Illustration by Elisa Visher Last month, Chris Hoover presented his research during the Berkeley EEID seminar series. Chris is a PhD student with Dr. Justin Remais at UC Berkeley working on optimal control strategies of Neglected Tropical Diseases (NTD’s) with applications to schistosomiasis. Schistosomiasis is the second most devastating parasitic disease worldwide and caused by parasitic flatworms called schistosomes. The disease is spread by fresh water contaminated with parasites that are released by freshwater snails. There is currently no vaccine to treat the disease but global control efforts have primarily on massive drug administration (MDA) often targeting school aged children. While MDA reduces morbidity, it many regions it has been inefficient in reducing transmission resulting in rebounds of the disease. Recent evidence suggests that MDA combined with snail control efforts is the most cost-effective intervention strategy. With this background in mind, Chris models the effect of worm population dynamics on schistosomiasis transmission dynamics with the ultimate goal of designing effective control strategies. Some important features of the Susceptible-Exposed-Infection model includes environmental transmission, parasite burden, and density dependent processes. Infection is modelled as the population mean worm burden. Negative (i.e. crowding) and positive (i.e. mate limitation) density dependent processes appear in the force of infection of the intermediate snail host. Using these features of the model, one can estimate the breaking point threshold of the population size (i.e. endemic equilibrium) below which the population gets reduced to zero (i.e. elimination). The breaking-point of the mean worm burden is analogous to the herd-immunity threshold as the host becomes resistant to the infection when the worm burden falls below the threshold. An additional feature of the model is that we can manipulate the exposure parameter influencing transmission that we can intervene on. By reducing the exposure contamination parameter and the mean worm burden, reasonable levels of MDA coverage can lead to the breaking-point (i.e. control). Current work seeks to understand how demographic stochasticity impacts intervention strategies, such as small population sizes around the breaking-point. The theoretical framework developed by Chris and collaborators is also very informative for real-world infectious diseases. For example, China has been successful in reducing schistosomiasis transmission using an integrated approach that includes snail habitat reduction, improvements in agricultural practices, and MDA. The work presented by Chris is an excellent example of applying well-grounded ecological theory to the management and control of infectious diseases. Summary by Senay Yitbarek
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