Optimal isolation strategies of emerging infectious diseases with limited resources

Threshold dynamics and optimal control on an age-structured SIRS epidemic model with vaccination

We consider a vaccination control into a age-structured susceptible-infective-recovered-susceptible (SIRS) model and study the global stability of the endemic equilibrium by the iterative method. The basic reproduction number $ R_0 $ is obtained. It is shown that if $ R_0 < 1 $, then the disease-free equilibrium is globally asymptotically stable, if $ R_0 > 1 $, then the disease-free and endemic equilibrium coexist simultaneously, and the global asymptotic stability of endemic equilibrium is also shown. Additionally, the Hamilton-Jacobi-Bellman (HJB) equation is given by employing the Bellman's principle of optimality. Through proving the existence of viscosity solution for HJB equation, we obtain the optimal vaccination control strategy. Finally, numerical simulations are performed to illustrate the corresponding analytical results.

Application of Optimal Control of Infectious Diseases in a Model-Free Scenario

Optimal control for infectious diseases has received increasing attention over the past few decades. In general, a combination of cost state variables and control effort have been applied as cost indices. Many important results have been reported. Nevertheless, it seems that the interpretation of the optimal control law for an epidemic system has received less attention. In this paper, we have applied Pontryagin's maximum principle to develop an optimal control law to minimize the number of infected individuals and the vaccination rate. We have adopted the compartmental model SIR to test our technique. We have shown that the proposed control law can give some insights to develop a control strategy in a model-free scenario. Numerical examples show a reduction of 50% in the number of infected individuals when compared with constant vaccination. There is not always a prior knowledge of the number of susceptible, infected, and recovered individuals required to formulate and solve the optimal control problem. In a model-free scenario, a strategy based on the analytic function is proposed, where prior knowledge of the scenario is not necessary. This insight can also be useful after the development of a vaccine to COVID-19, since it shows that a fast and general cover of vaccine worldwide can minimize the number of infected, and consequently the number of deaths. The considered approach is capable of eradicating the disease faster than a constant vaccination control method.

Optimal Immunity Control and Final Size Minimization by Social Distancing for the SIR Epidemic Model

The aim of this article is to understand how to apply partial or total containment to SIR epidemic model during a given finite time interval in order to minimize the epidemic final size, that is the cumulative number of cases infected during the complete course of an epidemic. The existence and uniqueness of an optimal strategy are proved for this infinite-horizon problem, and a full characterization of the solution is provided. The best policy consists in applying the maximal allowed social distancing effort until the end of the interval, starting at a date that is not always the closest date and may be found by a simple algorithm. Both theoretical results and numerical simulations demonstrate that it leads to a significant decrease in the epidemic final size. We show that in any case the optimal intervention has to begin before the number of susceptible cases has crossed the herd immunity level, and that its limit is always smaller than this threshold. This problem is also shown to be equivalent to the minimum containment time necessary to stop at a given distance after this threshold value.

Modelling epidemics with fractional-dose vaccination in response to limited vaccine supply

The control strategies of emergency infectious diseases are constrained by limited medical resources. The fractional dose vaccination strategy as one of feasible strategies was proposed in response to global shortages of vaccine stockpiles. Although a variety of epidemic models have been developed under the circumstances of limited resources in treatment, few models particularly investigated vaccination strategies in resource-limited settings. In this paper, we develop a two-group SIR model with incorporation of proportionate mixing patterns and n-fold fractional dose vaccination related parameters to evaluate the efficiency of fractional dose vaccination on disease control at the population level. The existence and uniqueness of the final size of the two-group SIR epidemic model, the formulation of the basic reproduction number and the relationship between them are established. Moreover, numerical simulations are performed based on this two-group vector-free model to investigate the effectiveness of n-fold fractional dose vaccination by using the emergency outbreaks of yellow fever in Angola in 2016. By employing linear and nonlinear dose-response relationships, we compare the resulting fluctuations of four characteristics of the epidemics, which are the outbreak size, the peak time of the outbreak, the basic reproduction number and the infection attack rate (IAR). For both types of dose-response relationships, dose-fractionation takes positive effects in lowering the outbreak size, delay the peak time of the outbreak, reducing the basic reproduction number and the IAR of yellow fever only when the vaccine efficacy is high enough. Moreover, five-fold fractional dose vaccination strategy may not be the optimal vaccination strategy as proposed by the World Health Organization if the dose-response relationship is nonlinear.

Sensitivity of joint contagiousness and susceptibility-based dynamic optimal control strategies for HIV prevention

Predicting the population-level effects of an infectious disease intervention that incorporate multiple modes of intervention is complicated by the joint non-linear dynamics of both infection transmission and the intervention itself. In this paper, we consider the sensitivity of Dynamic Optimal Control Profiles (DOCPs) for the optimal joint investment in both a contagiousness and susceptibility-based control of HIV to bio-behavioral, economic, and programmatic assumptions. The DOCP is calculated using recently developed numerical algorithms that allow controls to be represented by a set of piecewise constant functions that maintain a constant yearly budget. Our transmission model assumes multiple stages of HIV infection corresponding to acute and chronic infection and both within- and between-individual behavioral heterogeneity. We parameterize a baseline scenario from a longitudinal study of sexual behavior in MSM and consider sensitivity of the DOCPs to deviations from that baseline scenario. In the baseline scenario, the primary determinant of the dominant control were programmatic factors, regardless of budget. In sensitivity analyses, the qualitative aspects of the optimal control policy were often robust to significant deviation in assumptions regarding transmission dynamics. In addition, we found several conditions in which long-term joint investment in both interventions was optimal. Our results suggest that modeling in the service of decision support for intervention design can improve population-level effects of a limited set of economic resources. We found that economic and programmatic factors were as important as the inherent transmission dynamics in determining population-level intervention effects. Given our finding that the DOCPs were robust to alternative biological and behavioral assumptions it may be possible to identify DOCPs even when the data are not sufficient to identify a transmission model.

The global dynamics for a stochastic SIS epidemic model with isolation

In this paper, we investigate the dynamical behavior for a stochastic SIS epidemic model with isolation which is as an important strategy for the elimination of infectious diseases. It is assumed that the stochastic effects manifest themselves mainly as fluctuation in the transmission coefficient, the death rate and the proportional coefficient of the isolation of infective. It is shown that the extinction and persistence in the mean of the model are determined by a threshold value R 0 S . That is, if R 0 S < 1 , then disease dies out with probability one, and if R 0 S > 1 , then the disease is stochastic persistent in the means with probability one. Furthermore, the existence of a unique stationary distribution is discussed, and the sufficient conditions are established by using the Lyapunov function method. Finally, some numerical examples are carried out to confirm the analytical results.

Recognizing the impact of endemic hepatitis D virus on hepatitis B virus eradication

BACKGROUND

Hepatitis delta virus (HDV) in conjunction with hepatitis B virus (HBV) increases adult morbidity and mortality. A number of studies have performed cost-benefit analyses for HBV interventions, but they have ignored the impact of HDV on these outcomes.

METHODS

Using a mathematical model of HBV-HDV epidemiology, we compare health benefits and cost outcomes of four interventions: testing with HBV adult vaccination (diagnosis), diagnosis with antiviral treatment for HBV infections (mono-infections), diagnosis with antiviral treatment for HBV-HDV infections (dual-infections), and awareness programs. The relationship between optimal levels and outcomes of each of these interventions and HDV prevalence in HBV infected individuals ranging from 0 to 50% is determined.

RESULTS

Over a 50 year period under no intervention, HBV prevalence, per capita total cost and death toll increase by 2.25%, -$11 and 2.6-fold respectively in moderate HDV endemic regions compared to mono-infected regions; the corresponding values for high HDV endemic regions are 4.2%, -$21 and 3.9-fold. Optimal interventions can be strategized similarly in mono and dually endemic regions. Only implementation of all four interventions achieves a very low HBV prevalence of around 1.5% in a moderate HDV endemic region such as China, with 2.8 million fewer deaths compared to no intervention. Although the policy of implementation of all four interventions costs additional $382 billion compared to no intervention, it still remains cost-effective with an incremental cost-effectiveness ratio of $1400/QALY. Very high efficacy awareness programs achieve less prevalence with fewer deaths at a lower cost compared to treatment and/or vaccination programs.

CONCLUSION

HDV substantially affects the performance of any HBV-related intervention. Its exclusion results in over-estimation of the effectiveness of HBV interventions.