Measurability of the epidemic reproduction number in data-driven contact networks

Quan-Hui Liu, Marco Ajelli, Alberto Aleta, Stefano Merler, Yamir Moreno, Alessandro Vespignani

Proceedings of the National Academy of Sciences

November 21, 2018


The basic reproduction number is one of the conceptual cornerstones of mathematical epidemiology. Its classical definition as the number of secondary cases generated by a typical infected individual in a fully susceptible population finds a clear analytical expression in homogeneous and stratified mixing models. Along with the generation time (the interval between primary and secondary cases), the reproduction number allows for the characterization of the dynamics of an epidemic. A clear-cut theoretical picture, however, is hardly found in real data. Here, we infer from highly detailed sociodemographic data two multiplex contact networks representative of a subset of the Italian and Dutch populations. We then simulate an infection transmission process on these networks accounting for the natural history of influenza and calibrated on empirical epidemiological data. We explicitly measure the reproduction number and generation time, recording all individual-level transmission events. We find that the classical concept of the basic reproduction number is untenable in realistic populations, and it does not provide any conceptual understanding of the epidemic evolution. This departure from the classical theoretical picture is not due to behavioral changes and other exogenous epidemiological determinants. Rather, it can be simply explained by the (clustered) contact structure of the population. Finally, we provide evidence that methodologies aimed at estimating the instantaneous reproduction number can operationally be used to characterize the correct epidemic dynamics from incidence data.

Dengue seroprevalence in a cohort of schoolchildren and their siblings in Yucatan, Mexico (2015-2016)

Norma Pavía-Ruz, Gloria Abigail Barrera-Fuentes, Salha Villanueva-Jorge, Azael Che-Mendoza, Julio César Campuzano-Rincón, Pablo Manrique-Saide, Diana Patricia Rojas, Gonzalo M. Vazquez-Prokopec, M. Elizabeth Halloran, Ira M. Longini, Héctor Gómez-Dantés

PLoS Neglected Tropical Diseases

November 21, 2018


Dengue is a major public health problem in Latin America. Its transmission is highly heterogeneous, and its burden varies by geographic region, age group affected, serotype and other factors. While surveillance of dengue in the region has improved, several limitations remain, including under detection, misdiagnosis and the complexity of controlling a vector that has adapted to human dwellings in tropical and subtropical urban contexts. Prospective studies have become crucial to understand the transmission of dengue in urban environments and assess the impact of control strategies, such as the introduction of a dengue vaccine or additional vector control interventions. Our findings provide epidemiological data regarding the serological profile and risk factors for dengue infections in a cohort of children 0 to 15 years old in an endemic state in Mexico and confirmed the high exposure in these age groups. Likewise, enhanced and passive surveillance of cases gave us the opportunity to measure the behavior of dengue activity during chikungunya and Zika viruses’ arrival, which we believe will contribute to improve the design of surveillance and control strategies.

Epidemiology of dengue and other arboviruses in a cohort of school children and their families in Yucatan, Mexico: Baseline and first year follow-up

Diana Patricia Rojas, Gloria Abigail Barrera-Fuentes, Norma Pavia-Ruz, Mariel Salgado-Rodriguez, Azael Che-Mendoza, Pablo Manrique-Saide, Gonzalo M. Vazquez-Prokopec, M. Elizabeth Halloran, Ira M. Longini, Hector Gomez-Dantes

PLoS Neglected Tropical Diseases

November 21, 2018


Dengue is the most prevalent mosquito-borne viral disease of humans and is caused by the four serotypes of dengue virus. To estimate the incidence of dengue and other arboviruses, we analyzed the baseline and first year follow-up of a prospective school-based cohort study and their families in three cities in the state of Yucatan, Mexico. Through enhanced surveillance activities, acute febrile illnesses in the participants were detected and yearly blood samples were collected to evaluate dengue infection incidence. A Cox model was fitted to identify hazard ratios of arboviral infections in the first year of follow-up of the cohort. The incidence of dengue symptomatic infections observed during the first year of follow-up (2015–2016) was 3.5 cases per 1,000 person-years (95% CI: 1.9, 5.9). The incidence of dengue infections was 33.9 infections per 1,000 person-years (95% CI: 31.7, 48.0). The majority of dengue infections and seroconversions were observed in the younger age groups (≤ 14 years old). Other arboviruses were circulating in the state of Yucatan during the study period. The incidence of symptomatic chikungunya infections was 8.6 per 1,000 person-years (95% CI: 5.8, 12.3) and the incidence of symptomatic Zika infections was 2.3 per 1,000 person-years (95% CI: 0.9, 4.5). Our model shows that having a dengue infection during the first year of follow-up was significantly associated with being female, living in Ticul or Progreso, and being dengue naïve at baseline. Age was not significantly associated with the outcome, it was confounded by prior immunity to dengue that increases with age. This is the first report of a cohort in Latin America that provides incidence estimates of the three arboviruses co-circulating in all age groups. This study provides important information for understanding the epidemiology of dengue and other arboviruses and better informing public health policies.

Causes and consequences of spatial within-host viral spread

Molly E. Gallagher , Christopher B. Brooke , Ruian Ke , Katia Koelle


November 13, 2018


The spread of viral pathogens both between and within hosts is inherently a spatial process. While the spatial aspects of viral spread at the epidemiological level have been increasingly well characterized, the spatial aspects of viral spread within infected hosts are still understudied. Recent experimental studies, however, have started to shed more light on the mechanisms and spatial dynamics of viral spread within hosts. Here, we review these experimental studies as well as the limited number of computational modeling efforts that have begun to integrate spatial considerations for understanding within-host viral spread. We limit our review to influenza virus to highlight key mechanisms affecting spatial aspects of viral spread for pathogens of the respiratory tract. There is considerable empirical evidence for highly spatial within-host spread of influenza virus, yet few computational modeling studies that shed light on possible factors that structure the dynamics of this spatial spread. In existing modeling studies, there is also a striking absence of theoretical expectations of how spatial dynamics may impact the dynamics of viral populations. To mitigate this, we turn to the extensive ecological and evolutionary literature to provide informed theoretical expectations for what viral and host factors may impact the spatial patterns of within-host viral dynamics and for how spatial spread will affect the genetic composition of within-host viral populations. We end by discussing current knowledge gaps related to the spatial component of within-host influenza virus spread and the potential for within-host spatial considerations to inform the development of disease control strategies.

Seroprevalence and Symptomatic Attack Rate of Chikungunya Virus Infection, United States Virgin Islands, 2014–2015

Morgan J. Hennessey, Esther M. Ellis, Mark J. Delorey, Amanda J. Panella, Olga I. Kosoy, Hannah L. Kirking, Grace D. Appiah, Jin Qin, Alison J. Basile, Leora R. Feldstein, Brad J. Biggerstaff, Robert S. Lanciotti, Marc Fischer, J. Erin Staples

American Journal of Tropical Medicine and Hygiene

November 5, 2018


When introduced into a naïve population, chikungunya virus generally spreads rapidly, causing large outbreaks of fever and severe polyarthralgia. We randomly selected households in the U.S. Virgin Islands (USVI) to estimate seroprevalence and symptomatic attack rate for chikungunya virus infection at approximately 1 year following the introduction of the virus. Eligible household members were administered a questionnaire and tested for chikungunya virus antibodies. Estimated proportions were calibrated to age and gender of the population. We enrolled 509 participants. The weighted infection rate was 31% (95% confidence interval [CI]: 26–36%). Among those with evidence of chikungunya virus infection, 72% (95% CI: 65–80%) reported symptomatic illness and 31% (95% CI: 23–38%) reported joint pain at least once per week approximately 1 year following the introduction of the virus to USVI. Comparing rates from infected and noninfected study participants, 70% (95% CI: 62–79%) of fever and polyarthralgia and 23% (95% CI: 9–37%) of continuing joint pain in patients infected with chikungunya virus were due to their infection. Overall, an estimated 43% (95% CI: 33–52%) of the febrile illness and polyarthralgia in the USVI population during the outbreak was attributable to chikungunya virus and only 12% (95% CI: 7–17%) of longer term joint pains were attributed to chikungunya virus. Although the rates of infection, symptomatic disease, and longer term joint symptoms identified in USVI are similar to other outbreaks of the disease, a lower proportion of acute fever and joint pain was found to be attributable to chikungunya virus.

Genomic epidemiology supports multiple introductions and cryptic transmission of Zika virus in Colombia

Allison Black, Louise H Moncla, Katherine Laiton-Donato, Lissethe Pardo, Angelica Rico, Catalina Tovar, Diana P Rojas, Ira M Longini, M Elizabeth Halloran, Dioselina Peláez-Carvajal, Juan D Ramírez, Marcela Mercado-Reyes, Trevor Bedford


October 29, 2018


Colombia was the second most affected country during the American Zika virus (ZIKV) epidemic, with over 109,000 reported cases. Despite the scale of the outbreak, limited genomic sequence data were available from Colombia. We sequenced ZIKV genomes from Colombian clinical diagnostic samples and infected Aedes aegypti samples across the temporal and geographic breadth of the epidemic. Phylogeographic analysis of these genomes, along with other publicly-available ZIKV genomes from the Americas, indicates at least two separate introductions of ZIKV to Colombia, one of which was previously unrecognized. We estimate the timing of each introduction to Colombia, finding that ZIKV was introduced and circulated cryptically for 5 to 7 months prior to ZIKV confirmation in September 2015. These findings underscore the utility of genomic epidemiological studies for understanding epidemiologic dynamics, especially when many infections are asymptomatic

Quantifying the risk of local Zika virus transmission in the continental US during the 2015-2016 ZIKV epidemic

Kaiyuan Sun, Qian Zhang, Ana Pastore y Piontti, Matteo Chinazzi, Dina Mistry, Natalie E. Dean, Diana P. Rojas, Stefano Merler, Piero Poletti, Luca Rossi, M. Elizabeth Halloran, Ira M. Longini Jr., Alessandro Vespignani

BMC Medicine

October 18, 2018


Background: Local mosquito-borne Zika virus (ZIKV) transmission has been reported in two counties of the continental United State (US), prompting the issuance of travel, prevention, and testing guidance across the continental US. Large uncertainty, however, surrounds the quantification of the actual risk of ZIKV introduction and autochthonous transmission across different areas of the US. Method: We present a framework for the projection of ZIKV autochthonous transmission in the continental US during the 2015-2016 epidemic, using a data-driven stochastic and spatial epidemic model accounting for seasonal, environmental and detailed population data. The model generates an ensemble of travel-related case counts and simulate their potential to trigger local transmission at individual level. Results: We estimate the risk of ZIKV introduction and local transmission at the county level and at the 0.025 degree by 0.025 degree cell level across the continental US. We provide a risk measure based on the probability of observing local transmission in a specific location during a ZIKV epidemic modeled after the one observed during the years 2015-2016. The high spatial and temporal resolutions of the model allow us to generate statistical estimates of the number of ZIKV introductions leading to local transmission in each location. We find that the risk is spatially heterogeneously distributed and concentrated in a few specific areas that account for less than 1% of the continental US population. Locations in Texas and Florida that have actually experienced local ZIKV transmission are among the places at highest risk according to our results. We also provide an analysis of the key determinants for local transmission, and identify the key introduction routes and their contributions to ZIKV spread in the continental US. Conclusions: This framework provides quantitative risk estimates, fully captures the stochasticity of ZIKV introduction events, and is not biased by the under-ascertainment of cases due to asymptomatic infections. It provides general information on key risk determinants and data with potential uses in defining public health recommendations and guidance about ZIKV risk in the US.

Epidemiology of the silent polio outbreak in Rahat, Israel, based on modeling of environmental surveillance data

Andrew F. Brouwer, Joseph N. S. Eisenberg, Connor D. Pomeroy, Lester M. Shulman, Musa Hindiyeh, Yossi Manor, Itamar Grotto, James S. Koopman, Marisa C. Eisenberg


October 18, 2018


Israel experienced an outbreak of wild poliovirus type 1 (WPV1) in 2013–2014, detected through environmental surveillance of the sewage system. No cases of acute flaccid paralysis were reported, and the epidemic subsided after a bivalent oral polio vaccination (bOPV) campaign. As we approach global eradication, polio will increasingly be detected only through environmental surveillance. We developed a framework to convert quantitative polymerase chain reaction (qPCR) cycle threshold data into scaled WPV1 and OPV1 concentrations for inference within a deterministic, compartmental infectious disease transmission model. We used this approach to estimate the epidemic curve and transmission dynamics, as well as assess alternate vaccination scenarios. Our analysis estimates the outbreak peaked in late June, much earlier than previous estimates derived from analysis of stool samples, although the exact epidemic trajectory remains uncertain. We estimate the basic reproduction number was 1.62 (95% CI 1.04–2.02). Model estimates indicate that 59% (95% CI 9–77%) of susceptible individuals (primarily children under 10 years old) were infected with WPV1 over a little more than six months, mostly before the vaccination campaign onset, and that the vaccination campaign averted 10% (95% CI 1–24%) of WPV1 infections. As we approach global polio eradication, environmental monitoring with qPCR can be used as a highly sensitive method to enhance disease surveillance. Our analytic approach brings public health relevance to environmental data that, if systematically collected, can guide eradication efforts.

Successes and failures of the live-attenuated influenza vaccine, can we do better?

Laura Matrajt, M. Elizabeth Halloran, Rustom Antia


September 28, 2018


Live-attenuated vaccines are usually highly effective against many acute viral infections. However, the effective- ness of the live attenuated influenza vaccine (LAIV) can vary widely, ranging from 0% effectiveness in some studies done in the United States to 50% in studies done in Europe. The reasons for these discrepancies remain largely unclear. In this paper we use mathematical models to explore how the efficacy of LAIV is affected by the degree of mismatch with the currently circulating influenza strain and interference with pre-existing immunity. The model incorporates two key antigenic distances - the distance between pre-existing immunity and the currently circulating strain as well as the LAIV strain. Our models show that a LAIV that is matched with the currently circulating strain is likely to have only modest efficacy. Our results suggest that the efficacy of the vaccine would be increased (optimized) if, rather than being matched to the circulating strain, it is antigenically slightly further from pre-existing immunity compared with the circulating strain. The models also suggest two regimes in which LAIV that is matched to circulating strains may provide effective protection. The first is in children before they have built immunity from circulating strains. The second is in response to novel strains (such as antigenic shifts) which are at substantial antigenic distance from previously circulating strains. Our models provide an explanation for the variation in vaccine effectiveness, both between children and adults as well as between studies of vaccine effectiveness observed during the 2014-15 influenza season in different countries.

Designing a Study of Correlates of Risk for Ebola Vaccination

M. Elizabeth Halloran, Ira M. Longini, Peter B. Gilbert


August 24, 2018


The rVSV Ebola vaccine was shown to be very efficacious in a novel ring vaccination trial in Guinea. However, no correlates of vaccine protection have been established for Ebola vaccines. Several Ebola vaccine candidates are available, but conducting randomized trials of additional candidates in outbreak situations has become difficult. Establishing correlates of vaccine protection would be useful in helping vaccine candidates become licensed. In this note, we explore power and sample calculations to study potential correlates of risk (protection) during an Ebola vaccination campaign in an outbreak situation under a number of assumptions. At an overall vaccine efficacy of 75%, 50 Ebola endpoints in the vaccinees provided good power. At an overall vaccine efficacy of 90%, 20 Ebola endpoints gave good power under certain assumptions. In the May -- July 2018 Ebola outbreak in DRC, over 3000 individuals were vaccinated, with no reported cases in vaccinated individuals. To be feasible, this type of study need Ebola endpoints in vaccinated individuals.

Deep mutational scanning of hemagglutinin helps predict evolutionary fates of human H3N2 influenza variants

Juhye M Lee,  John Huddleston,  Michael B Doud,  Kathryn A Hooper,  Nicholas C Wu,  Trevor Bedford,  Jesse D Bloom


August 13, 2018


Human influenza virus rapidly accumulates mutations in its major surface protein hemagglutinin (HA). The evolutionary success of influenza virus lineages depends on how these mutations affect HA's functionality and antigenicity. Here we experimentally measure the effects on viral growth in cell culture of all single amino-acid mutations to the HA from a recent human H3N2 influenza virus strain. We show that mutations that are measured to be more favorable for viral growth are enriched in evolutionarily successful H3N2 viral lineages relative to mutations that are measured to be less favorable for viral growth. Therefore, despite the well-known caveats about cell-culture measurements of viral fitness, such measurements can still be informative for understanding evolution in nature. We also compare our measurements for H3 HA to similar data previously generated for a distantly related H1 HA, and find substantial differences in which amino acids are preferred at many sites. For instance, the H3 HA has less disparity in mutational tolerance between the head and stalk domains than the H1 HA. Overall, our work suggests that experimental measurements of mutational effects can be leveraged to help understand the evolutionary fates of viral lineages in nature---but only when the measurements are made on a viral strain similar to the ones being studied in nature.

Heterogeneity and longevity of antibody memory to viruses and vaccines

Alice Antia, Hasan Ahmed, Andreas Handel, Nichole E. Carlson, Ian J. Amanna, Rustom Antia, Mark Slifka  

PLOS Biology

August 10, 2018


Determining the duration of protective immunity requires quantifying the magnitude and rate of loss of antibodies to different virus and vaccine antigens. A key complication is heterogeneity in both the magnitude and decay rate of responses of different individuals to a given vaccine, as well as of a given individual to different vaccines. We analyzed longitudinal data on antibody titers in 45 individuals to characterize the extent of this heterogeneity and used models to determine how it affected the longevity of protective immunity to measles, rubella, vaccinia, tetanus, and diphtheria. Our analysis showed that the magnitude of responses in different individuals varied between 12- and 200-fold (95% coverage) depending on the antigen. Heterogeneity in the magnitude and decay rate contribute comparably to variation in the longevity of protective immunity between different individuals. We found that some individuals have, on average, slightly longer-lasting memory than others—on average, they have higher antibody levels with slower decay rates. We identified different patterns for the loss of protective levels of antibodies to different vaccine and virus antigens. Specifically, we found that for the first 25 to 50 years, virtually all individuals have protective antibody titers against diphtheria and tetanus, respectively, but about 10% of the population subsequently lose protective immunity per decade. In contrast, at the outset, not all individuals had protective titers against measles, rubella, and vaccinia. However, these antibody titers wane much more slowly, with a loss of protective immunity in only 1% to 3% of the population per decade. Our results highlight the importance of long-term longitudinal studies for estimating the duration of protective immunity and suggest both how vaccines might be improved and how boosting schedules might be reevaluated.

Rethinking the efficacy of acellular pertussis vaccines for primary immunization

Matthieu Domenech de Cellès, Pejman Rohani, Aaron A King


July 25, 2018


Background: The US has experienced a nationwide resurgence of pertussis since the mid-1970s, despite high vaccine coverage. Short-lived immunity induced by Diphtheria-Tetanus-acellular Pertussis (DTaP) vaccines in young children is widely believed to be responsible for this growing burden. However, the duration of protection conferred by DTaP vaccines remains incompletely quantified. Methods and Findings: We employed a rigorously validated, age-structured model of pertussis transmission to explore a range of hypotheses regarding the degree of waning DTaP-derived immunity. For every hypothesis, we calculated the vaccine effectiveness and the relative increase in the odds of acquiring pertussis (or odds ratio) in children aged 5 to 9 years. We then assessed the simulated DTaP vaccine traits that best reproduced the empirical values of odds ratios from recent US epidemiological studies. We found a marked association between the degree of waning immunity, the vaccine effectiveness, and the odds ratio. Unexpectedly, the odds ratio was positively associated with the vaccine effectiveness, as a consequence of non-linear, age-assortative dynamics. Based on the empirical odds ratios, we estimated that vaccine effectiveness exceeded 75% and that more than 65% of children remained immune to pertussis 5 years after the last DTaP dose. Conclusions: Our results show that temporal trends in the odds of acquiring pertussis are a seriously flawed measure of the durability of vaccine-induced protection. They further demonstrate that DTaP vaccines confer imperfect, but long-lived protection. We argue that control strategies should be based upon the best available estimates of vaccine properties and the age-structure of the transmission network.

Consistency and convergence rate of phylogenetic inference via regularization

Vu Dinh, Lam Si Tung Ho, Marc A. Suchard, Frederick A. Matsen IV

Annals of Statistics

June 27, 2018


It is common in phylogenetics to have some, perhaps partial, information about the overall evolutionary tree of a group of organisms and wish to find an evolutionary tree of a specific gene for those organisms. There may not be enough information in the gene sequences alone to accurately reconstruct the correct “gene tree.” Although the gene tree may deviate from the “species tree” due to a variety of genetic processes, in the absence of evidence to the contrary it is parsimonious to assume that they agree. A common statistical approach in these situations is to develop a likelihood penalty to incorporate such additional information. Recent studies using simulation and empirical data suggest that a likelihood penalty quantifying concordance with a species tree can significantly improve the accuracy of gene tree reconstruction compared to using sequence data alone. However, the consistency of such an approach has not yet been established, nor have convergence rates been bounded. Because phylogenetics is a nonstandard inference problem, the standard theory does not apply. In this paper, we propose a penalized maximum likelihood estimator for gene tree reconstruction, where the penalty is the square of the Billera–Holmes–Vogtmann geodesic distance from the gene tree to the species tree. We prove that this method is consistent, and derive its convergence rate for estimating the discrete gene tree structure and continuous edge lengths (representing the amount of evolution that has occurred on that branch) simultaneously. We find that the regularized estimator is “adaptive fast converging,” meaning that it can reconstruct all edges of length greater than any given threshold from gene sequences of polynomial length. Our method does not require the species tree to be known exactly; in fact, our asymptotic theory holds for any such guide tree.

Intermediate levels of vaccination coverage may minimize seasonal influenza outbreaks

Veronika I. Zarnitsyna, Irina Bulusheva, Andreas Handel, Ira M. Longini, M. Elizabeth Halloran, Rustom Antia 

PLoS One

June 26, 2018


For most pathogens, vaccination reduces the spread of the infection and total number of cases; thus, public policy usually advocates maximizing vaccination coverage. We use simple mathematical models to explore how this may be different for pathogens, such as influenza, which exhibit strain variation. Our models predict that the total number of seasonal influenza infections is minimized at an intermediate (rather than maximal) level of vaccination, and, somewhat counter-intuitively, further increasing the level of the vaccination coverage may lead to higher number of influenza infections and be detrimental to the public interest. This arises due to the combined effects of: competition between multiple co-circulating strains; limited breadth of protection afforded by the vaccine; and short-term strain-transcending immunity following natural infection. The study highlights the need for better quantification of the components of vaccine efficacy and longevity of strain-transcending cross-immunity in order to generate nuanced recommendations for influenza vaccine coverage levels.

Forecasting the effectiveness of indoor residual spraying for reducing dengue burden

Thomas J. Hladish, Carl A. B. Pearson, Diana Patricia Rojas, Hector Gomez-Dantes, M. Elizabeth Halloran, Gonzalo M. Vazquez-Prokopec, Ira M. Longini

PLoS Neglected Tropical Diseases

June 25, 2018



Historically, mosquito control programs successfully helped contain malaria and yellow fever, but recent efforts have been unable to halt the spread of dengue, chikungunya, or Zika, all transmitted by Aedes mosquitoes. Using a dengue transmission model and results from indoor residual spraying (IRS) field experiments, we investigated how IRS-like campaign scenarios could effectively control dengue in an endemic setting.

Methods and findings

In our model, we found that high levels of household coverage (75% treated once per year), applied proactively before the typical dengue season could reduce symptomatic infections by 89.7% (median of 1000 simulations; interquartile range [IQR]:[83.0%, 94.8%]) in year one and 78.2% (IQR: [71.2%, 88.0%]) cumulatively over the first five years of an annual program. Lower coverage had correspondingly lower effectiveness, as did reactive campaigns. Though less effective than preventative campaigns, reactive and even post-epidemic interventions retain some effectiveness; these campaigns disrupt inter-seasonal transmission, highlighting an off-season control opportunity. Regardless, none of the campaign scenarios maintain their initial effectiveness beyond two seasons, instead stabilizing at much lower levels of benefit: in year 20, median effectiveness was only 27.3% (IQR: [-21.3%, 56.6%]). Furthermore, simply ceasing an initially successful program exposes a population with lowered herd immunity to the same historical threat, and we observed outbreaks more than four-fold larger than pre-intervention outbreaks. These results do not take into account evolving insecticide resistance, thus long-term effectiveness may be lower if new, efficacious insecticides are not developed.


Using a detailed agent-based dengue transmission model for Yucatán State, Mexico, we predict that high coverage indoor residual spraying (IRS) interventions can largely eliminate transmission for a few years, when applied a few months before the typical seasonal epidemic peak. However, vector control succeeds by preventing infections, which precludes natural immunization. Thus, as a population benefits from mosquito control, it gradually loses naturally acquired herd immunity, and the control effectiveness declines; this occurs across all of our modeled scenarios, and is consistent with other empirical work. Long term control that maintains early effectiveness would require some combination of increasing investment, complementary interventions such as vaccination, and control programs across a broad region to diminish risk of importation.

Transmission-clearance trade-offs indicate that dengue virulence evolution depends on epidemiological context

Rotem Ben-Shachar, Katia Koelle

Nature Communications

June 15, 2018


An extensive body of theory addresses the topic of pathogen virulence evolution, yet few studies have empirically demonstrated the presence of fitness trade-offs that would select for intermediate virulence. Here we show the presence of transmission-clearance trade-offs in dengue virus using viremia measurements. By fitting a within-host model to these data, we further find that the interaction between dengue and the host immune response can account for the observed trade-offs. Finally, we consider dengue virulence evolution when selection acts on the virus’s production rate. By combining within-host model simulations with empirical findings on how host viral load affects human-to-mosquito transmission success, we show that the virus’s transmission potential is maximized at production rates associated with intermediate virulence and that the optimal production rate critically depends on dengue’s epidemiological context. These results indicate that long-term changes in dengue’s global distribution impact the invasion and spread of virulent dengue virus genotypes.

Transmissibility of Norovirus in Urban versus Rural Households in a Large Community Outbreak in China

Tim K. Tsang, Tian-Mu Chen, Ira M. Longini, Jr., M. Elizabeth Halloran, Ying Wu, Yang Yang


May 29, 2018


Background: Norovirus is a leading cause of outbreaks of acute infectious gastroenteritis worldwide, yet its transmissibility within households and associated risk factors remain unknown in developing countries.

Methods: Household, demographic, and clinical data were collected from a semi-urban area in south China where an outbreak occurred in the winter of 2014. Using a Bayesian modeling framework, we assessed the transmissibility and potential risk modifiers in both urban and rural households.

Results: In urban apartment buildings, the secondary attack rates were 84% (95% credible interval [CI]: 60%, 96%) among households of size two and 29% (95% CI: 9.6%, 53%) in larger households. In the rural village, secondary attack rate estimates were lower than the urban setting, 13% (0.51%, 54%) for households of size two and 7.3% (0.38%, 27%) for larger households. Males were 31% (95% CI: 3%, 50%) less susceptible to the disease than female. Water disinfection with chlorine was estimated to reduce environmental risk of infection by 60% (95% CI: 26%, 82%) and case isolation was estimated to reduce person-to-person transmission by 65% (95% CI: 15%, 93%). Nausea and vomiting were not associated with household transmission.

Conclusions: Norovirus is highly contagious within households, in particular in small households in urban communities. Our results suggest that water disinfection and case isolation are associated with reduction of outbreaks in resource-limited communities.

How single mutations affect viral escape from broad and narrow antibodies to H1 influenza hemagglutinin

Michael B. Doud, Juhye M. Lee,  Jesse D. Bloom

Nature Communications

April 11, 2018


Influenza virus can escape most antibodies with single mutations. However, rare antibodies broadly neutralize many viral strains. It is unclear how easily influenza virus might escape such antibodies if there was strong pressure to do so. Here, we map all single amino-acid mutations that increase resistance to broad antibodies to H1 hemagglutinin. Our approach not only identifies antigenic mutations but also quantifies their effect sizes. All antibodies select mutations, but the effect sizes vary widely. The virus can escape a broad antibody to hemagglutinin’s receptor-binding site the same way it escapes narrow strain-specific antibodies: via single mutations with huge effects. In contrast, broad antibodies to hemagglutinin’s stalk only select mutations with small effects. Therefore, among the antibodies we examine, breadth is an imperfect indicator of the potential for viral escape via single mutations. Antibodies targeting the H1 hemagglutinin stalk are quantifiably harder to escape than the other antibodies tested here.

Influenza A(H7N9) Virus Antibody Responses in Survivors 1 Year after Infection, China, 2017

Mai-Juan Ma, Cheng Liu, Meng-Na Wu, Teng Zhao, Guo-Lin Wang, Yang Yang, Hong-Jing Gu, Peng-Wei Cui, Yuan-Yuan Pang, Ya-Yun Tan, Hui Hang, Bao Lin, Jiang-Chun Qin, Li-Qun Fang, Wu-Chun Cao , Li-Ling Cheng

Emerging Infectious Diseases

April 2, 2018


Avian influenza A(H7N9) virus has caused 5 epidemic waves in China since its emergence in 2013. We investigated the dynamic changes of antibody response to this virus over 1 year postinfection in 25 patients in Suzhou City, Jiangsu Province, China, who had laboratory-confirmed infections during the fifth epidemic wave, October 1, 2016–February 14, 2017. Most survivors had relatively robust antibody responses that decreased but remained detectable at 1 year. Antibody response was variable; several survivors had low or undetectable antibody titers. Hemagglutination inhibition titer was >1:40 for <40% of the survivors. Measured in vitro in infected mice, hemagglutination inhibition titer predicted serum protective ability. Our findings provide a helpful serologic guideline for identifying subclinical infections and for developing effective vaccines and therapeutics to counter H7N9 virus infections.