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      A large-scale immuno-epidemiological simulation of influenza A epidemics

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          Abstract

          Background

          Agent based models (ABM) are useful to explore population-level scenarios of disease spread and containment, but typically characterize infected individuals using simplified models of infection and symptoms dynamics. Adding more realistic models of individual infections and symptoms may help to create more realistic population level epidemic dynamics.

          Methods

          Using an equation-based, host-level mathematical model of influenza A virus infection, we develop a function that expresses the dependence of infectivity and symptoms of an infected individual on initial viral load, age, and viral strain phenotype. We incorporate this response function in a population-scale agent-based model of influenza A epidemic to create a hybrid multiscale modeling framework that reflects both population dynamics and individualized host response to infection.

          Results

          At the host level, we estimate parameter ranges using experimental data of H1N1 viral titers and symptoms measured in humans. By linearization of symptoms responses of the host-level model we obtain a map of the parameters of the model that characterizes clinical phenotypes of influenza infection and immune response variability over the population. At the population-level model, we analyze the effect of individualizing viral response in agent-based model by simulating epidemics across Allegheny County, Pennsylvania under both age-specific and age-independent severity assumptions.

          Conclusions

          We present a framework for multi-scale simulations of influenza epidemics that enables the study of population-level effects of individual differences in infections and symptoms, with minimal additional computational cost compared to the existing population-level simulations.

          Electronic supplementary material

          The online version of this article (doi:10.1186/1471-2458-14-1019) contains supplementary material, which is available to authorized users.

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          Most cited references66

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          Modelling disease outbreaks in realistic urban social networks.

          Most mathematical models for the spread of disease use differential equations based on uniform mixing assumptions or ad hoc models for the contact process. Here we explore the use of dynamic bipartite graphs to model the physical contact patterns that result from movements of individuals between specific locations. The graphs are generated by large-scale individual-based urban traffic simulations built on actual census, land-use and population-mobility data. We find that the contact network among people is a strongly connected small-world-like graph with a well-defined scale for the degree distribution. However, the locations graph is scale-free, which allows highly efficient outbreak detection by placing sensors in the hubs of the locations network. Within this large-scale simulation framework, we then analyse the relative merits of several proposed mitigation strategies for smallpox spread. Our results suggest that outbreaks can be contained by a strategy of targeted vaccination combined with early detection without resorting to mass vaccination of a population.
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            Modeling targeted layered containment of an influenza pandemic in the United States.

            Planning a response to an outbreak of a pandemic strain of influenza is a high public health priority. Three research groups using different individual-based, stochastic simulation models have examined the consequences of intervention strategies chosen in consultation with U.S. public health workers. The first goal is to simulate the effectiveness of a set of potentially feasible intervention strategies. Combinations called targeted layered containment (TLC) of influenza antiviral treatment and prophylaxis and nonpharmaceutical interventions of quarantine, isolation, school closure, community social distancing, and workplace social distancing are considered. The second goal is to examine the robustness of the results to model assumptions. The comparisons focus on a pandemic outbreak in a population similar to that of Chicago, with approximately 8.6 million people. The simulations suggest that at the expected transmissibility of a pandemic strain, timely implementation of a combination of targeted household antiviral prophylaxis, and social distancing measures could substantially lower the illness attack rate before a highly efficacious vaccine could become available. Timely initiation of measures and school closure play important roles. Because of the current lack of data on which to base such models, further field research is recommended to learn more about the sources of transmission and the effectiveness of social distancing measures in reducing influenza transmission.
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              Understanding the symptoms of the common cold and influenza

              Ron Eccles (2005)
              Summary The common cold and influenza (flu) are the most common syndromes of infection in human beings. These diseases are diagnosed on symptomatology, and treatments are mainly symptomatic, yet our understanding of the mechanisms that generate the familiar symptoms is poor compared with the amount of knowledge available on the molecular biology of the viruses involved. New knowledge of the effects of cytokines in human beings now helps to explain some of the symptoms of colds and flu that were previously in the realm of folklore rather than medicine—eg, fever, anorexia, malaise, chilliness, headache, and muscle aches and pains. The mechanisms of symptoms of sore throat, rhinorrhoea, sneezing, nasal congestion, cough, watery eyes, and sinus pain are discussed, since these mechanisms are not dealt with in any detail in standard medical textbooks.
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                Author and article information

                Contributors
                slukens@nd.edu
                depasse@psc.edu
                roni.rosenfeld@cs.cmu.edu
                elodie.ghedin@nyu.edu
                edm29@pitt.edu
                stbrown@unicron.psc.edu
                gref@pitt.edu
                donburke@pitt.edu
                swigon@pitt.edu
                clermontg@ccm.upmc.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                29 September 2014
                29 September 2014
                2014
                : 14
                : 1
                : 1019
                Affiliations
                [ ]Department of Mathematics, University of Pittsburgh, Pittsburgh, PA USA
                [ ]Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA USA
                [ ]School of Computer Science, Carnegie Mellon University, Pittsburgh, PA USA
                [ ]Center for Vaccine Research, Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA USA
                [ ]Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA
                [ ]Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA USA
                [ ]Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA USA
                [ ]Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA USA
                [ ]Department of Biological Sciences, University of Notre Dame, South Bend, IN USA
                Article
                7130
                10.1186/1471-2458-14-1019
                4194421
                25266818
                1daf1765-0ae2-4873-8e20-89043f586be8
                © Lukens et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 July 2014
                : 18 September 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Public health
                Public health

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