Article

# Protecting residential care facilities from pandemic influenza.

Department of Biostatistics, School of Public Health, University of California, Los Angeles, CA 90095-1772, USA.

Proceedings of the National Academy of Sciences (Impact Factor: 9.81). 07/2008; 105(30):10625-30. DOI: 10.1073/pnas.0712014105 Source: PubMed

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Gerardo Chowell, Jun 20, 2015 Available from: Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

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**ABSTRACT:**Background Ebola is one of the most virulent human viral diseases, with a case fatality ratio between 25% to 90%. The 2014 West African outbreaks are the largest and worst in history. There is no specific treatment or effective/safe vaccine against the disease. Hence, control efforts are restricted to basic public health preventive (non-pharmaceutical) measures. Such efforts are undermined by traditional/cultural belief systems and customs, characterized by general mistrust and skepticism against government efforts to combat the disease. This study assesses the roles of traditional customs and public healthcare systems on the disease spread. Methods A mathematical model is designed and used to assess population-level impact of basic non-pharmaceutical control measures on the 2014 Ebola outbreaks. The model incorporates the effects of traditional belief systems and customs, along with disease transmission within health-care settings and by Ebola-deceased individuals. A sensitivity analysis is performed to determine model parameters that most affect disease transmission. The model is parameterized using data from Guinea, one of the three Ebola-stricken countries. Numerical simulations are performed and the parameters that drive disease transmission, with or without basic public health control measures, determined. Three effectiveness levels of such basic measures are considered. Results The distribution of the basic reproduction number (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\mathcal {R}_{0}$\end{document}R0) for Guinea (in the absence of basic control measures) is such that \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\mathcal {R}_{0}\in \;[0.77,1.35]$\end{document}R0∈[0.77,1.35], for the case when the belief systems do not result in more unreported Ebola cases. When such systems inhibit control efforts, the distribution increases to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$\mathcal {R}_{0}\in \;[1.15,2.05]$\end{document}R0∈[1.15,2.05]. The total Ebola cases are contributed by Ebola-deceased individuals (22%), symptomatic individuals in the early (33%) and latter (45%) infection stages. A significant reduction of new Ebola cases can be achieved by increasing health-care workers’ daily shifts from 8 to 24 hours, limiting hospital visitation to 1 hour and educating the populace to abandon detrimental traditional/cultural belief systems. Conclusions The 2014 outbreaks are controllable using a moderately-effective basic public health intervention strategy alone. A much higher (>50%) disease burden would have been recorded in the absence of such intervention. 2000 Mathematics Subject Classifications 92B05, 93A30, 93C15.BMC Medicine 12/2015; 13(1). DOI:10.1186/s12916-015-0318-3 · 7.28 Impact Factor -
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**ABSTRACT:**The paper presents a rigorous mathematical analysis of a deterministic model, which uses a standard incidence function, for the transmission dynamics of a communicable disease with an arbitrary number of distinct infectious stages. It is shown, using a linear Lyapunov function, that the model has a globally-asymptotically stable disease-free equilibrium whenever the associated reproduction threshold is less than unity. Further, the model has a unique endemic equilibrium when the threshold exceeds unity. The equilibrium is shown to be locally-asymptotically stable, for a special case, using a Krasnoselskii sub-linearity trick. Finally, a non-linear Lyapunov function is used to show the global asymptotic stability of the endemic equilibrium (for the special case). Numerical simulation results, using parameter values relevant to the transmission dynamics of influenza, are presented to illustrate some of the main theoretical results.Journal of Mathematical Analysis and Applications 06/2010; 366(1-366):202-217. DOI:10.1016/j.jmaa.2009.12.041 · 1.12 Impact Factor