Epidemic Outbreaks On Structured Populations: Article in Press
Epidemic Outbreaks On Structured Populations: Article in Press
Epidemic Outbreaks On Structured Populations: Article in Press
Abstract
Our chances to halt epidemic outbreaks rely on how accurately we represent the population structure underlying the disease spread.
When analysing global epidemics this force us to consider metapopulation models taking into account intra- and inter-community
interactions. Here I introduce and analyze a metapopulation model which accounts for several features observed in real outbreaks. First,
I demonstrate that depending on the intra-community expected outbreak size and the fraction of social bridges the epidemic outbreaks
die out or there is a finite probability to observe a global epidemics. Second, I show that the global scenario is characterized by resurgent
epidemics, their number increasing with increasing the intra-community average distance between individuals. Finally, I present
empirical data for the AIDS epidemics supporting the model predictions.
r 2006 Elsevier Ltd. All rights reserved.
0022-5193/$ - see front matter r 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jtbi.2006.09.018
ARTICLE IN PRESS
126 A. Vazquez / Journal of Theoretical Biology 245 (2007) 125–129
3. Spreading regimes
is the final expected outbreak size inside a community. Calculating the inverse Laplace transform of (6) I finally
When b ¼ 0 it coincides with the expected outbreak size obtain
inside a community (Vazquez, 2006b). When b40 (2)
provides a self-consistent equation to determine the overall X
1
lðltÞDðmþ1Þ1 elt
expected outbreak size after taking into account the inter- IðtÞ ¼ N C ðbN 1 Þm , (14)
m¼0
G½Dðm þ 1Þ
community transmissions.
To calculate N 0 ðtÞ I use the Laplace transform method. where GðxÞ is the gamma function. Fig. 3 shows the
Consider the incidence progression of the incidence as obtained from (14). As
IðtÞ ¼ N_ 0 ðtÞ (5) predicted above, the outbreak dies out when RC o1 while
when RC 41 it grows exponentially. More important, the
and its Laplace transform incidence exhibits oscillations at the early stages, their
Z 1 number increasing with increasing D. For example, we
^
IðoÞ ¼ dt eot IðtÞ. (6) distinguish about two oscillations for D ¼ 10 while for D ¼
0
30 several oscillations are observed. These oscillations
Substituting the recursive equation (2) in (6) I obtain represent resurgent epidemics, which are often observed in
f^ðoÞ real outbreaks (Riley et al., 2003; Anderson et al., 2004)
^
IðoÞ ¼ , (7) and simulations (Sattenspiel and Dietz, 1995; Watts et al.,
1 bf^ðoÞ 2005).
where
Z 1
f^ðoÞ ¼ dt eot F_ ðtÞ. (8) 0.25
0
0.2 D=10
The validity of (6) is restricted to o values satisfying
1 bf^ðoÞ40, resulting in different scenarios depending on I(t)/NC 0.15
the value of the parameter
0.1
RC ¼ bN C . (9)
^ 0.05
Local outbreaks: When RC o1 then IðoÞ is defined for all
oX0 and IðtÞ is obtained inverting the Laplace transform 0
^ is defined from (7) it follows
in (6). Furthermore, since Ið0Þ 0 20 40 60 80 100
that IðtÞ decreases to zero when t ! 1, i.e. the epidemic
0.1
outbreak dies out.
Global outbreaks: When RC 41 the incidence grows D=20
0.08
exponentially IðtÞeoc t , where oc is the positive root of the
equation 0.06
I(t)/NC
To understand the relevance of these results in a real RC in (11) represents the expected number of infected
world scenario I analyse data reported for the AIDS individuals leaving their community. The numerical
epidemics. First, I estimate the parameter RC determining simulations reported in Watts et al. (2005) indicated the
the spreading regime, local or global. Fig. 4a shows the existence of a transition at RC ¼ 1, from local outbreaks
value of RC across the USA by state. For most states when RC o1 to global epidemics when RC 41. I have
RC 41, reaching significantly large values for several states. demonstrated that there is indeed a phase transition at
For example, RC exceeds 1000 for California and New RC ¼ 1. Furthermore, the analytical solution provides an
York. These numbers indicate that the USA AIDS expression of RC as a function of the bridge’s fraction and
epidemics is in the global spread scenario (RC 41), in the intra-community expected outbreak size (9). RC
agreement with the general belief. represents a measure of the reproductive number at the
Second, I analyse the temporal evolution of the AIDS inter-community level. Its value can be estimated from the
incidence. Fig. 3b and c show the AIDS incidence in USA expected outbreak size inside a community and the bridge’s
and UK by year, indicating a similar temporal pattern. The fraction. Based on the resulting estimate we can determine
epidemics started with an increasing tendency of the if an epidemics is in the local or global epidemics scenario
incidence which, after reaching a maximum, switched to and react accordingly.
a decreasing trend. After some years, however, the The inter-community disease transmission is character-
epidemics resurges with a new incidence increase. This ized by oscillations at the early stages which represents
picture coincides with the model predictions in Fig. 4. resurgent epidemics, the number of these resurgencies
Therefore, a possible explanation of the observed being determined by the characteristic distance between
multiple peaks is the existence of a community structure, individuals within a community. In essence, when D is
which can be attributed to geographical location and other small the time scale characterizing the outbreak progres-
factors. sion within a community is very small (Barthélemy et al.,
6000
4000
RC
2000
0
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
D. Columbia
Florida
Georgia
Hawai
Idaho
Illinois
Indiana
Iowa
Kansas
Kentuchy
Luisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Soth Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
(a)
80000 2000
60000 1500
I(t) (AIDS)
40000 1000
20000 500
USA UK
0 0
1980 1985 1990 1995 2000 2005 1990 1995 2000 2005
(b) t (years) (c) t (years)
Fig. 4. USA AIDS epidemics: estimated RC ¼ bN C for the different USA states. (a) b was computed as the ratio between the number of state out-
immigrants and the total state population according to the 1995–2000 USA census (http://www.census.gov). N C was computed as the number of habitants
living with AIDS according to the 2005 statistics published by the US Department of Health (http://www.hhs.gov). AIDS incidence in the USA (b) and
UK (c) by year, as reported by the US Department of Health and the UK Health Protection Agency (http://www.hpa.org.uk), respectively.
ARTICLE IN PRESS
A. Vazquez / Journal of Theoretical Biology 245 (2007) 125–129 129
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