The spread and persistence of infectious diseases in structured populations

Abstract

A basic assumption of many epidemic models is that populations are composed of a homogeneous group of randomly mixing individuals. This is not a realistic assumption. Most actual populations are divided into a number of subpopulations, within which there may be relatively random mixing, but among which there is nonrandom mixing. As a consequence of the structuring of the population, there are several sources of heterogeneity within populations that can affect the course of an infection through the population. Two of these sources of heterogeneity are differences in contact number between subpopulations, and differences in the patterns of contact among subpopulations. A model for the spread of a disease in such a population is described. The model considers two levels of interaction: interactions between individuals within a subpopulation because of geographic proximity, and interactions between individuals of the same or different subpopulations because of attendance at common social functions. Because of this structure, it is possible to analyze with the model both heterogeneity in contact number and variation in the patterns of contact. A stability analysis of the model is presented which shows that there is a unique threshold for disease maintenance. Below the threshold the disease goes extinct, and the equilibrium is globally asymptotically stable. Above the threshold, the extinction equilibrium is unstable, and there is a unique endemic equilibrium. The analysis presents a sufficient condition for disease maintenance, which determines critical subpopulation sizes above which the disease cannot go extinct. The condition is a simple inequality relating the removal rate of infectives to the infection rate of susceptibles. In addition, bounds on the actual threshold and the effect of symmetry in the interaction matrix on the threshold are presented.