Disease transmission models for public health decision making: analysis of epidemic and endemic conditions caused by waterborne pathogens.

Abstract

Developing effective policy for environmental health issues requires integrating large collections of information that are diverse, highly variable, and uncertain. Despite these uncertainties in the science, decisions must be made. These decisions often have been based on risk assessment. We argue that two important features of risk assessment are to identify research needs and to provide information for decision making. One type of information that a model can provide is the sensitivity of making one decision over another on factors that drive public health risk. To achieve this goal, a risk assessment framework must be based on a description of the exposure and disease processes. Regarding exposure to waterborne pathogens, the appropriate framework is one that explicitly models the disease transmission pathways of pathogens. This approach provides a crucial link between science and policy. Two studies--a Giardia risk assessment case study and an analysis of the 1993 Milwaukee, Wisconsin, Cryptosporidium outbreak--illustrate the role that models can play in policy making.

Identifying Etiological Agents Causing Diarrhea in Low Income Ecuadorian Communities

“…6,7 For example, Vibrio spp. infection has been associated with raw or undercooked shellfish 6 and non-typhi Salmonella spp.…”

Modeling Infection Transmission

“…A most positive accomplishment contributing to infection transmission science is the development of methods to determine the population effects of such contact structure and to assess how the location of individuals with different risks within the contact structure alters their 305 importance on the population level of infection (45,77,88,93). Another sign that models are contributing more positively to a science of infection transmission is that they are being used productively to define efficient epidemiological study designs (6,8,14,24,37,38,40,88).…”

Incorporating susceptible subpopulations in microbial risk assessment: pediatric exposures to enteroviruses in river water

“…There are, however, limitations of addressing the transmission of infectious diseases as a static process (Koopman et al, 1991;Koopman and Longini, 1994;Eisenberg et al, 1996). Dynamic models of disease transmission (Hethcote, 1976;Anderson and May, 1991) are able to account for human exposures to contaminated media such as water, exposures to infected individuals that may result in personto-person transmission of infection (Eisenberg et al, 2002), and protection from infection (immunity) from prior exposures (Soller et al, 2002b). Nevertheless, until recently, few researchers or risk assessors have employed an epidemiology-based disease transmission framework to characterize the risk to human health associated with waterborne pathogens (Cooper et al, 1986; EOA Inc., U.C.…”