ABSTRACT
Understanding the prevalence of infections in the population of interest is critical for making data-driven public health responses to infectious disease outbreaks. Accurate prevalence estimates, however, can be difficult to calculate due to a combination of low population prevalence, imperfect diagnostic tests, and limited testing resources. In addition, strategies based on convenience samples that target only symptomatic or high-risk individuals will yield biased estimates of the population prevalence. We present Bayesian multilevel regression and poststratification models that incorporate probability sampling designs, the sensitivity and specificity of a diagnostic test, and specimen pooling to obtain unbiased prevalence estimates. These models easily incorporate all available prior information and can yield reasonable inferences even with very low base rates and limited testing resources. We examine the performance of these models with an extensive numerical study that varies the sampling design, sample size, true prevalence, and pool size. We also demonstrate the relative robustness of the models to key prior distribution assumptions via sensitivity analyses.
ABSTRACT
Global airline networks play a key role in the global importation of emerging infectious diseases. Detailed information on air traffic between international airports has been demonstrated to be useful in retrospectively validating and prospectively predicting case emergence in other countries. In this paper, we use a well-established metric known as effective distance on the global air traffic data from IATA to quantify risk of emergence for different countries as a consequence of direct importation from China, and compare it against arrival times for the first 24 countries. Using this model trained on official first reports from WHO, we estimate time of arrival (ToA) for all other countries. We then incorporate data on airline suspensions to recompute the effective distance and assess the effect of such cancellations in delaying the estimated arrival time for all other countries. Finally we use the infectious disease vulnerability indices to explain some of the estimated reporting delays.
