Title
Modeling individual heterogeneity in the acquisition of recurrent infections : an application to parvovirus B19Modeling individual heterogeneity in the acquisition of recurrent infections : an application to parvovirus B19
Author
Faculty/Department
Faculty of Medicine and Health Sciences
Research group
Vaccine & Infectious Disease Institute (VAXINFECTIO)
Publication type
article
Publication
Oxford,
Subject
Mathematics
Biology
Computer. Automation
Source (journal)
Biostatistics. - Oxford
Volume/pages
16(2015):1, p. 129-142
ISSN
1465-4644
ISI
000347417500012
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
Abstract
In recent years, it has been shown that individual heterogeneity in the acquisition of infectious diseases has a large impact on the estimation of important epidemiological parameters such as the (basic) reproduction number. Therefore, frailty modeling has become increasingly popular in infectious disease epidemiology. However, so far, using frailty models, it was assumed infections confer lifelong immunity after recovery, an assumption which is untenable for non-immunizing infections. Our work concentrates on refining the existing frailty models to encompass complexities of waning immunity and consequently recurrent infections while accounting for individual heterogeneity. Univariate and shared gamma frailty models, frequently used in practice, and correlated gamma frailty models that have proven to be a valuable alternative are considered. We show that incorrectly assuming lifelong immunity when applying frailty models introduces substantial bias in the estimation of both the baseline hazard and the frailty parameters, and consequently of the basic and effective reproduction number. We illustrate our work using cross-sectional serological data on parvovirus B19 (PVB19) from Belgium for which the link with varicella zoster virus is exploited.
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