Detection for novel pathogen pandemics

Thesis

Pandemics pose a significant threat to human health and global security. Novel pathogens present substantial pandemic risks and have unique public health challenges, given the uncharacterised nature of their causative agents and the consequent uncertainty about optimal countermeasures. Early detection of novel pathogen outbreaks is crucial for timely public health responses to mitigate devastating consequences. Following outbreak discovery, further detection is essential to ascertain the prevalence and understand the features of the epidemic. This thesis explores different aspects of detection for novel pathogen pandemics, including through a systematic analysis of existing national surveillance infrastructure worldwide for novel diseases. It examines the implications of current surveillance using modelling techniques and investigates diagnostic approaches to determining community infection prevalence in the early stages of a novel pathogen pandemic. We begin by providing an overview of novel pathogens, pandemic risks, and available detection methods, reviewing the literature on “Disease X” and historical case studies of recently emerged pathogens. Our analysis of 195 countries demonstrates that only a minority have evidence publicly available of novel disease considerations in their national public health surveillance systems. For those that mandate novel disease reporting, we model time-to-detection and outbreak size using the detection thresholds specified by different countries and explore whether population-level surveillance strategies could improve upon current detection. A serial cross-sectional investigation of SARS-CoV-2 infection prevalence in a community population in the early stage of the COVID-19 pandemic is presented, with four diagnostic approaches compared. Finally, we summarise our findings in the context of current and future detection for novel pathogen outbreaks and explore research directions that could guide improvements in early warning systems, diagnostic preparedness and pandemic prevention initiatives.

Authors: Nelson, CK

• DOI: 10.5287/ora-nyo48a0wn
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: disease surveillance; global health security; early detection; biosecurity; novel pathogens; infectious disease; pandemics; mathematical modelling; outbreaks; epidemiology; public health; biology; emerging infectious diseases; medicine
• Subjects: Early detection; Communicable diseases; COVID-19 (Disease); Pandemics; Biology; Medicine; Public health surveillance; Emerging infectious diseases; World health