Mose Ongau Fred, Johana K. Sigey, Jeconiah A. Okello, James M. Okwoyo & Giterere J. Kang'ethe

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Mose Ongau Fred, Johana K. Sigey, Jeconiah A. Okello, James M. Okwoyo & Giterere J. Kang'ethe

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3, May 2014

of Measles by Vaccination:

Case Study of KISII County, Kenya

Mose Ongau Fred*, Johana K. Sigey**, Jeconiah A. Okello***, James M. Okwoyo**** & Giterere J.

Kang’ethe*****

*Department of Pure and Applied Mathematics, Jomo Kenyatta University of Agriculture and Technology, Nairobi, KENYA.

E-Mail: moseongau{at}gmail{dot}com

**Department of Pure and Applied Mathematics, Jomo Kenyatta University of Agriculture and Technology, Nairobi, KENYA.

Email: jksigey{at}jkuat{dot}ac{dot}ke

***Department of Pure and Applied Mathematics, Jomo Kenyatta University of Agriculture and Technology, Nairobi, KENYA.

E-Mail: jokelo{at}jkuat{dot}ac{dot}ke

****School of Mathematics, University of Nairobi, Nairobi, KENYA. E-Mail: jmkwoyo{at}uonbi{dot}ac{dot}ke

*****Department of Pure and Applied Mathematics, Jomo Kenyatta University of Agriculture and Technology, Nairobi, KENYA.

E-Mail: kgiterere{at}jkuat{dot}ac{dot}ke

Abstract—Protection of children from vaccine-preventable diseases, such as measles, is among primary goal

for health workers. Since vaccination has turned out to be the most effective method against childhood

diseases, developing a framework that would predict an optimal vaccine coverage level needed to control the

spread of these diseases is important and essential. In this project, the use of a population with variable size to

provide this framework was adopted. It majorly relied on a compartmental model expressed by a set of

ordinary (O.D.E) and partial differential equations (P.D.E) based on the dynamics of measles infections. The

mathematical model equations, the mathematical analysis and the numerical simulations that followed served

to reveal quantitatively as well as qualitatively the consequences of the mathematical modeling on measles

vaccination. The numerical and qualitative analyses of the model were performed and different state variables

were determined. Qualitative results show that the model has the disease-free equilibrium which is locally

asymptotically stable for RO<1 and unstable for RO>1. Simulation of different epidemiological classes revealed

that most of the individuals undergoing treatment join the recovered class.

Modeling; Measles Herd Immunity; Vaccination.

Abbreviations—Centre for Disease Control (CDC); Measles Mumps Rubella (MMR); Millennium

Development Goal 4 (MDG4); Susceptible Exposed Infectives Removed (SEIR).

I. INTRODUCTION reported that during the first eight months of 2013, 159

people in the U.S. were reported to have measles. Also in

T

HE Measles virus is a paramyxovirus, genus 2011 MMWR of April 20, 2012 reported that 222 people had

Morbillivirus. Measles is an infectious disease highly contacted measles and many more cases in other parts of the

contageneous respiratory disease through person-to- world. The motivation of this research was to find a model

person transmission mode, with > 95% secondary attack rates that would help predict the ways of containing measles

among susceptible persons. It is the first and worst eruptive outbreaks.

fever occurring during childhood. It produces also a Worldwide; measles vaccination has been very effective,

characteristic red rash and can lead to serious and fatal prevented by MMR (measles, mumps and rubella) vaccine. In

complications including pneumonia, diarrheal and the last decade before the vaccine program an estimated 3-4

encephalitis. Many infected children subsequently suffer million people were infected yearly, of who 4000-5000 died,

blindness, deafness or impaired vision. Measles confer 48000 hospitalized and 1000 developed chronic disability

lifelong immunity from further attacks [Murray, 2003]. from measles encephalitis. Although global incidence has

The latest measles outbreaks in the U.S. in January 1st to been significantly reduced through vaccination, measles

August 24th 2013 in the MMWR of September 13th, 2013

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The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

remains a public health problem. Since vaccination coverage regional elimination outside Africa. Monitoring measles

is not uniformly high in Kenya, measles stands as the leading mortality is relevant for all partners involved in child

vaccine-preventable killer of many children in Africa; survival. The fourth Millennium Development Goal (MDG4)

measles is estimated to have caused 614 000 global deaths aims to reduce deaths of children by two thirds by 2015

annually in 2002, with more than half of measles deaths compared with 1990. The proportion of children vaccinated

occur in sub-Saharan Africa, as given by WHO (2006),and against measles was adopted as an indicator to measure

Grais et al., (2006). progress towards MDG4; a rebound in measles deaths would

The objectives of this research are to find threshold pose a substantial threat to achieving this goal.4,5 The rapid

conditions that determine whether an infectious disease will progress in measles control from 2000 to 2007 was based on

spread or will die out into a population remains one of the implementation of recommended measles mortality reduction

fundamental questions of epidemiological modeling. For this strategies, including increasing routine immunisation

purpose, there exists a key epidemiological quantity R0, the coverage, periodic Supplemental Immunisation Activities

basic reproductive ratio. R0 is the number of secondary cases (SIAs—i.e., mass vaccination campaigns aimed at

that result from a single infectious individual in an entirely immunising 100 percent of a predefined population within

susceptible population. Introduced by Ross in (1909) by several days or weeks), laboratory-supported surveillance,

Hethcote (2000), the current usage of R0 is the following: if and appropriate management of measles cases as by WHO.

R0< 1, the modeled disease dies out, and if R0> 1, the disease Progress in Global measles control and mortality reduction

spreads in the population. Reproductive ratios turned out to 2008. Countries that have fully implemented and sustained

be an important factor in determining targets for vaccination these strategies have experienced reductions in measles cases

coverage. In mathematical models, the reproductive number of greater than 90 percent [Otten et al., 2005]. However, not

R0 is determined by the dominant eigenvalue of the Jacobian all countries have managed to do so, and several of the largest

matrix at the infection-free equilibrium for models in a finite- recorded outbreaks of the past decade were during 2009–10,

dimensional space. WHO measles outbreaks (2011). Because most measles

The contributions of this manuscript are: a)to show that deaths are in countries where vital registration systems cannot

the spread of a disease largely depend on the contact rate, provide reliable information on cause-specific mortality,

therefore, the National Measles Control Programme should WHO has relied on mathematical models to estimate the

emphasize on the improvement in early detection of measles global burden of measles [Wolfson et al., 2007].

cases so that the disease transmission can be minimized. b) In 2000, countries represented by the World Health

To attain herd immunity level of 93.75% for the disease, Organization (WHO) Regional Office for Africa established a

mass vaccination exercise should be encouraged to cover the goal to reduce, by the end of 2005, measles mortality to 50

majority of the population whenever there is an outbreak of percent of the 506,000 deaths from measles estimated in

the disease in Kisii County, Kenya. 1999, [WHO UNICEF Measles Elimination, 2001].

Strategies adopted included strengthening routine

vaccination, providing a second opportunity for measles

II. RELATED WORKS/LITERATURE

vaccination through Supplemental Immunization Activities

SURVEY (SIAs), monitoring disease trends, and improving measles

case management.

Preparedness for, and measures to prevent outbreaks of

Previous models have not objectively incorporated

measles (measles outbreak in Daadab camps) and diarrhoea

measles surveillance data and instead relied on vaccination

diseases should be a priority, particularly if these poorly

coverage data as the primary indicator of local disease

immunized populations are housed in overcrowded settings

burden. Consequently, these models could neither

with limited water, sanitation and hygiene resources.

consistently capture the effects of large outbreaks on measles

According to public health risk assessment and interventions;

mortality where high vaccination coverage was not reported,

the horn of Africa: Drought and famine crisis: July 2011.

nor show periods of low mortality between outbreaks when

In 2007, Researchers from CDC reported that the global

low vaccination coverage was reported. To assess progress

goal to reduce measles deaths by 50% by 2005, compared

towards the 2010 global measles mortality reduction goal, we

with 1999 had been achieved. Firstly, Building on this

developed a new model that, unlike previous models, uses

accomplishment, in 2008 the World Health Organization

surveillance data objectively to estimate both incidence and

summit on measles endorsed a target of 90% reduction in

the age distribution of cases, accounts for herd immunity, and

measles mortality by 2010, compared with 2000. Endemic

uses robust statistical methods to estimate uncertainty.

transmission of measles virus was interrupted in the Kenyans

By 2011, all 194 WHO Member States had introduced or

in 2002, and four of the remaining five WHO regions (all

begun the process of introducing a two-dose measles

except Southeast Asia) have set target dates for measles

vaccination strategy delivered through routine immunization

elimination by 2020 or earlier. Secondly, the establishment of

services and/or SIAs. According to WHO and UNICEF

a global measles eradication goal has been extensively

estimates, global routine coverage with a first dose of measles

discussed by the World Health Assembly and advisory

vaccine (MCV1) increased from 72% in 2000 to 85% in 2010

committees to WHO and now hinges on progress towards

[WHO/UNICEF Measles Elimination, 2010]. During this

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The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

same period, coverage increased from 58% to 78% in the 47 with measles and are able to transmit the disease, and the

countries with the highest burden of measles. By the end of Recovered represented by R are people who have recovered

2010, the routine immunization schedules of 139 countries from the disease. Note that S+E+I+R=N, where N being the

included two doses of measles-containing vaccine (MCV), total population is constant. In all, the assumption is that the

and in 2011, GAVI supported 11 more countries to introduce population is a value somewhere between zero and N, with N

a routine second dose of measles (MCV2). The timing of meaning the population is at full capacity. It is further

MCV2 serves as an important contact between the child and assumed that all individuals are equally likely to be infected

the Expanded Programme on Immunization (EPI) because it by the infectious individuals in a case of contact except those

provides an opportunity to catch up on any missed who are immune. The undetected or late detected infectious

vaccinations and deliver boosters, e.g. Diphtheria-Tetanus- individuals are the ones contributing to disease transmission

Pertussis (DTP) vaccine to older age groups. and spread. Those detected are isolated to the hospital for

Overwhelming evidence demonstrates the benefit of immediate treatment and education. It is further assumed that

providing universal access to measles and rubella-containing those recovered become immune and they get some form of

vaccines. Globally, an estimated 535 000 children died of education about the transmission of the measles. The

measles in 2000. By 2010, the global push to improve transmission of the measles within the compartment is

vaccine coverage resulted in a 74% reduction in deaths. negligible. It’s further assumed that there is no treatment

These efforts, supported by the Measles and Rubella failure in the compartment, therefore a patient will either

Initiative, contributed 23% of the overall decline in under- recover or dies. The model is as follows:

five deaths between 1990 and 2008 and are driving progress

towards meeting Millennium Development Goal 4 (MDG4) 𝜌 Bir

Measles and Rubella strategic plan 2012-2020. th

In the year 2000, the World Health Organization (WHO) bN

1

s

estimated that 535 000 children died of measles, the majority 𝛽𝑆 𝜎𝐸𝛾

in developing countries, and this burden accounted for 5% of 𝑁 R

S E I

all under five mortality, levels & trends in child mortality

(t) (t) (t) (t)

report 2011. In some developing countries, case-fatality rates

𝜇𝑆𝜇𝐸 (𝜇 + 𝛿)𝐼𝜇𝑅

for measles among young children may still reach 5–6% by

Wolfson et al., (2009). In industrialized countries, De

De De De

approximately 10–30% of measles cases require

hospitalization, and one in a thousand of these cases among at at at at

Figure 1: The Horizontal Compartmental Model of Measles

children results in death from measles complications, as per hs hs hs hs

Vaccination

WHO (2001) and WHO (2005).

Let b be the Birth rate (new-born or immigrants or

recruitment rate), μ be the natural mortality/death rate or

III. METHODS/DISCUSSION emigrants, β be the rate (force) of infection per unit time , λ is

rate at which an infected individual becomes infectious per

In this problem a deterministic, compartmental, mathematical

unit time, α is the rate at which an infectious individual

model is used to describe the transmission dynamics of

recovered per unit time.

measles as by Hethcote & Waltman (1973, 1989 and 2000).

The population is homogeneously mixing and reflects the Table 2: Variables and Definitions of Sub-Populations used as

demography of a typical developing country like Kenya, as it Variables

experiments an exponential increasing dynamics. Variable Definition

Compartments with labels such as S, E, I, and R are often S(t) The number of susceptibles at time, t

E(t) The number of Exposed at time, t

used for the epidemiological classes. As most mothers has

I(t) The number of Infected at time, t

been infected, IgG antibodies transferred across the placenta,

R(t) The number of Removed at time, t

to newborn infants give them temporary passive immunity to

measles’ infection [Hethcote, 1989]. The model equation is Table 2: Parameter and their Definitions

kept simple: a deterministic, compartmental, mathematical Parameter Definition

model is formulated to describe the transmission dynamics of b Birth rate

measles. The progression of measles within the total µ Mortality rate

population can be simplified to four differential equations. 𝛽 Contact rate

1

These four equations represent four different groups of Average latent rate

𝜎

people: the Susceptibles, the Exposed, the Infectives, and the 1

Recovered. The Susceptibles (represented by ―S‖) are people 𝛾

Average infectious period

that have never come into contact with measles, the Exposed P Proportion of those successively vaccinated at birth

(represented by ―E‖) are people who have come into contact 𝛿 Differential mortality due to measles

with the disease but are not yet infectives, the Infectives

(represented by ―I‖) are people who have become infected

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The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

𝑑𝑆 𝐼

𝑑𝑡

= bN-βS𝑁 - µS (1) A first-order linear differential equation of the form

𝑑𝐸 𝐼 𝑑𝑁

𝑑𝑡

= βs𝑁 – (𝜎+𝜇)E (2)

𝑑𝑡

= 𝑏−𝜇 N

𝑑𝐼 Has a solution when integrated as

= 𝜎E- (𝛾 + 𝜇 + 𝛿)I (3)

𝑑𝑡

𝑑𝑅 Ln N= 𝑏 − 𝜇 t+c

= 𝛾I –𝜇𝑅 (4)

𝑑𝑡 Thus N (t)=C𝑒 𝑏−𝜇 𝑡 at t=o N(0)=C

𝑑𝑁

=0, and N=S+E+I+R is thus constant. Hence the solution of the linear differential equation then

𝑑𝑡

Properties of the SEIR Model Equations becomes

The basic properties of the of the model equations 1-4 are N(t)=N(0)e(b-µ)t

feasible solutions and positivity of solutions. The feasible Therefore, Ø is positively invariant.

solution shows the region in which the solution of the Positivity of Solutions

equations are biologically meaningful and the positivity of It can be proved that all the variables in the model equations

the solutions describes the non-negativity of the solutions of 1-4 are non-negative.

the equations 1-4. Let the initial data set be (S,E,I,R)(0)≥0∈Ø,then the

Feasible Solution solution set (S,E,I,R)(t)

The feasible solution set which is positively invariant set of Of the equations 1-4 is positive for all t>0.

the model is given by, Proof: from equation 1 if it is assumed that,

𝑑𝑆 𝐼 𝐼

𝑏 = b(1-p)N-µS-βS ≥-(µ+β )S

Ø= S, E, I, R ∈ R: S + E + I + R = N ≤ R+4 𝑑𝑡 𝑁 𝑁

𝜇 𝑑𝑆 𝐼 𝑑𝑆 𝐼

From the Model Equations 1-4 it will be shown that the Then ≥-(µ+βS )S or ≥-(µ+βS )S

𝑑𝑡 𝑁 𝑆 𝑁

region is positively invariant. Considering the steps below On integrating both sides we get

from the Model equations, the total population of individuals 𝐼

Ln S(t) ≥-(µ+β )t+C

𝑁

is given by

S(t)≥Ce-(µ+ΒI/N)t but at t=0, we have

N=S+E+I+R. 𝐼 𝐼

Therefore adding the differential equations 1-4, the S(t)≥S(0)e-(µ+β )t≥ 0, since (µ+β )>0

𝑁 𝑁

results becomes From equation 2,

𝑑𝑁 𝑑𝐸 𝐼

= 𝑏+𝜇 N =βS -(µ+𝜎)𝐸 ≥ −(µ + 𝜎)E

𝑑𝑡 𝑑𝑡 𝑁

𝑑𝐸

Therefore =−(µ + 𝜎)E

𝑑𝑡

IV. SEIR MODEL WITH VACCINATION On integrating both sides gives

Ln E(t)≥ −(µ + 𝜎)t + C ,at t=0 we have

In Kenya, vaccination against measles consists of one dose of E(t)≥E(0)e-(µ+𝜎) ≥0, since =(µ + 𝜎)>0.

standard titer Schwarz vaccine given to infants after early From equation 3

age. Nevertheless, during epidemics an early two-dose 𝑑𝐼

=𝜎𝐸-(γ+µ+𝛿)I≥-(γ+µ+𝛿)I

strategy is implemented: at different times, as given by 𝑑𝑡

Kaninda et al., (1998) and Grais et al., (2006). Before these Hence I(t)≥I(0)e-(γ+µ+ᵟ) since (γ+µ+𝛿)>0

times, suppose that children gain protection from the From equation 4, is obtained

𝑑𝑅

maternal antibodies. Taking into account this schedule of p =bpN+γI+µR

𝑑𝑡

vaccination, the differential equations for this deterministic Which has integrating factor I(t)=eµt hence its solution is

model are as follows from figure 1: 𝐼

𝑑𝑠

R(t)=γ +Ce-µt at t=0 we get

𝑑𝑡

= b(1 − p)N – βS𝑁𝐼 –𝜇𝑆 (5) 𝜇

𝐼

𝑑𝐸 𝐼

= βS𝑁 − (σ + μ)E (6) R(t)= γ +R(0)e-µt≥0 since µ>0.

𝑑𝑡 𝜇

𝑑𝐼

𝑑𝑡

= σE − (γ + μ + δ)I (7) Existence of Steady States of the System

𝑑𝑅 The equilibrium points of the system can be obtained by

𝑑𝑡

= bpN+ γI – μR (8)

𝑑𝑁

equating the rate of changes to zero.

=0, and N=S+E+I+R is also constant 𝑑𝑆 𝑑𝐸 𝑑𝐼 𝑑𝑅

𝑑𝑡

+ + + =0

From the Model equations, the total population of 𝑑𝑡 𝑑𝑡 𝑑𝑡 𝑑𝑡

individuals is given by Global Asymptotic Stability of the Model

N=S+E+I+R In proving the global stability of the SEIR Model, there is

Therefore adding the differential equations 1-4, the need to find the equilibrium points of the system 5-8.

results becomes If the system is set to zero, will give

𝑑𝑆 𝑑𝐸 𝑑𝐼 𝑑𝑅 𝑑(𝑆+𝐸+𝐼+𝑅) 𝑑𝑁 𝐼

+ + + = = = bN+µN, thus b(1-p)N-βS𝑁 -µS=0 (9)

𝑑𝑡 𝑑𝑡 𝑑𝑡 𝑑𝑡 𝑑𝑡 𝑑𝑡

𝑑𝑁 𝐼

= 𝑏+𝜇 N βS𝑁 -(𝜎 + 𝜇)E=0 (10)

𝑑𝑡

𝜎𝐸 − γ+µ+𝛿 )I=0 (11)

bpN+γI-µR=0 (12)

ISSN: 2321-2381 © 2014 | Published by The Standard International Journals (The SIJ) 64

The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

I= −

(γ+µ+𝛿)(𝜎+𝜇 ) 𝛽

b(1-p)N-µS-(𝜎 + 𝜇)E=0

Assuming that the birth rate, b is equal to death rate, µ i.e Using R0XS*=1

𝛽𝜎

b=µ R0=

(γ+µ+𝛿)(𝜎+𝜇 )

b(1−p)N−(𝜎+𝜇 )E 1 𝜎𝛾 1

S= 13 Therefore S*= and R = *

1−

𝜇 𝑅0 (γ+µ+𝛿)(𝜎+𝜇 ) 𝑅0

But b=µ then 𝜇 1 𝜎𝜇 1

µ(1−p)N−(𝜎+𝜇 )E And E*= 1− and I = *

1−

𝜎+𝜇 𝑅0 (γ+µ+𝛿)(𝜎+𝜇 ) 𝑅0

S=

𝜇 This corresponds to an endemic steady state with

From equation 11 we have constant number of people in the population being infected

𝜎𝐸 =(γ+µ+𝛿)I with the disease.

This is biologically reasonable when S*< N, that is when

Implying that 𝛽𝜎

𝜎𝐸 R0= > 1 where R0 is the basic reproduction ratio

I= 14 γ+µ+𝛿 𝜎+𝜇

(γ+µ+𝛿) of the infection.

But from equation 10 The local stability may be determined from eigenvalues

𝐼

βS =(𝜎 + 𝜇)E of the Jacobianmatrix of the model equations (5) - (8) .The

𝑁

(𝜎 + 𝜇)E= βS =

𝐼 𝛽 (𝜇 1−𝑃 𝑁− 𝜎+𝜇 𝐸)𝜎𝐸 Jacobian of Equations (5-8) at the equilibrium point (S∗, E∗,

𝑁 𝑁(γ+µ+𝛿) I∗, R∗) is

𝛽 (𝜇 1−𝑃 𝑁− 𝜎+𝜇 𝐸)𝜎𝐸 𝐼∗

(𝜎 + 𝜇)E= 𝑏 1 − 𝑝 − 𝛽 𝑁𝐼∗∗ − 𝜇 𝛽 0 𝑏𝑝

𝑁(γ+µ+𝛿) 𝑁∗

𝑏 1−𝑝 −(𝜎 + 𝜇) 𝜎 𝑏𝑝

Hence we get 𝒯 ∗= 𝑆∗ 𝑆∗ (18)

𝜎𝜇𝛽 1−𝑃 𝑁 𝛽𝜎𝐸 𝜎+𝜇 𝑏 1−𝑝 −𝛽 𝛽 −𝛾 + 𝜇 + 𝛿 𝛾 + 𝑏𝑝

E − − (𝜎 + 𝜇) =0 𝑁∗ 𝑁∗

0 −𝜇 + 𝑏𝑝

𝑁(γ+µ+𝛿) 𝑁 𝛾+𝜇 +𝛿 𝑏 1−𝑝 0

−𝐸𝛽𝜎 (𝜎+𝜇 ) 𝜎𝜇𝛽 (1−𝑃) Initial Conditions

E 𝑁(𝛾+𝜇 +𝛿)

+

𝛾+𝜇 +𝛿

− (𝜎 + 𝜇) =0 (15)

The mathematical formulation of the epidemic is completed

Either E=0 OR

−𝐸𝛽𝜎 (𝜎+𝜇 ) 𝜎𝜇𝛽 (1−𝑃)

given the initial conditions:

+ − (𝜎 + 𝜇) =0 (i). S (0) = S0>0 (ii). E (0) = E0> 0 (iii).I (0) = I0>0 (iv)

𝑁(𝛾+𝜇 +𝛿) 𝛾+𝜇 +𝛿

−𝐸𝛽𝜎 (𝜎+𝜇 ) 𝜎𝜇𝛽 (1−𝑃) R (0) = R0>0 for all t >0.

+ − (𝜎 + 𝜇) =0

𝑁(𝛾+𝜇 +𝛿) 𝛾+𝜇 +𝛿 In absence of infection E∗= I∗= 0, the Jacobian of (5-8)

−𝐸𝛽𝜎(𝜎 + 𝜇) 𝜎𝜇𝛽(1 − 𝑃) at the disease-free equilibrium

= 𝜎+𝜇 −

𝑁(𝛾 + 𝜇 + 𝛿) 𝛾+𝜇+𝛿 𝜀 0 = (S∗, 0, 0, R∗) is

Multiply both sides by N 𝛾 + 𝜇 + 𝛿 and divide by 𝒯∗

𝑏 1−𝑝 −𝜇 0 0 𝑏𝑝

𝛽𝜎(𝜎 + 𝜇 ) to get

𝑏 1−𝑝 (−𝜎 + 𝜇) 𝜎 𝑏𝑝

N 𝜎𝜇𝛽 (1−𝑃) −N(𝛾+𝜇 +𝛿) 𝜎+𝜇 (19)

E= = 𝛽𝑏 1 − 𝑝 𝛽𝑏(1 − 𝑝)

−(𝛾 + 𝜇 + 𝛿) 𝛾 + 𝑏𝑝

𝛽𝜎 (𝜎+𝜇 ) 𝑏 1−𝑝 −

N 𝜎𝜇𝛽 (1−𝑃) N(𝛾+𝜇 +𝛿) 𝜇 𝜇

0 −𝜇 + 𝑏𝑝

E= - 𝑏 1−𝑝 0

𝛽𝜎 (𝜎+𝜇 𝛽𝜎

𝑁 𝜇 1−𝑃 𝑁 𝛾+𝜇 +𝛿 Its eigenvalues are λ1 = −μ, λ2 = − (b − μ) and the roots

E= 𝜎+𝜇

– 𝛽𝜎

(16) of

Since the birth rate is equal to death rate i.e. b=µ X2 + (2μ + σ + γ + δ) X + (σ + μ) (γ + μ + δ) –

Thus 𝛽𝑏 1−𝑝 (20)

𝑁 𝜇 1−𝑃 𝑁 𝛾+𝜇 +𝛿 𝜇

E=E*= 𝜎+𝜇

– 𝛽𝜎

(17) The disease-free equilibrium 𝜀 0 is locally stable if Rp<1

Realizing that given E=0 from 13 S=1 and from 14 and 12 and unstable if Rp>1 where

I=0 and R=0. 𝑏𝛽𝑝

Rp= 1 − p 𝜇 𝜎+𝜇 𝛾+𝜇 +𝛿

(21)

Thus the disease free equilibrium Z0 is Z0=(1,0,0,0)

Consider S from equation 13 and E from equation 17 i.e. The eigenvalues at the disease „free equilibrium‟ are

b(1−p)N−(𝜎+𝜇 )E given by {- μ, - (μ + λ),-(μ + α), -μ}. All the eigenvalues

S= being negative means that the disease-free equilibrium is

𝜇

* N 𝜇 (1−𝑃) N(𝛾+𝜇 +𝛿) asymptotically stable. The basic reproductive number R0 can

E=E = –

(𝜎+𝜇 ) 𝛽𝜎

be computed by

It is realized that, R0×S*=1, Therefore, Ro =, where (μ + α) (μ + λ) ≠ 0

b 1−p N− 𝜎+𝜇 N 𝜇 (1−𝑃) N(𝛾+𝜇 +𝛿)

S= − This means the transmission rate, i.e., the rate at which

𝜇 (𝜎+𝜇 ) 𝛽𝜎

Also considering I from equation 14 and E from equation 17 exposed become infected and the contact rate, that is the

𝜎𝐸 N 𝜇 (1−𝑃) N(𝛾+𝜇 +𝛿) average number of effective contacts with other (susceptible)

I= and E=E*= - we get I by

(γ+µ+𝛿) (𝜎+𝜇 ) 𝛽𝜎 individuals per infective per unit time relative to the rate at

substituting E into I as which an infectious individuals recovered per unit time play

𝜎𝐸 𝜎 N 𝜇 (1−𝑃) N(𝛾+𝜇 +𝛿)

I= = I= - an important role in determining whether or not an epidemic

γ+µ+𝛿 (γ+µ+𝛿) (𝜎+𝜇 ) 𝛽𝜎

will occur. Hence the disease free equilibrium (1, 0, 0, 0) is

locally asymptotically stable provided that Ro < 1, that is, λ β

ISSN: 2321-2381 © 2014 | Published by The Standard International Journals (The SIJ) 65

The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

equilibrium is unstable, that is the system is said to be J(1,0,0)= 0 −(µ − δ) β =

uniformly persistent, in other words the disease is endemic. 0 δ −(μ − σ)

Thus, Ro is a threshold parameter for the model. As λ1 and λ2 −0.0875 0 −0.09091

are negative, it remains to prove that λ3 and λ4, the roots of 0 −0.2125 0.09091

the quadratic part of that characteristic polynomial of J∗are 0 0.125 −0.230336

both negative. Using Routh-Hurwitz theorem, it is the case The important sub-matrix is the second 2x2 matrix. From

when this, the trace (T) < 0, but if R0<1, then the determinant (D)>0

𝜆3 + λ4<0 and λ3 λ4>0 (22) and if R0>1then (D)<0for all parameters.

As λ3λ4 = − (2μ+σ+γ+δ) <0 is true (23) Routh-Hurwitz stability condition for T and D is given as

From λ3λ4 = (σ+μ)(γ+μ+δ)−βb(1 -p)μ>0 (24) follows:

Remark T=-(2μ + σ + α) =-0.44286

• Rpis the effective reproduction number in presence of D= (𝜇 + 𝛼) (𝜇 + 𝜎)(1-RO)=0.02488

vaccination. Hence the disease free study state when RO<0, and

If p = 0, we have the basic reproductive number R0 unstable when RO>0. The eigenvalues at the disease free

𝑏𝛽𝜎 (25) equilibrium are given by −𝜇, − 𝜇 + 𝜎 ,− 𝜇 + 𝛼 , . All the

= 𝜇 (𝜎+𝜇 )(𝛾+𝜇 +𝛿)

eigenvalues are negative meaning the disease free

equilibrium (1, 0, 0, 0) is asymptotically stable.

VI. RESULTS/PROBLEMS AND SOLUTIONS The endemic equilibrium (s*,e*,i*)=

1 𝜇 (𝑅𝑂−1) 𝜇 (𝑅𝑂−1)

, ,

This part gives an illustration of the analytical results of the 𝑅𝑂 𝑅𝑂(𝜇 −𝜎) 𝛽

model by carrying out stability analysis and numerical The Jacobian matrix for the endemic equilibrium is given

simulations of the model using the parameter values pertinent as

to Kenya in Kisii county in 2013. These parameters were −𝜇𝑅𝑂 0 −(𝜇 + 𝛼)(𝜇 + 𝜎)

obtained from different sources in the medical field literature Jendemic= 𝜇(𝑅0 − 1) −(𝜇 + 𝜎) (𝜇 + 𝛼)(𝜇 + 𝜎)

[Index Kemri, 2013; Immunization Action Programme, 2013; 0 𝜎 −(𝜇 + 𝛼)

Ministry of Health-Kisii Level 5, 2011]. Characteristic equation is given as

X3+a1X2+a2X+a3=0,where

Parameter Parameter

Literature Source a1=𝜎 + 𝛼 + 2 + 𝑅0 𝜇, a2=𝜇𝑅0(2𝜇 + 𝜎 + 𝛼),

Symbol Value

0.02755 per a3=𝜇(𝑅0 − 1) 𝜇2 − 𝜇 𝜎 + 𝛼 + 𝜎𝛼

b KEMRI 2013,kisii level 5 hospital If a1> 0, a2 > 0 and a1a2-a3> 0 are true then from the

year

0.00875 per Routh-Hurwitz criteria for stability, all the roots of the

𝜇 KEMRI 2013,kisii level 5 hospital

year Characteristic equation have negative real part which means

IMMUNIZATION stable equilibrium

0.09091 per

𝛽 PROGRAMME-KISII COUNTY-

day

2013

0.125 per Ministry of health-kisii level 5 VII. NUMERICAL SIMULATIONS OF THE

𝜎

day 2011 MODEL EQUATIONS

0.14286 per Ministry of health- kisii level 5

𝛼

day 2011

Stability Analysis of the Model

Endemic Model

𝑑𝑠

=µ-(µ+βi)s

𝑑𝑡

𝑑𝑒

=βsi-(µ+𝜎)e

𝑑𝑡

𝑑𝑖

= 𝜎𝑒 -(µ+𝛾 + 𝛿)i

𝑑𝑡

𝑑𝑟

= 𝛾 + 𝛿 𝑖 -µr

𝑑𝑡

Linearising the system of the differential equations, the

Jacobian matrix is given as

µ + βi µ 0 µ𝛽

𝛽𝑖 µ+𝜎 µ 𝑏 Figure 2: Simulation of the Susceptible Population

J(s,e,i,r)=

0 𝑏 µ+𝛾+𝛿 0

0 0 0 𝛾+𝛿

For the infection free equilibrium (s,e,i)=(1,0,0), the

Jacobian matrix then becomes

ISSN: 2321-2381 © 2014 | Published by The Standard International Journals (The SIJ) 66

The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

(9) - (12) the solutions S (t), E (t), I (t), R (t) and the

combined graph of both the four are displayed graphically in

figures 2.0-6.0.

Analysis of the Simulations

Figure 1.0 is the diagram showing the dynamics of the

susceptible population.

The Susceptible population decreases as time increases.

This decrease may be possibly because of the high rate of

recovery due to mass vaccination, since individuals become

permanently immune upon recovery. The contact rate also

has large impact on the spread of a disease through a

Figure 3: Simulation of the Exposed Population population. The higher the rates of contact, the more rapid the

spread of the disease, it is also observed that as the contact

rate decreases, the fraction of individuals infected decreases

at a faster rate as would be expected logically.

In figure 2.0 it can be observed that as the rate increases,

the population of exposed individuals shows some rapid

decrease after the earlier intervals of rise. The decrease in the

exposed population could be due to early detection and also

possibly due to those who enter the infective class. This

decrease could also be due to the education about the measles

transmission, very few individuals are coming out as infected

individuals. Also the dynamics of the exposed population

depend on the contact number.

In figure 3.0, it is realized that the population of infected

Figure 4: Simulation of the Infected Population individuals at the very beginning rise sharply as the rate

increases and then fall uniformly as time increases. This rapid

decline of the infected individuals may be due to early

detection of the measles and partly due to those who revert to

the Exposed class. This graph also demonstrates that the

contact rate has large impact on the spread of the disease

through population. If the contact rate is observed to be high

then the rate of infection of the disease will also be high as

would be expected logically. However, there exists another

parameter to consider as more individuals are infected with

the disease and I(t) grows, as some individuals are leaving the

infected class by being cured and joining the recovered class.

In figure 4.0, it is realized that the number of people

recovering increases steadily as rate increases.

Figure 5: Simulation of the Recovered Population

This may be due to early detection of the disease as well

as education about the measles transmission. It can also be

observed that the population of the recovered individuals rise

up steadily for some number of years and then drops and

remains nearly a constant. This could be due to the greater

number of infectious individuals who have been treated and

also acquired education about the measles transmission.

The conclusion and recommendations are offered to

stakeholders, the Kenyan central government, public health

agencies health care providers and the Kisii county

government to enable them determine how best to allocate

Figure 6: Simulation of the Combined Susceptible, Exposed, scarce resources for measles prevention and treatment in the

Infected and Recovered Populations country.

ISSN: 2321-2381 © 2014 | Published by The Standard International Journals (The SIJ) 67

The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

Conclusion Technology- Kisii CBD Campus for offering the course and

The model has shown success in attempting to predict the providing the necessary learning resources to facilitate the

causes of measles transmission within the Kisii County a successful completion of the course. Lastly I thank my

population. The model strongly indicated that the spread of a course-mates and friends for their necessary support and

disease largely depend on the contact rates with infected encouragement through the course.

individuals within a population.

From the model the herd immunity level for measles in REFERENCES

the county was found to be 93.75%. It is also realized that if

[1] R.M. Anderson & R.M. May (1983), ―Vaccination against

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longer persist in the population. Thus if this level can be [2] K. Andrei (2004), ―Lyapunov Functions and Global Properties

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[3] R.F. Grais, M.J. Ferrari, C. Dubray, O.N. Bjrnstad, B.T.

The model also pointed out that early detection has a

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positive impact on the reduction of measles transmission; that ―Estimating Transmission Intensity for a Measles Epidemic in

is there is a need to detect new cases as early as possible so as Niamey, Niger: Lessons for Intervention‖, Transactions of the

to provide early treatment for the disease. More people Royal Society of Tropical Medicine and Hygiene (In Press).

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Biosciences, Vol. 18, Pp. 365–382.

disease.

[5] H.W. Hethcote (1989), ―Optimal Ages for Vaccination for

Recommendations Measles‖, Mathematical Biosciences, Vol. 89, Pp. 29–52.

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counties like Kisii. It is realized that the herd immunity level Siam Review, Vol. 42, No. 4, Pp. 599–653.

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Maisonneuve, C. Paquet & A. Moren (1998), ―Measles

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immune because vaccine efficacy is usually not 100%. It [8] J. Murray (2003), ―Mathematical Biology 1. Introduction‖, 3rd

therefore means that part of the population will be immune Edition, Pp. 315

and others will be vaccinated but not immune. Therefore [9] I.M. Malfait, I.M. Jataou, M.C. Jollet, A. Margot, A.C.

DeBenoist & A. Moren (1994), ―Measles Epidemic in the

there is an urgent need for Health Ministry to come up with

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some new control strategies and more efficient ones to fight Efficacy and Immunization Strategies‖, Niger, 1990 to 1991.

the spread of the disease in the country. The Pediatric Infectious Disease Journal, Vol. 13, Pp. 38–45.

Therefore; from the outcome of the results, [10] S.A. Rost (2008), ―SEIR Model with Distribution Infinite

The model shows that the spread of a disease largely Delay‖, Applied Mathematics Letters, Vol. 15, Pp. 955–960

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that the disease transmission can be minimized. [12] World Health Organization, Department of Vaccinces and

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[13] World Health Organization, Department of Immunization

whenever there is an outbreak of the disease in Kisii Vaccines and Biologicals (2005), ―Vaccine Assessment and

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Immunizations and Biologicals.

[14] World Health Organization. Measles Vaccines: WHO Position

ACKNOWLEDGEMENT paper. Wkly. Epidemiol. Rec. 79, Pp. 130–142

MoseOngau Fred, was born on1st

I would like to thank the Almighty God for his great love, November, 1980 in Kisii county, Nyanza

good health and care He has given me in life and especially province, Kenya. He holds a Bachelor of

through this study. I would like to thank my supervisors: Prof Education Second Honours (Upper Division)

JohanaKibetSigey (JKUAT), Dr. JeconiahOkello (JKUAT), degree in Mathematics & Physics from

Dr. James Okwoyo (UON) and Dr. J. Kangethe (UON) for Kenyatta University, Kenya and is currently

pursuing a Master of Science degree in

their guidance, advice and encouragement to make the

Applied Mathematics from Jomo Kenyatta

conclusion of this work possible. Further thanks to the University of Agriculture and Technology,

management of Jomo Kenyatta University of agriculture and Kenya.

ISSN: 2321-2381 © 2014 | Published by The Standard International Journals (The SIJ) 68

The SIJ Transactions on Computer Science Engineering & its Applications (CSEA), Vol. 2, No. 3, May 2014

He is currently a teacher in Nyamagesa D.E.B Secondary School of Agriculture and Technology. Work involves teaching research

teaching mathematics and Physics from May 2012 to date), Kenya. methods and assisting in supervision of undergraduate and

He has much interest in the study of modeling and Epidemiology postgraduate students in the area of applied mathematics. He has

and their respective applications to engineering. published 10 papers on heat transfer in respected journals.

Supervision of postgraduate students

Johana Kibet Sigey, holds a Bachelor of

Science degree in mathematics and computer Doctor of philosophy: thesis (3 completed)

science first class honors from Jomo Kenyatta Masters of science in applied mathematics: (8 completed,

University of Agriculture and Technology, 8 ongoing)

Kenya, Master of Science degree in Applied Dr. Okwoyo James Mariita. James holds a Bachelor of Education

Mathematics from Kenyatta University and a degree in Mathematics and Physics from Moi University, Kenya,

PhD in applied mathematics from Jomo Master Science degree in Applied Mathematics from the University

Kenyatta University of Agriculture and of Nairobi and PhD in applied mathematics from Jomo Kenyatta

Technology, Kenya. University of Agriculture and Technology, Kenya.

He is currently the acting director, jkuat, Kisiicbd where he is also He is currently a lecturer at the University of Nairobi (November

the deputy director. He has been the substantive chairman - 2011 – Present) responsible for carrying out teaching and research

department of pure and applied mathematics – jkuat (January 2007 duties. He plays a key role in the implementation of University

to July- 2012). He holds the rank of senior lecturer, in applied research projects and involved in its publication. He was an assistant

mathematics pure and applied Mathematics department – jkuat since lecturer at the University of Nairobi (January 2009 – November

November 2009 to date. He has published 9 papers on heat transfer 2011). He has published 7 papers on heat transfer in respected

in respected journals. journals.

Teaching experience: 2000 to date- postgraduate programmes: Supervision of postgraduate students

(jkuat) Masters of science in applied mathematics: ( 8 completed,

Master of science in applied mathematics 8 ongoing)

Units: complex analysis I and ii, numerical analysis, fluid Dr.Giterere J. Kangethe. Kang’ethehold a

mechanics, ordinary differential equations, partial Diploma in information technology from

differentials equations and Riemannian geometry JKUAT He holds a Bachelor of Education

Supervision of postgraduate students degree in Mathematics education from

Doctor of philosophy: thesis (3 completed, 5 ongoing) Kenyatta University, Kenya, Master Science

Masters of science in applied mathematics: (8 completed, degree in Applied Mathematics from theJomo

8 ongoing) Kenyatta University ofAgriculture and

Technology, Kenya and PhD in applied

Dr. Okelo Jeconia Abonyo. He holds a PhD in Applied mathematics from Jomo Kenyatta University

Mathematics from Jomo Kenyatta University of Agriculture and of Agriculture and Technology, Kenya.

Technology as well as a Master of science degree in Mathematics He is currently a lecturer at theJomo Kenyatta University

and first class honors in Bachelor of Education, Science; specialized ofAgriculture and Technology, Kenya responsible for carrying out

in Mathematics with option in Physics, both from Kenyatta teaching and research duties. He plays a key role in the

University. I have dependable background in Applied Mathematics implementation of University research projects and involved in its

in particular fluid dynamics, analyzing the interaction between publication. He was an exams officer September– November 2013.

velocity field, electric field and magnetic field. Has a hand on He has published 4 papersin applied mathematics in respected

experience in implementation of curriculum at secondary and journals. He is also involved in Supervision of postgraduate students

university level. I have demonstrated sound leadership skills and

have ability to work on new initiatives as well as facilitating teams

to achieve set objectives. I have good analytical, design and problem

solving skills.

2011-To dateDeputy Director, School of Open learning and

Distance e Learning SODeL Examination, Admission &Records

(JKUAT), Senior lecturer Department of Pure and Applied

Mathematic and Assistant Supervisor at Jomo Kenyatta University

ISSN: 2321-2381 © 2014 | Published by The Standard International Journals (The SIJ) 69

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