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      Modelling the transmission and control strategies of varicella among school children in Shenzhen, China

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          Abstract

          Objectives

          Varicella (chickenpox) is a highly transmissible childhood disease. Between 2010 and 2015, it displayed two epidemic waves annually among school populations in Shenzhen, China. However, their transmission dynamics remain unclear and there is no school-based vaccination programme in Shenzhen to-date. In this study, we developed a mathematical model to compare a school-based vaccination intervention scenario with a baseline (i.e. no intervention) scenario.

          Methods

          Data on varicella reported cases were downloaded from the Infectious Disease Reporting Information Management System. We obtained the population size, age structure of children aged 15 or under, the class and school distribution from Shenzhen Education Bureau. We developed an Agent-Based Susceptible-Exposed-Infectious-Recovered (ABM-SEIR) Model that considered within-class, class-to-class and out-of-school transmission modes. The intervention scenario was that school-wide vaccination intervention occurred when an outbreak threshold was reached within a school. We varied this threshold level from five to ten cases. We compared the reduction of disease outbreak size and estimated the key epidemiological parameters under the intervention strategy.

          Results

          Our ABM-SEIR model provided a good model fit to the two annual varicella epidemic waves from 2013 to 2015. The transmission dynamics displayed strong seasonality. Our results suggested that a school-based vaccination strategy could effectively prevent large outbreaks at different thresholds.

          Conclusions

          There was a considerable increase in reported varicella cases from 2013 to 2015 in Shenzhen. Our modelling study provided important theoretical support for disease control decision making during school outbreaks and the development of a school-based vaccination programme.

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          Most cited references24

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          Using data on social contacts to estimate age-specific transmission parameters for respiratory-spread infectious agents.

          The estimation of transmission parameters has been problematic for diseases that rely predominantly on transmission of pathogens from person to person through small infectious droplets. Age-specific transmission parameters determine how such respiratory agents will spread among different age groups in a human population. Estimating the values of these parameters is essential in planning an effective response to potentially devastating pandemics of smallpox or influenza and in designing control strategies for diseases such as measles or mumps. In this study, the authors estimated age-specific transmission parameters by augmenting infectious disease data with auxiliary data on self-reported numbers of conversational partners per person. They show that models that use transmission parameters based on these self-reported social contacts are better able to capture the observed patterns of infection of endemically circulating mumps, as well as observed patterns of spread of pandemic influenza. The estimated age-specific transmission parameters suggested that school-aged children and young adults will experience the highest incidence of infection and will contribute most to further spread of infections during the initial phase of an emerging respiratory-spread epidemic in a completely susceptible population. These findings have important implications for controlling future outbreaks of novel respiratory-spread infectious agents.
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            A Small Community Model for the Transmission of Infectious Diseases: Comparison of School Closure as an Intervention in Individual-Based Models of an Influenza Pandemic

            Background In the absence of other evidence, modelling has been used extensively to help policy makers plan for a potential future influenza pandemic. Method We have constructed an individual based model of a small community in the developed world with detail down to exact household structure obtained from census collection datasets and precise simulation of household demographics, movement within the community and individual contact patterns. We modelled the spread of pandemic influenza in this community and the effect on daily and final attack rates of four social distancing measures: school closure, increased case isolation, workplace non-attendance and community contact reduction. We compared the modelled results of final attack rates in the absence of any interventions and the effect of school closure as a single intervention with other published individual based models of pandemic influenza in the developed world. Results We showed that published individual based models estimate similar final attack rates over a range of values for R0 in a pandemic where no interventions have been implemented; that multiple social distancing measures applied early and continuously can be very effective in interrupting transmission of the pandemic virus for R0 values up to 2.5; and that different conclusions reached on the simulated benefit of school closure in published models appear to result from differences in assumptions about the timing and duration of school closure and flow-on effects on other social contacts resulting from school closure. Conclusion Models of the spread and control of pandemic influenza have the potential to assist policy makers with decisions about which control strategies to adopt. However, attention needs to be given by policy makers to the assumptions underpinning both the models and the control strategies examined.
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              Global Varicella Vaccine Effectiveness: A Meta-analysis.

              Several varicella vaccines are available worldwide. Countries with a varicella vaccination program use 1- or 2-dose schedules.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2017
                18 May 2017
                : 12
                : 5
                : e0177514
                Affiliations
                [1 ]Shenzhen Center for Disease Control and Prevention, Shenzhen, China
                [2 ]Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China
                Shanxi University, CHINA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: XJT SZ DH AC.

                • Data curation: HM SM DK YQ ZC XW.

                • Formal analysis: XJT SZ DH AC.

                • Funding acquisition: XW.

                • Investigation: XJT SZ DH AC HM SM DK YQ ZC XW XX.

                • Methodology: XJT SZ DH AC.

                • Project administration: XJT SZ DH AC.

                • Resources: XJT SZ DH AC HM SM DK YQ ZC XW XX.

                • Software: XJT SZ DH AC.

                • Supervision: XJT SZ DH AC.

                • Validation: XJT SZ DH AC HM SM DK YQ ZC XW XX.

                • Visualization: XJT SZ DH AC.

                • Writing – original draft: AC XJT SZ DH.

                • Writing – review & editing: AC XJT SZ DH HM SM DK YQ ZC XW XX.

                Author information
                http://orcid.org/0000-0003-3253-654X
                Article
                PONE-D-17-09391
                10.1371/journal.pone.0177514
                5436677
                28542182
                16ecef2d-8195-4701-8ffc-4646d8489a4b
                © 2017 Tang et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 March 2017
                : 29 April 2017
                Page count
                Figures: 7, Tables: 5, Pages: 17
                Funding
                Funded by: ShenZhen Science and Technology Innovation Project Grant
                Award ID: JCYJ20150402102135501
                Award Recipient :
                This study was supported by Shenzhen Science and Technology Innovation Project 313 Grant (JCYJ20150402102135501). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Social Sciences
                Sociology
                Education
                Schools
                Biology and life sciences
                Organisms
                Viruses
                DNA viruses
                Herpesviruses
                Varicella Zoster Virus
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Herpesviruses
                Varicella Zoster Virus
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Herpesviruses
                Varicella Zoster Virus
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Herpesviruses
                Varicella Zoster Virus
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Public and Occupational Health
                Preventive Medicine
                Vaccination and Immunization
                People and Places
                Population Groupings
                Age Groups
                Medicine and Health Sciences
                Epidemiology
                Infectious Disease Epidemiology
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Epidemiology
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                People and Places
                Geographical Locations
                Asia
                China
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                Vaccines
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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