measures taken, including changes in the extent of closures of live poultry markets.

A modeling study of human infections with avian influenza A H7N9 virus in mainland China

OBJECTIVES

Since February 2013, more than 400 laboratory-confirmed human cases of avian influenza A H7N9 infection have been reported in mainland China. Little is known of the dynamics of this novel virus in poultry and human populations, which is essential for developing effective long-term control strategies for this zoonosis. The aim of this study was to evaluate the impact of screening and culling of infected poultry on the evolution of the H7N9 epidemic.

METHODS

A mathematical model for transmission dynamics of avian influenza A H7N9 virus in human and poultry populations was constructed. Parameters in the model were estimated using publicly available nationwide surveillance data on animal and human infections.

RESULTS

By fitting a two-host model, it was shown that screening for H7N9 in poultry and culling could effectively decrease the number of new human H7N9 cases. Furthermore, the elimination of circulating H7N9 virus is possible if an intensive, but technically feasible, poultry screening and culling policy is adopted.

CONCLUSIONS

Screening and culling infected poultry is a critical measure for preventing human H7N9 infections in the long term. This model may provide important insights for decision-making on a national intervention strategy for the long-term control of the H7N9 virus epidemic.

The pandemic potential of avian influenza A(H7N9) virus: a review

In March 2013 the first cases of human avian influenza A(H7N9) were reported to the World Health Organization. Since that time, over 650 cases have been reported. Infections are associated with considerable morbidity and mortality, particularly within certain demographic groups. This rapid increase in cases over a brief time period is alarming and has raised concerns about the pandemic potential of the H7N9 virus. Three major factors influence the pandemic potential of an influenza virus: (1) its ability to cause human disease, (2) the immunity of the population to the virus, and (3) the transmission potential of the virus. This paper reviews what is currently known about each of these factors with respect to avian influenza A(H7N9). Currently, sustained human-to-human transmission of H7N9 has not been reported; however, population immunity to the virus is considered very low, and the virus has significant ability to cause human disease. Several statistical and geographical modelling studies have estimated and predicted the spread of the H7N9 virus in humans and avian species, and some have identified potential risk factors associated with disease transmission. Additionally, assessment tools have been developed to evaluate the pandemic potential of H7N9 and other influenza viruses. These tools could also hypothetically be used to monitor changes in the pandemic potential of a particular virus over time.

Global dynamics of avian influenza epidemic models with psychological effect

Cross-sectional surveys conducted in Thailand and China after the outbreaks of the avian influenza A H5N1 and H7N9 viruses show a high degree of awareness of human avian influenza in both urban and rural populations, a higher level of proper hygienic practice among urban residents, and in particular a dramatically reduced number of visits to live markets in urban population after the influenza A H7N9 outbreak in China in 2013. In this paper, taking into account the psychological effect toward avian influenza in the human population, a bird-to-human transmission model in which the avian population exhibits saturation effect is constructed. The dynamical behavior of the model is studied by using the basic reproduction number. The results demonstrate that the saturation effect within avian population and the psychological effect in human population cannot change the stability of equilibria but can affect the number of infected humans if the disease is prevalent. Numerical simulations are given to support the theoretical results and sensitivity analyses of the basic reproduction number in terms of model parameters that are performed to seek for effective control measures for avian influenza.

Quantification of bird-to-bird and bird-to-human infections during 2013 novel H7N9 avian influenza outbreak in China

From February to May, 2013, 132 human avian influenza H7N9 cases were identified in China resulting in 37 deaths. We developed a novel, simple and effective compartmental modeling framework for transmissions among (wild and domestic) birds as well as from birds to human, to infer important epidemiological quantifiers, such as basic reproduction number for bird epidemic, bird-to-human infection rate and turning points of the epidemics, for the epidemic via human H7N9 case onset data and to acquire useful information regarding the bird-to-human transmission dynamics. Estimated basic reproduction number for infections among birds is 4.10 and the mean daily number of human infections per infected bird is 3.16*10-5 [3.08*10-5, 3.23*10-5]. The turning point of 2013 H7N9 epidemic is pinpointed at April 16 for bird infections and at April 9 for bird-to-human transmissions. Our result reveals very low level of bird-to-human infections, thus indicating minimal risk of widespread bird-to-human infections of H7N9 virus during the outbreak. Moreover, the turning point of the human epidemic, pinpointed at shortly after the implementation of full-scale control and intervention measures initiated in early April, further highlights the impact of timely actions on ending the outbreak. This is the first study where both the bird and human components of an avian influenza epidemic can be quantified using only the human case data.

Determination of original infection source of H7N9 avian influenza by dynamical model

H7N9, a newly emerging virus in China, travels among poultry and human. Although H7N9 has not aroused massive outbreaks, recurrence in the second half of 2013 makes it essential to control the spread. It is believed that the most effective control measure is to locate the original infection source and cut off the source of infection from human. However, the original infection source and the internal transmission mechanism of the new virus are not totally clear. In order to determine the original infection source of H7N9, we establish a dynamical model with migratory bird, resident bird, domestic poultry and human population, and view migratory bird, resident bird, domestic poultry as original infection source respectively to fit the true dynamics during the 2013 pandemic. By comparing the date fitting results and corresponding Akaike Information Criterion (AIC) values, we conclude that migrant birds are most likely the original infection source. In addition, we obtain the basic reproduction number in poultry and carry out sensitivity analysis of some parameters.