Protective Population Behavior Change in Outbreaks of Emerging Infectious Disease

Evans Lodge, a student from Calvin College, worked with Dr. John Drake to measure how human behaviors change during disease outbreaks.

Abstract: In outbreaks of emerging infectious disease, public health interventions aim at increasing the speed with which infected individuals are removed from the susceptible population, limiting opportunities for secondary infection. Isolation, hospitalization, and barrier-nursing practices are crucial for controlling disease spread in these contexts. Ebola virus disease (EVD), Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome (MERS) are all zoonotic infections that have caused significant international outbreaks in the past. Here, we use patient-level data from the 2014-2015 Liberian Ebola epidemic, 2003 Hong Kong SARS epidemic, 2014 Saudi Arabia MERS outbreaks, and 2015 South Korea MERS outbreak to quantify changing removal rates, burial practices, contact tracing, and other measures of protective behavior change. Using the removal rate, γ, as a measure of protective behavior change allows direct comparison of health behavior development in different outbreaks and locations. Robust regression analysis and analyses of covariance are used to estimate the rate at which γ increases in each outbreak by epidemic week and serial interval. Measured interactions between models show that mean removal rates varied within a factor of three, falling between the 2003 Hong Kong SARS outbreak and the 2014-2015 Ebola epidemic in Liberia.

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