Public and Occupational Health
Disease surveillance systems are essential for understanding the epidemiology of infectious diseases and improving population health. A well-designed surveillance system can achieve a high level of fidelity in estimates of interest (e.g., disease trends, risk factors) within its operational constraints. Currently, design parameters that define surveillance systems (e.g., number and placement of the surveillance sites, target populations, case definitions) are selected largely by expert opinion and practical considerations. Such an informal approach is less tenable when multiple aspects of surveillance design—or multiple surveillance objectives—need to be considered simultaneously, and are subject to resource or logistical constraints. Here we propose a framework to optimize surveillance system design given a set of defined surveillance objectives and a dynamical model of the disease system under study. The framework provides a platform for in silico surveillance system design, and allows the formulation of surveillance guidelines based on quantitative evidence, tailored to local realities and priorities. The framework is designed to facilitate greater collaboration between health planners and computational and data scientists to advance surveillance science and strengthen the architecture of surveillance networks.
Screening household members of newly detected tuberculosis cases is an efficient method for finding previously undiagnosed cases in high-burden settings. Despite the intuitive appeal of this approach, randomized trials examining the population-level effects of these interventions in settings with sustained community transmission have shown mixed results. One explanation for these inconclusive findings is that household transmission is responsible for a varying proportion of overall tuberculosis burden between locations, with the impact of household transmission being a function of both the overall incidence and the relative intensity of disease-transmitting contacts in the community and the household. In this manuscript, we use an individual-based network model to explore how local incidence levels and patterns of community contact impact the effectiveness of household-based approaches for interrupting tuberculosis transmission. Our analyses suggest that protective benefits of household-based interventions are maintained across a wide range of epidemiological settings. Our findings provide evidence for the robustness of household-based interventions and suggest that variable results from trials may be primarily due to implementation challenges rather than inherent limitations of these interventions.