End-of-outbreak determination under seasonal transmission

Abstract

At the apparent end of an infectious disease outbreak, policymakers must decide when to relax interventions, balancing epidemiological safety and economic efficiency. Here, we extend a renewal equation framework for estimating the risk of additional cases to scenarios with seasonal transmission, such as Aedes-borne virus transmission in temperate settings. In simulations, we demonstrate that the time of year is key to when it is safe to relax interventions under seasonal transmission: measures can be relaxed sooner if the last observed case occurs towards the end of the transmission season. We apply our framework to the 2017 chikungunya outbreak in Italy, integrating incidence data with estimates of temperature suitability for transmission, and further extend our approach to account for case under-reporting. Our model incorporating an end-of-season decline in transmission indicates a lower risk of additional cases late in the outbreak than a model based on incidence alone: assuming 60% case reporting, the seasonal model reaches a 1% risk threshold 22 days after the last observed case, compared with 39 days for the incidence-only model. Incorporating seasonality in model-based assessments of transmission risks at the end of an outbreak can therefore support more timely and reliable decision making.