A complete categorization of multiscale models of infectious disease systems

An ODEs multiscale model with cell proliferation for hepatitis C virus infection treated with direct acting antiviral agents

In a recent study, a mathematically identical ODE model is derived from a multiscale PDE model of hepatitis C virus infection, which helps to overcome the limitations of the PDE model in the analysis. Here, an extended proposed model is formulated for this transformed ODE model by including the hepatocyte proliferation of both uninfected and infected cells. Unlike the transformed model, the proposed model can predict the triphasic viral decline and the virus level after therapy cessation without oscillations. Numerical simulations are performed to investigate the effect of hepatocyte proliferation and therapy with direct-acting antivirals agents (DAAs). The basic reproduction number is obtained, the equilibrium points are specified, and their stability is analysed. A bifurcation analysis is performed to specify the bifurcation points and to study the effect of varying system parameters. Various viral load profiles generated by the model are confirmed to fit with reported data in the literature.

Immune digital twins for complex human pathologies: applications, limitations, and challenges

Digital twins represent a key technology for precision health. Medical digital twins consist of computational models that represent the health state of individual patients over time, enabling optimal therapeutics and forecasting patient prognosis. Many health conditions involve the immune system, so it is crucial to include its key features when designing medical digital twins. The immune response is complex and varies across diseases and patients, and its modelling requires the collective expertise of the clinical, immunology, and computational modelling communities. This review outlines the initial progress on immune digital twins and the various initiatives to facilitate communication between interdisciplinary communities. We also outline the crucial aspects of an immune digital twin design and the prerequisites for its implementation in the clinic. We propose some initial use cases that could serve as "proof of concept" regarding the utility of immune digital technology, focusing on diseases with a very different immune response across spatial and temporal scales (minutes, days, months, years). Lastly, we discuss the use of digital twins in drug discovery and point out emerging challenges that the scientific community needs to collectively overcome to make immune digital twins a reality.

Application of the replication-transmission relativity theory in the development of multiscale models of infectious disease dynamics

Despite the existence of a powerful theoretical foundation for the development of multiscale models of infectious disease dynamics in the form of the replication-transmission relativity theory, the majority of current modelling studies focus more on single-scale modelling. The explicit aim of this study is to change the current predominantly single-scale modelling landscape in the design of planning frameworks for the control, elimination and even eradication of infectious disease systems through the exploitation of multiscale modelling methods based on the application of the replication-transmission relativity theory. We first present a structured roadmap for the development of multiscale models of infectious disease systems. The roadmap is tested on hookworm infection. The testing of the feasibility of the roadmap established a fundamental result which can be generalized to confirm that the complexity of an infectious disease system is encapsulated with a level of organization spanning a microscale and a macroscale.

Mathematical methods for scaling from within-host to population-scale in infectious disease systems

Mathematical modellers model infectious disease dynamics at different scales. Within-host models represent the spread of pathogens inside an individual, whilst between-host models track transmission between individuals. However, pathogen dynamics at one scale affect those at another. This has led to the development of multiscale models that connect within-host and between-host dynamics. In this article, we systematically review the literature on multiscale infectious disease modelling according to PRISMA guidelines, dividing previously published models into five categories governing their methodological approaches (Garira (2017)), explaining their benefits and limitations. We provide a primer on developing multiscale models of infectious diseases.

Analysis of the risk and pre-emptive control of viral outbreaks accounting for within-host dynamics: SARS-CoV-2 as a case study

In the era of living with COVID-19, the risk of localised SARS-CoV-2 outbreaks remains. Here, we develop a multiscale modelling framework for estimating the local outbreak risk for a viral disease (the probability that a major outbreak results from a single case introduced into the population), accounting for within-host viral dynamics. Compared to population-level models previously used to estimate outbreak risks, our approach enables more detailed analysis of how the risk can be mitigated through pre-emptive interventions such as antigen testing. Considering SARS-CoV-2 as a case study, we quantify the within-host dynamics using data from individuals with omicron variant infections. We demonstrate that regular antigen testing reduces, but may not eliminate, the outbreak risk, depending on characteristics of local transmission. In our baseline analysis, daily antigen testing reduces the outbreak risk by 45% compared to a scenario without antigen testing. Additionally, we show that accounting for heterogeneity in within-host dynamics between individuals affects outbreak risk estimates and assessments of the impact of antigen testing. Our results therefore highlight important factors to consider when using multiscale models to design pre-emptive interventions against SARS-CoV-2 and other viruses.

An immuno-epidemiological model linking between-host and within-host dynamics of cholera

Cholera, a severe gastrointestinal infection caused by the bacterium Vibrio cholerae, remains a major threat to public health, with a yearly estimated global burden of 2.9 million cases. Although most existing models for the disease focus on its population dynamics, the disease evolves from within-host processes to the population, making it imperative to link the multiple scales of the disease to gain better perspectives on its spread and control. In this study, we propose an immuno-epidemiological model that links the between-host and within-host dynamics of cholera. The immunological (within-host) model depicts the interaction of the cholera pathogen with the adaptive immune response. We distinguish pathogen dynamics from immune response dynamics by assigning different time scales. Through a time-scale analysis, we characterise a single infected person by their immune response. Contrary to other within-host models, this modelling approach allows for recovery through pathogen clearance after a finite time. Then, we scale up the dynamics of the infected person to construct an epidemic model, where the infected population is structured by individual immunological dynamics. We derive the basic reproduction number ($ \mathcal{R}_0 $) and analyse the stability of the equilibrium points. At the disease-free equilibrium, the disease will either be eradicated if $ \mathcal{R}_0 < 1 $ or otherwise persists. A unique endemic equilibrium exists when $ \mathcal{R}_0 > 1 $ and is locally asymptotically stable without a loss of immunity.

Mechanistic modeling of viral particle production

Viral systems such as wild-type viruses, viral vectors, and virus-like particles are essential components of modern biotechnology and medicine. Despite their importance, the commercial-scale production of viral systems remains highly inefficient for multiple reasons. Computational strategies are a promising avenue for improving process development, optimization, and control, but require a mathematical description of the system. This article reviews mechanistic modeling strategies for the production of viral particles, both at the cellular and bioreactor scales. In many cases, techniques and models from adjacent fields such as epidemiology and wild-type viral infection kinetics can be adapted to construct a suitable process model. These process models can then be employed for various purposes such as in-silico testing of novel process operating strategies and/or advanced process control.

The transmission mechanism theory of disease dynamics: Its aims, assumptions and limitations

Most of the progress in the development of single scale mathematical and computational models for the study of infectious disease dynamics which now span over a century is build on a body of knowledge that has been developed to address particular single scale descriptions of infectious disease dynamics based on understanding disease transmission process. Although this single scale understanding of infectious disease dynamics is now founded on a body of knowledge with a long history, dating back to over a century now, that knowledge has not yet been formalized into a scientific theory. In this article, we formalize this accumulated body of knowledge into a scientific theory called the transmission mechanism theory of disease dynamics which states that at every scale of organization of an infectious disease system, disease dynamics is determined by transmission as the main dynamic disease process. Therefore, the transmission mechanism theory of disease dynamics can be seen as formalizing knowledge that has been inherent in the study of infectious disease dynamics using single scale mathematical and computational models for over a century now. The objective of this article is to summarize this existing knowledge about single scale modelling of infectious dynamics by means of a scientific theory called the transmission mechanism theory of disease dynamics and highlight its aims, assumptions and limitations.

Compositional modelling of immune response and virus transmission dynamics

Transmission models for infectious diseases are typically formulated in terms of dynamics between individuals or groups with processes such as disease progression or recovery for each individual captured phenomenologically, without reference to underlying biological processes. Furthermore, the construction of these models is often monolithic: they do not allow one to readily modify the processes involved or include the new ones, or to combine models at different scales. We show how to construct a simple model of immune response to a respiratory virus and a model of transmission using an easily modifiable set of rules allowing further refining and merging the two models together. The immune response model reproduces the expected response curve of PCR testing for COVID-19 and implies a long-tailed distribution of infectiousness reflective of individual heterogeneity. This immune response model, when combined with a transmission model, reproduces the previously reported shift in the population distribution of viral loads along an epidemic trajectory. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Model Integration in Computational Biology: The Role of Reproducibility, Credibility and Utility

During the COVID-19 pandemic, mathematical modeling of disease transmission has become a cornerstone of key state decisions. To advance the state-of-the-art host viral modeling to handle future pandemics, many scientists working on related issues assembled to discuss the topics. These discussions exposed the reproducibility crisis that leads to inability to reuse and integrate models. This document summarizes these discussions, presents difficulties, and mentions existing efforts towards future solutions that will allow future model utility and integration. We argue that without addressing these challenges, scientists will have diminished ability to build, disseminate, and implement high-impact multi-scale modeling that is needed to understand the health crises we face.

An Embedded Multiscale Modelling to Guide Control and Elimination of Paratuberculosis in Ruminants

In recent years, multiscale modelling approach has begun to receive an overwhelming appreciation as an appropriate technique to characterize the complexity of infectious disease systems. In this study, we develop an embedded multiscale model of paratuberculosis in ruminants at host level that integrates the within-host scale and the between-host. A key feature of embedded multiscale models developed at host level of organization of an infectious disease system is that the within-host scale and the between-host scale influence each other in a reciprocal (i.e., both) way through superinfection, that is, through repeated infection before the host recovers from the initial infectious episode. This key feature is demonstrated in this study through a multiscale model of paratuberculosis in ruminants. The results of this study, through numerical analysis of the multiscale model, show that superinfection influences the dynamics of paratuberculosis only at the start of the infection, while the MAP bacteria replication continuously influences paratuberculosis dynamics throughout the infection until the host recovers from the initial infectious episode. This is largely because the replication of MAP bacteria at the within-host scale sustains the dynamics of paratuberculosis at this scale domain. We further use the embedded multiscale model developed in this study to evaluate the comparative effectiveness of paratuberculosis health interventions that influence the disease dynamics at different scales from efficacy data.

Estimation and optimal control of the multiscale dynamics of Covid-19: a case study from Cameroon

This work aims at a better understanding and the optimal control of the spread of the new severe acute respiratory corona virus 2 (SARS-CoV-2). A multi-scale model giving insights on the virus population dynamics, the transmission process and the infection mechanism is proposed first. Indeed, there are human to human virus transmission, human to environment virus transmission, environment to human virus transmission and self-infection by susceptible individuals. The global stability of the disease-free equilibrium is shown when a given threshold T 0 is less or equal to 1 and the basic reproduction number R 0 is calculated. A convergence index T 1 is also defined in order to estimate the speed at which the disease extincts and an upper bound to the time of infectious extinction is given. The existence of the endemic equilibrium is conditional and its description is provided. Using Partial Rank Correlation Coefficient with a three levels fractional experimental design, the sensitivity of  R 0 , T 0 and T 1 to control parameters is evaluated. Following this study, the most significant parameter is the probability of wearing mask followed by the probability of mobility and the disinfection rate. According to a functional cost taking into account economic impacts of SARS-CoV-2, optimal fighting strategies are determined and discussed. The study is applied to real and available data from Cameroon with a model fitting. After several simulations, social distancing and the disinfection frequency appear as the main elements of the optimal control strategy against SARS-CoV-2.

Rationale and Criteria for a COVID-19 Model Framework

Complex systems are inherently multilevel and multiscale systems. The infectious disease system is considered a complex system resulting from the interaction between three sub-systems (host, pathogen, and environment) organized into a hierarchical structure, ranging from the cellular to the macro-ecosystem level, with multiscales. Therefore, to describe infectious disease phenomena that change through time and space and at different scales, we built a model framework where infectious disease must be considered the set of biological responses of human hosts to pathogens, with biological pathways shared with other pathologies in an ecological interaction context. In this paper, we aimed to design a framework for building a disease model for COVID-19 based on current literature evidence. The model was set up by identifying the molecular pathophysiology related to the COVID-19 phenotypes, collecting the mechanistic knowledge scattered across scientific literature and bioinformatic databases, and integrating it using a logical/conceptual model systems biology. The model framework building process began from the results of a domain-based literature review regarding a multiomics approach to COVID-19. This evidence allowed us to define a framework of COVID-19 conceptual model and to report all concepts in a multilevel and multiscale structure. The same interdisciplinary working groups that carried out the scoping review were involved. The conclusive result is a conceptual method to design multiscale models of infectious diseases. The methodology, applied in this paper, is a set of partially ordered research and development activities that result in a COVID-19 multiscale model.

Mathematical Modeling Predicts That Strict Social Distancing Measures Would Be Needed to Shorten the Duration of Waves of COVID-19 Infections in Vietnam

Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China in 2019, has spread throughout the world and has since then been declared a pandemic. As a result, COVID-19 has caused a major threat to global public health. In this paper, we use mathematical modeling to analyze the reported data of COVID-19 cases in Vietnam and study the impact of non-pharmaceutical interventions. To achieve this, two models are used to describe the transmission dynamics of COVID-19. The first model belongs to the susceptible-exposed-infectious-recovered (SEIR) type and is used to compute the basic reproduction number. The second model adopts a multi-scale approach which explicitly integrates the movement of each individual. Numerical simulations are conducted to quantify the effects of social distancing measures on the spread of COVID-19 in urban areas of Vietnam. Both models show that the adoption of relaxed social distancing measures reduces the number of infected cases but does not shorten the duration of the epidemic waves. Whereas, more strict measures would lead to the containment of each epidemic wave in one and a half months.

Modeling and analysis of different scenarios for the spread of COVID-19 by using the modified multi-agent systems - Evidence from the selected countries

Currently, there is a global pandemic of COVID-19. To assess its prevalence, it is necessary to have adequate models that allow real-time modeling of the impact of various quarantine measures by the state. The SIR model, which is implemented using a multi-agent system based on mobile cellular automata, was improved. The paper suggests ways to improve the rules of the interaction and behavior of agents. Methods of comparing the parameters of the SIR model with real geographical, social and medical indicators have been developed. That allows the modeling of the spatial distribution of COVID-19 as a single location and as the whole country consisting of individual regions that interact with each other by transport, taking into account factors such as public transport, supermarkets, schools, universities, gyms, churches, parks. The developed model also allows us to assess the impact of quarantine, restrictions on transport connections between regions, to take into account such factors as the incubation period, the mask regime, maintaining a safe distance between people, and so on. A number of experiments were conducted in the work, which made it possible to assess both the impact of individual measures to stop the pandemic and their comprehensive application. A method of comparing computer-time and dynamic parameters of the model with real data is proposed, which allowed assessing the effectiveness of the government in stopping the pandemic in the Chernivtsi region, Ukraine. A simulation of the pandemic spread in countries such as Slovakia, Turkey and Serbia was also conducted. The calculations showed the high-accuracy matching of the forecast model with real data.

Patch dynamics modeling framework from pathogens' perspective: Unified and standardized approach for complicated epidemic systems

Mathematical models are powerful tools to investigate, simulate, and evaluate potential interventions for infectious diseases dynamics. Much effort has focused on the Susceptible-Infected-Recovered (SIR)-type compartment models. These models consider host populations and measure change of each compartment. In this study, we propose an alternative patch dynamic modeling framework from pathogens' perspective. Each patch, the basic module of this modeling framework, has four standard mechanisms of pathogen population size change: birth (replication), death, inflow, and outflow. This framework naturally distinguishes between-host transmission process (inflow and outflow) and within-host infection process (replication) during the entire transmission-infection cycle. We demonstrate that the SIR-type model is actually a special cross-sectional and discretized case of our patch dynamics model in pathogens' viewpoint. In addition, this patch dynamics modeling framework is also an agent-based model from hosts' perspective by incorporating individual host's specific traits. We provide an operational standard to formulate this modular-designed patch dynamics model. Model parameterization is feasible with a wide range of sources, including genomics data, surveillance data, electronic health record, and from other emerging technologies such as multiomics. We then provide two proof-of-concept case studies to tackle some of the existing challenges of SIR-type models: sexually transmitted disease and healthcare acquired infections. This patch dynamics modeling framework not only provides theoretical explanations to known phenomena, but also generates novel insights of disease dynamics from a more holistic viewpoint. It is also able to simulate and handle more complicated scenarios across biological scales such as the current COVID-19 pandemic.

A hybrid multi-scale model of COVID-19 transmission dynamics to assess the potential of non-pharmaceutical interventions

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that emerged in Wuhan, China in December 2019. It has caused a global outbreak which represents a major threat to global health. Public health resorted to non-pharmaceutical interventions such as social distancing and lockdown to slow down the spread of the pandemic. However, the effect of each of these measures remains hard to quantify. We design a multi-scale model that simulates the transmission dynamics of COVID-19. We describe the motion of individual agents using a social force model. Each agent can be either susceptible, infected, quarantined, immunized or deceased. The model considers both mechanisms of direct and indirect transmission. We parameterize the model to reproduce the early dynamics of disease spread in Italy. We show that panic situations increase the risk of infection transmission in crowds despite social distancing measures. Next, we reveal that pre-symptomatic transmission accelerates the onset of the exponential growth of cases. After that, we demonstrate that the persistence of SARS-CoV-2 on hard surfaces determines the number of cases reached during the peak of the epidemic. Then, we show that the restricted movement of the individuals flattens the epidemic curve. Finally, model predictions suggest that measures stricter than social distancing and lockdown were used to control the epidemic in Wuhan, China.

Coupling the Macroscale to the Microscale in a Spatiotemporal Context to Examine Effects of Spatial Diffusion on Disease Transmission

There are many challenges to coupling the macroscale to the microscale in temporal or spatial contexts. In order to examine effects of an individual movement and spatial control measures on a disease outbreak, we developed a multiscale model and extended the semi-stochastic simulation method by linking individual movements to pathogen’s diffusion, linking the slow dynamics for disease transmission at the population level to the fast dynamics for pathogen shedding/excretion at the individual level. Numerical simulations indicate that during a disease outbreak individuals with the same infection status show the property of clustering and, in particular, individuals’ rapid movements lead to an increase in the average reproduction number \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R_0$$\end{document}R0, the final size and the peak value of the outbreak. It is interesting that a high level of aggregation the individuals’ movement results in low new infections and a small final size of the infected population. Further, we obtained that either high diffusion rate of the pathogen or frequent environmental clearance lead to a decline in the total number of infected individuals, indicating the need for control measures such as improving air circulation or environmental hygiene. We found that the level of spatial heterogeneity when implementing control greatly affects the control efficacy, and in particular, an uniform isolation strategy leads to low a final size and small peak, compared with local measures, indicating that a large-scale isolation strategy with frequent clearance of the environment is beneficial for disease control.

The research and development process for multiscale models of infectious disease systems

Multiscale modelling of infectious disease systems falls within the domain of complexity science—the study of complex systems. However, what should be made clear is that current progress in multiscale modelling of infectious disease dynamics is still as yet insufficient to present it as a mature sub-discipline of complexity science. In this article we present a methodology for development of multiscale models of infectious disease systems. This methodology is a set of partially ordered research and development activities that result in multiscale models of infectious disease systems built from different scientific approaches. Therefore, the conclusive result of this article is a methodology to design multiscale models of infectious diseases. Although this research and development process for multiscale models cannot be claimed to be unique and final, it constitutes a good starting point, which may be found useful as a basis for further refinement in the discourse for multiscale modelling of infectious disease dynamics.

Complex systems such as infectious disease systems are inherently multilevel and multiscale systems. The study of such complex systems is called complexity science. In this article we present a methodology to design multiscale models of infectious disease systems from a complex systems perspective. Within this perspective we define complexity science as the study of the interconnected relationships of the levels and scales of organization of a complex system. We therefore, define the degree of complexity of a complex system as the number of levels and scales of organization of the complex system needed to describe it. In this work we first present a common multiscale vision of the multilevel and multiscale structure of infectious disease systems as complex systems in which the levels and scales of organization of an infectious disease system interact through different self-sustained multiscale cycles/loops (primary multiscale loops, or secondary multiscale loops, or tertiary multiscale loops) formed at different levels of organization of an infectious disease system due to ongoing reciprocal influence between the microscale and the macroscale. Guided by this multiscale vision, we propose a four-stage research and development process that result in multiscale models of infectious disease systems built from different scientific approaches.

A general method for multiscale modelling of vector-borne disease systems

The inability to develop multiscale models which can describe vector-borne disease systems in terms of the complete pathogen life cycle which represents multiple targets for control has hindered progress in our efforts to control, eliminate and even eradicate these multi-host infections. This is because it is currently not easy to determine precisely where and how in the life cycles of vector-borne disease systems the key constrains which are regarded as crucial in regulating pathogen population dynamics in both the vertebrate host and vector host operate. In this article, we present a general method for development of multiscale models of vector-borne disease systems which integrate the within-host and between-host scales for the two hosts (a vertebrate host and a vector host) that are implicated in vector-borne disease dynamics. The general multiscale modelling method is an extension of our previous work on multiscale models of infectious disease systems which established a basic science and accompanying theory of how pathogen population dynamics at within-host scale scales up to between-host scale and in turn how it scales down from between-host scale to within-host scale. Further, the general method is applied to multiscale modelling of human onchocerciasis-a vector-borne disease system which is sometimes called river blindness as a case study.

The Replication-Transmission Relativity Theory for Multiscale Modelling of Infectious Disease Systems

It is our contention that for multiscale modelling of infectious disease systems to evolve and expand in scope, it needs to be founded on a theory. Such a theory would improve our ability to describe infectious disease systems in terms of their scales and levels of organization, and their inter-relationships. In this article we present a relativistic theory for multiscale modelling of infectious disease systems, that can be considered as an extension of the relativity principle in physics, called the replication-transmission relativity theory. This replication-transmission relativity theory states that at any level of organization of an infectious disease system there is no privileged/absolute scale which would determine, disease dynamics, only interactions between the microscale and macroscale. Such a relativistic theory provides a scientific basis for a systems level description of infectious disease systems using multiscale modelling methods. The central idea of this relativistic theory is that at every level of organization of an infectious disease system, the reciprocal influence between the microscale and the macroscale establishes a pathogen replication-transmission multiscale cycle. We distinguish two kinds of reciprocal influence between the microscale and the macroscale based on systematic differences in their conditions of relevancy. Evidence for the validity of the replication-transmission relativity theory is presented using a multiscale model of hookworm infection that is developed at host level when the relationship between the microscale and the macroscale is described by one of the forms of reciprocal influence.

Linked within-host and between-host models and data for infectious diseases: a systematic review

The observed dynamics of infectious diseases are driven by processes across multiple scales. Here we focus on two: within-host, that is, how an infection progresses inside a single individual (for instance viral and immune dynamics), and between-host, that is, how the infection is transmitted between multiple individuals of a host population. The dynamics of each of these may be influenced by the other, particularly across evolutionary time. Thus understanding each of these scales, and the links between them, is necessary for a holistic understanding of the spread of infectious diseases. One approach to combining these scales is through mathematical modeling. We conducted a systematic review of the published literature on multi-scale mathematical models of disease transmission (as defined by combining within-host and between-host scales) to determine the extent to which mathematical models are being used to understand across-scale transmission, and the extent to which these models are being confronted with data. Following the PRISMA guidelines for systematic reviews, we identified 24 of 197 qualifying papers across 30 years that include both linked models at the within and between host scales and that used data to parameterize/calibrate models. We find that the approach that incorporates both modeling with data is under-utilized, if increasing. This highlights the need for better communication and collaboration between modelers and empiricists to build well-calibrated models that both improve understanding and may be used for prediction.

A coupled multiscale model to guide malaria control and elimination

In this paper, we share with the biomathematics community a new coupled multiscale model which has the potential to inform policy and guide malaria control and elimination. The formulation of this multiscale model is based on integrating four submodels which are: (i) a sub-model for the mosquito-to-human transmission of malaria parasite, (ii) a sub-model for the human-to-mosquito transmission of malaria parasite, (iii) a within-mosquito malaria parasite population dynamics sub-model and (iv) a within-human malaria parasite population dynamics sub-model. The integration of the four submodels is achieved by assuming that the transmission parameters of the sub-model for the mosquito-to-human transmission of malaria at the epidemiological scale are functions of the dependent variables of the within-mosquito sporozoite population dynamics while the transmission parameters of the sub-model for the human-to-mosquito transmission of malaria are functions of the dependent variables of the within-human gametocyte population dynamics. This establishes a unidirectionally coupled multiscale model where the within-human and within-mosquito submodels are unidirectionally coupled to the human-to-mosquito and mosquito-to-human submodels. A fast and slow time scale analysis is performed on this system. The result is a simple multiscale model which describes the mechanics of malaria transmission in terms of the major components of the complete malaria parasite life-cycle. This multiscale modelling approach may be found useful in guiding malaria control and elimination.

FROM INDIVIDUAL HEALTH TO COMMUNITY HEALTH: TOWARDS MULTISCALE MODELING OF DIRECTLY TRANSMITTED INFECTIOUS DISEASE SYSTEMS

In this paper, we present a new method for developing a class of nested multiscale models for directly transmitted infectious disease systems that integrates within-host scale and between-host scale using community pathogen load (CPL) as a new public health measure of a community’s level of infectiousness and as an indicator of the effectiveness of health interventions. The approach develops a multiscale modeling science base for directly transmitted infectious disease systems (where the inside-host environment’s biological entities such as cells, tissues, organs, body fluids, whole body are the reservoir of infective pathogen in the community) that is comparable to an existing multiscale modeling science base for environmentally transmitted infectious diseases (where the outside-host geographical environment’s physical entities such as soil, air, formites/contact surfaces, food and water are the reservoir of infective pathogen in the community) where pathogen load in the environment is explicitly incorporated into the model. This is achieved by assuming that infected hosts in the community are homogeneous and unevenly distributed microbial habitats. We illustrate the utility of this multiscale modeling methodology by evaluating the comparative effectiveness of HIV/AIDS preventive and treatment interventions as a case study.

Replacement, Refinement, and Reduction in Animal Studies With Biohazardous Agents

Animal models are critical to the advancement of our knowledge of infectious disease pathogenesis, diagnostics, therapeutics, and prevention strategies. The use of animal models requires thoughtful consideration for their well-being, as infections can significantly impact the general health of an animal and impair their welfare. Application of the 3Rs—replacement, refinement, and reduction—to animal models using biohazardous agents can improve the scientific merit and animal welfare. Replacement of animal models can use in vitro techniques such as cell culture systems, mathematical models, and engineered tissues or invertebrate animal hosts such as amoeba, worms, fruit flies, and cockroaches. Refinements can use a variety of techniques to more closely monitor the course of disease. These include the use of biomarkers, body temperature, behavioral observations, and clinical scoring systems. Reduction is possible using advanced technologies such as in vivo telemetry and imaging, allowing longitudinal assessment of animals during the course of disease. While there is no single method to universally replace, refine, or reduce animal models, the alternatives and techniques discussed are broadly applicable and they should be considered when infectious disease animal models are developed.

A primer on multiscale modelling of infectious disease systems

The development of multiscale models of infectious disease systems is a scientific endeavour whose progress depends on advances on three main frontiers: (a) the conceptual framework frontier, (b) the mathematical technology or technical frontier, and (c) the scientific applications frontier. The objective of this primer is to introduce foundational concepts in multiscale modelling of infectious disease systems focused on these three main frontiers. On the conceptual framework frontier we propose a three-level hierarchical framework as a foundational idea which enables the discussion of the structure of multiscale models of infectious disease systems in a general way. On the scientific applications frontier we suggest ways in which the different structures of multiscale models can serve as infrastructure to provide new knowledge on the control, elimination and even eradication of infectious disease systems, while on the mathematical technology or technical frontier we present some challenges that modelers face in developing appropriate multiscale models of infectious disease systems. We anticipate that the foundational concepts presented in this primer will be central in articulating an integrated and more refined disease control theory based on multiscale modelling - the all-encompassing quantitative representation of an infectious disease system.