title: Reconstructing a spatially heterogeneous epidemic: Characterising the geographic spread of 2009 A/H1N1pdm infection in England.
abstract: Understanding how the geographic distribution of and movements within a population influence the spatial spread of infections is crucial for the design of interventions to curb transmission. Existing knowledge is typically based on results from simulation studies whereas analyses of real data remain sparse. The main difficulty in quantifying the spatial pattern of disease spread is the paucity of available data together with the challenge of incorporating optimally the limited information into models of disease transmission. To address this challenge the role of routine migration on the spatial pattern of infection during the epidemic of 2009 pandemic influenza in England is investigated here through two modelling approaches: parallel-region models, where epidemics in different regions are assumed to occur in isolation with shared characteristics; and meta-region models where inter-region transmission is expressed as a function of the commuter flux between regions. Results highlight that the significantly less computationally demanding parallel-region approach is sufficiently flexible to capture the underlying dynamics. This suggests that inter-region movement is either inaccurately characterized by the available commuting data or insignificant once its initial impact on transmission has subsided.
authors.affiliation: Medical Research Council Biostatistics Unit, Cambridge Insitute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Birrell
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
authors.forename: Xu-Sheng
authors.initials: XS
authors.lastname: Zhang
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Pebody
authors.affiliation: Fu Consulting, Hungerford, UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Gay
authors.affiliation: Medical Research Council Biostatistics Unit, Cambridge Insitute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.|Centre for Infectious Disease Surveillance and Control, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.
authors.forename: Daniela
authors.initials: D
authors.lastname: De Angelis
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000914:Antibodies, Viral / Q000096:biosynthesis / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003132:Commerce; D003198:Computer Simulation; D004739:England / Q000453:epidemiology; D062306:Geography, Medical; D006693:Holidays; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D008131:London / Q000453:epidemiology; D008875:Middle Aged; D008962:Models, Theoretical; D058873:Pandemics; D012574:Schools; D012621:Seasons; D000069078:Seroconversion; D014186:Transportation; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral