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Biomedical subjects

R M May

Publications and source records attributed to R M May.

At least 91 records · Page 5Linked to original sources
PubMed1988

Possible demographic consequences of AIDS in developing countries.

Simple mathematical models of the transmission dynamics of HIV that incorporate demographic and epidemiological processes to assess the potential impact of AIDS on human population growth and structure in developing countries suggest that AIDS is capable of changing population growth rates from positive to negative values over timescales of a few decades. The disease is predicted to have little if any impact on the dependency ratio of a population, defined as the number of children below age 15 years and elderly people over 64 years, divided by the number of adults between 15 to 64 years.

Acquired Immunodeficiency Syndrome↗
PubMed1986

The invasion, persistence and spread of infectious diseases within animal and plant communities.

Recent theoretical and empirical studies of the population biology of infectious diseases have helped to improve our understanding of the major factors that influence the three phases of a successful invasion, namely initial establishment, persistence in the longer term and spread to other host communities. Of central importance in all three phases is the magnitude of the basic reproductive rate or transmission potential of the parasite. The value of this parameter is determined by a variety of biological properties of the association between an individual parasite and its host and the interaction between their populations. The recent epidemic of acquired immunodeficiency syndrome (AIDS) in North America and Europe is employed to illustrate the factors that promote disease establishment and spread. The frequency distribution of the number of different sexual partners per unit of time within homosexual communities is shown to be of central importance with respect to future trends in the incidence of AIDS. Broader aspects of pathogen invasion are examined by reference to simple mathematical models of three species associations, which mirror parasite introduction into resident predator-prey, host-parasite and competitive interactions. Many outcomes are possible, depending on the values of the numerous parameters that influence multi-species population interactions. Pathogen invasion is shown to have far-reaching implications for the structure and stability of ecological communities.

Acquired Immunodeficiency Syndrome↗
PubMed1986

A preliminary study of the transmission dynamics of the human immunodeficiency virus (HIV), the causative agent of AIDS.

The paper describes some preliminary attempts to formulate simple mathematical models of the transmission dynamics of HIV infection in homosexual communities. In conjunction with a survey of the available epidemiological data on HIV infection and the incidence of AIDS, the models are used to assess how various processes influence the course of the initial epidemic following the introduction of the virus. Models of the early stages of viral spread provide crude methods for estimating the basic reproductive rate of the virus, given a knowledge of the incubation period of the disease (AIDS) and the initial doubling time of the epidemic. More complex models are formulated to assess the influence of variation in the incubation period and heterogeneity in sexual activity. The latter factor is shown to have a major effect on the predicted pattern of the epidemic; high levels of heterogeneity decrease its magnitude. Areas of biological uncertainty, future research needs, and public health implications are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Age-related changes in the rate of disease transmission: implications for the design of vaccination programmes.

Mathematical models are developed to aid in the investigation of the implications of heterogeneity in contact with infection within a community, on the design of mass vaccination programmes for the control of childhood viral and bacterial infections in developed countries. Analyses are focused on age-dependency in the rate at which individuals acquire infection, the question of 'who acquires infection from whom', and the implications of genetic variability in susceptibility to infection. Throughout, theoretical predictions are based on parameter estimates obtained from epidemiological studies and are compared with observed temporal trends in disease incidence and age-stratified serological profiles. Analysis of case notification records and serological data suggest that the rate at which individuals acquire many common infections changes from medium to high and then to low levels in the infant, child and teenage plus adult age groups respectively. Such apparent age-dependency in attack rate acts to reduce slightly the predicted levels of herd immunity required for the eradication of infections such as measles, when compared with the predictions of models based on age-independent transmission. The action of maternally derived immunity in prohibiting vaccination in infants, and the broad span of age classes over which vaccination currently takes place in the U.K., however, argue that levels of herd immunity of between 90 and 94% would be required to eliminate measles. Problems surrounding the interpretation of apparent age-related trends in the acquisition of infection and their relevance to the design of vaccination programmes, are discussed in relation to the possible role of genetically based variation in susceptibility to infection and observations on epidemics in 'virgin' populations. Heterogeneous mixing models provide predictions of changes in serology and disease incidence under the impact of mass vaccination which well mirror observed trends in England and Wales.

Adolescent↗
PubMed1984

Oscillatory fluctuations in the incidence of infectious disease and the impact of vaccination: time series analysis.

This paper uses the techniques of time series analysis (autocorrelation and spectral analysis) to examine oscillatory secular trends in the incidence of infectious diseases and the impact of mass vaccination programmes on these well-documented phenomena. We focus on three common childhood diseases: pertussis and mumps (using published disease-incidence data for England and Wales) and measles (using data from England and Wales, Scotland, North America and France). Our analysis indicates highly statistically significant seasonal and longer-term cycles in disease incidence in the prevaccination era. In general, the longer-term fluctuations (a 2-year period for measles, 3-year periods for pertussis and mumps) account for most of the cyclical variability in these data, particularly in the highly regular measles series for England and Wales. After vaccination, the periods of the longer-term oscillations tend to increase, an observation which corroborates theoretical predictions. Mass immunization against measles (which reduces epidemic fluctuations) magnifies the relative importance of the seasonal cycles. By contrast, we show that high levels of vaccination against whooping cough in England and Wales appear to have suppressed the annual cycle.

Biometry↗
PubMed1984

Spatial, temporal, and genetic heterogeneity in host populations and the design of immunization programmes.

The relevance of heterogeneity in infectious disease transmission to the design of immunization programmes is examined by the use of simple deterministic models of recurrent epidemic behaviour. In the context of spatial heterogeneity it is shown that an optimal vaccination programme, which concentrates on groups with relatively high density, can lead to eradication with overall coverage levels less than those estimated by a model which assumes homogeneity in host spatial distribution. Age-related heterogeneity in transmission can result in higher or lower coverage levels than those predicted by models which assume age-independent transmission, depending on the quantitative detail of how transmission changes with age. Genetic heterogeneity in host susceptibility to infection is shown to produce effects that are similar to those induced by age-related changes in transmission. It is concluded that much greater attention should be focused on transmission heterogeneity in future work on models of recurrent epidemic behaviour and the design of immunization programmes.

Biometry↗
PubMed1983

Epidemiology and genetics in the coevolution of parasites and hosts.

Recent studies suggest that parasites (interpreted broadly to include viruses, bacteria, protozoans and helminths) may influence the numerical magnitude or geographical distribution of their host populations; most of such studies focus on the population biology and epidemiology of the host-parasite association, taking no explicit account of the genetics. Other researchers have explored the possibility that the coevolution of hosts and parasites may be responsible for much of the genetic diversity found in natural populations, and may even be the main reason for sexual reproduction; such genetic studies rarely take accurate account of the density- and frequency-dependent effects associated with the transmission and maintenance of parasitic infections. This paper aims to combine epidemiology and genetics, reviewing the way in which earlier studies fit into a wider scheme and offering some new ideas about host-parasite coevolution. One central conclusion is that 'successful' parasites need not necessarily evolve to be harmless: both theory and some empirical evidence (particularly from the myxoma-rabbit system) indicate that many coevolutionary paths are possible, depending on the relation between virulence and transmissibility of the parasite or pathogen.

Animals↗
PubMed1983

Vaccination against rubella and measles: quantitative investigations of different policies.

This paper uses relatively simple and deterministic mathematical models to examine the impact that different immunization policies have on the age-specific incidence of rubella and measles. Following earlier work by Knox (1980) and others, we show that immunization programmes can, under some circumstances, increase the total number of cases among older age groups; the implications for the overall incidence of measles encephalitis and of congenital rubella syndrome are examined, paying attention both to the eventual equilibrium and to the short-term effect in the first few decades after immunization is initiated. Throughout, we use data (from the U.K., and U.S.A. and other countries) both in the estimation of the epidemiological parameters in our models, and in comparison between theoretical predictions and observed facts. The conclusions defy brief summary and are set out at the end of the paper.

Adolescent↗