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. 2017 Jul 21;57(1):605–628. doi: 10.1007/s12190-017-1124-1

Global analysis of an epidemic model with vaccination

Li-Ming Cai 1,, Zhaoqing Li 1, Xinyu Song 1
PMCID: PMC7090535  PMID: 32218713

Abstract

In this paper, an epidemic dynamical model with vaccination is proposed. Vaccination of both newborn and susceptible is included in the present model. The impact of the vaccination strategy with the vaccine efficacy is explored. In particular, the model exhibits backward bifurcations under the vaccination level, and bistability occurrence can be observed. Mathematically, a bifurcation analysis is performed, and the conditions ensuring that the system exhibits backward bifurcation are provided. The global dynamics of the equilibrium in the model are also investigated. Numerical simulations are also conducted to confirm and extend the analytic results.

Keywords: Epidemic model, Backward bifurcation, Vaccination, Global stability

Introduction

Mathematical models have become important tools in analyzing the spread and control of infectious diseases [2]. Based on the theory of Kermack and Mckendrick [19], the spread of infectious diseases usually can be described mathematically by compartmental models such as SIR,SIRS,SEIR,SEIRS models (where S represents the class of the susceptible population, E is the exposed class in the latent period, I is infectious class, R is the removed class, which has recovered with temporary or permanent immunity). In recent years, a variety of compartmental models have been formulated, and the mathematical analysis of epidemiology models has advanced rapidly, and the analyzed results are applied to infectious diseases [2, 18, 32]. Vaccination campaigns have been critical in attacking the spread of infectious diseases, e.g., pertussis, measles, and influenza. The eradication of smallpox has been considered as the most spectacular success of vaccination [44]. Although vaccination has been an effective strategy against infectious diseases, current preventive vaccine consisting of inactivated viruses do not protect all vaccine recipients equally. The vaccine-based protection is dependent on the immune status of the recipient [2, 32]. For example, influenza vaccines protect 70–90% of the recipients among healthy young adults and as low as 30–40% of the elderly and others with weakened immune systems (such as HIV-infected or immuno-suppressed transplant patients) (see, [14, 30, 44]).

Since vaccination is the process of administering weakened or dead pathogens to a healthy person or animal, with the intent of conferring immunity against a targeted form of a related disease agent, the individuals having the vaccine-induced immunity can be distinguished from the recovered individuals by natural immunity. Thus, vaccination can also be considered by adding some compartment naturally into the basic epidemic models. Over the past few decades, a large number of simple compartmental mathematical models with vaccinated population have been used in the literature to assess the impact or potential impact of imperfect vaccines for combatting the transmission diseases [1, 3, 11, 16, 20, 21, 23, 31, 43, 45]. In some of these studies (e.g., papers [16, 31, 43]), authors have shown that the dynamics of the model are determined by the disease’s basic reproduction number R0. If R0<1 the disease can be eliminated from the community; whereas an endemic occurs if R0>1. Therefore, if an efficient vaccination campaign acts to reduce the disease’s basic reproduction number R0 below the critical level of 1, then the disease can be eradicated. While in other studies, such as Alexander et al. [1] and Arino et al. [3], they have shown that the criterion for R0<1 is not always sufficient to control the spread of a disease. A phenomenon known as a backward bifurcation is observed. Mathematically speaking, when a backward bifurcation occurs, there are at least three equilibria for R0<1 in the model: the stable disease-free equilibrium, a large stable endemic equilibrium, and a small unstable endemic equilibrium which acts as a boundary between the basins of attraction for the two stable equilibria. In some cases, a backward bifurcation leading to bistability can occur. Thus, it is possible for the disease itself to become endemic in a population, given a sufficiently large initial outbreak. These phenomena have important epidemiological consequences for disease management. In recent years, backward bifurcation, which leads to multiple and subthreshold equilibria, has been attracting much attention (see, [1, 3, 4, 6, 11, 16, 17, 20, 21, 23, 24, 33, 34, 37, 40]). Several mechanisms with vaccination have been identified to cause the occurrence of backward bifurcation in paper [33].

In this paper, we shall investigate the effects of a vaccination campaign with an imperfect vaccine upon the spread of a non-fatal disease, such as hepatitis A, hepatitis B, tuberculosis and influenza, which features both exposed and infective stages. In particular, we focus on the vaccination parameters how to change the qualitative behavior of the model, which may lead to subthreshold endemic states via backward bifurcation. Global stability results for equilibria are obtained. The model constructed in this paper is an extension of the model in paper [31], including a new compartment for the latent class (an important feature for the infectious diseases eg. hepatitis A, hepatitis B, tuberculosis and influenza) and the disease cycle. It is one of the aims of this paper to strengthen the disease cycle to cause multiple endemic equilibria.

The paper is organized as follows. An epidemic model with vaccination of an imperfect vaccine is formulated in Sect. 2, and the basic reproduction number, and the existence of backward bifurcation and forward bifurcation are analyzed in Sect. 3. The global stability of the endemic equilibrium is established in Sect. 4. The paper is concluded with a discussion.

The model and the basic reproduction number

In order to derive the equations of the mathematical model, we divide the total population N in a community into five compartments: susceptible, exposed (not yet infectious), infective, recovered, and vaccinated; the numbers in these states are denoted by S(t), E(t), I(t), R(t), and V(t),  respectively. Let N(t)=S(t)+E(t)+I(t)+R(t)+V(t). The flow diagram of the disease spread is depicted in Fig. 1.

Fig. 1.

Fig. 1

Flowchart diagram for model (2.1)

All newborns are assumed to be susceptible. Of these newborns, a fraction α of individuals are vaccinated, where α(0,1]. Susceptible individuals are vaccinated at rate constant ψ. The parameter γ1 is the rate constant at which the exposed individuals become infectious, and γ2 is the rate constant that the infectious individuals become recovered and acquire temporary immunity. Finally, since the immunity acquired by infection wanes with time, the recovered individuals have the possibility γ3 of becoming susceptible again. β is the transmission coefficient (rate of effective contacts between susceptible and infective individuals per unit time; this coefficient includes rate of contacts and effectiveness of transmission). Since the vaccine does not confer immunity to all vaccine recipients, vaccinated individuals may become infected but at a lower rate than unvaccinated (those in class S). Thus in this case, the effective contact rate β is multiplied by a scaling factor σ (0σ1, where 1-σ describes the vaccine efficacy, σ=0 represents vaccine that offers 100% protection against infection, while σ=1 models a vaccine that offers no protection at all). It is assumed that the natural death rate and birth rate are μ and the disease-induced death rate is ignored. Thus the total population N is constant. Since the model consider the dynamics of the human populations, it is assumed that all the model parameters are nonnegative.

Thus, the following model of differential equations is formulated based on the above assumptions and Fig. 1,

dSdt=(1-α)μN-μS-βSIN-ψS+γ3R,dVdt=μαN+ψS-σβVIN-μV,dEdt=βSIN+σβVIN-(μ+γ1)E,dIdt=γ1E-(μ+γ2)I,dRdt=γ2I-(μ+γ3)R, 2.1

with nonnegative initial conditions and N(0)>0. System (2.1) is well posed: solutions remain nonnegative for nonnegative initial conditions. We illustrate here that there are limiting cases in system (2.1): if σ=0, the vaccine is perfectly effective, and α=ψ=0, there is no vaccination, system (2.1) will be reduced to the standard SEIRS model in [28]; if γ3=0 and the limit γ1, system (2.1) will be equivalent to an SVIR model in [31]. If we let α=0 and γ3=0, system (2.1) can be reduced to an SVEIR epidemic model in [16], where authors aim to assess the potential impact of a SARS vaccine via mathematical modelling. To explore the effect of the vaccination period and the latent period on disease dynamics, an SVEIR epidemic model with ages of vaccination and latency are formulated in paper [10]. In papers [10, 16, 28, 31], authors have shown that the dynamics of the model are determined by the disease’s basic reproduction number R0. That is, the disease free equilibrium is globally asymptotically stable for R01; and there is a unique endemic equilibrium which is globally asymptotically stable if R0>1. If ψ=0 and limit γ1, system (2.1) will be reduced into an SIV epidemic model in [36], where authors investigate the effect of imperfect vaccines on the disease’s transmission dynamics. In [36], it is shown that reducing the basic reproduction number R0 to values less than one no longer guarantees disease eradication. In this paper, we show that if a vaccination campaign with an imperfect vaccine and the disease cycle is considered, a more complicated dynamic behavior is observed in system (2.1). For example, the backward bifurcation occurs in system (2.1). In the following, first, it is easy to obtain that the total population N in system (2.1) is constant. To Simplify our notation, we define the occupation variable of compartments SEIV,  and R as the respective fractions of a constant population N that belong to each of the corresponding compartments. We still write the occupation variable of compartments as SEIV and R,  respectively. Thus, it is easy to verify that

D={(S,E,I,V,R)R+5:S+V+E+I+R=1} 2.2

is positively invariant and globally attracting in R+5. It suffices to study the dynamics of (2.1) on D. Thus, system (2.1) can be rewritten as the following system:

dSdt=(1-α)μ-μS-βSI-ψS+γ3R,dVdt=μα+ψS-σβVI-μV,dEdt=βSI+σβIV-(μ+γ1)E,dIdt=γ1E-(μ+γ2)I,dRdt=γ2I-(μ+γ3)R. 2.3

In the case σ=0, system (2.3) reduces to an SEIRS model without vaccination [28], where R0=βγ1(μ+γ1)(μ+γ2), is considered as the basic reproduction number of the model. The classical basic reproduction number is defined as the number of secondary infections produced by a single infectious individual during his or her entire infectious period. Mathematically, the reproduction number is defined as a spectral radius R0 (which is a threshold quantity for disease control) that defines the number of new infectious generated by a single infected individual in a fully susceptible population [39]. In the following, we shall use this approach to determine the reproduction number of system (2.3). It is easy to see that system (2.3) has always a disease-free equilibrium,

P0=(S0,E0,I0,R0,V0)=(μ(1-α)μ+ψ,0,0,0,μα+ψμ+ψ).

Let x=(E,I,R,S)T. System (2.3) can be rewritten as

x=F(x)-V(x),

where

F(x)=βSI+σβIV000,V(x)=(μ+γ1)E-γ1E+(μ+γ2)I-γ2I+(μ+γ3)RμS+βSI+ψS-γ3R-(1-α)μ.

The Jacobian matrices of F(x) and V(x) at the disease-free equilibrium P0 are, respectively,

DF(P0)=F00000000,DV(P0)=V000-γ2μ+γ300βS0-γ3μ+ψ,

where,

F=0βS0+σβV000,V=μ+γ10-γ1μ+γ2.

FV-1 is the next generation matrix of system (2.3). It follows that the spectral radius of matrix FV-1 is

ρ(FV-1)=βγ1(μ+γ1)(μ+γ2)(S0+σV0).

According to Theorem 2 in [39], the basic reproduction number of system (2.3) is

Rvac=βγ1(μ+γ1)(μ+γ2)(S0+σV0)=R0μ(1-α)+σ(μα+ψ)μ+ψ.

The basic reproduction number Rvac can be interpreted as follows: A proportion of γ1μ+γ1 of exposed individuals progress to the infective stage before dying; 1μ+γ2 represents the number of the secondary infection generated by an infective individual when he or she is in the infectious stage. Those newborns vaccinated individuals have generated the number βγ1(μ+γ1)(μ+γ2)μ(1-α)μ+ψ of the secondary infection. Average vaccinated individuals with vaccination rate ψ have generated the fraction βγ1(μ+γ1)(μ+γ2)σ(μα+ψ)μ+ψ of the secondary infection.

Equilibria and bifurcations

Now we investigate the conditions for the existence of endemic equilibria of system (2.3). Any equilibrium (SVEIR) of system (2.3) satisfies the following equations:

(1-α)μ-μS-βSI-ψS+γ3R=0,βSI+σβIV-(μ+γ1)E=0,γ1E-(μ+γ2)I=0,γ2I-(μ+γ3)R=0,V=1-S-E-I-R. 3.1

From the second and third equation of (3.1), we have βγ1(S+σV)=(μ+γ1)(μ+γ2). Since (S+σV)<1, this equation can be true only for βγ1>(μ+γ1)(μ+γ2); hence, there exists no endemic equilibrium for R01. For R0>1, the existence of endemic equilibria is determined by the presence in (0, 1] of positive real solutions of the quadratic equation

P(I)=AI2+BI+C=0, 3.2

where,

A=σβ2(μ+γ3)+σβ2(μ+γ2)(μ+γ3)γ1+σβ2γ2,B=β(μ+γ2)(μ+γ3)γ1[σ(μ+ψ)+μ+γ1]+σβγ2(μ+ψ)+βγ2γ3(σ-1)-σβ2(μ+γ3)+σβ(μ+ψ)(μ+γ3),C=μβ(1-α)(μ+γ3)(σ-1)+(μ+γ3)(μ+ψ)[(μ+γ1)(μ+γ2)γ1-σβ]=(μ+γ1)(μ+γ2)(μ+γ3)(μ+ψ)γ1[1-βγ1(μ(1-α)+σ(μα+ψ))(μ+γ1)(μ+γ2)(μ+ψ)]=(μ+γ1)(μ+γ2)(μ+γ3)(μ+ψ)γ1(1-Rvac). 3.3

From (3.2) and (3.3), we can see that the number of endemic equilibria of system (2.3) is zero, one, or two, depending on parameter values. For σ=0 (the vaccine is totally effective), it is obviously that there is at most one endemic equilibrium (P(S,E,I,R,V)) in system. From now on we make the realistic assumption that the vaccine is not totally effective, and thus 0<σ<1.

We notice that if Rvac=1, then we have

ψcrit=defR0μ[1+(σ-1)α]-μ1-σR0.

Since all the model parameters are positive, it follows from (3.3) that A>0. Furthermore, if Rvac>1, then C<0. Since

dRvacdψ=-βγ1(β+γ1)(μ+γ2)μ(1-σ)(1-α)(μ+ψ)2<0.

Thus, Rvac is a continuous decreasing function of ψ for ψ>0, and if ψ<ψcrit, then Rvac>1 and C<0. Therefore, it follows that P(I) of Eq. (3.2) has a unique positive root for Rvac>1.

Now we consider the case for Rvac<1. In this case, C>0, and ψψcrit. From (3.3), it is easy to see that B(ψ) is an increasing function of ψ. Thus, if B(ψcrit)0, then B(ψ)>0 for ψ>ψcrit. Thus, P(I) has no positive real root which implies system have no endemic equilibrium in this case. Thus, let us consider the case B(ψcrit)<0. In this case, let Δ(ψ)=defB2(ψ)-4AC(ψ). It is obvious that if C(ψcrit)=0, then Δ(ψcrit)>0. Notice that B(ψ) is an linear increasing function of ψ. Thus, there is a unique ψ¯¯>ψcrit such that B(ψ¯¯)=0, and thus Δ(ψ¯¯)<0. Since Δ(ψ) is a quadratic function of ψ with positive coefficient for ψ2, Δ(ψ) has a unique root ψ¯ in [ψcrit,ψ¯¯]. Thus, for Rvac<1 we have B(ψ)<0, A>0,C0, and Δ(ψ)>0 for ψ(ψcrit,ψ¯). Therefore, P(I) has two possible roots and system (2.3) has two endemic equilibria P1(S1,E1,I1,R1,V), P2(S2,E2,I2,R2,V)) for ψcrit<ψ<ψ¯. From the above discussion, we have B(ψ)>0 for ψ>ψ¯¯, and Δ(ψ)<0 for ψ(ψ¯,ψ¯¯). Therefore, it follows that system (2.3) has no endemic equilibria for ψ>ψ¯.

If Rvac=1, we have C=0. In this case, system has a unique endemic equilibrium for B(ψ)<0 and no endemic equilibrium for B(ψ)>0.

Summarizing the discussion above, we have the following Theorem:

Theorem 3.1

If Rvac>1(i.e.,ψ<ψcrit), system (2.3) has a unique endemic equilibrium P(S,E,I,R,V); If there exists Rvac<1(i.e.,ψ¯>ψcrit), system (2.3) has two endemic equilibria P1(S1,E1,I1,R1,V1), P2(S2,E2,I2,R2,V2) for ψcrit<ψ<ψ¯ and has no endemic equilibria for ψ>ψ¯; If Rvac=1(i.e.,ψ=ψcrit), system (2.3) has a unique endemic equilibrium P(S,E,I,R,V) for B(ψ)<0 and no endemic equilibrium for B(ψ)>0.

According to Theorem 2 of van den Driesche and Watmough [39], we have the following result.

Theorem 3.2

The disease-free equilibrium P0 is locally asymptotically stable when Rvac<1 and unstable when Rvac>1.

In the following, we first give a global result of the disease-free equilibrium of system (2.3) under some conditions.

Theorem 3.3

If R0<1, P0 is globally asymptotically stable in the feasible positively invariant region.

Proof

Consider the following Lyapunov functional

L=γ1E+(μ+γ1)I.

By directly calculating the derivative of L along system (2.3) and notice that S+σV<1, thus, we have

dLdt=γ1dEdt+(μ+γ1)dIdt=βγ1[S+σV]I-(μ+γ1)(μ+γ2)I(μ+γ1)(μ+γ2)(R0-1)I0,forR01.

It is easy to verify that the maximal compact invariant set in {(S,E,I,R,V)Ω:dLdt=0} is {P0} when R01. The global stability of P0 follows from the LaSalle invariance principle [22].

From the above discussion, we know that system (2.3) may undergo a bifurcation at the disease-free equilibrium when Rvac=1. Now we establish the conditions on the parameter values that cause a forward or backward bifurcation to occur. To do so, we shall use the following theorem whose proof is found in Castillo-Chavez and Song [5], which based on the use of the center manifold theory [15].

For the following general system with a parameter ϕ.

dxdt=f(x,ϕ):f:Rn×RRn,fC2(Rn×R). 3.4

Without loss of generality, it is assumed that x=0 is an equilibrium for system (3.4) for all values of the parameters ϕ, that is, f(0,ϕ)=0 for all ϕ.

Theorem 3.4

Assume that:

  1. A=Dxf(0,0) is the linearization matrix of system (3.4) around the equilibrium x=0 with ϕ evaluated at 0. Zero is simple eigenvalue of A and all other eigenvalue of A have negative real parts;

  2. Matrix A has a (non-negative ) right eigenvector ω and a left eigenvector v corresponding to the zero eigenvalue.

Let fk be the kth component of f and

a=k,i,j=1nvkωiωj2fkxixj(0,0),b=k,invkwi2fkxiϕ(0,0).

Then the local dynamics of system (3.4) around x=0 are totally determined by a and b.

  • (i)

    a>0,b>0. When ϕ<0 with |ϕ|1, x=0 is locally asymptotically stable and there exists a positive unstable equilibrium; when 0<ϕ1,x=0 is unstable and there exists a negative and locally asymptotically equilibrium;

  • (ii)

    a<0,b<0. When ϕ<0, with |ϕ|1, x=0 is unstable; when 0<ϕ1,x=0 is locally asymptotically stable and there exists a negative unstable equilibrium;

  • (iii)

    a>0,b<0.When ϕ<0, with |ϕ|1, x=0 is unstable and there exists a locally asymptotically stable negative equilibrium; when 0<ϕ1,x=0 is stable and a positive unstable equilibrium appears;

  • (iv)

    a<0,b>0. When ϕ changes from negative to positive, x=0 changes its stability from stable to unstable. Correspondingly, a negative unstable equilibrium becomes positive and locally asymptotically stable.

Now by applying Theorem 3.4, we shall show system (2.3) may exhibit a forward or a backward bifurcation when Rvac=1. Consider the disease-free equilibrium P0=(S0,0,0,0) and choose β as a bifurcation parameter. Solving Rvac=1 gives

β=β=(μ+γ1)(μ+γ2)(μ+ψ)γ1[μ(1-α)+σ(μα+ψ)]

Let J0 denote the Jacobian of the system (2.3) evaluated at the DFE P0 with β=β. By directly computing, we have

J0(P0,β)=-μ-ψ0-βS0γ30-(μ+γ1)βS0+σβ(1-S0)00γ1-μ-γ2000γ2-μ-γ3.

Let

|λ-J0(P0,β)|=0.

It is easy to obtain that J0(P0,β) has eigenvalues given by

λ1=-(μ+ψ);λ2=-(μ+γ3);λ3=0;λ4=-(2μ+γ1+γ2).

Thus, λ3=0 is a simple zero eigenvalue of the matrix J(P0,β) and the other eigenvalues are real and negative. Hence, when β=β, the disease free equilibrium P0 is a non-hyperbolic equilibrium. Thus, assumptions (A1) of Theorem 3.4 is verified. Now, we denote with ω=(ω1,ω2,ω3,ω4), a right eigenvector associated with the zero eigenvalue λ3=0.

Thus,

-(μ+ψ)ω1-βS0ω3+γ3ω4=0,-(μ+γ1)ω2+[βS0+σβ(1-S0)]ω3=0,γ1ω2-(μ+γ2)ω3=0,γ2ω3-(μ+γ3)ω4=0.

Thus, we have

ω=(γ2γ3(μ+γ3)(μ+ψ)-μ(1-α)(μ+γ1)(μ+γ2)γ1(μ+ψ)[μ(1-α)+σ(μα+ψ)],μ+γ2γ1,1,γ2μ+γ3).

The left eigenvector v=(v1,v2,v3,v4) satisfying vω=1 is given by

-(μ+ψ)v1=0,-(μ+γ1)v2+γ1v3=0,-βS0v1+β(S0+σ(1-S0))v2-(μ+γ2)v3+γ2v4=0,γ3v1-(μ+γ3)v4=0.

From the above, we obtain that

v=(0,γ1μ+γ1,1,0).

Let a and b be the coefficients defined as in Theorem 3.4.

Computation of a,b. For system (2.3), the associated non-zero partial derivatives of f (evaluated at the DFE (P0), x1=S,x2=I,x3=E,x4=R.) are given by

a=2v2ω1ω32f2SI(P0,β)+2v2ω2ω32f2EI(P0,β)+v2ω3ω32f2I2(P0,β)+2v2ω3ω42f2IR(P0,β)=2βγ1μ+γ1[γ2γ3(1-σ)(μ+γ3)(μ+ψ)-μ(1-σ)(1-α)(μ+γ1)(μ+γ2)γ1(μ+ψ)[μ(1-α)+σ(μα+ψ)]-σ(μ+γ3)(μ+γ2)+γ1γ2+γ1(μ+γ3)γ1(μ+γ3)].b=v2j=14wi2f2xjβ(P0,β)=2γ1μ+γ1(S0(1-σ)+σ)>0. 3.5

Since the coefficient b is always positive, according to Theorem 3.4, it is the sign of the coefficient a, which decides the local dynamics around the disease-free equilibrium P0 for β=β. If the coefficient a is positive, the direction of the bifurcation of system (2.3) at β=β is backward; otherwise, it is forward.

Thus, we formulate a condition, which is denoted by (H3):

γ2γ3(μ+γ3)(μ+ψ)>μ(1-α)(μ+γ1)(μ+γ2)γ1(μ+ψ)[μ(1-α)+σ(μα+ψ)]+σ((μ+γ2)(μ+γ3)+γ1γ2+γ1(μ+γ3))γ1(1-σ)(μ+γ3).

Thus, if (H3) holds, we have a>0, otherwise, a<0.

Summarizing the above results, we have the following theorem.

Theorem 3.5

If (H3) holds, system (2.3) exhibits a backward bifurcation at Rvac=1 (or equivalently β=β). Otherwise, system (2.3) exhibits a forward bifurcation at Rvac=1 (or equivalently when β=β).

Remark 1

From Theorem 3.5, it can follows that the occurrence of either a backward or forward bifurcation may be expected. In fact, in system (2.3), let α=0.3,μ=0.00004566,β=0.4,ψ=0.01,γ1=0.1,γ2=0.05,γ3=0.033,σ=0.15. It is easy to verify that the condition (H3) is satisfied. By applying Xpp plot software and choosing the above parameters, we can describe the backward bifurcation diagram of system (2.3) (see, Fig. 2). Let all parameter values be same as in Fig. 2, except ψ is changed as 0.2. The condition (H3) is not satisfied and we have forward bifurcation diagram Fig. 3 at Rvac=1. So it is clear that there is one threshold value of ψ say ψ such that backward bifurcation occurs of ψ<ψ and forward bifurcation occurs if ψ>ψ. Both of these bifurcation diagrams are obtained by considering β as bifurcation parameter and later it is plotted with respect to Rvac.

Fig. 2.

Fig. 2

The backward bifurcation diagram for model (2.3)

Fig. 3.

Fig. 3

The forward bifurcation diagram for model (2.3)

Global stability of the endemic equilibrium

In this section, we shall investigate the global stability of the unique endemic equilibrium for Rvac>1. Here we shall apply the geometric approach [25, 27, 38] to establish the global stability of the unique endemic equilibrium. In recent years, many authors [3, 16, 26, 28, 29] have applied this method to show global stability of the positive equilibria in system. Here, we follow the techniques and approaches in paper [3, 16] to investigate global stability of the endemic equilibrium in system (2.3). Here, we omit the introduction of the general mathematical framework of these theorems and only focus on their applications.

In the previous section, we have showed that if Rvac>1, system (2.3) has a unique endemic equilibrium in D. Furthermore, Rvac>1 implies that the disease-free equilibrium P0 is unstable (Theorem 3.2). The instability of P0, together with P0D, implies the uniform persistence of the state variables. This result can be also showed by using the same arguments from Proposition 4.2 in [27] and Proposition 2.2 in [29]. Hence, there exists a constant 0<δ<1 such that any solution of x~=(S,V,E,I,R) of system (2.3) with the initial conditions x~0=(S(0),V(0),E(0),I(0),R(0))Ω satisfies

limtinfx~>δ,x~=(S,V,E,I,R).

Thus, we first give the following result:

Proposition 4.1

System (2.3) is uniformly persist in D for Rvac>1 .

To prove our conclusion, we set the following differential equation

x˙=f(x), 4.1

where f:D(Rn)Rn, D is open set and simply connected and fC(Rn).

Let

μ¯(Q)=PfP-1+Pf[2](x)xP-1, 4.2

where, P(x) be a nonsingular (n2)×(n2) matrix-valued function, which is C1 on D and Pf(x) is the derivative of P(x) in the direction of the vector field f(x). f[2](x)x is also (n2)×(n2) matrix, the second additive compound of the Jacobian matrix f/x. μ¯ is the Lozinskii˘ measure with respect to a vector norm |·|. The following result comes from Corollary 2.6 in paper [25].

Theorem 4.1

Suppose that (i) D is simply connected and D0 is a compact set which is absorbing with respect to system (4.1); (ii) For some matrix P, there exists a positive constant ν such that μ¯(Q)-ν<0 for all xD0. Then the unique equilibrium x0 in system (4.1) is global asymptotically stable.

From Proposition 4.1, it is easy to verify that the condition (i) in Theorem 4.1 holds. Therefore, to prove our conclusion, we only verify that (ii) in Theorem 4.1 holds. According to paper [35], the Lozinskii˘ measure in Theorem 4.1 can be evaluated as follow:

μ¯(Q)=inf{κ:D+||z||κ||z||,forallsolutionsofz˙=Pz},

where D+ is the right-hand derivative.

Now we state our main result in this section.

Theorem 4.2

Suppose that the parameters in system (2.3) satisfy the following inequalities

γ3<γ1,μ+ψ>2γ1,μ>γ1. 4.3

Then the unique equilibrium P in system (2.3) is globally asymptotically stable for Rvac>1.

Proof

Let f(x)=(f1(x),f2(x),f3(x),f4(x))T, where f1(x)=(1-α)μ-μS-βSI-ψS+γ3R,f2(x)=μ+ψS-σβVI-μV,f3(x)=βSI+σβIV-(μ+γ1)E,f4(x)=γ1E-(μ+γ2)I, and x=(S,V,E,I)T. Then, the Jacobian matrix of system (2.3) can be written as

fx=-ψ-βI-μ-γ3-γ3-γ3-βS-γ3ψ-σβI-μ0-σβVβIσβI-γ1-μβS+σβV00γ1-γ2-μ.

The second additive compound [25](see, “Appendix”) of Jacobian matrix is the 6×6 matrix given by

f[2]x=-diagψ+βI(1+σ)+2μ+γ3ψ+βI+2μ+γ1+γ3ψ+βI+2μ+γ2+γ3γ1+σβI+2μγ2+σβI+2μγ1+γ2+2μ+00-σβVγ3βS+γ30σβI0βS+σβV-γ30βS+γ30γ100-γ3-γ3-βIψ00βS+σβVσβV00ψγ10000βI0σβI0.

Let

P=1E0000001E00000001E00001I00000001I01E00001I.

Set Q=PfP-1+Pf[2]xP-1, where Pf is the derivative of P in the direction of the vector field f. Thus, we have

PfP-1=-diag(E˙/E,E˙/E,E˙/E,I˙/I,I˙/I,I˙/I).

From (2.3), we have

E˙E=(βS+σβV)IE-μ-γ1I˙I=γ1EI-μ-γ2

Thus, we obtain that

Q=PfP-1+Pf[2]xP-1=Q110γ3-σβVIE(βS+γ3)IE0σβIQ22-γ3(βS+σβV)IE0(βS+γ3)IE-βIψQ330(βS+σβV)IEσβVIE0γ1EI0Q44-γ3-γ300γ1EIψQ550000βIσβIQ66,

where

Q11=-(ψ+βI+μ+σβI+γ3)+γ1-(βS+σβV)IE,Q22=-(ψ+βI+μ+γ3)-(βS+σβV)IE,Q33=-(σβI+μ)-(βS+σβV)IE,Q44=-(ψ+βI+μ+γ3)-γ1EIQ55=-(σβI+μ)-γ1EI,Q66=-(γ1+μ)-γ1EI.

As in [3, 16], we define the following norm on R6:

||z||=max{U1,U2}, 4.4

where zR6, with components zi,i=1,,6 and

U1(z1,z2,z3)=max{|z1|,|z2|+|z3|},ifsgn(z1)=sgn(z2)=sgn(z3)max{|z2|,|z1|+|z3|},ifsgn(z1)=sgn(z2)=-sgn(z3)max{|z1|,|z2|,|z3|},ifsgn(z1)=-sgn(z2)=sgn(z3)max{|z1|+|z3|,|z2|+|z3|},if-sgn(z1)=sgn(z2)=sgn(z3)

and let

U2(z4,z5,z6)=|z4|+|z5|+|z6|,ifsgn(z1)=sgn(z2)=sgn(z3)max{|z4|+|z5|,|z4|+|z6|},ifsgn(z1)=sgn(z2)=-sgn(z3)max{|z5|,|z4|+|z6|},ifsgn(z1)=-sgn(z2)=sgn(z3)max{|z4|+|z6|,|z5|+|z6|},if-sgn(z1)=sgn(z2)=sgn(z3)

Now we demonstrate the existence of some κ>0 such that

D+||z||-κ||z||. 4.5

By linearity, if this inequality is true for some z, then it is also true for -z. Similar to analyzing methods in paper [3, 16], our proof is subdivided into eight separate cases, based on the different octants and the definition of the norm (4.4). To facilitate our analysis, we use the following inequalities:

U1(t)|z2|,|z3|,|z2+z3|,U2(t)|z4|,|z5|,|z6|,|z5+z6|,|z4+z5+z6|,

for all z=(z1,z2,z3,z4,z5,z2,z6)TR6.

Case 1. Let U1(z)>U2(z),z1,z2,z3>0 and |z1|>|z2|+|z3|.

Then we have ||z||=z1 and U2(z)<z1. Taking the right derivative of ||z||, we have

D+||z||=z˙1=-(ψ+βI(1+σ)+μ+γ3+(βS+σβV)IE-γ1)z1+γ3z3-σβVIEz4+(βS+γ3)IEz5-(ψ+βI(1+σ)+μ+γ3+(βS+σβV)IE-γ1)|z1|+γ3|z3|+σβVIE|z4|+(βS+γ3)IE|z5|.

Since |z1|>|z3|,|z4|,|z5|U2(z)<|z1|, and |z1|=||z||, thus, we obtain

D+||z||γ1|z1|-(ψ+βI(1+σ)+μ)|z1|+γ3IE|z5|(γ1-(ψ+βI(1+σ)+μ)+max{γ1,γ3IE})||z||. 4.6

Case 2. Similarly, it is easy to verify that Eq. (4.6) also holds for U1>U2 and z1,z2,z3<0 when |z1|>|z2|+|z3|.

Thus, if we require that 2γ1<ψ+μ holds, then the inequality (4.5) holds for case 1 and case 2.

Case 3. Let U1(z)>U2(z), z1,z2,z3>0 and |z1|<|z2|+|z3|. Thus, we have ||z||=|z2|+|z3|=z2+z3 and U2(z)<|z2|+|z3|. So,we have

D+||z||=z˙2+z˙3=-(1-σ)βIz1-(βI+μ+γ3+(βS+σβV)IE)z2-(σβI+μ+(βS+σβV)IE+γ3)z3+(βS+σβV)IE(z4+z5+z6)+γ3IEz6-(1-σ)βI|z1|-(βI+μ+γ3+(βS+σβV)IE)|z2|-(σβI+μ+(βS+σβV)IE+γ3)|z3|+(βS+σβV)IE|(z4+z5+z6)|+γ3IE|z6|.

Using the inequalities |z6|,|z4+z5+z6|U2(z)<|z2|+|z3|, from the above, we obtain that

D+||z||-(βI+μ+γ3)|z2|-(σβI+μ+γ3)|z3|+γ3IE|z6|(max{γ1,γ3IE}-(σβI+μ+γ3))||z||. 4.7

Case 4. By linearity, Eq. (4.7) also holds for U1>U2 and z1,z2,z3<0 when |z1|<|z2|+|z3|.

Thus, if we require that γ1<γ3+μ holds, then the inequality (4.5) holds for case 3 and case 4.

Case 5. Let U1(z)>U2(z), z1<0<z2,z3 and |z1|>|z2|. Thus, we have ||z||=|z1|+|z3|, and U2(z)<|z1|+|z3|. By directly calculating, we obtain that

D+||z||=-z˙1+z˙3=(ψ+σβI+μ+γ3-γ1+(βS+σβV)IE)z1-γ3z3-γ3IEz5+ψz2-(σβI+μ+(βS+σβV)IEz3+σβVIE(z4+z5+z6)-(ψ+σβI+μ+γ3-γ1+(βS+σβV)IE)|z1|-γ3|z3|+γ3IE|z5|+ψ|z2|-(σβI+μ+(βS+σβV)IE|z3|+σβVIE|z4+z5+z6|

Using the inequalities |z5|,|z4+z5+z6|U2(z)<|z1|+|z3| , we have

D+||z||-(σβI+μ+γ3+βSIE)|z1|+γ1|z1|+γ3IE|z5|-(σβI+μ+βSIE)|z3|(max{γ1,γ3IE}-(σβI+μ+βSIE))||z||. 4.8

Case 6. By linearity, Eq. (4.8) also holds for U1>U2 and z2,z3<0<z1, when |z1|<|z2|.

Thus, if we require that γ1<μ holds, then the inequality (4.5) holds for case 5 and case 6.

Case 7. Let U1(z)>U2(z), z1<0<z2,z3 and |z1|<|z2|. Thus, we have ||z||=|z2|+|z3|=z2+z3 and U2(z)<|z2|+|z3|. Thus, we have

D+||z||=z˙2+z˙3=(σ-1)βIz1-(βI+μ+γ3+(βS+σβV)IE)z2+γ3IEz5-(σβI+μ+γ3+(βS+σβV)IEz3+(βS+σβV)IE(z4+z5+z6)(1-σ)βI|z1|-(βI+μ+γ3+(βS+σβV)IE)|z2|+γ3IE|z5|-(σβI+μ+γ3+(βS+σβV)IE)|z3|+(βS+σβV)IE|z4+z5+z6|

Using the inequalities ,|z5|,|z4+z5+z6|U2(z)<|z2|+|z3|, and |z1||z2|, we have

D+||z||-(σβI+μ+γ3)|z2|+γ3IE|z5|-(σβI+μ+γ3)|z3|(max{γ1,γ3IE}-(σβI+μ+γ3))||z||. 4.9

Case 8. By linearity, Eq. (4.9) also holds for U1>U2 and z2,z3<0<z1, when |z1|<|z2|.

Thus, if we require that γ1<γ3+μ holds, then the inequality (4.5) holds for case 7 and case 8.

Therefore, from the discussion above, we know that if inequalities (4.3)hold, then there exists κ>0 such that D+||z||-κ||z|| for all zR4 and all nonnegative SVE and I. All conditions in Theorem 4.1 can be satisfied when inequalities (4.3) hold. Therefore, by Theorem 4.1, we can determine that if inequalities (4.3) hold, then the unique endemic equilibrium of system (2.3) is globally stable in D for Rvac>1.

Remark 2

In Sect. 3, we have shown that system (2.3) exhibit a backward bifurcation for Rvac1. As stressed in [3], for cases in which the model exhibits bistability, the compact absorbing set required in Theorem 4.1 does not exist. By applying similar methods in [3], a sequence of surfaces that exists for time ϵ>0 and minimizes the functional measuring surface area may be obtained. Therefore, the global dynamics of system (2.3) in the bistability region can be further investigated as it has been done in paper [3].

Discussion

In this paper, an epidemic model with vaccination has been investigated. By analysis, it is showed that the proposed model exhibits a more complicated dynamic behavior. Backward bifurcation under the vaccination level conditions, and bistability phenomena can be observed. The global stability of the unique endemic equilibrium in the model is demonstrated for Rvac>1. Note that the model (2.3) can be solved in an efficient way by means of the multistage Adomian decomposition method (MADM) as a relatively new method [8, 9, 12, 13]. The MADM has some superiority over the conventional solvers such as the R-K family. To illustrate the various theoretical results contained in this paper, the effect of some important parameter values on the dynamical behavior of system (2.3) is investigated in the following.

Now we consider first the role of the disease cycle on the backward bifurcation. If γ3=0, [i.e., the disease cycle-free in model (2.3)], then the expression for the bifurcation coefficient, a, given in Eq. (3.5) reduces to

a=-2βγ1μ+γ1[μ(1-α)(μ+γ1)(μ+γ2)γ1(μ+ψ)(μ(1-α)+σ(μα+ψ))+μ+γ2γ1σ+γ2μσ+σ]<0.

Thus, the backward bifurcation phenomenon of system (2.3) will not occur if γ3=0. This is in line with results in papers [16, 31], where the disease cycle-free model (2.3) has a globally asymptotically stable disease-free equilibrium if the basic reproduction number is less than one.

Differentiating a, given in Eq. (3.5), with respect to γ3 gives

aγ3=2βγ1γ2μ+γ1[μ(1-σ)+σ(μ+ψ)(μ+ψ)(μ+γ)2]>0.

Hence, the bifurcation coefficient, a is an increasing functions of γ3. Thus, the feasibility of backward bifurcation occurring increases with disease cycle.

Now we consider the role of vaccination on the backward bifurcation. Let α=ψ=σ=0, then the expression for the bifurcation coefficient, a, given in Eq. (3.5), is reduces to

a=2βγ1μ+γ1[γ2γ3μ(μ+γ3)-(μ+γ1)(μ+γ2)γ1μ]<2βγ12μ+γ1+γ2(γ2μ-(1+μγ1)(1+γ2μ))<-2βγ12μ+γ1+γ2(1+μ+γ2γ1)<0.

Thus, the backward bifurcation phenomenon of system (2.3) will not occur if α=ψ=σ=0 (i.e., the model (2.3will not undergo backward bifurcation in the absence of vaccination). This is also in line with results in paper [26], where the vaccination-free model (2.3) has a globally asymptotically stable equilibrium if the basic reproduction number R0 is less than one. Furthermore, the impact of the vaccine-related parameters (ψ,σ) on the backward bifurcation is assessed by carrying out an analysis on the bifurcation coefficient a as follows. Differentiating a, given in Eq. (3.5), partially with respect to ψ, gives

aψ=-2βγ1(1-σ)μ+γ1[γ2γ3(μ+γ3)(μ+ψ)2+μ(1-α)(μ+γ1)(μ+γ2)[μ(1-α)+σ(μα+μ+2ψ)]γ1(μ+ψ)2[μ(1-α)+σ(μα+ψ)]2]<0.

Thus, the backward bifurcation coefficient, a is a decreasing function of the vaccination rate ψ. Hence, the possibility of backward occurring decreases with increasing vaccination rate ( i.e., vaccinating more susceptible individuals decrease the likelihood of the occurrence of backward bifurcation).

Differentiating the bifurcation coefficient a, given in Eq. (3.5), partially with respect to σ gives

aσ=2βγ1μ+γ1M1,

with

M1=-(γ2γ3(μ+γ3)(μ+ψ)+μ(1-α)(μ+γ1)(μ+γ2)(μ+ψ+σ(μα+ψ))γ1(μ+ψ)[μ(1-α)+σ(μα+ψ)]2+μ+γ2γ1+γ2μ+γ3+1).

Thus, the bifurcation coefficient, a is a decreasing function with respect to σ. That is, the likelihood of backward bifurcation occurring decreases with increasing vaccine efficacy. Let α=0.3,μ=0.00004566,β=0.4,ψ=0.005,γ1=0.1,γ2=0.05,γ3=0.033. By direct calculating, it is easy to verify that M1 is negative and also condition (H3) is satisfied. Figure 4 depicts the backward bifurcation occurring phenomena with lower vaccine efficacy with σ=0.15; Fig. 5 depicts the likelihood of backward bifurcation occurring with higher vaccine efficacy σ=0.45.

Fig. 4.

Fig. 4

The backward bifurcation diagram with respect to vaccine efficacy σ=0.15

Fig. 5.

Fig. 5

The backward bifurcation diagram with respect to vaccine efficacy σ=0.45

In addition, it is obvious that our expression for the basic reproduction number in system (2.3), i.e.,

Rvac=βγ1(μ+γ1)(μ+γ2)μ(1-α)+σ(μα+ψ)μ+ψ

is independent of the loss rate of immunity γ3. From the above analysis, we have found that the dynamics of the model are not determined by the basic reproduction number, and the phenomena of the backward bifurcation in system may occur. Moreover, it is found that the occurrence feasibility is increasing with the loss rate of immunity γ3.

From the following expression,

dRvacdψ=-R0μ(1-σ)(1-α)(μ+ψ)2<0,dRvacdα=-R0μ(1-σ)μ+ψ<0,

it is easy to see that the policy of vaccinations with imperfect vaccines can decrease the the basic reproduction number Rvac. Thus, the imperfect vaccine may be beneficial to the community. This is also a positive point, sice it is know that the use of some imperfect vaccine can sometime result in detrimental consequences to the community [3, 20].

At last, we must point out that although the system (2.3) with (2.2) is well posed mathematically, we acknowledge the biological reality that the fraction of the constant total population which occupies a compartment can only be within the subset Q of rational values within R+5, and furthermore only within a sub-subset of values within Q belonging to n / N where n belongs to the integers Z[0,N]. In addition, we also point out that the analysis of the model (2.1) may become somewhat different if disease fatalities and more complex vital dynamics are included, in particular, if the population size is no longer constant. In the future, we may investigate many various modeling possibilities to simulate a real world biological process based on model (2.1). On the other hand, we note that the population in our model (2.1) is assumed to be homogeneously mixed. In fact, different individual may have different number of contacts. Thus, a complex network-based approach on diseases transmission may be closer to a realistic situation [7, 41, 42]. In the future, we shall investigate dynamics of the proposed model based on a complex network.

Acknowledgements

We would like to thank Dr Chin-Hong Park( Editor-in-Chief) and the four reviewers for their constructive comments and suggestions that have helped us to improve the manuscript significantly.

Appendix

The second additive compound matrix A[2] for a 6×6 matrix A=(aij) is

A[2]=a11+a22a23a24-a13-a140a32a11+a33a34a120-a14a42a43a11+a440a12a13-a31a210a22+a33a34-a24-a410a21a43a22+a44a230-a41a31-a42a32a33+a44

Footnotes

This work was supported by the National Natural Science Foundation of China (11371305, 11671346, 11601465), China Scholarship Council (201308410212) and Nanhu Scholars Program for Young Scholars XYNU.

Contributor Information

Li-Ming Cai, Email: limingcai@amss.ac.cn.

Xinyu Song, Email: xysong88@163.com.

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