Foot-and-mouth disease (FMD) in the UK provides an ideal opportunity to explore optimal control measures for an infectious disease. The presence of fine-scale spatio-temporal data for the 2001 epidemic has allowed the development of epidemiological models that are more accurate than those generally created for other epidemics and provide the opportunity to explore a variety of alternative control measures. Vaccination was not used during the 2001 epidemic; however, the recent DEFRA (Department for Environment Food and Rural Affairs) contingency plan details how reactive vaccination would be considered in future. Here, using the data from the 2001 epidemic, we consider the optimal deployment of limited vaccination capacity in a complex heterogeneous environment. We use a model of FMD spread to investigate the optimal deployment of reactive ring vaccination of cattle constrained by logistical resources. The predicted optimal ring size is highly dependent upon logistical constraints but is more robust to epidemiological parameters. Other ways of targeting reactive vaccination can significantly reduce the epidemic size; in particular, ignoring the order in which infections are reported and vaccinating those farms closest to any previously reported case can substantially reduce the epidemic. This strategy has the advantage that it rapidly targets new foci of infection and that determining an optimal ring size is unnecessary.

This Research Article explores the benefits of applying Adaptive Management approaches to disease outbreaks, finding that formally integrating science and policy allows one to reduce uncertainty and improve disease management outcomes.

Formal decision-analytic methods can be used to frame disease control problems, the first step of which is to define a clear and specific objective. We demonstrate the imperative of framing clearly-defined management objectives in finding optimal control actions for control of disease outbreaks. We illustrate an analysis that can be applied rapidly at the start of an outbreak when there are multiple stakeholders involved with potentially multiple objectives, and when there are also multiple disease models upon which to compare control actions. The output of our analysis frames subsequent discourse between policy-makers, modelers and other stakeholders, by highlighting areas of discord among different management objectives and also among different models used in the analysis. We illustrate this approach in the context of a hypothetical foot-and-mouth disease (FMD) outbreak in Cumbria, UK using outputs from five rigorously-studied simulation models of FMD spread. We present both relative rankings and relative performance of controls within each model and across a range of objectives. Results illustrate how control actions change across both the base metric used to measure management success and across the statistic used to rank control actions according to said metric. The output of our analysis frames subsequent discourse between policy-makers, modelers and other stakeholders, by highlighting areas of discord among different management objectives and also among different models used in the analysis. This work represents a first step towards reconciling the extensive modelling work on disease control problems with frameworks for structured decision making.

Spatial heterogeneities and spatial separation of hosts are often seen as key factors when developing accurate predictive models of the spread of pathogens. The question we address in this paper is how coarse the resolution of the spatial data can be for a model to be a useful tool for informing control policies. We examine this problem using the specific case of foot-and-mouth disease spreading between farms using the formulation developed during the 2001 epidemic in the United Kingdom. We show that, if our model is carefully parameterized to match epidemic behavior, then using aggregate county-scale data from the United States is sufficient to closely determine optimal control measures (specifically ring culling). This result also holds when the approach is extended to theoretical distributions of farms where the spatial clustering can be manipulated to extremes. We have therefore shown that, although spatial structure can be critically important in allowing us to predict the emergent population-scale behavior from a knowledge of the individual-level dynamics, for this specific applied question, such structure is mostly subsumed in the parameterization allowing us to make policy predictions in the absence of high-quality spatial information. We believe that this approach will be of considerable benefit across a range of disciplines where data are only available at intermediate spatial scales.foot-and-mouth | modeling T he spatial distribution of organisms is viewed as critically important for determining population dynamics. Numerous examples from the epidemiological and ecological literature have shown that spatial structure has a profound impact on how population-level dynamics emerge from individual-level behavior (123-4). For infectious diseases in particular, where transmission generally occurs over relatively short distances, spatial structure (and in particular the spatial distribution of sessile hosts) plays three roles: hosts that are far from sources of infection are at very little risk, local transmission and depletion of susceptible hosts can dramatically reduce the speed of epidemic growth, and local control measures can be applied using spatial proximity as a method of targeting at-risk hosts. These three elements are present for any spatial distribution of hosts, but are generally amplified by clustering. The impact of spatial structure on the spread of infectious disease has been examined for humans (5), wildlife (6, 7), and livestock (8, 9), but the ability to make useful quantitative predictions relies on the availability of good quality spatial and epidemic data. In recent years, considerable research has focused on the spread of livestock infections due to the extreme vulnerability of the livestock industry, the potential economic costs, the variety of strategies that can be used as control measures, and the costs associated with such measures.The UK 2001 epidemic of foot-and-mouth disease (FMD) provides a prime example of what can be achieved when comprehensive spatial models, detailed hos...