HPVsim: An agent-based model of HPV transmission and cervical disease.

In 2020, the WHO launched its first global strategy to accelerate the elimination of cervical cancer, outlining an ambitious set of targets for countries to achieve over the next decade. At the same time, new tools, technologies, and strategies are in the pipeline that may improve screening performance, expand the reach of prophylactic vaccines, and prevent the acquisition, persistence and progression of oncogenic HPV. Detailed mechanistic modelling can help identify the combinations of current and future strategies to combat cervical cancer. Open-source modelling tools are needed to shift the capacity for such evaluations in-country. Here, we introduce the Human papillomavirus simulator (HPVsim), a new open-source software package for creating flexible agent-based models parameterised with country-specific vital dynamics, structured sexual networks, and co-transmitting HPV genotypes. HPVsim includes a novel methodology for modelling cervical disease progression, designed to be readily adaptable to new forms of screening. The software itself is implemented in Python, has built-in tools for simulating commonly-used interventions, includes a comprehensive set of tests and documentation, and runs quickly (seconds to minutes) on a laptop. Performance is greatly enhanced by HPVsim's multiscale modelling functionality. HPVsim is open source under the MIT License and available via both the Python Package Index (via pip install) and GitHub (hpvsim.org).

Synchrony of Bird Migration with Global Dispersal of Avian Influenza Reveals Exposed Bird Orders.

Highly pathogenic avian influenza virus (HPAIV) A H5, particularly clade 2.3.4.4, has caused worldwide outbreaks in domestic poultry, occasional spillover to humans, and increasing deaths of diverse species of wild birds since 2014. Wild bird migration is currently acknowledged as an important ecological process contributing to the global dispersal of HPAIV H5. However, this mechanism has not been quantified using bird movement data from different species, and the timing and location of exposure of different species is unclear. We sought to explore these questions through phylodynamic analyses based on empirical data of bird movement tracking and virus genome sequences of clade 2.3.4.4 and 2.3.2.1. First, we demonstrate that seasonal bird migration can explain salient features of the global dispersal of clade 2.3.4.4. Second, we detect synchrony between the seasonality of bird annual cycle phases and virus lineage movements. We reveal the differing exposed bird orders at geographical origins and destinations of HPAIV H5 clade 2.3.4.4 lineage movements, including relatively under-discussed orders. Our study provides a phylodynamic framework that links the bird movement ecology and genomic epidemiology of avian influenza; it highlights the importance of integrating bird behavior and life history in avian influenza studies.

Sociocultural determinants of global mask-wearing behavior.

Behavioral responses influence the trajectories of epidemics. During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) reduced pathogen transmission and mortality worldwide. However, despite the global pandemic threat, there was substantial cross-country variation in the adoption of protective behaviors that is not explained by disease prevalence alone. In particular, many countries show a pattern of slow initial mask adoption followed by sharp transitions to high acceptance rates. These patterns are characteristic of behaviors that depend on social norms or peer influence. We develop a game-theoretic model of mask wearing where the utility of wearing a mask depends on the perceived risk of infection, social norms, and mandates from formal institutions. In this model, increasing pathogen transmission or policy stringency can trigger social tipping points in collective mask wearing. We show that complex social dynamics can emerge from simple individual interactions and that sociocultural variables and local policies are important for recovering cross-country variation in the speed and breadth of mask adoption. These results have implications for public health policy and data collection.

Understanding the coevolution of mask wearing and epidemics: A network perspective.

Nonpharmaceutical interventions (NPIs) such as mask wearing can be effective in mitigating the spread of infectious diseases. Therefore, understanding the behavioral dynamics of NPIs is critical for characterizing the dynamics of disease spread. Nevertheless, standard infection models tend to focus only on disease states, overlooking the dynamics of "beneficial contagions," e.g., compliance with NPIs. In this work, we investigate the concurrent spread of disease and mask-wearing behavior over multiplex networks. Our proposed framework captures both the competing and complementary relationships between the dueling contagion processes. Further, the model accounts for various behavioral mechanisms that influence mask wearing, such as peer pressure and fear of infection. Our results reveal that under the coupled disease-behavior dynamics, the attack rate of a disease-as a function of transition probability-exhibits a critical transition. Specifically, as the transmission probability exceeds a critical threshold, the attack rate decreases abruptly due to sustained mask-wearing responses. We empirically explore the causes of the critical transition and demonstrate the robustness of the observed phenomena. Our results highlight that without proper enforcement of NPIs, reductions in the disease transmission probability via other interventions may not be sufficient to reduce the final epidemic size.

Advection exacerbates population decline from habitat loss: maintaining threatened taxa while restoring natural river flow regimes.

Modification of flow regimes and habitat degradation are the strongest, most common, and often co-occurring human activities affecting riverine populations. Ongoing efforts to restore peak flow events found under pristine flow regimes could increase advection-driven dispersal for many species. In rivers with extensive habitat loss, increased advection could transport individuals from remnant populations into degraded downstream areas, causing restored flow regimes to decrease persistence of threatened species. To demonstrate such possible 'washout' effects across imperiled taxa, we evaluate population growth in spatial models of insect, fish, and mollusc taxa that experience advective dispersal and either long-term habitat loss or temporary drought disturbances. As a case study to quantify advective dispersal in threatened species, we use intensive mark-recapture methods in a Rio Grande population of the endangered mussel Popenaias popeii belonging to the Unionida order, the most threatened faunal taxa worldwide. Our mark-recapture models estimate high levels of annual downstream emigration (16-51%) and immigration from upstream habitats (32-48%) of adult P. popeii, a result consistent with hydrodynamic experiments. Across taxa where such advective dispersal occurs in specific life stages, our population model suggests that washout effects might strongly reduce population recovery under high levels of habitat loss, especially for sessile or shorter lived species. Averting this potential negative consequence of restoring hydrology requires simultaneously restoring or protecting long, contiguous stretches of suitable habitats. In heavily impacted systems, we suggest integrating hydrodynamic studies and field surveys to detect the presence of advective dispersal and prioritize areas for habitat restoration to enhance population persistence.

Waning immunity and re-emergence of measles and mumps in the vaccine era.

Vaccine-preventable diseases (VPD) including measles and mumps have been re-emerging in countries with sustained high vaccine coverage. For mumps, waning immunity has been recognized as a major contributor to recent outbreaks. Although unvaccinated individuals account for most cases in recent measles outbreaks, the role of immune waning remains unclear. Accumulating serological and epidemiological evidence suggests that natural immunity induced by infection may be more durable compared to vaccine-induced immunity. As the proportion of population immunity via vaccination gradually increases and boosting through natural exposures becomes rare, risk of outbreaks may increase. Mechanistic insights into the coupled immuno-epidemiological dynamics of waning and boosting will be important to understand optimal vaccination strategies to combat VPD re-emergence and achieve eradication.

Economic and Behavioral Influencers of Vaccination and Antimicrobial Use.

Despite vast improvements in global vaccination coverage during the last decade, there is a growing trend in vaccine hesitancy and/or refusal globally. This has implications for the acceptance and coverage of a potential vaccine against COVID-19. In the United States, the number of children exempt from vaccination for "philosophical belief-based" non-medical reasons increased in 12 of the 18 states that allowed this policy from 2009 to 2017 (1). Meanwhile, the overuse and misuse of antibiotics, especially in young children, have led to increasing rates of drug resistance that threaten our ability to treat infectious diseases. Vaccine hesitancy and antibiotic overuse exist side-by-side in the same population of young children, and it is unclear why one modality (antibiotics) is universally seen as safe and effective, while the other (vaccines) is seen as potentially hazardous by some. In this review, we consider the drivers shaping the use of vaccines and antibiotics in the context of three factors: individual incentives, risk perceptions, and social norms and group dynamics. We illustrate how these factors contribute to the societal and individual costs of vaccine underuse and antimicrobial overuse. Ultimately, we seek to understand these factors that are at the nexus of infectious disease epidemiology and social science to inform policy-making.

Life history and temporal variability of escape events interactively determine the fitness consequences of aquaculture escapees on wild populations.

Domesticated individuals are likely to be maladaptive in the wild due to adaptation to captivity. Escaped aquaculture fish can cause unintended fitness and demographic consequences for their wild conspecifics through interbreeding and competition. Escape events from different sources exhibit great heterogeneity in their frequencies and magnitudes, ranging from rare but large spillover during a storm, to continuous low-level leakage caused by operational errors. The timescale of escape events determines the distribution of gene flow from aquaculture to the wild. The evolutionary consequences of this variation in timescale will depend on the degree of generation overlap and the focal species' life history attributes, especially those under selection in aquaculture (e.g., growth rate, which can influence additional demographically important traits such as age at maturity). To evaluate the effects of variable escape both within and across generations, we construct an age-structured model of coupled genetic and demographic dynamics and parameterize it for species with contrasting life history characteristics (Salmo salar and Gadus morhua). Our results are consistent with earlier discrete-generation models that constant, low-level spillover can have a greater impact than rare, large pulses of leakage, even after accounting for the averaging effects of overlapping generations. The age-structured model also allows detailed evaluation of the role of different life history traits, which reveals that species with longer generation times might experience greater fitness consequences of aquaculture spillover but are less sensitive to variability in spillover. Additionally, environment-induced earlier maturity of escapees can increase the fitness effects on wild fish, especially those with shorter generation times. Our results suggest that effective management to minimize the unintended fitness consequences of aquaculture releases might require extensive monitoring efforts on constant, low-level spillover and assessment of the focal species' life history characteristics.