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Spread of yellow fever virus outbreak in Angola and the Democratic Republic of the Congo 2015-16: a modelling study.

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cam.issuedOnline2016-12-23
dc.contributor.authorKraemer, Moritz UG
dc.contributor.authorFaria, Nuno R
dc.contributor.authorReiner, Robert C
dc.contributor.authorGolding, Nick
dc.contributor.authorNikolay, Birgit
dc.contributor.authorStasse, Stephanie
dc.contributor.authorJohansson, Michael A
dc.contributor.authorSalje, Henrik
dc.contributor.authorFaye, Ousmane
dc.contributor.authorWint, GR William
dc.contributor.authorNiedrig, Matthias
dc.contributor.authorShearer, Freya M
dc.contributor.authorHill, Sarah C
dc.contributor.authorThompson, Robin N
dc.contributor.authorBisanzio, Donal
dc.contributor.authorTaveira, Nuno
dc.contributor.authorNax, Heinrich H
dc.contributor.authorPradelski, Bary SR
dc.contributor.authorNsoesie, Elaine O
dc.contributor.authorMurphy, Nicholas R
dc.contributor.authorBogoch, Isaac I
dc.contributor.authorKhan, Kamran
dc.contributor.authorBrownstein, John S
dc.contributor.authorTatem, Andrew J
dc.contributor.authorde Oliveira, Tulio
dc.contributor.authorSmith, David L
dc.contributor.authorSall, Amadou A
dc.contributor.authorPybus, Oliver G
dc.contributor.authorHay, Simon I
dc.contributor.authorCauchemez, Simon
dc.contributor.orcidSalje, Henrik [0000-0003-3626-4254]
dc.date.accessioned2021-11-25T09:22:56Z
dc.date.available2021-11-25T09:22:56Z
dc.date.issued2017-03
dc.description.abstractBACKGROUND: Since late 2015, an epidemic of yellow fever has caused more than 7334 suspected cases in Angola and the Democratic Republic of the Congo, including 393 deaths. We sought to understand the spatial spread of this outbreak to optimise the use of the limited available vaccine stock. METHODS: We jointly analysed datasets describing the epidemic of yellow fever, vector suitability, human demography, and mobility in central Africa to understand and predict the spread of yellow fever virus. We used a standard logistic model to infer the district-specific yellow fever virus infection risk during the course of the epidemic in the region. FINDINGS: The early spread of yellow fever virus was characterised by fast exponential growth (doubling time of 5-7 days) and fast spatial expansion (49 districts reported cases after only 3 months) from Luanda, the capital of Angola. Early invasion was positively correlated with high population density (Pearson's r 0·52, 95% CI 0·34-0·66). The further away locations were from Luanda, the later the date of invasion (Pearson's r 0·60, 95% CI 0·52-0·66). In a Cox model, we noted that districts with higher population densities also had higher risks of sustained transmission (the hazard ratio for cases ceasing was 0·74, 95% CI 0·13-0·92 per log-unit increase in the population size of a district). A model that captured human mobility and vector suitability successfully discriminated districts with high risk of invasion from others with a lower risk (area under the curve 0·94, 95% CI 0·92-0·97). If at the start of the epidemic, sufficient vaccines had been available to target 50 out of 313 districts in the area, our model would have correctly identified 27 (84%) of the 32 districts that were eventually affected. INTERPRETATION: Our findings show the contributions of ecological and demographic factors to the ongoing spread of the yellow fever outbreak and provide estimates of the areas that could be prioritised for vaccination, although other constraints such as vaccine supply and delivery need to be accounted for before such insights can be translated into policy. FUNDING: Wellcome Trust.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.78544
dc.identifier.eissn1474-4457
dc.identifier.issn1473-3099
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/331099
dc.languageeng
dc.language.isoeng
dc.publisherElsevier BV
dc.publisher.urlhttp://dx.doi.org/10.1016/s1473-3099(16)30513-8
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectAedes
dc.subjectAngola
dc.subjectAnimals
dc.subjectDemocratic Republic of the Congo
dc.subjectDisease Outbreaks
dc.subjectHumans
dc.subjectImmunization Schedule
dc.subjectModels, Statistical
dc.subjectRural Population
dc.subjectTravel
dc.subjectUrban Population
dc.subjectVaccination
dc.subjectYellow Fever
dc.subjectYellow fever virus
dc.titleSpread of yellow fever virus outbreak in Angola and the Democratic Republic of the Congo 2015-16: a modelling study.
dc.typeArticle
dcterms.dateAccepted2016-11-09
prism.endingPage338
prism.issueIdentifier3
prism.publicationDate2017
prism.publicationNameLancet Infect Dis
prism.startingPage330
prism.volume17
rioxxterms.licenseref.startdate2017-03
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1016/S1473-3099(16)30513-8

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