title: Transmission heterogeneity and autoinoculation in a multisite infection model of HPV.
abstract: The human papillomavirus (HPV) is sexually transmitted and can infect oral, genital, and anal sites in the human epithelium. Here, we develop a multisite transmission model that includes autoinoculation to study HPV and other multisite diseases. Under a homogeneous-contacts assumption, we analyze the basic reproduction number R0, as well as type and target reproduction numbers, for a two-site model. In particular, we find that R0 occupies a space between taking the maximum of next generation matrix terms for same site transmission and taking the geometric average of cross-site transmission terms in such a way that heterogeneity in the same-site transmission rates increases R0 while heterogeneity in the cross-site transmission decreases it. Additionally, autoinoculation adds considerable complexity to the form of R0. We extend this analysis to a heterosexual population, which additionally yields dynamics analogous to those of vector-host models. We also examine how these issues of heterogeneity may affect disease control, using type and target reproduction numbers.
authors.affiliation: Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Mathematics, University of Michigan, 530 Church St., Ann Arbor, MI 48109, United States.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Brouwer
authors.affiliation: Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
authors.forename: Rafael
authors.initials: R
authors.lastname: Meza
authors.affiliation: Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Mathematics, University of Michigan, 530 Church St., Ann Arbor, MI 48109, United States. Electronic address: marisae@umich.edu.
authors.forename: Marisa C
authors.initials: MC
authors.lastname: Eisenberg
mesh_terms: D050936:Basic Reproduction Number; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D055641:Mathematical Concepts; D008954:Models, Biological; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000635:transmission*
keywords: Autoinoculation; Basic reproduction number; Disease control; HPV; Heterogeneity; Multisite model