Modified SIR models to Forecast Epidemics:

Modeling Gonorrhea in Erie County

Joel Adornetto, Neil Miller
Advisor: Dr. Saziye Bayram, Dr. Joaquin Carbonara

Buffalo State College
Biological Background for Gonorrhea
Gonorrhea is a sexually transmitted disease and is the second most
common disease in the United States.

It is estimated that 700,000 persons in the United States get new
Gonorrheal infections each year only half of these are reported.

Large amounts of reliable data exists about Gonorrhea.

Any sexually active person can be infected with gonorrhea.
Goals of Modeling a Disease
Although medical advances have reduced the consequences of
infectious disease, preventing infections in the first place is
preferable to treating them.

Once a model has been formulated that captures the main features
of the progression and transmission of a particular disease, it can
be used to predict the effects of different strategies for disease
eradication or control.

Infectious disease modeling, though often inexact, has enormous
potential to help improve human lives.


Erie County Data
The Erie County Center for Disease Surveillance,
has provided the number of cases of Gonorrhea
reported between 2001 and 2006.

The data is organized in two ways:
Yearly (6 data points) with Age and Sex distribution
Monthly (72 data points) only given number of cases
Yearly Erie County Data
ERIE
COUNTY
<10 10-14 15-19 20-29 30-39 40+ TOTAL
M F T M F T M F T M F T M F T M F T M F TOTAL
2001 1 0 1 8 44 52 260 534 794 538 623 1161 176 113 289 92 33 125 1075 1351 2426
2002 0 1 1 8 42 50 212 414 626 429 406 835 124 99 223 87 17 104 860 980 1840
2003 0 3 3 2 33 35 150 348 498 342 349 691 123 96 219 94 30 124 713 859 1572
2004 1 1 2 2 26 28 161 314 475 327 334 661 111 70 181 66 23 89 669 768 1437
2005 0 2 2 5 21 26 148 361 509 399 422 821 125 96 221 102 31 133 779 934 1713
2006 0 0 0 7 29 36 177 378 555 371 449 821 139 86 225 114 37 152 808 981 1791
To simplify our model we decided to use the following groups:
Ages 10-19 are considered to be Teenager
Ages 20+ are considered to be Adults
Ages 10 and under are not considered in the model
Yearly Erie County Data
Teenager Adult
Cases/Year M F M F TOTAL
2001 268 578 806 769 2,421
2002 220 456 640 522 1,838
2003 152 381 559 475 1,567
2004 163 340 504 427 1,434
2005 153 382 626 549 1,710
2006 184 407 624 572 1,787
Monthly Erie County Data
DIAGNOSED
GONORRHE
A
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL
2001 259 182 177 179 206 177 224 226 191 237 184 184 2,426
2002 170 144 162 171 157 131 164 151 161 167 127 135 1,840
2003 142 116 130 107 145 129 145 140 122 142 107 147 1,572
2004 139 107 115 77 111 119 126 144 115 136 124 122 1,435
2005 143 133 122 111 101 103 142 188 177 204 162 127 1,713
2006 173 141 148 128 139 162 137 177 126 154 174 132 1,791
Monthly Erie County Data
Teenager Adult
Cases/Month M F M F TOTAL CASES
2001 22 48 67 64 202
2002 18 38 53 44 153
2003 13 32 47 40 131
2004 14 28 42 36 120
2005 13 32 52 46 143
2006 15 34 52 48 149
SIR and SIS Models
An SIR model consists of three group
Susceptible: Those who may contract the disease
Infected: Those infected
Recovered: Those with natural immunity or those that have died.



An SIS model consists of two group
Susceptible: Those who may contract the disease
Infected: Those infected



Important Parameters
is the transmission coefficient, which determines the rate ate
which the disease travels from one population to another.

is the recovery rate: (I persons)/(days required to recover)

R
0
is the basic reproduction number.



(Number of new cases arising from one infective) x (Average duration of infection)
If R
0
> 1 then I > 0 and an epidemic occurs


( ) o

o
/ 1 ) (
0 o o
S S R = =
SIR and SIS Models
SIR Model:





SIS Model:


I R
I SI I
SI S

o
o
= A
= A
= A
I SI I
I SI S
o
o
= A
+ = A
Basic SIS model for Gonorrhea
m m f m m m
m m m f m m
f f m f f f
f f m f f f
I I S I
I I S S
I I S I
I I S S
o
o
o
o
= A
+ = A
= A
+ = A
days
days
F
M
M F
F
M
F M
F
M
30 / 1
10 / 1
S" " into back I" " from going females of rate removal the is
S" " into back I" " from going males of rate removal the is
females to males from rate ion transmiss the is
males to females from rate ion transmiss the is
~
~
<
<

o o
o
o
PARAMETERS
Basic SIS model for Gonorrhea
m m f m m m
m m m f m m
f f m f f f
f f m f f f
I I S I
I I S S
I I S I
I I S S
o
o
o
o
= A
+ = A
= A
+ = A
Since the population is assumed to be constant:
We can simplify the equations by eliminating the susceptible group.
S = N I, where N is the total population
m m f m m m m
f f m f f f f
I I I N I
I I I N I
o
o
= A
= A
) (
) (
Basic SIS model for Gonorrhea
The next step in the process is to find an equilibrium solution. This means that the
population does not change in the next time step. This is found by setting the change in the
infected population to zero and solving for the infected female and male population.
m m f m m m m
f f m f f f f
I I I N I
I I I N I
o
o
= A
= A
) (
) (
f m
m f m f
m
m f
m f m f
f
N
N N
I
N
N N
I
+

=
+

= rate removal relative a is

Basic SIS model for Gonorrhea
The existence of only one nonzero equilibrium point shows that there is at most one
endemic level of the disease. Increasing the removal rates is the way that these endemic
levels can be decreased. The precise formulas allow prediction of the endemic level
expected from any relative removal rate a public health program might achieve.
f m
m f m f
m
m f
m f m f
f
N
N N
I
N
N N
I
+

=
+

Basic SIS model for Gonorrhea
f m
m f m f
m
m f
m f m f
f
N
N N
I
N
N N
I
+

=
+

Biological analysis
m f m f
N N
This must be positive, since we cannot have a negative infected population
Also, since it has a positive value, it means that Gonorrhea will always be present
Thus, data collection for statistical estimates of the infection and removal rates can
help judge where a disease is likely to remain endemic.
Assumptions for our Erie County Model
The total population is constant through each time step
i.e. N
total
= Infected + Susceptible

Only heterosexual interaction is accounted for

The age group 0-12 will not be considered

We are constructing a modified SIS model
There are eight groups in our model






Population in Erie County
2000 Census
Male Female TOTAL
Teenagers 67,799 64,201 132,000
Adults 323,461 371,027 694,488
TOTAL 391,260 435,228 826,488
Information provided by the 2000 Erie County Census


Teenagers are assumed to be the ages of 10 19
Adults are assumed to be over the age of 19
Our SIS Model for Gonorrhea
FT F MA MT FT F FT
FT F MA FT F MT FT F FT
I I I S I
I I S I S S
o
o o
+ = A
+ = A
) (
FA F MA MT FA F FA
FA F MA MT FA F FA
I I I S I
I I I S S
o
o
+ = A
+ + = A
) (
) (
MT M FA FT MT M MT
MT M FA FT MT M MT
I I I S I
I I I S S
o
o
+ = A
+ + = A
) (
) (
MA M FA FT MA M MA
MA M FA FT MA M MA
I I I S I
I I I S S
o
o
+ = A
+ + = A
) (
) (
Susceptible/Infected Female Adults (Age: 20+)

Susceptible/Infected Male Teenagers (Age: 10-19)

Susceptible/Infected Male Adults (Age: 20+)
Susceptible/Infected Female Teenagers (Age: 10-19)

Closer Look of our SIS Model
FT F MA MT FT F FT
FT F MA FT F MT FT F FT
I I I S I
I I S I S S
o
o o
+ = A
+ = A
) (
Susceptible/Infected Female Teenagers (Age: 10-19)

S
FT
= Susceptible Female Teenagers
I
FT
= Infected Female Teenagers
S
MA
= Susceptible Male Adults
I
MT
= Infected Male Teenagers

Alpha = Transmission Rate
Gamma = Removal Rate



Closer Look of our SIS Model
FT F MA MT FT F FT
FT F MA FT F MT FT F FT
I I I S I
I I S I S S
o
o o
+ = A
+ = A
) (
Susceptible/Infected Female Teenagers (Age: 10-19)

Since the population is constant we can rewrite some of our parameters to reduce the number or
equations we have.

The number of infected male teenagers = total male teenagers - susceptible male teenagers
I
MT
= N
MT
S
MT
I
FT
= N
FT
S
FT


) ( ) ( ) (
FT FT F MA MA FT F MT MT FT F FT
S N S N S S N S S + = A o o
This set of equations becomes
Findings
There is a non zero equilibrium solution for our model

We believe that the data we were provided is on the tail end of
an equilibrium solution, with small perturbations





The transmission rate needs to be extremely small to get similar
infected populations


Challenges
Assumptions must be made, and this of course can lead to error
What is the transmission rate for a given disease
How long is the recovery period

Further difficulty is encountered when little data is available on a particular
subject
i.e. our model does not consider homosexual relations, as we have no data
specific to the infected persons sexual habits
Collecting the data yourself could be a solution

Multiple variables make graphing data very difficult or impossible
We made the assumption that we have a constant population to reduce
the number of equations. This made it possible to write Mathematica
code to run the model vs. time.

Increasing the number of groups increases the accuracy and usefulness of a
model but it typically makes the model more difficult.



Conclusions
Modeling is an effective way to determine dynamics of a population.

Creating a model to analysis a population lets you see how
transmission/removal rates affect the susceptible class.

Personally collecting data to formulate a model can be beneficial to a specific
disease.

Further analysis on our model should tell us the specific transmission rates for
all eight groups. We can do this by starting off with the known removal rates
and the equilibrium equations, and then work backwards to find Ro and
alpha.

Hopefully we will eventually be able to forecast future outbreak, by
monitoring the transmission rates and comparing it to a critical threshold
value.



References
Erie County Department of Health

Sexually Transmitted Disease Resource Site

for Disease Control (CDC)

Mathematical Models in Biology, An Introduction
Elizabeth Allman & John Rhodes