Unintended consequences and the paradox of control: Management of emerging pathogens with age-specific virulence

PLoS Negl Trop Dis. 2018 Apr 9;12(4):e0005997. doi: 10.1371/journal.pntd.0005997. eCollection 2018 Apr.

Abstract

We project forward total Zika virus disease (ZVD) under varying hazards of infection and consider how the age distribution of disease burden varies between these scenarios. Pathogens with age structured disease outcomes, such as rubella and Zika virus, require that management decisions consider their impact not only on total disease incidence but also on distribution of disease burden within a population. Some situations exhibit a "paradox of control" in which reductions of overall transmission decrease the total incidence but increase the incidence of severe disease. This happens because of corresponding increases in the average age of infection. Beginning with the current population structure and demographic rates of Brazil, we project forward total ZVD burden as measured by cases occurring in pregnant women and document the scenarios under which a paradox of control for ZVD management emerges. We conclude that while a paradox of control can occur for ZVD, the higher total costs from increasing the average age of infection will only be realized after several decades and vanish under conservative discounting of future costs. This indicates that managers faced with an emerging pathogen are justified to prioritize current disease incidence over potential increases in severe disease outcomes in the endemic state.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution*
  • Brazil / epidemiology
  • Cost of Illness
  • Cost-Benefit Analysis
  • Disease Outbreaks / prevention & control
  • Humans
  • Incidence
  • Virulence
  • Zika Virus / pathogenicity*
  • Zika Virus Infection / economics*
  • Zika Virus Infection / epidemiology*
  • Zika Virus Infection / transmission

Grants and funding

The research was supported in part by National Science Foundation grant CCF-1215682. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.