Evidence of cryptic incidence in childhood diseases

Christian E. Gunning, Matthew J. Ferrari, Erik B. Erhardt, Helen J. Wearing

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Persistence and extinction are key processes in infectious disease dynamics that, owing to incomplete reporting, are seldom directly observable. For fully immunizing diseases, reporting probabilities can be readily estimated from demographic records and case reports. Yet reporting probabilities are not sufficient to unambiguously reconstruct disease incidence from case reports. Here, we focus on disease presence (i.e. marginal probability of nonzero incidence), which provides an upper bound on the marginal probability of disease extinction. We examine measles and pertussis in pre-vaccine era United States (US) cities, and describe a conserved scaling relationship between population size, reporting probability and observed presence (i.e. non-zero case reports). We use this relationship to estimate disease presence given perfect reporting, and define cryptic presence as the difference between estimated and observed presence.We estimate that, in early twentieth century US cities, pertussis presence was higher than measles presence across a range of population sizes, and that cryptic presencewas common in small cities with imperfect reporting. While the methods employed here are specific to fully immunizing diseases, our results suggest that cryptic incidence deserves careful attention, particularly in diseases with low case counts, poor reporting and longer infectious periods.

Original languageEnglish (US)
Article number20171268
JournalProceedings of the Royal Society B: Biological Sciences
Issue number1861
StatePublished - Aug 30 2017

All Science Journal Classification (ASJC) codes

  • General Biochemistry, Genetics and Molecular Biology
  • General Immunology and Microbiology
  • General Environmental Science
  • General Agricultural and Biological Sciences


Dive into the research topics of 'Evidence of cryptic incidence in childhood diseases'. Together they form a unique fingerprint.

Cite this