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Abstract Background Geographical and temporal diffusion patterns of a human pandemic due to Swine Origin Influenza Virus (S-OIV) remain uncertain. The extent to which national and international pandemic preparedness plans and control strategies can slow or stop the process is not known. However, despite preparedness efforts, it appears that, particularly in the USA, Mexico, Canada and the UK, local chains of virus transmission can sustain autonomous dynamics which may lead to the next pandemic. Forecasts of influenza experts usually rely on information related to new circulating strains. Methods We attempted to quantify the possible spread of the pandemic across a network of 52 major cities and to predict the effect of vaccination against the pandemic strain, if available. Predictions are based on simulations from a stochastic SEIR model. Parameters used in the simulations are set to values consistent with recent estimations from the outbreak in Mexico. Results We show that a two-wave pandemic dynamic may be observed in Southern hemisphere because of seasonal constraints for a maximum value of the basic reproductive number (R0, max) within a city equal to 1.5 and a mean generation interval (GI) of 2 days. In this case and in the absence of vaccination, attack rates may reach 46% when considering a completely susceptible population. More severe scenarios characterized by higher values of R0, max (2.2) and GI (3.1) yield an attack rate of 77%. By extrapolation, we find that mass vaccination in all countries (i.e. up to 50% of the population) implemented 6 months after the start of the pandemic may reduce the cumulative number of cases by 91% in the case of the low transmissible strain (R0, max = 1.5). This relative reduction is only 44% for R0, max = 2.2 since most of the cases occur in the first 6 months and so before the vaccination campaign. Conclusion Although uncertainties remain about the epidemiological and clinical characteristics of the new influenza strain, this study provides the first analysis of the potential spread of the pandemic and first assessment of the impact of different immunization strategies.

Cattle tracing databases have become major resources for representing demographic processes of livestock and assessing potential risk of infections spreading by trade. The herds registered in these databases are nodes of a network of commercial movements, which can be altered to lower the risk of disease transmission. In this study, we develop an algorithm aimed at reducing the number of infected animals and herds, by rewiring specific movements responsible for trade flows from high- to low-prevalence herds. The algorithm is coupled with a generic computational model based on the French cattle movement tracing database (BDNI), and used to describe different scenarios for the spread of infection within and between herds from a recent outbreak (epidemic) or a five-year-old outbreak (endemic). Results show that rewiring successfully contains infections to a limited number of herds, especially if the outbreak is recent and the estimation of disease prevalence frequent, while the respective impact of the parameters of the algorithm depend on the infection parameters. Allowing any animal movement from high to low-prevalence herds reduces the effectiveness of the algorithm in epidemic settings, while frequent and fine-grained prevalence assessments improve the impact of the algorithm in endemic settings. Our approach focusing on a few commercial movements is expected to lead to substantial improvements in the control of a targeted disease, although changes in the network structure should be monitored for potential vulnerabilities to other diseases. This general algorithm could be applied to any network of controlled individual movements liable to spread disease., (© 2024. The Author(s).)

Considering human decision-making is essential for understanding the mechanisms underlying the propagation of real-life diseases. We present an extension of a model for pathogen spread that considers farmers' dynamic decision-making regarding the adoption of a control measure in their own herd. Farmers can take into account the decisions and observed costs of their trade partners or of their geographic neighbours. The model and construction of such costs are adapted to the case of bovine viral diarrhoea, for which an individual-based stochastic model is considered. Simulation results suggest that obtaining information from geographic neighbours might lead to a better control of bovine viral diarrhoea than considering information from trade partners. In particular, using information from all geographic neighbours at each decision time seems to be more beneficial than considering only the information from one geographic neighbour or trade partner at each time. This study highlights the central role that social dynamics among farmers can take in the spread and control of bovine viral diarrhoea, providing insights into how public policy efforts could be targeted in order to increase voluntary vaccination uptake against this disease in endemic areas., (© 2022. The Author(s).)

Background: SARS-CoV-2 is a rapidly spreading disease affecting human life and the economy on a global scale. The disease has caused so far more then 5.5 million deaths. The omicron outbreak that emerged in Botswana in the south of Africa spread around the globe at further increased rates, and caused unprecedented SARS-CoV-2 infection incidences in several countries. At the start of December 2021 the first omicron cases were reported in France., Methods: In this paper we investigate the spreading potential of this novel variant relatively to the delta variant that was also in circulation in France at that time. Using a dynamic multi-variant model accounting for cross-immunity through a status-based approach, we analyze screening data reported by Santé Publique France over 13 metropolitan French regions between 1st of December 2021 and the 30th of January 2022. During the investigated period, the delta variant was replaced by omicron in all metropolitan regions in approximately three weeks. The analysis conducted retrospectively allows us to consider the whole replacement time window and compare regions with different times of omicron introduction and baseline levels of variants' transmission potential. As large uncertainties regarding cross-immunity among variants persist, uncertainty analyses were carried out to assess its impact on our estimations., Results: Assuming that 80% of the population was immunized against delta, a cross delta/omicron cross-immunity of 25% and an omicron generation time of 3.5 days, the relative strength of omicron to delta, expressed as the ratio of their respective reproduction rates, [Formula: see text], was found to range between 1.51 and 1.86 across regions. Uncertainty analysis on epidemiological parameters led to [Formula: see text] ranging from 1.57 to 2.34 on average over the metropolitan French regions, weighted by population size., Conclusions: Upon introduction, omicron spread rapidly through the French territory and showed a high fitness relative to delta. We documented considerable geographical heterogeneities on the spreading dynamics. The historical reconstruction of variant emergence dynamics provide valuable ground knowledge to face future variant emergence events., (© 2022. The Author(s).)

Robust epidemiological knowledge and predictive modelling tools are needed to address challenging objectives, such as: understanding epidemic drivers; forecasting epidemics; and prioritising control measures. Often, multiple modelling approaches can be used during an epidemic to support effective decision making in a timely manner. Modelling challenges contribute to understanding the pros and cons of different approaches and to fostering technical dialogue between modellers. In this paper, we present the results of the first modelling challenge in animal health - the ASF Challenge - which focused on a synthetic epidemic of African swine fever (ASF) on an island. The modelling approaches proposed by five independent international teams were compared. We assessed their ability to predict temporal and spatial epidemic expansion at the interface between domestic pigs and wild boar, and to prioritise a limited number of alternative interventions. We also compared their qualitative and quantitative spatio-temporal predictions over the first two one-month projection phases of the challenge. Top-performing models in predicting the ASF epidemic differed according to the challenge phase, host species, and in predicting spatial or temporal dynamics. Ensemble models built using all team-predictions outperformed any individual model in at least one phase. The ASF Challenge demonstrated that accounting for the interface between livestock and wildlife is key to increasing our effectiveness in controlling emerging animal diseases, and contributed to improving the readiness of the scientific community to face future ASF epidemics. Finally, we discuss the lessons learnt from model comparison to guide decision making., Competing Interests: Declaration of interest The authors have no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

To control the spread of an infectious disease over a large network, the optimal allocation by a social planner of a limited resource is a fundamental and difficult problem. We address this problem for a livestock disease that propagates on an animal trade network according to an epidemiological-demographic model based on animal demographics and trade data. We assume that the resource is dynamically allocated following a certain score, up to the limit of resource availability. We adapt a greedy approach to the metapopulation framework, obtaining new scores that minimize approximations of two different objective functions, for two control measures: vaccination and treatment. Through intensive simulations, we compare the greedy scores with several heuristics. Although topology-based scores can limit the spread of the disease, information on herd health status seems crucial to eradicating the disease. In particular, greedy scores are among the most effective in reducing disease prevalence, even though they do not always perform the best. However, some scores may be preferred in real life because they are easier to calculate or because they use a smaller amount of resources. The developed approach could be adapted to other epidemiological models or to other control measures in the metapopulation setting.

The effective reproduction number Reff is a critical epidemiological parameter that characterizes the transmissibility of a pathogen. However, this parameter is difficult to estimate in the presence of silent transmission and/or significant temporal variation in case reporting. This variation can occur due to the lack of timely or appropriate testing, public health interventions and/or changes in human behavior during an epidemic. This is exactly the situation we are confronted with during this COVID-19 pandemic. In this work, we propose to estimate Reff for the SARS-CoV-2 (the etiological agent of the COVID-19), based on a model of its propagation considering a time-varying transmission rate. This rate is modeled by a Brownian diffusion process embedded in a stochastic model. The model is then fitted by Bayesian inference (particle Markov Chain Monte Carlo method) using multiple well-documented hospital datasets from several regions in France and in Ireland. This mechanistic modeling framework enables us to reconstruct the temporal evolution of the transmission rate of the COVID-19 based only on the available data. Except for the specific model structure, it is non-specifically assumed that the transmission rate follows a basic stochastic process constrained by the observations. This approach allows us to follow both the course of the COVID-19 epidemic and the temporal evolution of its Reff(t). Besides, it allows to assess and to interpret the evolution of transmission with respect to the mitigation strategies implemented to control the epidemic waves in France and in Ireland. We can thus estimate a reduction of more than 80% for the first wave in all the studied regions but a smaller reduction for the second wave when the epidemic was less active, around 45% in France but just 20% in Ireland. For the third wave in Ireland the reduction was again significant (>70%)., Competing Interests: The authors have declared that no competing interests exist.

Accounting for individual decisions in mechanistic epidemiological models remains a challenge, especially for unregulated endemic animal diseases for which control is not compulsory. We propose a new integrative model by combining two sub-models. The first one for the dynamics of a livestock epidemic on a metapopulation network, grounded on demographic and animal trade data. The second one for farmers' behavior regarding the adoption of a control measure against the disease spread in their herd. The measure is specified as a protective vaccine with given economic implications, and the model is numerically studied through intensive simulations and sensitivity analyses. While each tested parameter of the model has an impact on the overall model behavior, the most important factor in farmers' decisions is their frequency, as this factor explained almost 30% of the variation in decision-related outputs of the model. Indeed, updating frequently local health information impacts positively vaccination, and limits strongly the propagation of the pathogen. Our study is relevant for the understanding of the interplay between decision-related human behavior and livestock epidemic dynamics. The model can be used for other structures of epidemic models or different interventions, by adapting its components.

Bovine respiratory diseases (BRD) are a major concern for the beef cattle industry, as beef calves overwhelmingly develop BRD symptoms during the first weeks after their arrival at fattening units. These cases occur after weaned calves from various cow-calf producers are grouped into batches to be sold to fatteners. Cross-contaminations between calves from different origins (potentially carrying different pathogens), together with increased stress because of the process of batch creation, can increase their risks of developing BRD symptoms. This study investigated whether reducing the number of different origins per batch is a strategy to reduce the risk of BRD cases. We developed an algorithm aimed at creating batches with as few origins as possible, while respecting constraints on the number and breed of the calves. We tested this algorithm on a dataset of 137,726 weaned calves grouped into 9701 batches by a French organization. We also computed an index assessing the risks of developing BRD because of the batch composition by considering four pathogens involved in the BRD system. While increasing the heterogeneity of batches in calf bodyweight, which is not expected to strongly impact the performance, our algorithm successfully decreased the average number of origins in the same batch and their risk index. Both this algorithm and the risk index can be used as part of decision tool to assess and possibly minimize BRD risk at batch creation, but they are generic enough to assess health risk for other production animals, and optimize the homogeneity of selected characteristics.

To explore the regional spread of endemic pathogens, investigations are required both at within and between population levels. The bovine viral diarrhoea virus (BVDV) is such a pathogen, spreading among cattle herds mainly due to trade movements and neighbourhood contacts, and causing an endemic disease with economic consequences. To assess the contribution of both transmission routes on BVDV regional and local spread, we developed an original epidemiological model combining data-driven and mechanistic approaches, accounting for heterogeneous within-herd dynamics, animal movements and neighbourhood contacts. Extensive simulations were performed over 9 years in an endemic context in a French region with high cattle density. The most uncertain model parameters were calibrated on summary statistics of epidemiological data, highlighting that neighbourhood contacts and within-herd transmission should be high. We showed that neighbourhood contacts and trade movements complementarily contribute to BVDV spread on a regional scale in endemically infected and densely populated areas, leading to intense fade-out/colonization events: neighbourhood contacts generate the vast majority of outbreaks (72%) but mostly in low immunity herds and correlated to a rather short presence of persistently infected animals (P); trade movements generate fewer infections but could affect herds with higher immunity and generate a prolonged presence of P. Both movements and neighbourhood contacts should be considered when designing control or eradication strategies for densely populated region.

Q fever, a worldwide zoonotic disease caused by Coxiella burnetii, is a looming concern for livestock and public health. Epidemiological features of inter-herd transmission of C. burnetii in cattle herds by wind and trade of cows are poorly understood. We present a novel dynamic spatial model describing the inter-herd regional spread of C. burnetii in dairy cattle herds, quantifying the ability of airborne transmission and animal trade in C. burnetii propagation in an enzootic region. Among all the new herd infections, 92% were attributed to airborne transmission and the rest to cattle trade. Infections acquired following airborne transmission were shown to cause relatively small and ephemeral intra-herd outbreaks. On the contrary, disease-free herds purchasing an infectious cow experienced significantly higher intra-herd prevalence. The results also indicated that, for short duration, both transmission routes were independent from each other without any synergistic effect. The model outputs applied to the Finistère department in western France showed satisfactory sensitivity (0.71) and specificity (0.80) in predicting herd infection statuses at the end of one year in a neighbourhood of 3 km around expected incident herds, when compared with data. The model developed here thus provides important insights into the spread of C. burnetii between dairy cattle herds and paves the way for implementation and assessment of control strategies.

Conventional epidemiological studies of infections spreading through trade networks, e.g., via livestock movements, generally show that central large-size holdings (hubs) should be preferentially surveyed and controlled in order to reduce epidemic spread. However, epidemiological strategies alone may not be economically optimal when costs of control are factored in together with risks of market disruption from targeting core holdings in a supply chain. Using extensive data on animal movements in supply chains for cattle and swine in France, we introduce a method to identify effective strategies for preventing outbreaks with limited budgets while minimizing the risk of market disruptions. Our method involves the categorization of holdings based on position along the supply chain and degree of market share. Our analyses suggest that trade has a higher risk of propagating epidemics through cattle networks, which are dominated by exchanges involving wholesalers, than for swine. We assess the effectiveness of contrasting interventions from the perspectives of regulators and the market, using percolation analysis. We show that preferentially targeting minor, non-central agents can outperform targeting of hubs when the costs to stakeholders and the risks of market disturbance are considered. Our study highlights the importance of assessing joint economic-epidemiological risks in networks underlying pathogen propagation and trade., (© 2016 The Authors.)

Mycobacterium avium subsp. paratuberculosis (Map) causes Johne's disease, with large economic consequences for dairy cattle producers worldwide. Map spread between farms is mainly due to animal movements. Locally, herd size and management are expected to influence infection dynamics. To provide a better understanding of Map spread between dairy cattle farms at a regional scale, we describe the first spatio-temporal model accounting simultaneously for population and infection dynamics and indirect local transmission within dairy farms, and between-farm transmission through animal trade. This model is applied to Brittany, a French region characterized by a high density of dairy cattle, based on data on animal trade, herd size and farm management (birth, death, renewal, and culling) from 2005 to 2013 for 12,857 dairy farms. In all simulated scenarios, Map infection highly persisted at the metapopulation scale. The characteristics of initially infected farms strongly impacted the regional Map spread. Network-related features of incident farms influenced their ability to contaminate disease-free farms. At the herd level, we highlighted a balanced effect of the number of animals purchased: when large, it led to a high probability of farm infection but to a low persistence. This effect was reduced when prevalence in initially infected farms increased. Implications of our findings in the current enzootic situation are that the risk of infection quickly becomes high for farms buying more than three animals per year. Even in regions with a low proportion of infected farms, Map spread will not fade out spontaneously without the use of effective control strategies.

Between 2007 and 2009, the largest human Q fever epidemic ever described occurred in the Netherlands. The source was traced back to dairy goat farms, where abortion storms had been observed since 2005. Since one putative cause of these abortion storms is the intensive husbandry systems in which the goats are kept, the objective of this study was to assess whether these could be explained by herd size, reproductive pattern and other demographic aspects of Dutch dairy goat herds alone. We adapted an existing, fully parameterized simulation model for Q fever transmission in French dairy cattle herds to represent the demographics typical for Dutch dairy goat herds. The original model represents the infection dynamics in a herd of 50 dairy cows after introduction of a single infected animal; the adapted model has 770 dairy goats. For a full comparison, herds of 770 cows and 50 goats were also modeled. The effects of herd size and goat versus cattle demographics on the probability of and time to extinction of the infection, environmental bacterial load and abortion rate were studied by simulation. The abortion storms could not be fully explained by demographics alone. Adequate data were lacking at the moment to attribute the difference to characteristics of the pathogen, host, within-herd environment, or a combination thereof. The probability of extinction was higher in goat herds than in cattle herds of the same size. The environmental contamination was highest within cattle herds, which may be taken into account when enlarging cattle farming systems.

Q fever is a worldwide zoonosis caused by the bacterium Coxiella burnetii. The control of this infection in cattle is crucial: infected ruminants can indeed encounter reproductive disorders and represent the most important source of human infection. In the field, vaccination is currently advised in infected herds but the comparative effectiveness of different vaccination protocols has never been explored: the duration of the vaccination programme and the category of animals to be vaccinated have to be determined. Our objective was to compare, by simulation, the effectiveness over 10 years of three different vaccination strategies in a recently infected dairy cattle herd.A stochastic individual-based epidemic model coupled with a model of herd demography was developed to simulate three temporal outputs (shedder prevalence, environmental bacterial load and number of abortions) and to calculate the extinction rate of the infection. For all strategies, the temporal outputs were predicted to strongly decrease with time at least in the first years of vaccination. However, vaccinating only three years was predicted inadequate to stabilize these dynamic outputs at a low level. Vaccination of both cows and heifers was predicted as being slightly more effective than vaccinating heifers only. Although the simulated extinction rate of the infection was high for both scenarios, the outputs decreased slower when only heifers were vaccinated.Our findings shed new light on vaccination effectiveness related to Q fever. Moreover, the model can be further modified for simulating and assessing various Q fever control strategies such as environmental and hygienic measures.

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Although ruminants are recognized as the most important source of human infection, no previous studies have focused on assessing the characteristics of the bacterial spread within a cattle herd and no epidemic model has been proposed in this context. We assess the key epidemiological parameters from field data in a Bayesian framework that takes into account the available knowledge, missing data and the uncertainty of the observation process owing to the imperfection of diagnostic tests. We propose an original individual-based Markovian model in discrete time describing the evolution of the infection for each animal. Markov chain Monte Carlo methodology is used to estimate parameters of interest from data consisting of individual health states of 217 cows of five chronically infected dairy herds sampled every week for a four-week period. Outputs are the posterior distributions of the probabilities of transition between health states and of the environmental bacterial load. Our findings show that some herds are characterized by a very low infection risk while others have a mild infection risk and a non-negligible intermittent shedding probability. Moreover, the antibody status seems to be a key point in the bacterial spread (shedders with antibodies shed for a longer period of time than shedders without antibodies). In addition to the biological insights, these estimates also provide information for calibrating simulation models to assess control strategies for C. burnetii infection.

Epidemic models usually rely on the assumption of exponentially distributed sojourn times in infectious states. This is sometimes an acceptable approximation, but it is generally not realistic and it may influence the epidemic dynamics as it has already been shown in one population. Here, we explore the consequences of choosing constant or gamma-distributed infectious periods in a metapopulation context. For two coupled populations, we show that the probability of generating no secondary infections is the largest for most parameter values if the infectious period follows an exponential distribution, and we identify special cases where, inversely, the infection is more prone to extinction in early phases for constant infection durations. The impact of the infection duration distribution on the epidemic dynamics of many connected populations is studied by simulation and sensitivity analysis, taking into account the potential interactions with other factors. The analysis based on the average nonextinct epidemic trajectories shows that their sensitivity to the assumption on the infectious period distribution mostly depends on R0, the mean infection duration and the network structure. This study shows that the effect of assuming exponential distribution for infection periods instead of more realistic distributions varies with respect to the output of interest and to other factors. Ultimately it highlights the risk of misleading recommendations based on modelling results when models including exponential infection durations are used for practical purposes.

The recurrence of influenza A epidemics has originally been explained by a "continuous antigenic drift" scenario. Recently, it has been shown that if genetic drift is gradual, the evolution of influenza A main antigen, the haemagglutinin, is punctuated. As a consequence, it has been suggested that influenza A dynamics at the population level should be approximated by a serial model. Here, simple models are used to test whether a serial model requires gradual antigenic drift within groups of strains with the same antigenic properties (antigenic clusters). We compare the effect of status based and history based frameworks and the influence of reduced susceptibility and infectivity assumptions on the transient dynamics of antigenic clusters. Our results reveal that the replacement of a resident antigenic cluster by a mutant cluster, as observed in data, is reproduced only by the status based model integrating the reduced infectivity assumption. This combination of assumptions is useful to overcome the otherwise extremely high model dimensionality of models incorporating many strains, but relies on a biological hypothesis not obviously satisfied. Our findings finally suggest the dynamical importance of gradual antigenic drift even in the presence of punctuated immune escape. A more regular renewal of susceptible pool than the one implemented in a serial model should be part of a minimal theory for influenza at the population level.

The dynamics of viral shedding and symptoms following influenza virus infection are key factors when considering epidemic control measures. The authors reviewed published studies describing the course of influenza virus infection in placebo-treated and untreated volunteers challenged with wild-type influenza virus. A total of 56 different studies with 1,280 healthy participants were considered. Viral shedding increased sharply between 0.5 and 1 day after challenge and consistently peaked on day 2. The duration of viral shedding averaged over 375 participants was 4.80 days (95% confidence interval: 4.31, 5.29). The frequency of symptomatic infection was 66.9% (95% confidence interval: 58.3, 74.5). Fever was observed in 37.0% of A/H1N1, 40.6% of A/H3N2 (p = 0.86), and 7.5% of B infections (p = 0.001). The total symptoms scores increased on day 1 and peaked on day 3. Systemic symptoms peaked on day 2. No such data exist for children or elderly subjects, but epidemiologic studies suggest that the natural history might differ. The present analysis confirms prior expert opinion on the duration of viral shedding or the frequency of asymptomatic influenza infection, extends prior knowledge on the dynamics of viral shedding and symptoms, and provides original results on the frequency of respiratory symptoms or fever.

Background: Although strategies to contain influenza pandemics are well studied, the characterization and the implications of different geographical and temporal diffusion patterns of the pandemic have been given less attention., Methodology/main Findings: Using a well-documented metapopulation model incorporating air travel between 52 major world cities, we identified potential influenza pandemic diffusion profiles and examined how the impact of interventions might be affected by this heterogeneity. Clustering methods applied to a set of pandemic simulations, characterized by seven parameters related to the conditions of emergence that were varied following Latin hypercube sampling, were used to identify six pandemic profiles exhibiting different characteristics notably in terms of global burden (from 415 to >160 million of cases) and duration (from 26 to 360 days). A multivariate sensitivity analysis showed that the transmission rate and proportion of susceptibles have a strong impact on the pandemic diffusion. The correlation between interventions and pandemic outcomes were analyzed for two specific profiles: a fast, massive pandemic and a slow building, long-lasting one. In both cases, the date of introduction for five control measures (masks, isolation, prophylactic or therapeutic use of antivirals, vaccination) correlated strongly with pandemic outcomes. Conversely, the coverage and efficacy of these interventions only moderately correlated with pandemic outcomes in the case of a massive pandemic. Pre-pandemic vaccination influenced pandemic outcomes in both profiles, while travel restriction was the only measure without any measurable effect in either., Conclusions: our study highlights: (i) the great heterogeneity in possible profiles of a future influenza pandemic; (ii) the value of being well prepared in every country since a pandemic may have heavy consequences wherever and whenever it starts; (iii) the need to quickly implement control measures and even to anticipate pandemic emergence through pre-pandemic vaccination; and (iv) the value of combining all available control measures except perhaps travel restrictions.

Recent avian flu epidemics (A/H5N1) in Southeast Asia and case reports from around the world have led to fears of a human pandemic. Control of these outbreaks in birds would probably lead to reduced transmission of the avian virus to humans. This study presents a mathematical model based on stochastic farm-to-farm transmission that incorporates flock size and spatial contacts to evaluate the impact of control strategies. Fit to data from the recent epidemic in the Netherlands, we evaluate the efficacy of control strategies and forecast avian influenza dynamics. Our results identify high-risk areas of spread by mapping of the farm level reproductive number. Results suggest that an immediate depopulation of infected flocks following an accurate and quick diagnosis would have a greater impact than simply depopulating surrounding flocks. Understanding the relative importance of different control measures is essential for response planning.

Although syndromic surveillance systems using nonclinical data have been implemented in the United States, the approach has yet to be tested in France. We present the results of the first model based on drug sales that detects the onset of influenza season and forecasts its trend. Using weekly lagged sales of a selected set of medications, we forecast influenzalike illness (ILI) incidence at the national and regional level for 3 epidemic seasons (2000-01, 2001-02, and 2002-03) and validate the model with real-time updating on the fourth (2003-04). For national forecasts 1-3 weeks ahead, the correlation between observed ILI incidence and forecast was 0.85-0.96, an improvement over the current surveillance method in France. Our findings indicate that drug sales are a useful additional tool to syndromic surveillance, a complementary and independent source of information, and a potential improvement for early warning systems for both epidemic and pandemic planning.

Objective: To study the role of resistance characteristics of viral mutants in the prediction of virologic and immunologic response to antiretroviral therapy in HIV-infection., Methods: This study is based on a mathematical model that generates viral and immunologic dynamics of HIV infection, taking into account drug-resistant mutants and therapy. We analyzed predictive factors of the increase in CD4 cell count and of the decrease in viral load from baseline after 6 months of HAART on a sample of 300 simulated individuals. The set of potential predictors was constituted by patients' state at initiation of therapy and by resistance characteristics of viral strains at that time. Predictive models, obtained by stepwise regression, were selected and compared using Mallows' Cp criterion., Results: In addition to baseline viral load and CD4 cell count, known to influence response to therapy, baseline CD8 cell count and resistance characteristics of detectable strains are shown to improve the accuracy of the prediction. On the contrary, resistance parameters of low frequency viral mutants have no predictive value., Conclusions: Characteristics of preexisting detectable resistant mutants as determinants of virologic and immunologic response to antiretroviral therapy increase the capacity to predict the outcome of the treatment. Therefore, the use of phenotypic and genotypic testing could be crucial and should be considered for the choice of therapy.