Risk-Based Ring Vaccination: A Strategy for

Pandemic Control and Vaccine Allocation

Dinh Song An Nguyen1, Marie Charpignon2, Kathryn L
Schaber3,
Maimuna Shahnaz Majumder3, and Andrew Perrault1.
The Ohio State University1, MIT2, Boston Childrenʼs Hospital 3
Outline
● Motivation
● Problem statement
● Methodology
○ Agent-based Modeling (ABM)
○ Contact matrix
○ Probability of infection
○ Ring vaccination
● Results
Motivation
Ring vaccination is a control strategy in which contacts of confirmed infected patients are
chosen to vaccinate before everyone else.

Henao-Restrepo et al. 2017

Motivation
- Containment of infectious disease under resource constraints.
- Target those who are most at risk => Reduce number of overall infections.
- Performs better than other intervention strategy under circumstances.

Ring vaccination has been applied and has successfully eradicated and or
contained various diseases:

- Smallpox [Kretzschmar, Mirjam et al. 2004]

- Ebola [Dean, Ira, 2022]
Assumptions
- Vaccines can be safely delivered to people who are exposed.
- Vaccines can prevent infection for those who are exposed.
- There are resource constraints during the intervention (e.g. vaccine
availability is limited).
Research questions
- How effective is ring vaccination compared to other strategies?
- Is risk-based ring vaccination better than standard ring vaccination?
- What is the effect of ring vaccination on superspreading?
Hypothesis
- We built an agent-based model to simulate Ebola infection.
- We compared the results from risk-based ring strategy with results from
standard ring vaccination, randomized vaccination, and unlimited ring
vaccination.
- Standard ring vaccination provides little advantage until a high number of
doses are available.
- Risk-based ring vaccination reduced the number of infections and deaths
better than standard ring vaccination. It also provides a shift in infection wave,
delaying infection peak by 5-20 days.
- Different number of daily doses affect the results.
Outline
1. Agent based model (ABM)
2. Risk-based ring vaccination
3. Results
4. Discussion
Methodology: Agent-based model (ABM)
- ABM is a computational technique that aims to simulate a complex system in
which each individual is an agent that has specific attributes and behaviors.
- Each agent can interact with each other as well as the environment based on
certain rules.
- Used in various fields to study how interactions and behaviors can have
effects on complex system.
Methodology: Agent

Agent #0 Agent #101

Age: 62 Age: 34

Sex: Female Sex: Male

Household with agents: #3432, #6545, Household with agents: #3517, #6615,
#9118 #9169
ABM: agent status
- Susceptible: agent is susceptible to be infected, hasn’t been vaccinated yet.
- Infected: agent is infected and can transmit disease.
- Incubating: agent has been exposed to Ebola and is waiting for the symptom
to show, can’t infect other agents yet.
- Vaccinated: agent is vaccinated and is waiting to build up immunity.
- Removed: agent who is either immune or recovered
- Deceased
Methodology: data and social network
- Used real household data and contact data from Zambia and South Africa (14651
people and 3436 households) [Dodd et al. 2015]
- For household contacts: make a complete graph where every agent in a
household is connected to each other.
- For non-household contacts: stochastically sample the number of contacts
through the contact matrix using Poisson distribution [Dodd et al. 2015].
- Contact is sampled bi-directional.

Dodd et al. 2015

Methodology: contact matrix
●
Data
Ebola type of contacts
- Daily household contact types are uniformly distributed [Bower et al. 2016].
- Non-household contact has risk ratio of 2.45

Contact type Probability Risk ratio

Handled fluids 16.3% 9.7

Direct wet contact 40.3% 8.3

Direct dry contact 17% 5.6

Indirect wet contact 17% 5.6

Indirect dry contact 10% 1.3

Minimal contact 13.8% 1

Methodology: Parameters
Probability of infection
●
Related work
Compartmental model (SIR)

- Too homogeneous and generalized.

- Can’t capture the details and dynamic of diseases.

Branching process model

- Does not consider household structure/contacts [Kucharski 2016].

- Lack of triadic closure (individuals forming connections when they have a
mutual connections).
Agent Based Modeling (ABM) for Ring Vaccination
- ABM can provide more realistic scenarios given the complex social network
of each individual.
- ABM can capture the heterogeneity of each agent in the model
- Able to separate the biological factors from the behavioral factors
- Provide the flexibility to control different parameters that is specific to agents:
- Age
- Contact pattern
- Behavior
- Settings:
- Contacts change daily
- 30% of agents are untraced e.g. not eligible for vaccine and can’t contact trace
- If untraced agents die, there will be funeral for 1 day after death (# contacts = [100,250])
Risk-based Ring Vaccination
- For each individuals in the ring, calculate the probability of them getting
infected. Let 𝑥 be the seed case, 𝑦 is contact of 𝑥, and 𝑧 denote a contact of 𝑦.
We define the risk for 𝑦 as
- 𝑅(𝑦) = 𝑃𝑟 (base) · 𝑊 𝑥,𝑦
- where 𝑊 𝑥,𝑦 is the risk ratio associated with the highest intensity contact
between 𝑥 and 𝑦 after 𝑥 developed symptoms. For 𝑧, we define the risk as
- 𝑅(𝑧|𝑦 is not infected) = 𝑃𝑟 (base) · 𝑊𝑥,𝑦 · 𝑃𝑟 (base) · 𝑊𝑦,𝑧
- 𝑅(𝑧|𝑦 is infected) = 𝑃𝑟 (base) · 𝑊𝑦,𝑧
Risk-based Ring Vaccination
- Individuals in the ring who are eligible for the vaccines (susceptible and
incubated agents) are then vaccinated in order of their risk ranking with a
30% chance of being missed.
- If there are still some vaccines left after everyone in the ring has been
vaccinated, then the remaining vaccines will be randomly distributed to the
susceptible agents that are not in the identified clusters.
Standard ring vaccination Random vaccination
- Gather individuals in the rings of infected - Randomly chosen eligible people at
patients. random to vaccinate.
- Vaccinate eligible individuals in no
specific orders.
- Chosen individuals have 30% chance of
being “missed” at the time of vaccination.
Result – simulation comparison
Metric Mean (95% CI) Mean (95% CI) (old) Target
(mod)

Total R 2.23 (2.075, 2.388) 1.57 (1.317, 1.824) 1.9-2.5

HH R 0.67 (0.627, 0.722) 0.51 (0.397, 0.63)

NHH R 1.56 (1.39, 1.725) 1.06 (0.76, 1.354)

Avg Total Cont 130.99 (121.496, 148.57 (133.505, ?

140.493) 163.635)

Avg Unique 97.25 (88.927, 108.50 (88.867, ?

105.574) 128.135)
Cont

Trace R 0.69 (0.605, 0.778) 0.48 (0.371, 0.597) 0.6

Untrace R 5.77 (5.149, 6.396) 3.34 (2.925, 3.756) 7

HH SAR 0.16 (0.149, 0.165) 0.13 (0.105, 0.152) 0.042

NHH SAR 0.048 (0.045, 0.051) 0.024 (0.021, 0.028) 0.004

Result - infection count under different daily vaccine doses
- X-axis: days
- Y-axis: average daily infection count
Discussion
- Risk-based ring vaccination requires slightly more information than standard
ring vaccination but is much more impactful even at lower daily doses.
- Different number of daily vaccine dosage induces different behaviors and
yields different results.
- What are the costs of ring vaccination? Is it worth the additional overhead
cost?
- What effects do superspreading events have on ring vaccination?
- What are different way to rank risks to apply ring vaccination more effectively.
- How does ring vaccination work with other diseases (e.g. airborne disease)