Matthew J. Ferrari

The dynamics of measles in sub-Saharan Africa

Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission—generating high amplitude epidemics—within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur.

Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data

BACKGROUND In 2008 all WHO member states endorsed a target of 90% reduction in measles mortality by 2010 over 2000 levels. We developed a model to estimate progress made towards this goal. METHODS We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class. FINDINGS Estimated global measles mortality decreased 74% from 535,300 deaths (95% CI 347,200-976,400) in 2000 to 139,300 (71,200-447,800) in 2010. Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO southeast Asia region. India accounted for 47% of estimated measles mortality in 2010, and the WHO African region accounted for 36%. INTERPRETATION Despite rapid progress in measles control from 2000 to 2007, delayed implementation of accelerated disease control in India and continued outbreaks in Africa stalled momentum towards the 2010 global measles mortality reduction goal. Intensified control measures and renewed political and financial commitment are needed to achieve mortality reduction targets and lay the foundation for future global eradication of measles. FUNDING US Centers for Disease Control and Prevention (PMS 5U66/IP000161).

Global Patterns in Seasonal Activity of Influenza A/H3N2, A/H1N1, and B from 1997 to 2005: Viral Coexistence and Latitudinal Gradients

Despite a mass of research on the epidemiology of seasonal influenza, overall patterns of infection have not been fully described on broad geographic scales and for specific types and subtypes of the influenza virus. Here we provide a descriptive analysis of laboratory-confirmed influenza surveillance data by type and subtype (A/H3N2, A/H1N1, and B) for 19 temperate countries in the Northern and Southern hemispheres from 1997 to 2005, compiled from a public database maintained by WHO (FluNet). Key findings include patterns of large scale co-occurrence of influenza type A and B, interhemispheric synchrony for subtype A/H3N2, and latitudinal gradients in epidemic timing for type A. These findings highlight the need for more countries to conduct year-round viral surveillance and report reliable incidence data at the type and subtype level, especially in the Tropics.

Explaining seasonal fluctuations of measles in Niger using nighttime lights imagery.

Changes in human population density as measured by satellite images of nighttime lights predict measles. Measles epidemics in West Africa cause a significant proportion of vaccine-preventable childhood mortality. Epidemics are strongly seasonal, but the drivers of these fluctuations are poorly understood, which limits the predictability of outbreaks and the dynamic response to immunization. We show that measles seasonality can be explained by spatiotemporal changes in population density, which we measure by quantifying anthropogenic light from satellite imagery. We find that measles transmission and population density are highly correlated for three cities in Niger. With dynamic epidemic models, we demonstrate that measures of population density are essential for predicting epidemic progression at the city level and improving intervention strategies. In addition to epidemiological applications, the ability to measure fine-scale changes in population density has implications for public health, crisis management, and economic development.

Network frailty and the geometry of herd immunity

The spread of infectious disease through communities depends fundamentally on the underlying patterns of contacts between individuals. Generally, the more contacts one individual has, the more vulnerable they are to infection during an epidemic. Thus, outbreaks disproportionately impact the most highly connected demographics. Epidemics can then lead, through immunization or removal of individuals, to sparser networks that are more resistant to future transmission of a given disease. Using several classes of contact networks—Poisson, scale-free and small-world—we characterize the structural evolution of a network due to an epidemic in terms of frailty (the degree to which highly connected individuals are more vulnerable to infection) and interference (the extent to which the epidemic cuts off connectivity among the susceptible population that remains following an epidemic). The evolution of the susceptible network over the course of an epidemic differs among the classes of networks; frailty, relative to interference, accounts for an increasing component of network evolution on networks with greater variance in contacts. The result is that immunization due to prior epidemics can provide greater community protection than random vaccination on networks with heterogeneous contact patterns, while the reverse is true for highly structured populations.

Reduced vaccination and the risk of measles and other childhood infections post-Ebola

Vaccinate children despite Ebola During the medical emergency caused by the Ebola virus outbreak in West Africa, routine childhood vaccination programs have been suspended. If vaccination is not resumed soon, there could be even more deaths. Measles is highly infectious, and outbreaks are a sign of health care systems in trouble. Using mathematical modelling, Takahashi et al. estimate that about a million children across Liberia, Sierra Leone, and Guinea are vulnerable to measles. Aggressive public health programs are vital for this region to minimize harm, not only from measles but also from polio, malaria, tuberculosis, and other childhood infections. Science, this issue p. 1240 Ebola is terrible, but childhood vaccination needs to resume in West Africa to prevent more deaths from common infections. The Ebola epidemic in West Africa has caused substantial morbidity and mortality. The outbreak has also disrupted health care services, including childhood vaccinations, creating a second public health crisis. We project that after 6 to 18 months of disruptions, a large connected cluster of children unvaccinated for measles will accumulate across Guinea, Liberia, and Sierra Leone. This pool of susceptibility increases the expected size of a regional measles outbreak from 127,000 to 227,000 cases after 18 months, resulting in 2000 to 16,000 additional deaths (comparable to the numbers of Ebola deaths reported thus far). There is a clear path to avoiding outbreaks of childhood vaccine-preventable diseases once the threat of Ebola begins to recede: an aggressive regional vaccination campaign aimed at age groups left unprotected because of health care disruptions.

Time is of the essence: exploring a measles outbreak response vaccination in Niamey, Niger

The current World Health Organization recommendations for response during measles epidemics focus on case management rather than outbreak response vaccination (ORV) campaigns, which may occur too late to impact morbidity and mortality and have a high cost per case prevented. Here, we explore the potential impact of an ORV campaign conducted during the 2003–2004 measles epidemic in Niamey, Niger. We measured the impact of this intervention and also the potential impact of alternative strategies. Using a unique geographical, epidemiologic and demographic dataset collected during the epidemic, we developed an individual-based simulation model. We estimate that a median of 7.6% [4.9–8.9] of cases were potentially averted as a result of the outbreak response, which vaccinated approximately 57% (84 563 of an estimated 148 600) of children in the target age range (6–59 months), 23 weeks after the epidemic started. We found that intervening early (up to 60 days after the start of the epidemic) and expanding the age range to all children aged 6 months to 15 years may lead to a much larger (up to 90%) reduction in the number of cases in a West African urban setting like Niamey. Our results suggest that intervening earlier even with lower target coverage (approx. 60%), but a wider age range, may be more effective than intervening later with high coverage (more than 90%) in similar settings. This has important implications for the implementation of reactive vaccination interventions as they can be highly effective if the response is fast with respect to the spread of the epidemic.

Pollinator Behavior Mediates Negative Interactions between Two Congeneric Invasive Plant Species

Simultaneously flowering plant species may indirectly interact with each other by influencing the quantity of pollinator visitation and/or the quality of pollen that is transferred. These effects on pollination may depend on how pollinators respond to floral resources at multiple levels. In this study, we demonstrate pollinator‐mediated negative interactions between two invasive plants, Carduus acanthoides and Carduus nutans. Using constructed arrays of the two species, alone and in mixture, we quantified pollinator visitation at the patch and individual plant levels and measured seed production. We found that co‐occurrence of our species led to a shift in pollinator services at both levels. Greater interference occurred when arrays were small and spacings between neighboring plants were large. A spatially explicit movement model suggests that pollinator foraging behavior, which mediates the interactions between plants, was driven by floral display size rather than species identity per se. Pollinator behavior significantly reduced the proportion of seed set for both species relative to that in single‐species arrays. Overall, the dependence of pollinator behavior on patch size, spacing between plants, and patch composition can lead to pollinator‐mediated plant interactions that range from facilitative to competitive.

Ebola cases and health system demand in Liberia.

The authors develop a multi-type branching process model of the 2014 Liberian Ebola outbreak that incorporates the impacts of changes in behavior on potential transmission scenarios, thereby informing the path to containment of the epidemic.

Indirect costs of a nontarget pathogen mitigate the direct benefits of a virus-resistant transgene in wild Cucurbita

Virus-resistant transgenic squash are grown throughout the United States and much of Mexico and it is likely that the virus-resistant transgene (VRT) has been introduced to wild populations repeatedly. The evolutionary fate of any resistance gene in wild populations and its environmental impacts depend upon trade-offs between the costs and benefits of the resistance gene. In a 3-year field study using a wild gourd and transgenic and nontransgenic introgressives, we measured the effects of the transgene on fitness, on herbivory by cucumber beetles, on the incidence of mosaic viruses, and on the incidence of bacterial wilt disease (a fatal disease vectored by cucumber beetles). In each year, the first incidence of zucchini yellow mosaic virus occurred in mid-July and spread rapidly through the susceptible plants. We found that the transgenic plants had greater reproduction through both male and female function than the susceptible plants, indicating that the VRT has a direct fitness benefit for wild gourds under the conditions of our study. Moreover, the VRT had no effect on resistance to cucumber beetles or the incidence of wilt disease before the spread of the virus. However, as the virus spread through the fields, the cucumber beetles became increasingly concentrated upon the healthy (mostly transgenic) plants, which increased exposure to and the incidence of wilt disease on the transgenic plants. This indirect cost of the VRT (mediated by a nontarget herbivore and pathogen) mitigated the overall beneficial effect of the VRT on fitness.