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- All Subjects: Epidemiology
- All Subjects: Survey
- Creators: Mubayi, Anuj
Due to the COVID-19 pandemic, declared in March of 2020, there have been many lifestyle changes which have likely influenced tobacco smoking behavior. Such lifestyle changes include lockdowns, stay at home orders, reduction in social cues related to smoking, increased stress, and boredom among other things. This study utilized a cross-sectional survey which looked into these behaviors, primarily perceived risk to COVID-19, and determined if there is an association between perceived risk and education level/race. Education level is a proxy for income and material resources, therefore making it more likely that people with lower levels of education have fewer resources and higher perceived risk to negative effects of COVID-19. Additionally, people of color are often marginalized in the medical community along with being the target of heavy advertising by tobacco companies which have likely impacted risk to COVID-19 as well.
thropological research goal. This dissertation looks at the role of data-driven social
networks on infectious disease transmission and evolution. The dissertation has two
projects. The first project is an examination of the effects of the superspreading
phenomenon, wherein a relatively few individuals are responsible for a dispropor-
tionate number of secondary cases, on the patterns of an infectious disease. The
second project examines the timing of the initial introduction of tuberculosis (TB) to
the human population. The results suggest that TB has a long evolutionary history
with hunter-gatherers. Both of these projects demonstrate the consequences of social
networks for infectious disease transmission and evolution.
The introductory chapter provides a review of social network-based studies in an-
thropology and epidemiology. Particular emphasis is paid to the concept and models
of superspreading and why to consider it, as this is central to the discussion in chapter
2. The introductory chapter also reviews relevant epidemic mathematical modeling
studies.
In chapter 2, social networks are connected with superspreading events, followed
by an investigation of how social networks can provide greater understanding of in-
fectious disease transmission through mathematical models. Using the example of
SARS, the research shows how heterogeneity in transmission rate impacts super-
spreading which, in turn, can change epidemiological inference on model parameters
for an epidemic.
Chapter 3 uses a different mathematical model to investigate the evolution of TB
in hunter-gatherers. The underlying question is the timing of the introduction of TB
to the human population. Chapter 3 finds that TB’s long latent period is consistent
with the evolutionary pressure which would be exerted by transmission on a hunter-
igatherer social network. Evidence of a long coevolution with humans indicates an
early introduction of TB to the human population.
Both of the projects in this dissertation are demonstrations of the impact of var-
ious characteristics and types of social networks on infectious disease transmission
dynamics. The projects together force epidemiologists to think about networks and
their context in nontraditional ways.
While myriad studies exist which reconstruct patterns of discrete trait evolution along an inferred phylogeny, attempts to translate the results of phyloegographic analyses into actionable metrics that can be used by public health agencies to direct the development of interventions aimed at reducing pathogen spread are conspicuously absent from the literature. In this dissertation, I focus on developing an intuitive metric, the phylogenetic risk ratio (PRR), which I use to translate the results of Bayesian phylogeographic modeling studies into a form actionable by public health agencies. I apply the PRR to two case studies: i) age-associated diffusion of influenza A/H3N2 during the 2016-17 US epidemic and ii) host associated diffusion of West Nile virus in the US. I discuss the limitations of this (and Bayesian phylogeographic) approaches when studying non-geographic traits for which limited metadata is available in public molecular sequence databases and statistically principled solutions to the missing metadata problem in the phylogenetic context. Then, I perform a simulation study to evaluate the statistical performance of the missing metadata solution. Finally, I provide a solution for researchers whom are interested in using the PRR and phylogenetic UTMs in their own genomic epidemiological studies yet are deterred by the idiosyncratic, error-prone processes required to implement these methods using popular Bayesian phylogenetic inference software packages. My solution, Build-A-BEAST, is a publicly available, object-oriented system written in python which aims to reduce the complexity and idiosyncrasy of creating XML files necessary to perform the aforementioned analyses. This dissertation extends the conceptual framework of Bayesian phylogeographic methods, develops a method to translates the output of phylogenetic models into an actionable form, evaluates the use of priors for missing metadata, and, finally, provides a solution which eases the implementation of these methods. In doing so, I lay the foundation for future work in disseminating and implementing Bayesian phylogeographic methods for routine public health surveillance.
Treatment non-adherence is a less focused (so far) but crucial factor for the hindrance in WHO’s past VL elimination goals. Moreover, treatment non-adherers, hidden from surveillance, lead to high case-underreporting. Dynamical models are developed capturing the role of treatment-related human behaviors (patients’ infectivity, treatment access and non-adherence) on VL dynamics. The results suggest that the average duration of treatment adherence must be increased from currently 10 days to 17 days for a 28-day Miltefosine treatment to eliminate VL.
For STH, children are considered as a high-risk group due to their hygiene behaviors leading to higher exposure to contamination. Hence, Ghana, a resource-limited country, currently implements a school-based Mass Drug Administration (sMDA) program only among children. School staff (adults), equally exposed to this high environmental contamination of STH, are largely ignored under the current MDA program. Cost-effective MDA policies were modeled and compared using alternative definitions of “high-risk population”. This work optimized and evaluated how MDA along with the treatment for high-risk adults makes a significant improvement in STH control under the same budget. The criticality of risk-structured modeling depends on the infectivity coefficient being substantially different for the two adult risk groups.
This dissertation pioneers in highlighting the cruciality of treatment-related risk groups for NTD-control. It provides novel approaches to quantify relevant metrics and impact of population factors. Compliance with the principles and strategies from this study would require a change in political thinking in the neglected regions in order to achieve persistent NTD-control.