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American Journal of Epidemiology Advance Access published online on August 3, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj274
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received February 14, 2006
Accepted July 12, 2006

ORIGINAL CONTRIBUTIONS

Estimating in Real Time the Efficacy of Measures to Control Emerging Communicable Diseases

Simon Cauchemez 1 *, Pierre-Yves Boëlle 2, Guy Thomas 2, and Alain-Jacques Valleron 2

1 Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, United Kingdom; Universite Pierre et Marie Curie-Paris6, UMR S 707, Paris, France; INSERM, Epidemiology, Information Systems, Models (UMR S 707), Paris, France
2 Universite Pierre et Marie Curie-Paris6, UMR S 707, Paris, France; INSERM, Epidemiology, Information Systems, Models (UMR S 707), Paris, France; Assistance Publique-Hôpitaux de Paris, Hopital Saint-Antoine, Department of Public Health, Paris, France

* To whom correspondence should be addressed.
Simon Cauchemez, E-mail: s.cauchemez{at}imperial.ac.uk


  Abstract

Controlling an emerging communicable disease requires prompt adoption of measures such as quarantine. Assessment of the efficacy of these measures must be rapid as well. In this paper, the authors present a framework to monitor the efficacy of control measures in real time. Bayesian estimation of the reproduction number R (mean number of cases generated by a single infectious person) during an outbreak allows them to judge rapidly whether the epidemic is under control (R < 1). Only counts and time of onset of symptoms, plus tracing information from a subset of cases, are required. Markov chain Monte Carlo and Monte Carlo sampling are used to infer the temporal pattern of R up to the last observation. The operating characteristics of the method are investigated in a simulation study of severe acute respiratory syndrome-like outbreaks. In this particular setting, control measures lacking efficacy (R ≥ 1.1) could be detected after 2 weeks in at least 70% of the epidemics, with less than a 5% probability of a wrong conclusion. When control measures are efficacious (R = 0.5), this situation may be evidenced in 68% of the epidemics after 2 weeks and 92% of the epidemics after 3 weeks, with less than a 5% probability of a wrong conclusion.

Keywords: communicable diseases, emerging; disease outbreaks; epidemiologic methods; population surveillance; SARS virus.
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