title: A three-scale network model for the early growth dynamics of 2014 west Africa ebola epidemic.
abstract: BACKGROUND
  In mid-October 2014, the number of cases of the West Africa Ebola virus epidemic in Guinea, Sierra Leone and Liberia exceeded 9,000 cases. The early growth dynamics of the epidemic has been qualitatively different for each of the three countries. However, it is important to understand these disparate dynamics as trends of a single epidemic spread over regions with similar geographic and cultural aspects, with likely common parameters for transmission rates and reproduction number R0.
  
  
  METHODS
  We combine a discrete, stochastic SEIR model with a three-scale community network model to demonstrate that the different regional trends may be explained by different community mixing rates. Heuristically, the effect of different community mixing rates may be understood as the observation that two individuals infected by the same chain of transmission are more likely to share the same contacts in a less-mixed community. Local saturation effects occur as the contacts of an infected individual are more likely to already be exposed by the same chain of transmission.
  
  
  RESULTS
  The effects of community mixing, together with stochastic effects, can explain the qualitative difference in the growth of Ebola virus cases in each country, and why the probability of large outbreaks may have recently increased. An increase in the rate of Ebola cases in Guinea in late August, and a local fitting of the transient dynamics of the Ebola cases in Liberia, suggests that the epidemic in Liberia has been more severe, and the epidemic in Guinea is worsening, due to discrete seeding events as the epidemic spreads into new communities.
  
  
  CONCLUSIONS
  A relatively simple network model provides insight on the role of local effects such as saturation that would be difficult to otherwise quantify. Our results predict that exponential growth of an epidemic is driven by the exposure of new communities, underscoring the importance of limiting this spread.
authors: Department of Mathematics and Statistics, University of South Alabama, Mobile, Alabama, USA.
authors: Maria A
authors: MA
authors: Kiskowski
keywords: Ebola virus; Guinea; disease model; disease outbreak; ebola; networks