Dimple Patel HW #10 ABE 4662

1. Problem #1.9-7 2. Answer the following questions based on the U.S. Response to Cholera Outbreak in Haiti
from the U.S. DEPARTMENT OF STATE Office of the Spokesman on November 18, 2010. : http://www.america.gov/st/texttransenglish/2010/November/20101119102452su0.3537976.html a. The cholera outbreak in Haiti is caused by poor health infrastructure but also another factor contributed significantly, what was this? i. Since there were no outbreaks in the last 50 years, the population has no immunity to it (compounded with the fact that this was a particularly virulent strain), making people more susceptible to Cholera. b. The USAID has been an initial responder to the incident what is their strategy focused on to deal with the outbreaks there are four main parts, what are they? i. Chlorinating/cleaning drinking water ii. Oral rehydration therapy for those that have cholera already iii. Educating this new generation of Haitians on care and prevention iv. Expanding cholera treatment facilities for severe cases c. Explain oral rehydration therapy and where was it first implemented. i. It is a simple mix of sugar, salt, and clean water which was first implemented in South Asia. d. Dr. Menon from the CDC has mention their approach to help Haiti, what are they? i. They focus on patients who make it to the hospital (reducing the fatality rates), work with patients in the community, prevention, work on lab and epidemiological surveillance, work on the science to adjust interventions e. What was the cause of the initial outbreak in cholera, what was the source? i. A breach in the water hygiene infrastructure cause by the earthquake, but the specific source where the pathogen came from is unknown f. Dr. Menon mentions models of South American countries, what was a key factor in the model he describes? i. Infant mortality played a role: higher infant mortality rates meant higher cholera spread. Also the percentage of carriers who dont know they are spreading the disease.

3. Lab 14 - Epidemiological Model

a. After 150 Days:

Heavily infected population

200

150
# people

100

50

0 0 20 40 60 80 Time (Day) 100 120 140

heavily infected population : ASHSandPrevInfraTEST

Cumulative cholera deaths

600

450
# people

300

150

0 0 20 40 60 80 Time (Day) 100 120 140

cumulative cholera deaths : ASHSandPrevInfraTEST

Smoothed fraction of contaminated water

0.0004

0.0003

0.0002

0.0001

0 0 20 40 60 80 Time (Day) 100 120 140

smoothed fraction of contaminated water : ASHSandPrevInfraTEST

b. After 10 years:

Evolution of all Subpopulations

15 M 11.25 M
# people

7.5 M 3.75 M 0 0 365 730 1095 1460 1825 2190 2555 2920 3285 3650 Time (Day)

susceptible population : ASHSandPrevInfraTEST recovered temporarily immune population : ASHSandPrevInfraTEST mildly infected population : ASHSandPrevInfraTEST recently infected population : ASHSandPrevInfraTEST heavily infected population : ASHSandPrevInfraTEST

cumulative cholera deaths

600

450
person

300

150

0 0 365 730 1095 1460 1825 2190 2555 2920 3285 3650 Time (Day)

cumulative cholera deaths : ASHSandPrevInfraTEST

cholera deaths
10

7.5 person/Day

2.5

0 0 365 730 1095 1460 1825 2190 2555 2920 3285 3650 Time (Day)

cholera deaths : ASHSandPrevInfraTEST

This tells us that in the next 10 years if nothing is done, the cumulative cholera deaths will only grow in the 1st year. After that there will be no more deaths (zero slope portion in 2nd graph) because of the immunity built up in the population. The Rate of cholera infection will also exponentially decay over the 10 years (3rd graph). The susceptible population will increase to a certain point and level off as people either recover or die from the disease, and the temporarily recovered population

will decrease and level off at a very low number as less people get the disease (1st graph).

c. Sensitivity study at 150 day simulation i. Connectedness of the Aquifers At half the original = 14%:

cholera infections
200

150 person/Day

100

50

0 0 20 40 60 80 Time (Day) 100 120 140

cholera infections : ASHSandPrevInfraTEST

At double the original = 56%:

cholera infections
2,000

1,500 person/Day

1,000

500

0 0 20 40 60 80 Time (Day) 100 120 140

cholera infections : ASHSandPrevInfraTEST

This graph shows that increasing connectivity of aquifers increases the spike in infection rate and slope afterwards. Also as expected, decreasing connectivity of produces a smaller peak followed by exponential decline in infection rates. This is because more people are susceptible to drinking contaminated water.

ii. Create a linear relationship for effect of the fraction of infected on the fraction of contaminated water for the first 150 days:

Smoothed fraction of contaminated water

0.004

0.003

0.002

0.001

0 0 20 40 60 80 Time (Day) 100 120 140

smoothed fraction of contaminated water : ASHSandPrevInfraTEST

This shows that with a linear relationship, the number of infected has an increasing effect on contaminated water over time. Whereas with the (original) logarithmic relationship, the number of infected becomes exponentially less important over time. iii. Change level of prevention iv. Change average state of health services

d. The level of prevention is changed abruptly from 10% to 70%, and the

average state of health services is increased suddenly from 50% to 70% for the first 150 days:

i. Before change

cumulative cholera deaths

600

450
person

300

150

0 0 20 40 60 80 Time (Day) 100 120 140

cumulative cholera deaths : ASHSandPrevInfraTEST

cholera infections
400

300 person/Day

200

100

0 0 20 40 60 80 Time (Day) 100 120 140

cholera infections : ASHSandPrevInfraTEST

ii. After change

cumulative cholera deaths

20

15
person

10

0 0 20 40 60 80 Time (Day) 100 120 140

cumulative cholera deaths : ASHSandPrevInfraTEST

cholera infections
200

150 person/Day

100

50

0 0 20 40 60 80 Time (Day) 100 120 140

cholera infections : ASHSandPrevInfraTEST

With a higher level of prevention and better health services, the cumulative death toll is much less and begins to level off, and the spike

in infection rate is much smaller as less people are contracting the disease and those infected are given better care.
e. This model does not take into account direct modes of infection (contact with contaminated fecal matter), but only assumes indirect modes (contaminated water). It also does not take into account population growth over time since it only bases its model on current population. And lastly, it does not take into account environmental factors (such as rain) that could affect transmission rates. Thi model could be adapted to Haiti if it adjusted to reflect Haitis population, level of prevention, and state of health services. Variables such as effect of earthquake on water hygiene infrastructure and state of water hygiene infrastructure need to be added and taken into account.