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Andrew Brouwer : Harnessing environmental surveillance: mathematical modeling in the fight against polio

Israel experienced an outbreak of wild poliovirus type 1 (WPV1) in 2013-14, detected through environmental surveillance of the sewage system. No cases of acute flaccid paralysis were reported, and the epidemic subsided after a bivalent oral polio vaccination (bOPV) campaign. As we approach global eradication, polio will increasingly be detected only through environmental surveillance. However, we have lacked the theory to translate environmental surveillance into public health metrics; it is a priori unclear how much environmental surveillance can even say about population-level disease dynamics. We developed a framework to convert quantitative polymerase chain reaction (qPCR) cycle threshold data into scaled WPV1 and OPV1 concentrations for inference within a deterministic, compartmental infectious disease transmission model. We used differential algebra and profile likelihood techniques to perform identifiability analysis, that is, to assess how much information exists in the data for the model, and to quantify inference uncertainty. From the environmental surveillance data, we estimated the epidemic curve and transmission dynamics, determining that the outbreak likely happened much faster than previously thought. Our mathematical modeling approach brings public health relevance to environmental data that, if systematically collected, can guide eradication efforts.

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