Zindoga Mukandavire

Estimating the reproductive numbers for the 2008–2009 cholera outbreaks in Zimbabwe

Cholera remains an important global cause of morbidity and mortality, capable of causing periodic epidemic disease. Beginning in August 2008, a major cholera epidemic occurred in Zimbabwe, with 98,585 reported cases and 4,287 deaths. The dynamics of such outbreaks, particularly in nonestuarine regions, are not well understood. We explored the utility of mathematical models in understanding transmission dynamics of cholera and in assessing the magnitude of interventions necessary to control epidemic disease. Weekly data on reported cholera cases were obtained from the Zimbabwe Ministry of Health and Child Welfare (MoHCW) for the period from November 13, 2008 to July 31, 2009. A mathematical model was formulated and fitted to cumulative cholera cases to estimate the basic reproductive numbers R0 and the partial reproductive numbers from all 10 provinces for the 2008–2009 Zimbabwe cholera epidemic. Estimated basic reproductive numbers were highly heterogeneous, ranging from a low value of just above unity to 2.72. Partial reproductive numbers were also highly heterogeneous, suggesting that the transmission routes varied by province; human-to-human transmission accounted for 41–95% of all transmission. Our models suggest that the underlying patterns of cholera transmission varied widely from province to province, with a corresponding variation in the amenability of outbreaks in different provinces to control measures such as immunization. These data underscore the heterogeneity of cholera transmission dynamics, potentially linked to differences in environment, socio-economic conditions, and cultural practices. The lack of traditional estuarine reservoirs combined with these estimates of R0 suggest that mass vaccination against cholera deployed strategically in Zimbabwe and surrounding regions could prevent future cholera epidemics and eventually eliminate cholera from the region.

Cholera in Haiti: Reproductive numbers and vaccination coverage estimates

Cholera reappeared in Haiti in October, 2010 after decades of absence. Cases were first detected in Artibonite region and in the ensuing months the disease spread to every department in the country. The rate of increase in the number of cases at the start of epidemics provides valuable information about the basic reproductive number (). Quantitative analysis of such data gives useful information for planning and evaluating disease control interventions, including vaccination. Using a mathematical model, we fitted data on the cumulative number of reported hospitalized cholera cases in Haiti. varied by department, ranging from 1.06 to 2.63. At a national level, 46% vaccination coverage would result in an () <1, which would suppress transmission. In the current debate on the use of cholera vaccines in endemic and non-endemic regions, our results suggest that moderate cholera vaccine coverage would be an important element of disease control in Haiti.

Modeling HIV/AIDS and Tuberculosis Coinfection

An HIV/AIDS and TB coinfection model which considers antiretroviral therapy for the AIDS cases and treatment of all forms of TB, i.e., latent and active forms of TB, is presented. We begin by presenting an HIV/AIDS-TB coinfection model and analyze the TB and HIV/AIDS submodels separately without any intervention strategy. The TB-only model is shown to exhibit backward bifurcation when its corresponding reproduction number is less than unity. On the other hand, the HIV/AIDS-only model has a globally asymptotically stable disease-free equilibrium when its corresponding reproduction number is less than unity. We proceed to analyze the full HIV-TB coinfection model and extend the model to incorporate antiretroviral therapy for the AIDS cases and treatment of active and latent forms of TB. The thresholds and equilibria quantities for the models are determined and stabilities analyzed. From the study we conclude that treatment of AIDS cases results in a significant reductions of numbers of individuals progressing to active TB. Further, treatment of latent and active forms of TB results in delayed onset of the AIDS stage of HIV infection.

Tuberculosis transmission model with chemoprophylaxis and treatment.

A tuberculosis model which incorporates treatment of infectives and chemoprophylaxis is presented. The model assumes that latently infected individuals develop active disease as a result of endogenous re-activation, exogenous re-infection and disease relapse, though a small fraction is assumed to develop active disease soon after infection. We start by formulating and analyzing a TB model without any intervention strategy that we extend to incorporate chemoprophylaxis and treatment of infectives. The epidemic thresholds known as reproduction numbers and equilibria for the models are determined, and stabilities analyzed. The reproduction numbers for the models are compared to assess the possible community benefits achieved by treatment of infectives, chemoprophylaxis and a holistic approach of these intervention strategies. The study shows that treatment of infectives is more effective in the first years of implementation (≈ 10 years) as treatment results in clearing active TB immediately and there after chemoprophylaxis will do better in controlling the number of infectives due to reduced progression to active TB.

HIV/AIDS MODEL FOR ASSESSING THE EFFECTS OF PROPHYLACTIC STERILIZING VACCINES, CONDOMS AND TREATMENT WITH AMELIORATION

HIV/AIDS vaccination model for heterosexual transmission with explicit incubation period is presented as a system of delay differential equations. The model considers prophylactic vaccination of sexually immature (pre- and early-adolescents) and mature susceptibles in a community. We start by formulating and analyzing an HIV/AIDS vaccination model that we extend to incorporate condom use based on efficacy and compliance. Further, we extend HIV/AIDS vaccination model with condom use by incorporating treatment which allows AIDS patients to undergo amelioration. The thresholds and equilibria for the models are determined, and stabilities analyzed. The basic reproductive numbers for the models are computed and compared to assess the possible community benefits of using prophylactic vaccines, condoms and treatment with amelioration of AIDS patients. We conclude from the study that vaccination and condom use can reduce the basic reproductive number to values below unity but treatment with amelioration intended to lengthen the lives of AIDS patients may result in more numbers of HIV infections and fail to reduce to values less than unity as intended for disease control.

Modelling and analysis of the effects of malnutrition in the spread of cholera

Although cholera has existed for ages, it has continued to plague many parts of the world. In this study, a deterministic model for cholera in a community is presented and rigorously analysed in order to determine the effects of malnutrition in the spread of the disease. The important mathematical features of the cholera model are thoroughly investigated. The epidemic threshold known as the basic reproductive number and equilibria for the model are determined, and stabilities are investigated. The disease-free equilibrium is shown to be globally asymptotically stable. Local stability of the endemic equilibrium is determined using centre manifold theory and conditions for its global stability are derived using a suitable Lyapunov function. Numerical simulations suggest that an increase in susceptibility to cholera due to malnutrition results in an increase in the number of cholera infected individuals in a community. The results suggest that nutritional issues should be addressed in impoverished communities affected by cholera in order to reduce the burden of the disease.

ANALYSIS OF AN HIV/AIDS MODEL WITH PUBLIC-HEALTH INFORMATION CAMPAIGNS AND INDIVIDUAL WITHDRAWAL

Primary prevention measures designed to alter susceptibility and/or reduce exposure of susceptible individuals to diseases, remain the mainstay in the fight against HIV/AIDS. A model for HIV/AIDS, that investigates the reduction in infection by advocating for sexual behavior change through public-health information campaigns and withdrawal of individuals with AIDS from sexual activity is proposed and analyzed. The contact rate is modeled using an incidence function with saturation that depends on the number of infectives. The dynamics of the model is determined using the model reproduction number . Numerical simulations are presented to illustrate the role of some key epidemiological parameters. The results from the study demonstrate that an increase in the rate of dissemination of effective public-health information campaigns results in a decrease in the prevalence of the disease. Similarly, an increase in the fraction of individuals with AIDS who withdraw from sexual activities reduces the burden of the disease.

Modelling the effects of pre-exposure and post-exposure vaccines in tuberculosis control

Epidemic control strategies alter the spread of the disease in the host population. In this paper, we describe and discuss mathematical models that can be used to explore the potential of pre-exposure and post-exposure vaccines currently under development in the control of tuberculosis. A model with bacille Calmette-Guerin (BCG) vaccination for the susceptibles and treatment for the infectives is first presented. The epidemic thresholds known as the basic reproduction numbers and equilibria for the models are determined and stabilities are investigated. The reproduction numbers for the models are compared to assess the impact of the vaccines currently under development. The centre manifold theory is used to show the existence of backward bifurcation when the associated reproduction number is less than unity and that the unique endemic equilibrium is locally asymptotically stable when the associated reproduction number is greater than unity. From the study we conclude that the pre-exposure vaccine currently under development coupled with chemoprophylaxis for the latently infected and treatment of infectives is more effective when compared to the post-exposure vaccine currently under development for the latently infected coupled with treatment of the infectives.

Modelling circumcision and condom use as HIV/AIDS preventive control strategies

We present a sex-structured model for heterosexual transmission of HIV/AIDS with explicit incubation period for modelling the effect of male circumcision as a preventive strategy for HIV/AIDS. The model is formulated using integro-differential equations, which are shown to be equivalent to delay differential equations with delay due to incubation period. The threshold and equilibria for the model are determined and stabilities are examined. We extend the model to incorporate the effects of condom use as another preventive strategy for controlling HIV/AIDS. Basic reproductive numbers for these models are computed and compared to assess the effectiveness of male circumcision and condom use in a community. The models are numerically analysed to assess the effects of the two preventive strategies on the transmission dynamics of HIV/AIDS. We conclude from the study that in the continuing absence of a preventive vaccine or cure for HIV/AIDS, male circumcision is a potential effective preventive strategy of HIV/AIDS to help communities slow the development of the HIV/AIDS epidemic and that it is even more effective if implemented jointly with condom use. The study provides insights into the possible community benefits that male circumcision and condom use as preventive strategies provide in slowing or curtailing the HIV/AIDS epidemic.

Modelling the effects of condom use and antiretroviral therapy in controlling HIV/AIDS among heterosexuals, homosexuals and bisexuals

A deterministic compartmental sex-structured HIV/AIDS model for assessing the effects of homosexuals and bisexuals in heterosexual settings in which homosexuality and bisexuality issues have remained taboo is presented. We extend the model to focus on the effects of condom use as a single strategy approach in HIV prevention in the absence of any other intervention strategies. Initially, we model the use of male condoms, followed by incorporating the use of both the female and male condoms. The model includes two primary factors in condom use to control HIV which are condom efficacy and compliance. Reproductive numbers for these models are computed and compared to assess the effectiveness of male and female condom use in a community. We also extend the basic model to consider the effects of antiretroviral therapy as a single strategy. The results from the study show that condoms can reduce the number of secondary infectives and thus can slow the development of the HIV/AIDS epidemic. Further, we note from the study that treatment of AIDS patients may enlarge the epidemic when the treatment drugs are not 100% effective and when treated AIDS patients indulge in risky sexual behaviour. Thus, the treatment with amelioration of AIDS patients should be accompanied with intense public health educational programs, which are capable of changing the attitude of treated AIDS patients towards safe sex. It is also shown from the study that the use of condoms in settings with the treatment may help in reducing the number of secondary infections thus slowing the epidemic.