How social structures, space, and behaviors shape the spread of infectious diseases using chikungunya as a case study

Significance

Although the determinants of infectious disease transmission have been extensively investigated in small social structures such as households or schools, the impact of the wider environment (e.g., neighborhood) on transmission has received less attention. Here we use an outbreak of chikungunya as a case study where detailed epidemiological data were collected and combine it with statistical approaches to characterize the multiple factors that influence the risk of infectious disease transmission and may depend on characteristics of the individual (e.g., age, sex), of his or her close relatives (e.g., household members), or of the wider neighborhood. Our findings highlight the role that integrating statistical approaches with in-depth information on the at-risk population can have on understanding pathogen spread.

Abstract

Whether an individual becomes infected in an infectious disease outbreak depends on many interconnected risk factors, which may relate to characteristics of the individual (e.g., age, sex), his or her close relatives (e.g., household members), or the wider community. Studies monitoring individuals in households or schools have helped elucidate the determinants of transmission in small social structures due to advances in statistical modeling; but such an approach has so far largely failed to consider individuals in the wider context they live in. Here, we used an outbreak of chikungunya in a rural community in Bangladesh as a case study to obtain a more comprehensive characterization of risk factors in disease spread. We developed Bayesian data augmentation approaches to account for uncertainty in the source of infection, recall uncertainty, and unobserved infection dates. We found that the probability of chikungunya transmission was 12% [95% credible interval (CI): 8–17%] between household members but dropped to 0.3% for those living 50 m away (95% CI: 0.2–0.5%). Overall, the mean transmission distance was 95 m (95% CI: 77–113 m). Females were 1.5 times more likely to become infected than males (95% CI: 1.2–1.8), which was virtually identical to the relative risk of being at home estimated from an independent human movement study in the country. Reported daily use of antimosquito coils had no detectable impact on transmission. This study shows how the complex interplay between the characteristics of an individual and his or her close and wider environment contributes to the shaping of infectious disease epidemics.