Search bioRxiv⌕ Search

Biology subjects

Abbott, S.

Publications and source records attributed to Abbott, S..

5 recordsLinked to original sources

EpiFusion: Joint inference of the effective reproduction number by integrating phylodynamic and epidemiological modelling with particle filtering

Accurately estimating the effective reproduction number (Rt) of a circulating pathogen is a fundamental challenge in the study of infectious disease. The fields of epidemiology and pathogen phylodynamics both share this goal, but to date, methodologies and data employed by each remain largely distinct. Here we present EpiFusion: a joint approach that can be used to harness the complementary strengths of each field to improve estimation of outbreak dynamics for large and poorly sampled epidemics, such as arboviral or respiratory outbreaks, and validate it for retrospective analysis. We propose a model of Rt that estimates outbreak trajectories conditional upon both phylodynamic (time-scaled trees estimated from genetic sequences) and epidemiological (case incidence) data. We simulate stochastic outbreak trajectories that are weighted according to epidemiological and phylodynamic observation models and fit using particle Markov Chain Monte Carlo. To assess performance, we test EpiFusion on simulated outbreaks in which transmission and/or surveillance rapidly changes and find that using EpiFusion to combine epidemiological and phylodynamic data maintains accuracy and increases certainty in trajectory and Rt estimates, compared to when each data type is used alone. Finally, we benchmark EpiFusions performance against existing methods to estimate Rt and demonstrate advances in efficiency and accuracy. Importantly, our approach scales efficiently with dataset size, including the use of phylogenetic trees generated from large genomic datasets. EpiFusion is designed to accommodate future extensions that will improve its utility, such as introduction of population structure, accommodations for phylogenetic uncertainty, and the ability to weight the contributions of genomic or case incidence to the inference. Author SummaryUnderstanding infectious disease spread is fundamental to protecting public health, but can be challenging as disease spread is a phenomenon that cannot be directly observed. So, epidemiologists use data in conjunction with mathematical models to estimate disease dynamics. Often, combinations of different models and data can be used to answer the same questions - for example traditional epidemiology commonly uses case incidence data (the number of people who have tested positive for a disease at a certain time) whereas phylodynamic models use pathogen genomic sequence data and our knowledge of their evolution to model disease population dynamics. Each of these approaches have strengths and limitations, and data of each type can be sparse or biased, particularly in rapidly developing outbreaks or lower-middle income countries. An increasing number of approaches attempt to fix this problem by incorporating diverse concepts and data types together in their models. We aim to contribute to this movement by introducing EpiFusion, a modelling framework that makes improvements on efficiency and temporal resolution. EpiFusion uses particle filtering to simulate epidemic trajectories over time and weight their likelihood according to both case incidence data and a phylogenetic tree using separate observation models, resulting in the inference of trajectories in agreement with both sets of data. Improvements in our ability to accurately and confidently model pathogen spread help us to respond to infectious disease outbreaks and improve public health.

evolutionary biology↗

Improving modelling for epidemic responses: reflections from members of the UK infectious disease modelling community on their experiences during the COVID-19 pandemic

The COVID-19 pandemic both relied and placed significant burdens on the experts involved from research and public health sectors. The sustained high pressure of a pandemic on responders, such as healthcare workers, can lead to lasting psychological impacts including acute stress disorder, post-traumatic stress disorder, burnout, and moral injury, which can impact individual wellbeing and productivity. As members of the infectious disease modelling community, we convened a reflective workshop to understand the professional and personal impacts of response work on our community and to propose recommendations for future epidemic responses. The attendees represented a range of career stages, institutions, and disciplines. This piece was collectively produced by those present at the session based on our collective experiences. Key issues we identified at the workshop were lack of institutional support, insecure contracts, unequal credit and recognition, and mental health impacts. Our recommendations include rewarding impactful work, fostering academia-public health collaboration, decreasing dependence on key individuals by developing teams, increasing transparency in decision-making, and implementing sustainable work practices. Despite limitations in representation, this workshop provided valuable insights into the UK COVID-19 modelling experience and guidance for future public health crises. Recognising and addressing the issues highlighted is crucial, in our view, for ensuring the effectiveness of epidemic response work in the future.

scientific communication and education↗

Reassessing the Evidence for Universal School-age Bacillus Calmette Guerin (BCG) Vaccination in England and Wales

BackgroundIn 2005, England and Wales switched from universal BCG vaccination against tuberculosis (TB) disease for school-age children to targeted vaccination of neonates. We assessed the quantitative evidence that informed this policy change.\n\nMethodsWe recreated a previous approach for estimating the impact of ending the BCG schools scheme in England and Wales, updating the model with parameter uncertainty. We investigated scenarios considered by the UKs Joint Committee on Vaccination and Immunisation, and explored new approaches using notification data. We estimated the number of vaccines needed to prevent a single notification, and the average annual additional notifications caused by ending the BCG schools scheme.\n\nResultsWe found a 1.9% annual decrease in TB incidence rates best matched notification data. We estimate that 1600 (2.5-97.5% Quantiles (Q): 1300 - 2100) vaccines would have been required to prevent a single notification in 2004. If the scheme had ended in 2001, 302 (2.5-97.5% Q: 238 - 369) additional annual notifications would have occurred compared to if the scheme had continued. If the scheme ended in 2016, 120 (2.5-97.5% Q: 88 - 155) additional annual notifications would have occurred.\n\nConclusionsOur estimates of the impact of ending the BCG schools scheme were highly sensitive to the annual decrease in incidence rates. The impact of ending the BCG schools scheme was found to be greater than previously thought when parameter values were updated and notification data were used. Our results highlight the importance of including uncertainty when forecasting the impact of changes in vaccination policy.\n\nWhat is already known on this subjectO_LITargeted Bacillus Calmette Guerin (BCG) vaccination against TB is recommended in low incidence countries over universal vaccination.\nC_LIO_LIThe impact of replacing universal BCG vaccination in England and Wales with a targeted programme in 2005 was assessed under the assumption of static declines in TB rates.\nC_LIO_LIThe BCG Guerin vaccine was shown to be effective in the UK born in England, regardless of the age at which it was given. School-age vaccination maybe more beneficial in this population than in other settings.\nC_LI\n\nWhat this study addsO_LIUsing notification data from England and Wales from 1973 to 2015, we estimate that the ending the BCG schools scheme likely resulted in more additional cases than was predicted.\nC_LIO_LIThe inclusion of parameter uncertainty, and measurement error, allowed the uncertainty in the final estimates to be presented. Previously published estimates may have been spuriously precise.\nC_LIO_LIThis study highlights the need for a more detailed evaluation of the 2005 change in BCG policy. In particular, the impact of including the introduction of targeted neonatal vaccination and capturing the long term, indirect, effects needs further study.\nC_LI

epidemiology↗

Estimating the effect of the 2005 change in BCG policy in England: A retrospective cohort study

BackgroundIn 2005, England changed from universal Bacillus Calmette-Guerin (BCG) vaccination of school-age children to targeted BCG vaccination of high-risk children at birth.\n\nMethodsWe combined notification data from the Enhanced Tuberculosis Surveillance system, with demographic data from the Labour Force Survey to construct retrospective cohorts of individuals in England relevant to both the universal, and targeted vaccination programmes between Jan 1, 2000 and Dec 31, 2010. For each cohort, we estimated incidence rates over a 5 year follow-up period and used Poisson and Negative Binomial regression models in order to estimate the impact of the change in policy on TB.\n\nResultsIn the non-UK born, we found evidence for an association between a reduction in incidence rates and the change in BCG policy (school-age IRR: 0.74 (95%CI 0.61, 0.88), neonatal IRR: 0.62 (95%CI 0.44, 0.88)). We found some evidence that the change in BCG policy was associated with a increase in incidence rates in the UK born school-age population (IRR: 1.08 (95%CI 0.97, 1.19)) and weaker evidence of an association with a reduction in incidence rates in UK born neonates (IRR: 0.96 (95%CI 0.82, 1.14)). Overall, we found that the change in BCG policy was associated with directly preventing 385 (95% CI -105, 881) TB cases.\n\nConclusionsWithdrawing universal vaccination at school-age and targeting BCG vaccination towards high-risk neonates was associated with reduced incidence of TB in England. This was largely driven by reductions in the non-UK born. There was a slight increase in UK born school-age cases.\n\nKey MessagesO_LIThere is little existing literature on the impact of withdrawing universal school-age BCG vaccination and introducing high-risk neonatal BCG vaccination on TB incidence rates in the populations directly affected by the vaccination programmes.\nC_LIO_LIThere was strong evidence that the change in policy was associated with a decrease in TB incidence rates in non-UK born neonates and school-age children. In the UK born individuals, there was some evidence that the change in policy was associated with an increase in TB incidence rates in those relevant to the universal school-age scheme, with little evidence of a decrease in incidence rates in those relevant to the high-risk neonatal vaccination scheme.\nC_LIO_LIOverall the change in vaccination policy was associated with preventing TB cases, mainly in the non-UK born.\nC_LIO_LIThese results provide an important evaluation of the direct effects of both withdrawing and implementing a BCG vaccination programme in a low incidence, high income, country and are relevant to several other countries that have made similar changes to their vaccination programmes.\nC_LI

epidemiology↗

Exploring the effects of BCG vaccination in patients diagnosed with tuberculosis: observational study using the Enhanced Tuberculosis Surveillance system

BackgroundBacillus Calmette-Guerin (BCG) is one of the most widely-used vaccines worldwide. BCG primarily reduces the progression from infection to disease, however there is evidence that BCG may provide additional benefits. We aimed to investigate whether there is evidence in routinely-collected surveillance data that BCG vaccination impacts outcomes for tuberculosis (TB) cases in England.\n\nMethodsWe obtained all TB notifications for 2009-2015 in England from the Enhanced Tuberculosis surveillance system. We considered five outcomes: All-cause mortality, death due to TB (in those who died), recurrent TB, pulmonary disease, and sputum smear status. We used logistic regression, with complete case analysis, to investigate each outcome with BCG vaccination, years since vaccination and age at vaccination, adjusting for potential confounders. All analyses were repeated using multiply imputed data.\n\nResultsWe found evidence of an association between BCG vaccination and reduced all-cause mortality (aOR:0.76 (95%CI 0.64 to 0.89), P:0.001) and weak evidence of an association with reduced recurrent TB (aOR:0.90 (95%CI 0.81 to 1.00), P:0.056). Analyses using multiple imputation suggested that the benefits of vaccination for all-cause mortality were reduced after 10 years.\n\nConclusionsWe found that BCG vaccination was associated with reduced all-cause mortality in people with TB although this benefit was less pronounced more than 10 years after vaccination. There was weak evidence of an association with reduced recurrent TB.\n\nHighlightsO_LIFound evidence of an association between BCG vaccination and reduced all-cause mortality in TB cases.\nC_LIO_LIWeaker evidence of an association between BCG vaccination and reduced repeat TB episodes in TB cases.\nC_LIO_LIThere was little evidence of an association with other TB outcomes.\nC_LIO_LIWe explored the identified associations by age and time since vaccination.\nC_LI

epidemiology↗