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From August to November 2017, Madagascar endured an outbreak of plague. A total of 2417 cases of plague were confirmed, causing a death toll of 209. Public health intervention efforts were introduced and successfully stopped the epidemic at the end of November. The plague, however, is endemic in the region and occurs annually, posing the risk of future outbreaks. To understand the plague transmission, we collected real-time data from official reports, described the outbreak's characteristics, and estimated transmission parameters using statistical and mathematical models. The pneumonic plague epidemic curve exhibited multiple peaks, coinciding with sporadic introductions of new bubonic cases. Optimal climate conditions for rat flea to flourish were observed during the epidemic. Estimate of the plague basic reproduction number during the large wave of the epidemic was high, ranging from 5 to 7 depending on model assumptions. The incubation and infection periods for bubonic and pneumonic plague were 4.3 and 3.4 days and 3.8 and 2.9 days, respectively. Parameter estimation suggested that even with a small fraction of the population exposed to infected rat fleas (1/10,000) and a small probability of transition from a bubonic case to a secondary pneumonic case (3%), the high human-to-human transmission rate can still generate a large outbreak. Controlling rodent and fleas can prevent new index cases, but managing human-to-human transmission is key to prevent large-scale outbreaks.
In this article we review a variety of methods to enable understanding and modelling the spread of a pest or pathogen post-entry. Building upon our experience of multidisciplinary research in this area, we propose practical guidelines and a framework for model development, to help with the application of mathematical modelling in the field of invasion ecology for post-entry spread. We evaluate the pros and cons of a range of methods, including references to examples of the methods in practice. We also show how issues of data deficiency and uncertainty can be addressed. The aim is to provide guidance to the reader on the most suitable elements to include in a model of post-entry dispersal in a risk assessment, under differing circumstances. We identify both the strengths and weaknesses of different methods and their application as part of a holistic, multidisciplinary approach to biosecurity research.