Marinova, D. | Search bioRxiv

bioRxiv2018

Design principles for TB vaccines’ clinical trials based on spreading dynamics

Tuberculosis (TB) is one of the most complex diseases from the perspective of mathematical epidemiology. Individuals recently infected with the bacillus Mycobacterium tuberculosis can either develop TB directly in a matter of several weeks, or enter into an asymptomatic latent TB infection state (LTBI) that only occasionally derives into active disease, sometimes even decades after the infection event. The possible interruptions that a vaccine might provoke on these two mechanisms are indistinguishable in phase II clinical trials. In this work, we present a new methodology that allows differentiating vaccines that slow down the progression to disease from vaccines that prevent it. By introducing a stochastic framework for simulating synthetic clinical trials based on transmission models, we show how the method proposed here contributes both to reduce uncertainty in vaccine characterization and impact forecasts as well as to assist the design of clinical trials, improving their probabilities of success.

epidemiology↗

bioRxiv2017

A data-driven model for the assessment of age-dependent patterns of Tuberculosis burden and impact evaluation of novel vaccines.

In the case of tuberculosis (TB), the capabilities of epidemic models to produce quantitatively robust forecasts are limited by multiple hindrances. Among these, understanding the complex relationship between disease epidemiology and populations' age structure has been highlighted as one of the most relevant. TB dynamics depends on age in multiple ways, some of which are traditionally simplified in the literature. That is the case of the heterogeneities in contact intensity among different age-strata that are common to all air-borne diseases, but still typically neglected in the TB case. Furthermore, whilst demographic structures of many countries are rapidly aging, demographic dynamics is pervasively ignored when modeling TB spreading. In this work, we present a TB transmission model that incorporates country-specific demographic prospects and empirical contact data around a data-driven description of TB dynamics. Using our model, we find that the inclusion of demographic dynamics is followed by an increase in the burden levels prospected for the next decades in the areas of the world that are most hit by the disease nowadays. Similarly, we show that considering realistic patterns of contacts among individuals in different age-strata reshapes the transmission patterns reproduced by the models, a result with potential implications for the design of age-focused epidemiological interventions.\n\nSignificance StatementEven though tuberculosis (TB) is acknowledged as a strongly age-dependent disease, it remains unclear how TB epidemics would react, in the following decades, to the generalized aging that human populations are experiencing worldwide. This situation is partly caused by the limitations of current transmission models at describing the relationship between demography and TB transmission. Here, we present a data-driven epidemiological model that, unlike previous approaches, explicitly contemplates relevant aspects of the coupling between agestructure and TB dynamics, such as demographic evolution and contact heterogeneities. Using our model, we identify substantial biases in epidemiological forecasts rooted in an inadequate description of these aspects, both at the level of aggregated incidence and mortality rates and their distribution across age-strata.

epidemiology↗