Long-Term Spatiotemporal Changes in Endemic Threshold Populations in England and Wales – A Multi-Disease Study

Munro, Alastair (2021) Long-Term Spatiotemporal Changes in Endemic Threshold Populations in England and Wales – A Multi-Disease Study. PhD thesis, University of Nottingham.

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Metapopulation dynamics play a critical role in driving endemic persistence and transmission of childhood infections. The endemic threshold is defined as the minimum population size required to sustain a continuous chain of infection transmission. The concept is fundamental to the implementation of effective vaccine-based disease control programmes. Vaccination serves to increase endemic threshold population size, promoting disease fadeout and eventual elimination of infection. To date, empirical geographical investigations of endemic threshold populations have tended to focus on isolated populations in island communities. Few studies have examined endemic threshold dynamics in ‘mainland’ regional populations with divergent spatial structures and varying levels of connectivity between subpopulations.

This thesis presents a geographical analysis of spatiotemporal changes in endemic threshold populations for three childhood infections (measles, pertussis and scarlet fever) in two regional metapopulations of England and Wales: Lancashire and South Wales. Drawing upon weekly disease records of the Registrar-General of England and Wales over a 30-year period (January 1940–December 1969), empirical regression techniques were used to estimate the endemic threshold populations for childhood infections in the two study regions. Hotspot and survival analyses were performed to compare disease fadeout duration and probability for both regions in the pre-vaccine and vaccine eras, respectively. Endemic-epidemic modelling was undertaken to identify and analyse potential drivers of disease persistence.

The findings reveal strong regional differences in estimates of endemic threshold populations over time and space for all three childhood infections. Regional differences in endemic threshold populations reflect significant regional variations in spatial connectivity, population dispersion and level of geographical isolation. Significant growth in fadeout duration was observed in the vaccine era for pertussis non-hotspots in both regions, consistent with geographical synchronisation of epidemic activity.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Smallman-Raynor, Matthew
Algar, Adam
Keywords: Population modelling; Childhood infections; Disease persistence; Endemic threshold; England and Wales; Geographical connectivity
Subjects: G Geography. Anthropology. Recreation > G Geography (General)
H Social sciences > HB Economic theory
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > School of Geography
Item ID: 67076
Depositing User: Munro, Alastair
Date Deposited: 08 Dec 2021 04:40
Last Modified: 08 Dec 2021 04:40
URI: https://eprints.nottingham.ac.uk/id/eprint/67076

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