Epidemic curves made easy using the R package incidence

The latency time of SARS-CoV- 2 Delta variant in infection- and vaccine-naive individuals from Vietnam

BACKGROUND

The latency time (from infection to infectiousness) guides the choice of measures required to control an infectious disease. Estimates of the SARS-CoV- 2 latency time are sparse due to lack of appropriate and representative data. Infection time is rarely known exactly and exposure information may be subject to several biases. Information on the endpoint requires repeated testing. Moreover, estimation is challenging because both the starting point and endpoint are typically interval censored and data may be subject to length-biased sampling (truncation).

METHODS

We collected detailed information on exposure from public health reports produced during an outbreak with the SARS-CoV- 2 Delta variant in Ho Chi Minh City, Vietnam, in May-July 2021. Using a custom digital form and application facilitated reliable choices on exposure window. This comprehensive data set on exposure and test results from 1951 individuals, collected in the absence of large-scale vaccination or earlier infection, is the first of its kind outside of China. We accounted for the doubly interval censored nature of the observations and went beyond the standard assumption of a constant infection risk over calendar time (exponential growth) and allowed for flexibility regarding the latency time (generalized gamma distribution). We addressed right truncation due to a cutoff in data collection and a finite quarantine length. Employing a Bayesian approach, using the program JAGS, made the analyses relatively straightforward.

RESULTS

Assuming exponential growth, our estimate of SARS-CoV- 2 Delta variant's mean latency time was 3.22 (95% Credible Interval 2.89 - 3.55) days; the median was 1.81 (95% CrI 1.44- 2.16) days; the 95 th percentile was 10.98 (95% CrI 9.91 - 12.41) days. These values were much larger if a uniform infection risk was assumed.

CONCLUSIONS

Using a Bayesian approach with the JAGS program, we were able to estimate the SARS-CoV- 2 latency time distribution of the Delta variant in infection-naive and vaccine-naive individuals. Estimates were sensitive to the assumptions made regarding the risk of infection within the exposure window. Compared to earlier studies, the median latency time was shorter, while the 95 th percentile was larger. Our results stress the importance of thoughtful data collection and analysis for evidence-based control of an infectious disease.

Bayesian estimation of the time-varying reproduction number for pulmonary tuberculosis in Iran: A registry-based study from 2018 to 2022 using new smear-positive cases

Introduction

Tuberculosis (TB) is one of the most prevalent infectious diseases in the world, causing major public health problems in developing countries. The rate of TB incidence in Iran was estimated to be 13 per 100,000 in 2021. This study aimed to estimate the reproduction number and serial interval for pulmonary tuberculosis in Iran.

Material and methods

The present national historical cohort study was conducted from March 2018 to March 2022 based on data from the National Tuberculosis and Leprosy Registration Center of Iran's Ministry of Health and Medical Education (MOHME). The study included 30,762 tuberculosis cases and 16,165 new smear-positive pulmonary tuberculosis patients in Iran. We estimated the reproduction number of pulmonary tuberculosis in a Bayesian framework, which can incorporate uncertainty in estimating it. Statistical analyses were accomplished in R software.

Results

The mean age at diagnosis of patients was 52.3 ± 21.2 years, and most patients were in the 35-63 age group (37.1%). Among the data, 9121 (56.4%) cases were males, and 7044 (43.6%) were females. Among patients, 7459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3039 (18.8%) cases were non-Iranians, and 2978 (98%) were Afghans. The time-varying reproduction number for pulmonary tuberculosis disease was calculated at an average of 1.06 ± 0.05 (95% Crl 0.96-1.15).

Conclusions

In this study, the incidence and the time-varying reproduction number of pulmonary tuberculosis showed the same pattern. The mean of the time-varying reproduction number indicated that each infected person is causing at least one new infection over time, and the chain of transmission is not being disrupted.

A regionally tailored epidemiological forecast and monitoring program to guide a healthcare system in the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, analytics and predictive models built on regional data provided timely, accurate monitoring of epidemiological behavior, informing critical planning and decision-making for health system leaders. At Atrium Health, a large, integrated healthcare system in the southeastern United States, a team of statisticians and physicians created a comprehensive forecast and monitoring program that leveraged an array of statistical methods.

METHODS

The program utilized the following methodological approaches: (i) exploratory graphics, including time plots of epidemiological metrics with smoothers; (ii) infection prevalence forecasting using a Bayesian epidemiological model with time-varying infection rate; (iii) doubling and halving times computed using changepoints in local linear trend; (iv) death monitoring using combination forecasting with an ensemble of models; (v) effective reproduction number estimation with a Bayesian approach; (vi) COVID-19 patients hospital census monitored via time series models; and (vii) quantified forecast performance.

RESULTS

A consolidated forecast and monitoring report was produced weekly and proved to be an effective, vital source of information and guidance as the healthcare system navigated the inherent uncertainty of the pandemic. Forecasts provided accurate and precise information that informed critical decisions on resource planning, bed capacity and staffing management, and infection prevention strategies.

CONCLUSIONS

In this paper, we have presented the framework used in our epidemiological forecast and monitoring program at Atrium Health, as well as provided recommendations for implementation by other healthcare systems and institutions to facilitate use in future pandemics.

Spatiotemporal analysis of foot and mouth disease outbreaks in cattle and small ruminants in Türkiye between 2010 and 2019

Determining the dynamics associated with foot-and-mouth disease (FMD) outbreaks is important for being able to develop effective strategic plans against the disease. In this direction, spatiotemporal analysis of FMD virus (FMDV) epidemic data that occurred in Türkiye between 2010 and 2019 was carried out. Spatiotemporal analysis was performed by the space-time scan statistic using data from a total of 7,796 FMD outbreaks. Standard deviational ellipse analysis (SDE) was performed to analyse the directional trend of FMD. Five, six, and three significant and high-risk clusters were identified by the space-time cluster analysis for serotypes A, O, and Asia-1, respectively. The SDE analysis indicated that direction of FMD transmission was northeast to southwest. A significant decrease in the number of outbreaks and cases were observed between 2014 and 2019 compared to 2010-2013 (p = 0.010). Most of the serotype A, serotype O, and serotype Asia-1 associated FMD outbreaks were observed during the dry season (April to September). Among FMD cases, cattle and small ruminants accounted for 80.75% (180,932 cases) and 19.25% (43,116 cases), respectively. Among the serotypes detected in the cases, the most frequently detected serotype was serotype O (50.84%), followed by serotypes A (35.67%) and Asia-1 (13.49%). The results obtained in this study may contribute to when and where control programs could be implemented more efficiently for the prevention and control of FMD. Developing risk-defined regional control plans by taking into account the current livestock production including uncontrolled animal movements in border regions, rural livestock, livestock trade between provinces are recommended.

ModInterv COVID-19: An online platform to monitor the evolution of epidemic curves

We present the software ModInterv as an informatics tool to monitor, in an automated and user-friendly manner, the evolution and trend of COVID-19 epidemic curves, both for cases and deaths. The ModInterv software uses parametric generalized growth models, together with LOWESS regression analysis, to fit epidemic curves with multiple waves of infections for countries around the world as well as for states and cities in Brazil and the USA. The software automatically accesses publicly available COVID-19 databases maintained by the Johns Hopkins University (for countries as well as states and cities in the USA) and the Federal University of Viçosa (for states and cities in Brazil). The richness of the implemented models lies in the possibility of quantitatively and reliably detecting the distinct acceleration regimes of the disease. We describe the backend structure of software as well as its practical use. The software helps the user not only to understand the current stage of the epidemic in a chosen location but also to make short term predictions as to how the curves may evolve. The app is freely available on the internet (http://fisica.ufpr.br/modinterv), thus making a sophisticated mathematical analysis of epidemic data readily accessible to any interested user.

Human and animal botulism surveillance in France from 2008 to 2019

Botulism is a human and animal neurological disease caused by the action of bacterial neurotoxins (botulinum toxins) produced by bacteria from the genus Clostridium. This disease induces flaccid paralysis that can result in respiratory paralysis and heart failure. Due to its serious potential impact on public health, botulism is a closely monitored notifiable disease in France through a case-based passive surveillance system. In humans, this disease is rare, with an average of 10 outbreaks reported each year, mainly due to the consumption of contaminated foods. Type B and to a lesser extend type A are responsible for the majority of cases of foodborne botulism. Each year, an average of 30 outbreaks are recorded on poultry farms, about 20 cases in wild birds and about 10 outbreaks in cattle, involving a large number of animals. Mosaic forms C/D and D/C in birds and cattle, respectively, are the predominant types in animals in France. Types C and D have also been observed to a lesser extent in animals. With the exception of botulinum toxin E, which was exceptionally detected throughout the period in wild birds, the types of botulism found in animal outbreaks are different from those identified in human outbreaks over the last ten years in France and no human botulism outbreaks investigated have been linked to animal botulism. In line with the One Health concept, we present the first integrative approach to the routine surveillance of botulism in humans and animals in France.

Two major epidemics of highly pathogenic avian influenza virus H5N8 and H5N1 in domestic poultry in France, 2020-2022

The spread of highly pathogenic avian influenza (HPAI) viruses worldwide has serious consequences for animal health and a major economic impact on the poultry production sector. Since 2014, Europe has been severely hit by several HPAI epidemics, with France being the most affected country. Most recently, France was again affected by two devastating HPAI epidemics in 2020-21 and 2021-22. We conducted a descriptive analysis of the 2020-21 and 2021-22 epidemics, as a first step towards identifying the poultry sector's remaining vulnerabilities regarding HPAI viruses in France. We examined the spatio-temporal distribution of outbreaks that occurred in France in 2020-21 and 2021-22, and we assessed the outbreaks' spatial distribution in relation to the 2016-17 epidemic and to the two 'high-risk zones' recently incorporated into French legislation to strengthen HPAI prevention and control. There were 468 reported outbreaks during the 2020-21 epidemic and 1375 outbreaks during the 2021-22 epidemic. In both epidemics, the outbreaks' distribution matched extremely well that of 2016-17, and most outbreaks (80.6% and 68.4%) were located in the two high-risk zones. The southwestern high-risk zone was affected in both epidemics, while the western high-risk zone was affected for the first time in 2021-22, explaining the extremely high number of outbreaks reported. As soon as the virus reached the high-risk zones, it started to spread between farms at very high rates, with each infected farm infecting between two and three other farms at the peaks of transmission. We showed that the spatial distribution model used to create the two high-risk zones was able to predict the location of outbreaks for the 2020-21 and 2021-22 epidemics. These zones were characterized by high poultry farm densities; future efforts should, therefore, focus on reducing the density of susceptible poultry in highly dense areas.

Investigation of healthcare-associated COVID-19 in a large French hospital group by whole-genome sequencing

OBJECTIVES

Despite the quick implementation of infection prevention and control procedures and the use of personal protective equipment within healthcare facilities, many cases of nosocomial COVID-19 transmission have been reported. We aimed to estimate the frequency and impact of healthcare-associated COVID-19 (HA-COVID-19) and evaluate the contribution of whole-genome sequencing (WGS) in cluster investigation.

METHODS

We estimated the frequency and mortality of HA-COVID-19 infections from September 1 to November 30, 2020, with a focus on the evolution of hospitalized community-associated COVID-19 (CA-COVID-19) cases and cases detected among healthcare workers (HCWs) within the Sorbonne University Hospital Group (Paris, France). We thoroughly examined 12 clusters through epidemiological investigations and WGS.

RESULTS

Overall, 209 cases of HA-COVID-19 were reported. Evolution of HA-COVID-19 incidence closely correlated with the incidence of CA-COVID-19 and COVID-19 among HCWs. During the study period, 13.9 % of hospitalized patients with COVID-19 were infected in the hospital and the 30-day mortality rate of HA-COVID-19 was 31.5 %. Nosocomial transmission of SARS-CoV-2 led to clusters involving both patients and HCWs. WGS allowed the exclusion of one-third of cases initially assigned to a cluster.

CONCLUSIONS

WGS analysis combined with comprehensive epidemiological investigations is essential to understand transmission routes and adapt the IPC response to protect both patients and HCWs.

COVID-19 in Japan, January-March 2020: insights from the first three months of the epidemic

BACKGROUND

Understanding the characteristics and natural history of novel pathogens is crucial to inform successful control measures. Japan was one of the first affected countries in the COVID-19 pandemic reporting their first case on 14 January 2020. Interventions including airport screening, contact tracing, and cluster investigations were quickly implemented. Here we present insights from the first 3 months of the epidemic in Japan based on detailed case data.

METHODS

We conducted descriptive analyses based on information systematically extracted from individual case reports from 13 January to 31 March 2020 including patient demographics, date of report and symptom onset, symptom progression, travel history, and contact type. We analysed symptom progression and estimated the time-varying reproduction number, Rt, correcting for epidemic growth using an established Bayesian framework. Key delays and the age-specific probability of transmission were estimated using data on exposures and transmission pairs.

RESULTS

The corrected fitted mean onset-to-reporting delay after the peak was 4 days (standard deviation: ± 2 days). Early transmission was driven primarily by returning travellers with Rt peaking at 2.4 (95% CrI: 1.6, 3.3) nationally. In the final week of the trusted period (16-23 March 2020), Rt accounting for importations diverged from overall Rt at 1.1 (95% CrI: 1.0, 1.2) compared to 1.5 (95% CrI: 1.3, 1.6), respectively. Household (39.0%) and workplace (11.6%) exposures were the most frequently reported potential source of infection. The estimated probability of transmission was assortative by age with individuals more likely to infect, and be infected by, contacts in a similar age group to them. Across all age groups, cases most frequently onset with cough, fever, and fatigue. There were no reported cases of patients < 20 years old developing pneumonia or severe respiratory symptoms.

CONCLUSIONS

Information collected in the early phases of an outbreak are important in characterising any novel pathogen. The availability of timely and detailed data and appropriate analyses is critical to estimate and understand a pathogen's transmissibility, high-risk settings for transmission, and key symptoms. These insights can help to inform urgent response strategies.

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

Nigeria currently reports the second highest number of cholera cases in Africa, with numerous socioeconomic and environmental risk factors. Less investigated are the role of extreme events, despite recent work showing their potential importance. To address this gap, we used a machine learning approach to understand the risks and thresholds for cholera outbreaks and extreme events, taking into consideration pre-existing vulnerabilities. We estimated time varying reproductive number (R) from cholera incidence in Nigeria and used a machine learning approach to evaluate its association with extreme events (conflict, flood, drought) and pre-existing vulnerabilities (poverty, sanitation, healthcare). We then created a traffic-light system for cholera outbreak risk, using three hypothetical traffic-light scenarios (Red, Amber and Green) and used this to predict R. The system highlighted potential extreme events and socioeconomic thresholds for outbreaks to occur. We found that reducing poverty and increasing access to sanitation lessened vulnerability to increased cholera risk caused by extreme events (monthly conflicts and the Palmers Drought Severity Index). The main limitation is the underreporting of cholera globally and the potential number of cholera cases missed in the data used here. Increasing access to sanitation and decreasing poverty reduced the impact of extreme events in terms of cholera outbreak risk. The results here therefore add further evidence of the need for sustainable development for disaster prevention and mitigation and to improve health and quality of life.

Epidemiological Factors Associated With Caligus rogercresseyi Infection, Abundance, and Spatial Distribution in Southern Chile

Sea lice (Caligus rogercresseyi) are external parasites that affect farmed salmonids in Chile, and the scale of their sanitary and economic impact cannot be overstated. Even though space–time patterns suppose parasite aggregation, specific locations related to different infestation levels, as well as their associated factors across the geographic range involved, had not been investigated as of the writing of the present article. The understanding of the effects and factors entailed by the presence of C. rogercresseyi may be deemed a key element of Integrated Pest Management (IPM). In the present study, the multivariate spatial scan statistic was used to identify geographic areas and times of C. rogercresseyi infestation and to estimate the factors associated with such patterns. We used official C. rogercresseyi monitoring data at the farm level, with a set of 13 covariates, to provide adjustment within the analyses. The analyses were carried out for a period of 5 years (2012–2016), and they included three fish species (Salmo salar, Oncorhynchus mykiss, and Oncorhynchus kisutch) in order to assess the consistency of the identified clusters. A retrospective multinomial, spatial, and temporal scan test was implemented to identify farm clusters of either of the different categories of C. rogercresseyi infested farms: baseline, medium, and high, based on the control chemical threshold established by the health authority. The baseline represents adequate farm performance against C. rogercresseyi infestation. Then, production and environmental factors of the medium and high infestation farms were compared with the baseline using regression techniques. The results revealed a total of 26 clusters (p < 0.001), of which 12 correspond to baseline, 1 to medium, and the remaining 13 to high infestation clusters. In general, baseline clusters are detected in a latitudinal gradient on estuarine areas, with increasing relative risks to complex island water systems. There is a spatial structure in specific sites, north of Los Lagos Region and central Aysén Region, with high infestation clusters and epidemic peaks during 2013. In addition, average weight, salmon species, chemotherapeutants, latitude, temperature, salinity, and year category are factors associated with these C. rogercresseyi patterns. Recommendations for an IPM plan are provided, along with a discussion that considers the involvement of stock density thresholds by salmon species and the spatial structure of the efficacy of chemical control, both intended to avoid the advance of resistance and to minimize environmental residues.

Second wave of COVID-19 in Italy: Preliminary estimation of reproduction number and cumulative case projections

The second wave of a novel coronavirus in Italy has caused 247,369 new cases and 1782 deaths only in October 2020. This significantly alarming infectious disease controlling board to impose again mitigation measures for controlling the epidemic growth. In this paper, we estimate the latest COVID-19 reproduction number (R_0) and project the epidemic size for the future 45 days. The R_0 value has calculated as 2.83 (95% CI: 1.5-4.2) and the cumulative incidences 100,015 (95% CI; 73,201-100,352), and daily incidences might be reached up to 15,012 (95% CI: 8234-16,197) respectively.

Estimation of the Basic Reproduction Numbers of the Subtypes H5N1, H5N8, and H5N6 During the Highly Pathogenic Avian Influenza Epidemic Spread Between Farms

It is important to understand pathogen transmissibility in a population to establish an effective disease prevention policy. The basic reproduction number (R 0) is an epidemiologic parameter for understanding the characterization of disease and its dynamics in a population. We aimed to estimate the R 0 of the highly pathogenic avian influenza (HPAI) subtypes H5N1, H5N8, and H5N6, which were associated with nine outbreaks in Korea between 2003 and 2018, to understand the epidemic transmission of each subtype. According to HPAI outbreak reports of the Animal and Plant Quarantine Agency, we estimated the generation time by calculating the time of infection between confirmed HPAI-positive farms. We constructed exponential growth and maximum likelihood (ML) models to estimate the basic reproduction number, which assumes the number of secondary cases infected by the index case. The Kruskal-Wallis test was used to analyze the epidemic statistics between subtypes. The estimated generation time of H5N1, H5N8, and H5N6 were 4.80 days [95% confidence interval (CI) 4.23-5.38] days, 7.58 (95% CI 6.63-8.46), and 5.09 days (95% CI 4.44-5.74), respectively. A pairwise comparison showed that the generation time of H5N8 was significantly longer than that of the subtype H5N1 (P = 0.04). Based on the ML model, R 0 was estimated as 1.69 (95% CI 1.48-2.39) for subtype H5N1, 1.60 (95%CI 0.97-2.23) for subtype H5N8, and 1.49 (95%CI 0.94-2.04) for subtype H5N6. We concluded that R 0 estimates may be associated with the poultry product system, climate, species specificity based on the HPAI virus subtype, and prevention policy. This study provides an insight on the transmission and dynamics patterns of various subtypes of HPAI occurring worldwide. Furthermore, the results are useful as scientific evidence for establishing a disease control policy.

The First 100 Days of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Control in Vietnam

Background

One hundred days after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Vietnam on 23 January, 270 cases were confirmed, with no deaths. We describe the control measures used by the government and their relationship with imported and domestically acquired case numbers, with the aim of identifying the measures associated with successful SARS-CoV-2 control.

Methods

Clinical and demographic data on the first 270 SARS-CoV-2 infected cases and the timing and nature of government control measures, including numbers of tests and quarantined individuals, were analyzed. Apple and Google mobility data provided proxies for population movement. Serial intervals were calculated from 33 infector-infectee pairs and used to estimate the proportion of presymptomatic transmission events and time-varying reproduction numbers.

Results

A national lockdown was implemented between 1 and 22 April. Around 200 000 people were quarantined and 266 122 reverse transcription polymerase chain reaction (RT-PCR) tests conducted. Population mobility decreased progressively before lockdown. In total, 60% (163/270) of cases were imported; 43% (89/208) of resolved infections remained asymptomatic for the duration of infection. The serial interval was 3.24 days, and 27.5% (95% confidence interval [CI], 15.7%-40.0%) of transmissions occurred presymptomatically. Limited transmission amounted to a maximum reproduction number of 1.15 (95% CI, .·37–2.·36). No community transmission has been detected since 15 April.

Conclusions

Vietnam has controlled SARS-CoV-2 spread through the early introduction of mass communication, meticulous contact tracing with strict quarantine, and international travel restrictions. The value of these interventions is supported by the high proportion of asymptomatic and imported cases, and evidence for substantial presymptomatic transmission.

The First 100 Days of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Control in Vietnam

BACKGROUND

One hundred days after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Vietnam on 23 January, 270 cases were confirmed, with no deaths. We describe the control measures used by the government and their relationship with imported and domestically acquired case numbers, with the aim of identifying the measures associated with successful SARS-CoV-2 control.

METHODS

Clinical and demographic data on the first 270 SARS-CoV-2 infected cases and the timing and nature of government control measures, including numbers of tests and quarantined individuals, were analyzed. Apple and Google mobility data provided proxies for population movement. Serial intervals were calculated from 33 infector-infectee pairs and used to estimate the proportion of presymptomatic transmission events and time-varying reproduction numbers.

RESULTS

A national lockdown was implemented between 1 and 22 April. Around 200 000 people were quarantined and 266 122 reverse transcription polymerase chain reaction (RT-PCR) tests conducted. Population mobility decreased progressively before lockdown. In total, 60% (163/270) of cases were imported; 43% (89/208) of resolved infections remained asymptomatic for the duration of infection. The serial interval was 3.24 days, and 27.5% (95% confidence interval [CI], 15.7%-40.0%) of transmissions occurred presymptomatically. Limited transmission amounted to a maximum reproduction number of 1.15 (95% CI, .·37-2.·36). No community transmission has been detected since 15 April.

CONCLUSIONS

Vietnam has controlled SARS-CoV-2 spread through the early introduction of mass communication, meticulous contact tracing with strict quarantine, and international travel restrictions. The value of these interventions is supported by the high proportion of asymptomatic and imported cases, and evidence for substantial presymptomatic transmission.

Modeling Study: Characterizing the Spatial Heterogeneity of the COVID-19 Pandemic through Shape Analysis of Epidemic Curves

Background

The COVID-19 incidence rates across different geographical regions (e.g., counties in a state, states in a nation, countries in a continent) follow different shapes and patterns. The overall summaries at coarser spatial scales, that are obtained by simply averaging individual curves (across regions), hide nuanced variability and blur the spatial heterogeneity at finer spatial scales. For instance, a decreasing incidence rate curve in one region is obscured by an increasing rate curve for another region, when the analysis relies on coarse averages of locally heterogeneous transmission dynamics.

Objective

To highlight regional differences in COVID-19 incidence rates and to discover prominent patterns in shapes of incidence rate curves in multiple regions (USA and Europe).

Methods

We employ statistical methods to analyze shapes of local COVID-19 incidence rate curves and statistically group them into distinct clusters, according to their shapes. Using this information, we derive the so-called shape averages of curves within these clusters, which represent the dominant incidence patterns of these clusters. We apply this methodology to the analysis of the daily incidence trajectory of the COVID-pandemic for two geographic areas: A state-level analysis within the USA and a country-level analysis within Europe during late-February to October 1st, 2020.

Results

Our analyses reveal that pandemic curves often differ substantially across regions. However, there are only a handful of shapes that dominate transmission dynamics for all states in the USA and countries in Europe. This approach yields a broad classification of spatial areas into different characteristic epidemic trajectories. In particular, spatial areas within the same cluster have followed similar transmission and control dynamics.

Conclusion

The shape-based analysis of pandemic curves presented here helps divide country or continental data into multiple regional clusters, each cluster containing areas with similar trend patterns. This clustering helps highlight differences in pandemic curves across regions and provides summaries that better reflect dynamical patterns within the clusters. This approach adds to the methodological toolkit for public health practitioners to facilitate decision making at different spatial scales.

Use of Network Analysis and Spread Models to Target Control Actions for Bovine Tuberculosis in a State from Brazil

Livestock movements create complex dynamic interactions among premises that can be represented, interpreted, and used for epidemiological purposes. These movements are a very important part of the production chain but may also contribute to the spread of infectious diseases through the transfer of infected animals over large distances. Social network analysis (SNA) can be used to characterize cattle trade patterns and to identify highly connected premises that may act as hubs in the movement network, which could be subjected to targeted control measures in order to reduce the transmission of communicable diseases such as bovine tuberculosis (TB). Here, we analyzed data on cattle movement and slaughterhouse surveillance for detection of TB-like lesions (TLL) over the 2016-2018 period in the state of Rio Grande do Sul (RS) in Brazil with the following aims: (i) to characterize cattle trade describing the static full, yearly, and monthly snapshots of the network contact trade, (ii) to identify clusters in the space and contact networks of premises from which animals with TLL originated, and (iii) to evaluate the potential of targeted control actions to decrease TB spread in the cattle population of RS using a stochastic metapopulation disease transmission model that simulated within-farm and between-farm disease spread. We found heterogeneous densities of premises and animals in the study area. The analysis of the contact network revealed a highly connected (~94%) trade network, with strong temporal trends, especially for May and November. The TLL cases were significantly clustered in space and in the contact network, suggesting the potential for both local (e.g., fence-to-fence) and movement-mediated TB transmission. According to the disease spread model, removing the top 7% connected farms based on degree and betweenness could reduce the total number of infected farms over three years by >50%. In conclusion, the characterization of the cattle network suggests that highly connected farms may play a role in TB dissemination, although being close to infected farms was also identified as a risk factor for having animals with TLL. Surveillance and control actions based on degree and betweenness could be useful to break the transmission cycle between premises in RS.

Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified.

Mycoplasma bovis outbreak in New Zealand cattle: An assessment of transmission trends using surveillance data

Mycoplasma bovis most likely infected New Zealand cattle in the latter half of 2015. Infection was detected in mid-2017 after which control activities were implemented. An official eradication programme commenced in mid-2018, which is ongoing. We examined farm-level tracing and surveillance data to describe the outbreak, analyse transmission trends and make inference on progress towards eradication. Results indicate that cattle movements were the primary means of spread. Although case farms were distributed throughout both islands of New Zealand, most animal movements off infected farms did not result in newly infected farms, indicating Mycoplasma bovis is not highly transmissible between farms. To describe and analyse outbreak trends, we undertook a standard descriptive outbreak investigation, including construction of an epidemic curve and calculation of estimated dissemination ratios. We then employed three empirical models-a non-linear growth model, time series model and branching process model based on time-varying effective reproduction numbers-to further analyse transmission trends and provide short-term forecasts of farm-level incidence. Our analyses suggest that Mycoplasma bovis transmission in New Zealand has declined and progress towards eradication has been made. Few incident cases were forecast for the period between 8 September and 17 December 2019. To date, no case farms with an estimated infection date assigned to this period have been detected; however, case detection is ongoing, and these results need to be interpreted cautiously considering model validation and other important contextual information on performance of the eradication programme, such as the time between infection, detection and implementation of movement controls on case farms.

Phenomenological Modelling of COVID-19 Epidemics in Sri Lanka, Italy, the United States, and Hebei Province of China

The COVID-19 pandemic has resulted in increasing number of infections and deaths every day. Lack of specialized treatments for the disease demands preventive measures based on statistical/mathematical models. The analysis of epidemiological curve fitting, on number of daily infections across affected countries, provides useful insights on the characteristics of the epidemic. A variety of phenomenological models are available to capture the dynamics of disease spread and growth. The number of daily new infections and cumulative number of infections in COVID-19 over four selected countries, namely, Sri Lanka, Italy, the United States, and Hebei province of China, from the first day of appearance of cases to 2^nd July 2020 were used in the study. Gompertz, logistic, Weibull, and exponential growth curves were fitted on the cumulative number of infections across countries. AIC, BIC, RMSE, and R² were used to determine the best fitting curve for each country. Results revealed that the most appropriate growth curves for Sri Lanka, Italy, the United States, and China (Hebei) are the logistic, Gompertz, Weibull, and Gompertz curves, respectively. Country-wise, overall growth rate, final epidemic size, and short-term forecasts were evaluated using the selected model. Daily log incidences in each country were regressed before and after the identified peak time of the respective outbreak of epidemic. Hence, doubling time/halving time together with daily growth rates and predictions was estimated. Findings and relevant interpretations demonstrate that the outbreak seems to be extinct in Hebei, China, whereas further transmissions are possible in the United States. In Italy and Sri Lanka, current outbreaks transmit in a decreasing rate.

Impact of COVID-19 epidemic curtailment strategies in selected Indian states: An analysis by reproduction number and doubling time with incidence modelling

The Government of India in-network with the state governments has implemented the epidemic curtailment strategies inclusive of case-isolation, quarantine and lockdown in response to ongoing novel coronavirus (COVID-19) outbreak. In this manuscript, we attempt to estimate the impact of these steps across ten selected Indian states using crowd-sourced data. The trajectory of the outbreak was parameterized by the reproduction number (R0), doubling time, and growth rate. These parameters were estimated at two time-periods after the enforcement of the lockdown on 24th March 2020, i.e. 15 days into lockdown and 30 days into lockdown. The authors used a crowd sourced database which is available in the public domain. After preparing the data for analysis, R0 was estimated using maximum likelihood (ML) method which is based on the expectation minimum algorithm where the distribution probability of secondary cases is maximized using the serial interval discretization. The doubling time and growth rate were estimated by the natural log transformation of the exponential growth equation. The overall analysis shows decreasing trends in time-varying reproduction numbers (R(t)) and growth rate (with a few exceptions) and increasing trends in doubling time. The curtailment strategies employed by the Indian government seem to be effective in reducing the transmission parameters of the COVID-19 epidemic. The estimated R(t) are still above the threshold of 1, and the resultant absolute case numbers show an increase with time. Future curtailment and mitigation strategies thus may take into account these findings while formulating further course of action.

The cost of insecurity: from flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019

The ongoing Ebola outbreak in the eastern Democratic Republic of the Congo is facing unprecedented levels of insecurity and violence. We evaluate the likely impact in terms of added transmissibility and cases of major security incidents in the Butembo coordination hub. We also show that despite this additional burden, an adapted response strategy involving enlarged ring vaccination around clusters of cases and enhanced community engagement managed to bring this main hotspot under control.

Demographic and Comorbidities Data Description of Population in Mexico with SARS-CoV-2 Infected Patients(COVID19): An Online Tool Analysis

The Word Health Organization (WHO) declared in March 2020 that we are facing a pandemic designated as COVID-19, which is the acronym of coronavirus disease 2019, caused by a new virus know as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Mexico, the first cases of COVID-19, was reported by the Secretary of Health on 28 February 2020. More than sixteen thousand cases and more than fifteen thousand deaths have been reported in Mexico, and it continues to rise; therefore, this article proposes two online visualization tools (a web platform) that allow the analysis of demographic data and comorbidities of the Mexican population. The objective of these tools is to provide graphic information, fast and updated, based on dataset obtained directly from National Governments Health Secretary (Secretaría de Salud, SSA) which is daily refreshed with the information related to SARS-CoV-2. To allow a dynamical update and friendly interface, and approach with R-project, a well-known Open Source language and environment for statistical computing and Shiny package, were implemented. The dataset is loaded automatically from the latest version released by the federal government of Mexico. Users can choose to study particular groups determined by gender, entity, type of result (positive, negative, pending outcome) and comorbidity. The image results are plots that can be instantly interpreted and supported by the text summary. This tool, in addition to being a consultation for the general public, is useful in Public Health to facilitate the visualization of the data, allowing its timely interpretation due to the changing nature of COVID-19, it can even be used for decision-making by leaders, for the benefit of the health of the community.

Understanding Spatial Heterogeneity of COVID-19 Pandemic Using Shape Analysis of Growth Rate Curves

The growth rates of COVID-19 across different geographical regions (e.g., states in a nation, countries in a continent) follow different shapes and patterns. The overall summaries at coarser spatial scales that are obtained by simply averaging individual curves (across regions) obscure nuanced variability and blurs the spatial heterogeneity at finer spatial scales. We employ statistical methods to analyze shapes of local COVID-19 growth rate curves and statistically group them into distinct clusters, according to their shapes. Using this information, we derive the so-called elastic averages of curves within these clusters, which correspond to the dominant incidence patterns. We apply this methodology to the analysis of the daily incidence trajectory of the COVID-pandemic at two spatial scales: A state-level analysis within the USA and a country-level analysis within Europe during mid-February to mid-May, 2020. Our analyses reveal a few dominant incidence trajectories that characterize transmission dynamics across states in the USA and across countries in Europe. This approach results in broad classifications of spatial areas into different trajectories and adds to the methodological toolkit for guiding public health decision making at different spatial scales.

Modifications of emergency dental clinic protocols to combat COVID-19 transmission

During the COVID-19 pandemic, incidence rates for dental diseases will continue unabated. However, the intent to prevent the spread of this lethal respiratory disease will likely lead to reduced treatment access due to restrictions on population movements. These changes have the potential to increase dental-related emergency department visits and subsequently contribute to greater viral transmission. Moreover, dentists experience unique challenges with preventing transmission due to frequent aerosol-producing procedures. This paper presents reviews and protocols implemented by directors and residents at the Dental College of Georgia to manage a dental emergency clinic during the COVID-19 pandemic. The methods presented include committee-based prioritization of dental patients, a multilayered screening process, team rotations with social and temporal spacing, and modified treatment room protocols. These efforts aid in the reduction of viral transmission, conservation of personal protective equipment, and expand provider availability. These protocols transcend a university and hospital-based models and are applicable to private and corporate models.

Early Transmission Dynamics of Novel Coronavirus (COVID-19) in Nigeria

On 31 December 2019, the World Health Organization (WHO) was notified of a novel coronavirus disease in China that was later named COVID-19. On 11 March 2020, the outbreak of COVID-19 was declared a pandemic. The first instance of the virus in Nigeria was documented on 27 February 2020. This study provides a preliminary epidemiological analysis of the first 45 days of COVID-19 outbreak in Nigeria. We estimated the early transmissibility via time-varying reproduction number based on the Bayesian method that incorporates uncertainty in the distribution of serial interval (time interval between symptoms onset in an infected individual and the infector), and adjusted for disease importation. By 11 April 2020, 318 confirmed cases and 10 deaths from COVID-19 have occurred in Nigeria. At day 45, the exponential growth rate was 0.07 (95% confidence interval (CI): 0.05-0.10) with a doubling time of 9.84 days (95% CI: 7.28-15.18). Separately for imported cases (travel-related) and local cases, the doubling time was 12.88 days and 2.86 days, respectively. Furthermore, we estimated the reproduction number for each day of the outbreak using a three-weekly window while adjusting for imported cases. The estimated reproduction number was 4.98 (95% CrI: 2.65-8.41) at day 22 (19 March 2020), peaking at 5.61 (95% credible interval (CrI): 3.83-7.88) at day 25 (22 March 2020). The median reproduction number over the study period was 2.71 and the latest value on 11 April 2020, was 1.42 (95% CrI: 1.26-1.58). These 45-day estimates suggested that cases of COVID-19 in Nigeria have been remarkably lower than expected and the preparedness to detect needs to be shifted to stop local transmission.

Inference of the generalized-growth model via maximum likelihood estimation: A reflection on the impact of overdispersion

Recently, the generalized-growth model was introduced as a flexible approach to characterize growth dynamics of disease outbreaks during the early ascending phase. In this work, by using classical maximum likelihood estimation to obtain parameter estimates, we evaluate the impact of varying levels of overdispersion on the inference of the growth scaling parameter through comparing Poisson and Negative binomial models. In particular, under exponential and sub-exponential growth scenarios, we evaluate, via simulations, the error rate of making an incorrect characterization of early outbreak growth patterns. Simulation results show that the ability to correctly identify early outbreak growth patterns can be affected by overdispersion even when accounted for using the Negative binomial model. We exemplify our findings using data on five different outbreaks. Overall, our results show that estimates should be interpreted with caution when data are overdispersed.

Roles of Different Transport Modes in the Spatial Spread of the 2009 Influenza A(H1N1) Pandemic in Mainland China

There is increasing concern about another influenza pandemic in China. However, the understanding of the roles of transport modes in the 2009 influenza A(H1N1) pandemic spread across mainland China is limited. Herein, we collected 127,797 laboratory-confirmed cases of influenza A(H1N1)pdm09 in mainland China from May 2009 to April 2010. Arrival days and peak days were calculated for all 340 prefectures to characterize the dissemination patterns of the pandemic. We first evaluated the effects of airports and railway stations on arrival days and peak days, and then we applied quantile regressions to quantify the relationships between arrival days and air, rail, and road travel. Our results showed that early arrival of the virus was not associated with an early incidence peak. Airports and railway stations in prefectures significantly advanced arrival days but had no significant impact on peak days. The pandemic spread across mainland China from the southeast to the northwest in two phases that were split at approximately 1 August 2009. Both air and road travel played a significant role in accelerating the spread during phases I and II, but rail travel was only significant during phase II. In conclusion, in addition to air and road travel, rail travel also played a significant role in accelerating influenza A(H1N1)pdm09 spread between prefectures. Establishing a multiscale mobility network that considers the competitive advantage of rail travel for mid to long distances is essential for understanding the influenza pandemic transmission in China.