Integrating Social and Biological Processes of Infectious Disease Transmission at Three Levels: Household, Community and Region.

다국어 초록 (Multilingual Abstract)

This dissertation addresses infectious disease transmission at several levels: within households, communities, and villages within a region. At each level, we consider the elements of social behavior and social structure relevant for understanding infectious disease transmission dynamics and risk of infection. In the first chapter, which focuses on the household level, we analyze a series of household outbreaks of norovirus (NoV), a common gastrointestinal pathogen. This paper takes advantage of a natural experiment in which many households were infected at once after exposure to an infectious food-handler. This allows us to examine within-household transmission in a way that is separated from other social processes. In the second paper, we focus on community level norovirus transmission, incorporating insights from the household-level analysis in paper one with empirical data on social processes. We focus specifically on age-structured contact patterns in order to build a community-wide model of norovirus transmission. This model sheds light on the role social behavior plays in the community-level epidemiology of gastrointestinal pathogens. Finally, in the third paper, we focus at the geographic regional level, examining the risk of gastrointestinal illness across communities. This paper looks at how variability in remoteness and community-wide social networks impacts risk of gastrointestinal illness in a group of 19 villages in rural, northern coastal Ecuador. Taken together, these papers address a number of theoretical and methodological issues that are important to both the epidemiology of infectious diseases and the sociology of health and illness.