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e3SIM: epidemiological-ecological-evolutionary simulation framework for genomic epidemiology

Infectious disease dynamics are driven by the complex interplay of epidemiological, ecological, and evolutionary processes. Accurately modeling these interactions is crucial for understanding pathogen spread and informing public health strategies. However, existing simulators often fail to capture the dynamic interplay between these processes, resulting in oversimplified models that do not fully reflect real-world complexities in which the pathogens genetic evolution dynamically influences disease transmission. We introduce the epidemiological-ecological-evolutionary simulator (e3SIM), an open-source framework that concurrently models the transmission dynamics and molecular evolution of pathogens within a host population while integrating environmental factors. Using an agent-based, discrete-generation, forward-in-time approach, e3SIM incorporates compartmental models, host-population contact networks, and quantitative-trait models for pathogens. This integration allows for realistic simulations of disease spread and pathogen evolution. Key features include a modular and scalable design, flexibility in modeling various epidemiological and population-genetic complexities, incorporation of time-varying environmental factors, and a user-friendly graphical interface. We demonstrate e3SIMs capabilities through simulations of realistic outbreak scenarios with SARS-CoV-2 and Mycobacterium tuberculosis, illustrating its flexibility for studying the genomic epidemiology of diverse pathogen types.

bioinformatics↗

Persistent cross-species transmission systems dominate Shiga toxin-producing Escherichia coli O157:H7 epidemiology in a high incidence region: a genomic epidemiology study

BackgroundSeveral areas of the world suffer notably high incidence of Shiga toxin-producing Escherichia coli, among them Alberta, Canada. We assessed the impact of persistent cross-species transmission systems on the epidemiology of E. coli O157:H7 in Alberta. MethodsWe sequenced and assembled 229 E. coli O157:H7 isolates originating from collocated cattle (n=108) and human (n=121) populations from 2007-2015 in Alberta. We constructed a timed phylogeny using BEAST2 using a structured coalescent model. We then extended the tree with human isolates through 2019 (n=430) to assess the long-term disease impact of locally persistent lineages. Shiga toxin gene (stx) profile was determined for all isolates. ResultsDuring 2007 to 2015, we estimated 108 (95% HPD 104, 112) human lineages arose from cattle lineages, and 14 (95% HPD 5, 23) from other human lineages; i.e., 88.5% of human lineages arose from cattle lineages. We identified 11 persistent lineages local to Alberta, which were associated with 38.0% (95% CI 29.3%, 47.3%) of human isolates. Of 117 isolates in locally persistent lineages, 6.0% carried only the Shiga toxin gene stx2a and the rest both stx1a and stx2a. During the later period, six locally persistent lineages continued to be associated with human illness, including 74.7% (95% CI 68.3%, 80.3%) of reported cases in 2018 and 2019. The stx profile of isolates in locally persistent lineages shifted from the earlier period, with 51.2% encoding only stx2a. ConclusionsOur study identified multiple locally evolving lineages transmitted between cattle and humans persistently associated with E. coli O157:H7 illnesses for up to 13 years. Of concern, there was a dramatic shift in locally persistent lineages toward strains with the more virulent stx2a-only profile. Locally persistent lineages may be a principal cause of the high incidence of E. coli O157:H7 in locations such as Alberta and offer opportunities for understanding the disease ecology supporting E. coli O157:H7 persistence, as well as for local prevention efforts.

microbiology↗

Genomic and epidemiological evidence for the emergence of a putative L. donovani/L. infantum hybrid with unusual epidemiology in Northern Italy

Leishmania (L.) infantum is the main causative agent of animal and human leishmaniasis in the Mediterranean basin. Despite its clinical significance, little is known on the genetic diversity of L. infantum parasites circulating in Italy. Here, we apply a comparative genomics approach on seven L. infantum isolates from different hosts (human, dog, cat, marten) and geographic regions (Emilia-Romagna, Sicily, Sardinia) as a first attempt to explore the breadth of parasite genetic heterogeneity in Italy. We revealed important genome instability at karyotype levels, with each isolate presenting a unique aneuploidy profile. Read depth analysis further identified strain-specific changes in gene dosage, which affected important virulence factors most of which are encoded by multi-copy gene arrays, such as amastins or surface antigen-like proteins. SNP-based clustering analysis of these genomes together with over 80 publicly available L. infantum and L. donovani genomes placed the Italian isolates into three geographically distinct clusters, with two isolates grouping with Spanish strains, two isolates grouping with Tunisian strains, and three isolates clustering with putative L. infantum/L. donovani hybrids isolated in Cyprus. As judged by microsatellite profiling of 73 isolates from dogs, sand flies and VL cases, these hybrid isolates are representative of a sub-population of parasites circulating in northeastern Italy that preferentially infects humans, but not dogs. In conclusion, our data uncover a remarkable heterogeneity of L. infantum isolates that indicates different geographic origin, including a novel hybrid-like genotype associated with an unusual infection pattern, placing Italy at the crossroad of Leishmania infection in the Mediterranean region.

genomics↗

Genetic diversity of blaKPC-gene-containing IncF plasmids from epidemiologically related and unrelated Enterobacteriaceae

BackgroundLimited information is available on whether blaKPC-containing plasmids from isolates in a hospital outbreak can be differentiated from epidemiologically unrelated blaKPC-containing plasmids based on sequence data. ObjectiveThis study aimed to evaluate the performance of three approaches to distinguish epidemiologically related from unrelated blaKPC-containing IncF plasmids. MethodEpidemiologically related isolates, were short- and long-read whole genome sequenced on an Illumina MiSeq and MinION sequencer. A hybrid assembly was performed and plasmid sequences were extracted from the assembly graph. Epidemiologically unrelated plasmid sequences were extracted from the GenBank. Pairwise comparisons were performed of epidemiologically related and unrelated plasmids based on SNP differences using snippy, phylogenetic distance using Roary and using a similarity index that penalizes size differences between plasmids (Stoesser-index). The percentage of pairwise comparisons misclassified as genetically related or as clonally unrelated was determined using different genetic thresholds for genetic relatedness for all three comparison methods. ResultsDespite the median number of SNP differences, Roary phylogenetic distance, and Stoesser-index differed between the epidemiologically related and unrelated plasmids, the range of differences overlapped between the two comparison groups for all three comparison methods. When using a genetic similarity threshold that classified 100% of epidemiologically related plasmid pairs as genetically related, the percentages of plasmids misclassified as epidemiologically related ranged from 6.7% (Roary) to 20.8% (Stoesser-index). DiscussionAlthough epidemiologically related plasmids can be distinguished from unrelated plasmids based on genetic similarity, epidemiologically related and unrelated blaKPC-containing IncF plasmids show a high degree of sequence similarity. The phylogenetic distance as determined using Roary showed the highest degree of discriminatory power between the epidemiologically related and unrelated plasmids. Impact statementAccurately distinguishing epidemiologically related from unrelated plasmids is essential to detect nosocomial plasmid transmission in outbreaks. However, limited information is available on whether blaKPC-containing plasmids from isolates in a hospital outbreak can be differentiated from epidemiologically unrelated blaKPC-containing plasmids based on sequence data. This study aimed to evaluate the performance of three approaches to distinguish epidemiologically related from unrelated blaKPC-containing IncF plasmids. Pairwise comparisons were performed of epidemiologically related and unrelated plasmids based on SNP differences using snippy, phylogenetic distance using Roary and using a similarity index that penalizes size differences between plasmids (Stoesser-index). Based on our results, epidemiologically related plasmids can be distinguished from unrelated plasmids based on genetic similarity. Despite this, epidemiologically related and unrelated blaKPC-containing IncF plasmids show a high degree of sequence similarity and judgements on the horizontal transfer of these plasmids during hospital outbreaks based on genetic identity should be made with caution. The phylogenetic distance determined using Roary showed the highest discriminatory power between the epidemiologically related and unrelated plasmids. Data summaryShort-and long-read sequence data of the epidemiologically related Enterobacteriaceae isolates included in this study are available from the publicly available European Nucleotide Archive of the European Bioinformatics Institute under study accession number: PRJEB41009. The authors confirm that all supporting data have been provided within the article and through the supplementary data files.

microbiology↗

Using phylogenetic summary statistics for epidemiological inference

Since the coining of the term phylodynamics, the use of phylogenies to understand infectious disease dynamics has steadily increased. As methods for phylodynamics and genomic epidemiology have proliferated and grown more computationally expensive, the epidemiological information they extract has also evolved to better complement what can be learned through traditional epidemiological data. However, for genomic epidemiology to continue to grow, and for the accumulating number of pathogen genetic sequences to fulfill their potential widespread utility, the extraction of epidemiological information from phylogenies needs to be simpler and more efficient. Summary statistics provide a straightforward way of extracting information from a phylogenetic tree, but the relationship between these statistics and epidemiological quantities needs to be better understood. In this work we address this need via simulation. Using two different benchmark scenarios, we evaluate 74 tree summary statistics and their relationship to epidemiological quantities. In addition to evaluating the epidemiological information that can be inferred from each summary statistic, we also assess the computational cost of each statistic. This helps us optimize the selection of summary statistics for specific applications. Our study offers guidelines on essential considerations for designing or choosing summary statistics. The evaluated set of summary statistics, along with additional helpful functions for phylogenetic analysis, is accessible through an open-source Python library. Our research not only illuminates the main characteristics of many tree summary statistics but also provides valuable computational tools for real-world epidemiological analyses. These contributions aim to enhance our understanding of disease spread dynamics and advance the broader utilization of genomic epidemiology in public health efforts. Author SummaryOur study focuses on the use of phylogenetic analysis to get valuable epidemiological insights. We conducted a simulation study to evaluate 74 phylogenetic summary statistics and their relationship to epidemiological quantities, shedding light on the potential of each of these statistics to quantify different characteristics of disease spread dynamics. Additionally, we assessed the computational cost of each statistic. This gives us additional information when selecting a statistic for a particular application. Our research is available through an open-source Python library. This work helps us enhance our understanding of phylogenetic tree structures and contributes to the broader application of genomic epidemiology in public health initiatives.

genetics↗

The Kendrick Modelling Platform: Language Abstractions and Tools for Epidemiology

BackgroundMathematical and computational models are widely used for examining transmission, pathogenicity and propagation of infectious diseases. Software implementation of such models and their accompanied modelling tools do not adhere to well established software engineering principles. These principles include both modularity and clear separation of concerns that can promote reproducibility and reusability by other researchers. On the contrary the software written for epidemiology is monolithic, highly coupled and severely heterogeneous. This reality ultimately makes these computational models hard to study and to reuse, both because of the programming competence required and because of the incompatibility of the different approaches involved. Our goal with Kendrick is to simplify the creation of epidemiological models through a unified Domain-Specific Language for epidemiology that can support a variety of modelling and simulation approaches classically used in the field. This goal can be achieved by promoting reproducibility and reuse with modular modelling abstractions.\n\nResultsWe show through several examples how our modular abstractions and tools can reproduce uniformly complex mathematical and computational models of epidemics, despite being simulated by different methods. This is achieved without requiring sophisticated programming skills from the part of the user. We then successfully validate each kind of simulation through statistical analysis between the time series generated and the known theoretical expectations.\n\nConclusionsKendrick is one of the few DSLs for epidemiology that does not burden its users with implementation details or expecting sophisticated programming skills. It is also currently the only language for epidemiology that supports modularity through clear separation of concerns that promote reproducibility and reuse. Kendricks wider adoption and further development from the epidemiological community could boost research productivity in epidemiology by allowing researchers to easily reproduce and reuse each others software models and simulations. The tool can also be used by people who are not necessarily epidemiology modelers.

epidemiology↗

ScTree: Scalable and robust mechanistic integration of epidemiological and genomic data for transmission tree inference

Phylodynamic models capture joint epidemiological-evolutionary dynamics during an outbreak, providing a powerful tool to enhance understanding and management of disease transmission. Existing phylodynamic approaches, however, mostly rely on various non-mechanistic or semi-mechanistic approximations of the underlying epidemiological-evolutionary process. Previous work by Lau et al. [1] has shown that full Bayesian mechanistic models, without relying on these approximations, can enable highly accurate joint inference of the epidemiological-evolutionary dynamics including the unobserved transmission tree [1, 2]. However, the Lau method faces major computational bottlenecks. As the volume of genomic data collected during outbreaks continues to grow, it is crucial to develop scalable yet accurate phylodynamic methods. Here we propose a new Bayesian phylodynamic model, overcoming the major scalability issue in the Lau 2015 method and enabling a readily deployable, yet accurate, phylodynamic modeling framework. Specifically, we develop a scalable spatio-temporal phylodynamic framework for inferring the transmission tree (ScTree) and other key epidemiological parameters considering the infinite sites assumption in modeling mutation on the sequence level, in contrast to Lau 2015 in which mutation was modeled explicitly on the nucleotide level. Our approach features full Bayesian implementation utilizing a realistic likelihood to mechanistically integrate epidemiological and evolutionary processes. We develop a computationally-efficient data-augmentation Markov Chain Monte Carlo algorithm, inferring key model parameters and unobserved dynamics including the transmission tree. We assess performance of our method using multiple simulated outbreak datasets. Our results indicate that our method can achieve high inference accuracy, comparable to the performance of the Lau 2015 method. Additionally, our method scales significantly more efficiently for large outbreaks, with computing time increasing linearly with outbreak size, compared to the exponential scaling of the Lau method. We also demonstrate our methods utility by applying our validated modeling framework to a dataset describing a foot-and-mouth disease outbreak in the UK [3]. Our results show that our method is able to generate estimates of the transmission dynamics consistent with those from the Lau 2015 method, further demonstrating the robustness of our new approach. In summary, our method provides a computationally-efficient, highly scalable, accurate modeling framework for inferring the joint spatio-temporal dynamics of epidemiological and evolutionary processes, facilitating timely and effective outbreak responses in space and time. Our method is implemented in our R package ScTree. Author summaryPhylodynamic models integrate epidemiological and evolutionary dynamics to better understand disease transmission during outbreaks. However, many existing models rely on approximations that limit their accuracy and interpretability. Previous work by Lau et al. has shown that full Bayesian mechanistic models, without relying on these approximations, can enable highly accurate joint inference of the epidemiological-evolutionary dynamics including the unobserved transmission tree. Their method, however, faced significant computational challenges, particularly with large datasets. In this study, we present a new Bayesian phylodynamic model, ScTree, designed to overcome the scalability issues of the Lau 2015 method. By adopting the infinite-sites assumption for modeling mutations, rather than explicitly modeling nucleotide-level changes, ScTree achieves a significant improvement in computational efficiency while retaining accuracy of model inference. Our method, validated through simulations and real outbreak data, provides results comparable to the original Lau model but at a fraction of the computational cost, demonstrating its scalability and practical application for real-time outbreak responses. ScTree is implemented as an R package, making it accessible for further research and public health use.

evolutionary biology↗

MGDrivE 3: A decoupled vector-human framework for epidemiological simulation of mosquito genetic control tools and their surveillance

Novel mosquito genetic control tools, such as CRISPR-based gene drives, hold great promise in reducing the global burden of vector-borne diseases. As these technologies advance through the research and development pipeline, there is a growing need for modeling frameworks incorporating increasing levels of entomological and epidemiological detail in order to address questions regarding logistics and biosafety. Epidemiological predictions are becoming increasingly relevant to the development of target product profiles and the design of field trials and interventions, while entomological surveillance is becoming increasingly important to regulation and biosafety. We present MGDrivE 3 (Mosquito Gene Drive Explorer 3), a new version of a previously-developed framework, MGDrivE 2, that investigates the spatial population dynamics of mosquito genetic control systems and their epidemiological implications. The new framework incorporates three major developments: i) a decoupled sampling algorithm allowing the vector portion of the MGDrivE framework to be paired with a more detailed epidemiological framework, ii) a version of the Imperial College London malaria transmission model, which incorporates age structure, various forms of immunity, and human and vector interventions, and iii) a surveillance module that tracks mosquitoes captured by traps throughout the simulation. Example MGDrivE 3 simulations are presented demonstrating the application of the framework to a CRISPR-based homing gene drive linked to dual disease-refractory genes and their potential to interrupt local malaria transmission. Simulations are also presented demonstrating surveillance of such a system by a network of mosquito traps. MGDrivE 3 is freely available as an open-source R package on CRAN (https://cran.r-project.org/package=MGDrivE2) (version 2.1.0), and extensive examples and vignettes are provided. We intend the software to aid in understanding of human health impacts and biosafety of mosquito genetic control tools, and continue to iterate per feedback from the genetic control community. Author summaryVector-borne diseases such as malaria cause massive morbidity and mortality throughout much of the world. Currently-available control measures, such as insecticide-based tools and antimalarial drugs, have limited impact and are waning in effectiveness, hence there is a need for novel tools to complement existing ones. Mosquito genetic control tools, such as gene drive systems and genetic versions of the sterile insect technique, offer a range of promising options, the development of which has greatly expanded since the advent of CRISPR-based gene-editing. Recently, we proposed MGDrivE 2 (Mosquito Gene Drive Explorer 2), which incorporates epidemiology into simulations of the dynamics of these systems in spatially-structured mosquito populations; however, that framework relied on simple model representations of vector-borne diseases. Here, we present MGDrivE 3, which decouples the vector portion of the model from the human portion, allowing the mosquito genetic control framework to be paired with more-detailed epidemiological frameworks. As an example, we implement the human transmission dynamics of the Imperial College London malaria model. We also incorporate a network of mosquito traps for surveillance. As genetic control technology edges closer towards field implementation, more detailed predictions of its epidemiological and biosafety implications are needed. We propose MGDrivE 3 to fulfill this role.

ecology↗

A generic multi-level stochastic modelling framework in computational epidemiology

There is currently an overwhelming increased interest in predictive biology and computational modelling. The development of reliable, reproducible and revisable simulation models in computational life sciences is often pointed out as a challenging issue. Population dynamics, including epidemiology, has not yet developed a language to formalize complex models in a univocal and automatable way, hence hindering the capability to implement in short time reliable, revisable and expert-friendly models intended for realistic mechanistic simulations. In epidemiology specifically, models aim not only at understanding pathogen spread but also at assessing control measures at several scales. To achieve this goal efficiently, best software practices should be supported by Artificial Intelligence methods to handle experts knowledge. The framework EMULSION presented here intends to both tackle multiple modelling paradigms in epidemiology and facilitate the automation of model design. We therefore built both a domain-specific language (DSL) for the modular description of complex epidemiological models, and a generic simulation engine designed to embed existing modelling paradigms within a homogeneous architecture based on adaptive software agents. The diversity of concerns (biology, economics, human activities) involved in real pathosystems requires an explicit, comprehensive and intelligible way to describe epidemiological models, to involve experts without computer science skills throughout the modelling, simulation and output analysis steps. This approach was applied to compare hypotheses in modelling a zoonosis (Q fever), to study its transmission dynamics within and between cattle herds at a regional scale, and to assess the contribution of transmission pathways. Separating model description from the simulation engine allowed epidemiologists to be involved in assumption revision, while guaranteeing very few code modifications. We assessed the added value of EMULSION by applying the DSL and the simulation engine to a concrete disease. Future extensions of EMULSION towards a broader range of epidemiological concerns will reduce significantly the time required to design and assess models and control measures against endemic and epidemic diseases. Ultimately, we believe this effort is a major lever to increase scientists preparedness to face emerging threats for public health and provide rapid, reliable, and reasoned assessments of control measures.

epidemiology↗

Elucidating relationships between P.falciparum prevalence and measures of genetic diversity with a combined genetic-epidemiological model of malaria

There is an abundance of malaria genetic data being collected from the field, yet using this data to understand features of regional epidemiology remains a challenge. A key issue is the lack of models that relate parasite genetic diversity to epidemiological parameters. Classical models in population genetics characterize changes in genetic diversity in relation to demographic parameters, but fail to account for the unique features of the malaria life cycle. In contrast, epidemiological models, such as the Ross-Macdonald model, capture malaria transmission dynamics but do not consider genetics. Here, we have developed an integrated model encompassing both parasite evolution and regional epidemiology. We achieve this by combining the Ross-Macdonald model with an intra-host continuous-time Moran model, thus explicitly representing the evolution of individual parasite genomes in a traditional epidemiological framework. Implemented as a stochastic simulation, we use the model to explore relationships between measures of parasite genetic diversity and parasite prevalence, a widely-used metric of transmission intensity. First, we explore how varying parasite prevalence influences genetic diversity at equilibrium. We find that multiple genetic diversity statistics are correlated with prevalence, but the strength of the relationships depends on whether variation in prevalence is driven by host- or vector-related factors. Next, we assess the responsiveness of a variety of statistics to malaria control interventions, finding that those related to mixed infections respond quickly (~ months) whereas other statistics, such as nucleotide diversity, may take decades to respond. These findings provide insights into the opportunities and challenges associated with using genetic data to monitor malaria epidemiology. Author summaryKnowledge of how the prevalence of P.falciparum malaria varies, either between regions or through time, is critical to the operation of malaria control programs. Yet obtaining this information through traditional methods is fraught with challenges. Parasite genetic data is increasingly accessible, and may provide an alternative means to estimate P.falciparum prevalence in the field. However, our understanding of how the genetic diversity of parasite populations relates to prevalence is limited, and suitable models to guide our understanding are largely lacking. Here, we merge two classical models - the Ross-Macondald and the Moran - to produce a framework in which the relationships between parasite genetic diversity and prevalence can be explored. We find that several genetic diversity statistics are correlated with prevalence, although to differing degrees, and over different time scales. Overall, statistics related to mixed infection are robustly and rapidly responsive to changes in prevalence, suggesting they may be a useful focal point for the development of malaria surveillance methods that harness genetic data.

genomics↗

A comparison of short- and long-read whole genome sequencing for microbial pathogen epidemiology

Whole genome sequencing provides the highest resolution for characterizing pathogen evolution, epidemiology, and diagnostics. Genome assemblies contain information on the identity and potential phenotypes of a pathogen. Likewise, variant calling can inform on transmission patterns and evolutionary relationships. Recent improvements in Oxford Nanopore long-read sequencing have made its use attractive for genomic epidemiology. However, the accuracy and optimal strategy for analysis of Nanopore reads remains to be determined. We compared the use of Illumina short reads and Oxford Nanopore long reads for genome assembly and variant calling of phytopathogenic bacteria. We generated short- and long-read datasets for diverse phytopathogenic Agrobacterium strains. We then analyzed these data using multiple pipelines designed for either short or long reads and compared the results. We found that assemblies made from long reads were more complete than those made from short-read data and contained few sequence errors. Variant calling pipelines differed in their ability to accurately call variants and infer genotypes from long reads. Results suggest that computationally fragmenting long reads can improve the accuracy of variant calling in population-level studies. Using fragmented long reads, pipelines designed for short reads were more accurate at recovering genotypes than pipelines designed for long reads. Further, short- and long-read datasets can be analyzed together with the same pipelines. These findings show that Oxford Nanopore sequencing is accurate and can be sufficient for microbial pathogen genomics and epidemiology. Ultimately, this enhances the ability of researchers and clinicians to understand and mitigate the spread of pathogens. ImportanceGenome assembly and variant calling are important steps in microbial population studies and epidemiology. Most variant calling and genotyping pipelines are designed for Illumina short sequencing reads. Oxford Nanopore Technology long-read sequencing results in more complete genome assemblies but has historically been of lower quality. Here, we show that Nanopore long reads are now of sufficient quality for bacterial whole genome assembly and epidemiology. We benchmarked the accuracy of multiple variant-calling pipelines with short and long reads. Using an optimized variant calling approach, variant calls and genotypes inferred from long reads are as accurate as those inferred from short reads. Importantly, we found that gold-standard variant calling pipelines designed for short reads are also accurate with long reads when long reads are first fragmented into shorter sequences. This finding allows researchers to incorporate the advantages of Nanopore sequencing for genome assembly, while maintaining high accuracy for epidemiology and population analysis.

genomics↗

Transfer entropy as a tool for inferring causality from observational studies in epidemiology

Recently Wieners causality theorem, which states that one variable could be regarded as the cause of another if the ability to predict the future of the second variable is enhanced by implementing information about the preceding values of the first variable, was linked to information theory through the development of a novel metric called transfer entropy. Intuitively, transfer entropy can be conceptualized as a model-free measure of directed information flow from one variable to another. In contrast, directionality of information flow is not reflected in traditional measures of association which are completely symmetric by design. Although information theoretic approaches have been applied before in epidemiology, their value for inferring causality from observational studies is still unknown. Therefore, in the present study we use a set of simulation experiments, reflecting the most classical and widely used epidemiological observational study design, to validate the application of transfer entropy in epidemiological research. Moreover, we illustrate the practical applicability of this information theoretic approach to real-world epidemiological data by demonstrating that transfer entropy is able to extract the correct direction of information flow from longitudinal data concerning two well-known associations, i.e. that between smoking and lung cancer and that between obesity and diabetes risk. In conclusion, our results provide proof-of-concept that the recently developed transfer entropy method could be a welcome addition to the epidemiological armamentarium, especially to dissect those situations in which there is a well-described association between two variables but no clear-cut inclination as to the directionality of the association.

epidemiology↗

Proof of concept for quantitative urine NMR metabolomics pipeline for large-scale epidemiology and genetics

BackgroundQuantitative molecular data from urine are rare in epidemiology and genetics. NMR spectroscopy could provide these data in high-throughput, and it has already been applied in epidemiological settings to analyse urine samples. However, quantitative protocols for large-scale applications are not available.\n\nMethodsWe describe in detail how to prepare urine samples and perform NMR experiments to obtain quantitative metabolic information. Semi-automated quantitative lineshape fitting analyses were set up for 43 metabolites and applied to data from various analytical test samples and from 1,004 individuals from a population-based epidemiological cohort. Novel analyses on how urine metabolites associate with quantitative serum NMR metabolomics data (61 metabolic measures; n=995) were performed. In addition, confirmatory genome-wide analyses of urine metabolites were conducted (n=578). The fully automated quantitative regression-based spectral analysis is demonstrated for creatinine and glucose (n= 4,548).\n\nResultsIntra-assay metabolite variations were mostly <5% indicating high robustness and accuracy of the urine NMR spectroscopy methodology per se. Intra-individual metabolite variations were large, ranging from 6% to 194%. However, population-based inter-individual metabolite variations were even larger (from 14% to 1655%), providing a sound base for epidemiological applications. Metabolic associations between urine and serum were found clearly weaker than those within serum and within urine, indicating that urinary metabolomics data provide independent metabolic information. Two previous genome-wide hits for formate and 2-hydroxyisobutyrate were replicated at genome-wide significance.\n\nConclusionsQuantitative urine metabolomics data suggest broad novelty for systems epidemiology. A roadmap for an open access methodology is provided.

epidemiology↗

Evaluating sepsis definitions for clinical decision support against a definition for epidemiological disease surveillance

Epidemiological definitions for sepsis have been used to improve disease surveillance and assist in national assessment of sepsis detection and treatment. However, epidemiological definitions are often optimized for retrospective review and alignment of epidemiological and real-time clinical decision support definitions is unknown. This 15-month retrospective observational study involving 43,046 adult patient encounters and 30,973 unique patients compared cohorts captured by the EHR-based Sepsis-1, Sepsis-3, and Duke Adult Sepsis definitions. We assessed hospital length of stay, in-hospital mortality, admission to the intensive care unit, and sensitivity and specificity of these definitions compared to the Centers for Disease Control and Prevention epidemiological gold-standard definition. Both Duke Adult Sepsis and Sepsis-3 maintained a high specificity, but the former had higher sensitivity. By directly comparing definitions designed for clinical decision support with an epidemiological disease surveillance tool, this work provides guidance to health systems seeking to implement clinical decision support to improve sepsis management.

epidemiology↗

EPIDEMIOLOGICAL AND SPACE ASPECTS OF THE SCHOOLS OF THE NATIONAL LEPROSY CAMPAIGN: the case of Sobral - Ceara

The objective of this study is to describe the epidemiological and spatial aspects of leprosy of the schoolchildren participating in the National Leprosy Campaign in the municipality of Sobral, Ceara, in the year 2016. This is a cross-sectional epidemiological study with spatial analysis of secondary data obtained in the records instruments used in the Campaign (self-image files), with public school schoolchildren from five to fourteen years old. From this population a sample was taken to be studied from the calculation of a standard error limit of 5%, confidence level of 99.99% and an expected frequency of 50%, resulting in 1,216 students, corresponding to 19.7% of a total of 6,169 schoolchildren who returned the completed self-indexed records. A descriptive analysis was performed for all the variables of interest of the study object and for the spatial analysis the QGIS program 2.18 was used. Of the 1,216 schoolchildren participating in the study, 31.7% had body spots and 18.1% (220/1126) of the total number of schoolchildren had leprosy cases in the study. Of the 1,216 students in the study, 31.7% (386/1). Among the schoolchildren with spots on the body, 6.2% (75/1126) reported having cases of leprosy in the family, 59.3% (195/329) are birthmarks, 20.7% Among children with spots suspected of leprosy (39.2%, 129/329), they were found to be dormant (9.3%) (31/329) and 10.6% (35/329) The strategies for the screening of new suspected leprosy cases developed through campaigns helped to mobilize around the epidemiological situation of leprosy, facilitating the dissemination of information to leprosy patients. the population on the recognition of signs and symptoms, treatment and cure of leprosy.\n\nAUTHOR SUMMARYLeprosy is an infectious and contagious, chronic disease caused by Mycobacterium leprae (M. leprae), which has high infectivity and low pathogenicity. Brazil is part of the group of three countries responsible for 80.2% of all new cases registered in the world in 2017 and in the Region of the Americas contributed with 92.3% of new cases. The National Leprosy Campaign aims to find new cases of leprosy in children 5 (five) to 14 years of age. Sobral, a city of Ceara, with high disease burden, has been joining the campaign every year since 2013. This study describes the epidemiological and spatial aspects of leprosy of students participating in the National Leprosy Campaign in the municipality of Sobral, Ceara, in 2016. Strategies for screening new suspected leprosy cases developed through Campaigns, in addition to contributing to the identification of new cases in the community, promote a mobilization around the epidemiological disease situation and dissemination of information to the population on the recognition of signs and symptoms, treatment and cure of leprosy.

epidemiology↗

Real-time genomic and epidemiological investigation of a multi-institution outbreak of KPC-producing Enterobacteriaceae: a translational study

BackgroundUntil recently, KPC-producing Enterobacteriaceae were rarely identified in Australia. Following an increase in the number of incident cases across the state of Victoria, we undertook a real-time combined genomic and epidemiological investigation. The scope of this study included identifying risk factors and routes of transmission, and investigating the utility of genomics to enhance traditional field epidemiology for informing management of established widespread outbreaks.\n\nMethods and FindingsAll KPC-producing Enterobacteriaceae isolates referred to the state reference laboratory from 2012 onwards were included. Whole-genome sequencing (WGS) was performed in parallel with a detailed descriptive epidemiological investigation of each case, using Illumina sequencing on each isolate. This was complemented with PacBio long-read sequencing on selected isolates to establish high-quality reference sequences and interrogate characteristics of KPC-encoding plasmids. Initial investigations indicated the outbreak was widespread, with 86 KPC-producing Enterobacteriaceae isolates (K. pneumoniae 92%) identified from 35 different locations across metropolitan and rural Victoria between 2012-2015. Initial combined analyses of the epidemiological and genomic data resolved the outbreak into distinct nosocomial transmission networks, and identified healthcare facilities at the epicentre of KPC transmission. New cases were assigned to transmission networks in real-time, allowing focussed infection control efforts. PacBio sequencing confirmed a secondary transmission network arising from inter-species plasmid transmission. Insights from Bayesian transmission inference and analyses of within-host diversity informed the development of state-wide public health and infection control guidelines, including interventions such as an intensive approach to screening contacts following new case detection to minimise unrecognised colonisation.\n\nConclusionsA real-time combined epidemiological and genomic investigation proved critical to identifying and defining multiple transmission networks of KPC Enterobacteriaceae, while data from either investigation alone were inconclusive. The investigation was fundamental to informing infection control measures in real-time and the development of state-wide public health guidelines on carbapenemase producing Enterobacteriaceae management.

genomics↗

Feedback Between Coevolution and Epidemiology Can Help or Hinder the Maintenance of Genetic Variation in Host-Parasite Models

Understanding if and when coevolution helps maintains genetic variation in hosts of a directly-transmissible pathogen is fundamental to quantifying the prevalence and impact of coevolution on disease epidemiology. Here, we extend our previous work on the maintenance of genetic variation in a classic matching-alleles coevolutionary model by exploring the effects of ecological and epidemiological feedbacks, where both allele frequencies and population sizes are allowed to vary over time. In general, we find that coevolution rarely maintains more host genetic variation than expected under neutral genetic drift alone. When and if coevolution maintains or depletes genetic variation relative to neutral drift is determined, predominantly, by two factors: the deterministic stability of the Red Queen allele frequency cycles and the frequency at which pathogen fixation occurs, as this results in directional selection and the depletion of genetic variation in the host. Compared to purely coevolutionary models with constant host and pathogen population sizes, ecological and epidemiological feedbacks stabilize Red Queen cycles deterministically, but population fluctuations in the pathogen increase the rate of pathogen fixation, especially in epidemiological models. Taken together our results illustrate the importance of considering the ecological and epidemiological context in which coevolution occurs when examining the impact of Red Queen cycles on genetic variation.

evolutionary biology↗

High throughput detection and genetic epidemiology of SARS-CoV-2 using COVIDSeq next generation sequencing

The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance and for determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for detection of SARS-CoV-2, with an additional advantage of enabling genetic epidemiology of SARS-CoV-2.

genomics↗