Cholera modeling: challenges to quantitative analysis and predicting the impact of interventions.
Several mathematical models of epidemic cholera have recently been proposed in response to outbreaks in Zimbabwe and Haiti. These models aim to estimate the dynamics of cholera transmission and the impact of possible interventions, with a goal of providing guidance to policy makers in deciding among alternative courses of action, including vaccination, provision of clean water, and antibiotics. Here, we discuss concerns about model misspecification, parameter uncertainty, and spatial heterogeneity intrinsic to models for cholera. We argue for caution in interpreting quantitative predictions, particularly predictions of the effectiveness of interventions. We specify sensitivity analyses that would be necessary to improve confidence in model-based quantitative prediction, and suggest types of monitoring in future epidemic settings that would improve analysis and prediction.
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
Yonatan H
YH
Grad
Joel C
JC
Miller
Marc
M
Lipsitch
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002771:Cholera / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D003661:Decision Support Techniques; D004196:Disease Outbreaks / Q000517:prevention & control; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008954:Models, Biological; D015203:Reproducibility of Results; D035501:Uncertainty; D014611:Vaccination; D018508:Water Purification; D015030:Zimbabwe / Q000453:epidemiology
D000900:Anti-Bacterial Agents