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

by Spencer Carran, Matthew Ferrari, Timothy Reluga 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 th eir 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 becaus e 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 mana gement 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 emergin g pathogen are justified to prioritize current disease incidence over potential increases in severe disease outcomes in the endemic state.
Source: PLoS Neglected Tropical Diseases - Category: Tropical Medicine Authors: Source Type: research