Monitoring real-time transmission heterogeneity from Incidence data
Authors: Zhang Yunjun , Britton Tom , Zhou Xiaohua 
Published: April 2022

AbstractThe transmission heterogeneity of an epidemic is associated with a complex mixture of host, pathogen and environmental factors. And it may indicate superspreading events to reduce the efficiency of population-level control measures and to sustain the epidemic over a larger scale and a longer duration. Methods have been proposed to identify significant transmission heterogeneity in historic epidemics based on several data sources, such as contact history, viral genomes and spatial information, which is sophisticated and may not be available, and more importantly ignore the temporal trend of transmission heterogeneity. Here we attempted to establish a convenient method to estimate real-time heterogeneity over an epidemic. Within the branching process framework, we introduced an instant-individualheterogenous infectiousness model to jointly characterized the variation in infectiousness both between individuals and among different times. With this model, we could simultaneously estimate the transmission heterogeneity and the reproduction number from incidence time series. We validated the model with both simulated data and five historic epidemics. Our estimates of the overall and real-time heterogeneities of the five epidemics were consistent with those presented in the literature. Additionally, our model is robust to the ubiquitous bias of under-reporting and misspecification of serial interval. By analyzing the recent data from South Africa, we found evidences that the Omicron might be of more significant transmission heterogeneity than the Delta. Our model based on incidence data was proved to be reliable in estimating the real-time transmission heterogeneity.Author summaryThe transmission of many infectious diseases is usually heterogeneous in time and space. Such transmission heterogeneity may indicate superspreading events (where some infected individuals transmit to disproportionately more susceptible than others), reduce the efficiency of the population-level control measures, and sustain the epidemic over a larger scale and a longer duration. Classical methods of monitoring epidemic spread centered on the reproduction number which represent the average transmission potential of the epidemic at the population level, but failed to reflect the systematic variation in transmission. Several recent methods have been proposed to identify significant transmission heterogeneity in the epidemics such as Ebola, MERS, COVID-19. However, these methods are developed based on some sophisticated information such as contact history, viral genome and spatial information, of the confirmed cases, which are typically field-specific and not easy to generalize. In this study, we proposed a simple and generic method of estimating transmission heterogeneity from incidence time series, which provided consistent estimation of heterogeneity with those records with sophisticated data. It also helps in exploring the transmission heterogeneity of the newly emerging variant of Omicron. Our model enhances current understanding of epidemic dynamics, and highlight the potential importance of targeted control measures.