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Foot and Mouth Disease (FMD) affects cloven-hoofed animals globally and has become a major economic burden for many countries around the world. Countries that have had recent FMD outbreaks are prohibited from exporting most meat products; this has major economic consequences for farmers in those countries, particularly farmers that experience outbreaks or are near outbreaks. Reducing the number of FMD outbreaks in countries where the disease is endemic is an important challenge that could drastically improve the livelihoods of millions of people. As a result, significant effort is expended on surveillance; but there is a concern that uninformative surveillance strategies may waste resources that could be better used on control management. Rapid detection through sentinel surveillance may be a useful tool to reduce the scale and burden of outbreaks. In this study, we use an extensive outbreak and cattle shipment network dataset from the Republic of Türkiye to retrospectively test three possible strategies for sentinel surveillance allocation in countries with endemic FMD and minimal existing FMD surveillance infrastructure that differ in their data requirements: ranging from low to high data needs, we allocate limited surveillance to [1] farms that frequently send and receive shipments of animals (Network Connectivity), [2] farms near other farms with past outbreaks (Spatial Proximity) and [3] farms that receive many shipments from other farms with past outbreaks (Network Proximity). We determine that all of these surveillance methods find a similar number of outbreaks – 2-4.5 times more outbreaks than were detected by surveying farms at random. On average across surveillance efforts, the Network Proximity and Network Connectivity methods each find a similar number of outbreaks and the Spatial Proximity method always finds the fewest outbreaks. Since the Network Proximity method does not outperform the other methods, these results indicate that incorporating both cattle shipment data and outbreak data provides only marginal benefit over the less data-intensive surveillance allocation methods for this objective. We also find that these methods all find more outbreaks when outbreaks are rare. This is encouraging, as early detection is critical for outbreak management. Overall, since the Spatial Proximity and Network Connectivity methods find a similar proportion of outbreaks, and are less data-intensive than the Network Proximity method, countries with endemic FMD whose resources are constrained could prioritize allocating sentinels based on whichever of those two methods requires less additional data collection. 

The structure of contact networks affects the likelihood of disease spread at the population scale and the risk of infection at any given node. Though this has been well characterized for both theoretical and empirical networks for the spread of epidemics on completely susceptible networks, the long-term impact of network structure on risk of infection with an endemic pathogen, where nodes can be infected more than once, has been less well characterized. Here, we analyze detailed records of the transportation of cattle among farms in Turkey to characterize the global and local attributes of the directed—weighted shipments network between 2007-2012. We then study the correlations between network properties and the likelihood of infection with, or exposure to, foot-and-mouth disease (FMD) over the same time period using recorded outbreaks. The shipments network shows a complex combination of features (local and global) that have not been previously reported in other networks of shipments; i.e. small-worldness, scale-freeness, modular structure, among others. We find that nodes that were either infected or at high risk of infection with FMD (within one link from an infected farm) had disproportionately higher degree, were more central (eigenvector centrality and coreness), and were more likely to be net recipients of shipments compared to those that were always more than 2 links away from an infected farm. High in-degree (i.e. many shipments received) was the best univariate predictor of infection. Low in-coreness (i.e. peripheral nodes) was the best univariate predictor of nodes always more than 2 links away from an infected farm. These results are robust across the three different serotypes of FMD observed in Turkey and during periods of low-endemic prevalence and high-prevalence outbreaks. 

Probabilistic predictions support public health planning and decision making, especially in infectious disease emergencies. Aggregating outputs from multiple models yields more robust predictions of outcomes and associated uncertainty. While the selection of an aggregation method can be guided by retrospective performance evaluations, this is not always possible. For example, if predictions are conditional on assumptions about how the future will unfold (e.g. possible interventions), these assumptions may never materialize, precluding any direct comparison between predictions and observations. Here, we summarize literature on aggregating probabilistic predictions, illustrate various methods for infectious disease predictions via simulation, and present a strategy for choosing an aggregation method when empirical validation cannot be used. We focus on the linear opinion pool (LOP) and Vincent average, common methods that make different assumptions about between-prediction uncertainty. We contend that assumptions of the aggregation method should align with a hypothesis about how uncertainty is expressed within and between predictions from different sources. The LOP assumes that between-prediction uncertainty is meaningful and should be retained, while the Vincent average assumes that between-prediction uncertainty is akin to sampling error and should not be preserved. We provide an R package for implementation. Given the rising importance of multi-model infectious disease hubs, our work provides useful guidance on aggregation and a deeper understanding of the benefits and risks of different approaches. 

Abstract BackgroundThe development of public health policy is inextricably linked with governance structure. In our increasingly globalized world, human migration and infectious diseases often span multiple administrative jurisdictions that might have different systems of government and divergent management objectives. However, few studies have considered how the allocation of regulatory authority among jurisdictions can affect disease management outcomes. MethodsHere we evaluate the relative merits of decentralized and centralized management by developing and numerically analyzing a two-jurisdictionSIRSmodel that explicitly incorporates migration. In our model, managers choose between vaccination, isolation, medication, border closure, and a travel ban on infected individuals while aiming to minimize either the number of cases or the number of deaths. ResultsWe consider a variety of scenarios and show how optimal strategies differ for decentralized and centralized management levels. We demonstrate that policies formed in the best interest of individual jurisdictions may not achieve global objectives, and identify situations where locally applied interventions can lead to an overall increase in the numbers of cases and deaths. ConclusionsOur approach underscores the importance of tailoring disease management plans to existing regulatory structures as part of an evidence-based decision framework. Most importantly, we demonstrate that there needs to be a greater consideration of the degree to which governance structure impacts disease outcomes.