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. 2020 Jul 27;101(2):1281–1300. doi: 10.1007/s11071-020-05825-x

Threshold dynamics of a time-delayed epidemic model for continuous imperfect-vaccine with a generalized nonmonotone incidence rate

Isam Al-Darabsah 1,
PMCID: PMC7383700  PMID: 32836815

Abstract

In this paper, we study the dynamics of an infectious disease in the presence of a continuous-imperfect vaccine and latent period. We consider a general incidence rate function with a non-monotonicity property to interpret the psychological effect in the susceptible population. After we propose the model, we provide the well-posedness property and calculate the effective reproduction number RE. Then, we obtain the threshold dynamics of the system with respect to RE by studying the global stability of the disease-free equilibrium when RE<1 and the system persistence when RE>1. For the endemic equilibrium, we use the semi-discretization method to analyze its linear stability. Then, we discuss the critical vaccination coverage rate that is required to eliminate the disease. Numerical simulations are provided to implement a case study regarding data of influenza patients, study the local and global sensitivity of RE<1, construct approximate stability charts for the endemic equilibrium over different parameter spaces and explore the sensitivity of the proposed model solutions.

Keywords: Epidemic model, Delay differential equations, Latent period, Vaccination, Persistence, Global stability

Introduction

In 1979, Cooke introduced a “time delay” to represent the disease incubation period in studying the spread of an infectious disease transmitted by a vector in [1]. Since then, many authors have incorporated time delays in epidemic models in different scenarios, such as vaccination period [2], asymptomatic carriage period [3], immune period [4] and incubation period or latent period [37]. More precisely, in [3], a disease transmission model with two delays in incubation and asymptomatic carriage periods is investigated. In [4], the authors study an SEIRS epidemic model with constant latent and immune periods. In [5], a latent period and relapse are considered in a general mathematical model for disease transmission. In [7], the authors studied a time-delayed SIR model with nonlinear incidence rate and Holling functional type II treatment rate for epidemic transmission. Also, many authors studied time-delayed epidemic models with vaccination [811]. For example, the authors in [9] study a vaccination model with a time delay to represent the time that an unaware susceptible individual takes to become aware of the infection. Due to the inherent complexity of epidemiological transmission, other works studied epidemic complex network models. For example, in [12], the authors studied a semi-random epidemic network and discussed the relationship between its topological structure and the optimal control of the epidemic. In [13], the authors used the concept of epidemiology to analyze data from real computer virus epidemics by using complex network models. They studied an SIS model on scale-free graphs by largescale simulations and analytical methods.

Vaccines are considered to be one of the most significant medical means of disease control and prevention [14]. They have played a major role in the spread and eradication of many infectious diseases, such as smallpox, or partially, like measles. Many authors in the literature have studied the dynamics of epidemics models with different types of vaccination schedules [1519]. For instance, in [16], an SIR model with a generalized incidence under preventive vaccination and treatment controls is proposed. In [20], the authors developed an SIVS epidemic model with degree-related transmission rates and imperfect vaccination on scale-free networks. In [17], the authors establish two SVIR models: one with continuous vaccination strategy and another one with pulse vaccination strategy. An epidemic model to study the potential impact of a SARS vaccine when it is imperfect is proposed in [18]. The dynamics of cholera epidemics with impulsive vaccination is studied in [15].

To incorporate the effect of behavioral changes on the disease spreading dynamics, the authors in [21] introduce a nonlinear incidence rate of the form

Sg(I)=βSIq11+dIq2 1

where S and I represent the numbers of susceptible and infectious individuals, respectively, β is the probability of transmission per contact per unit time, and the constant q1 is positive while the constants q2,d are nonnegative. Here, the constant d measures the inhibitory effect. In (1), βIq1 measures the infection force of the disease and 1/(1+dIq2) represents the inhibition effect from the behavioral change of the susceptible individuals when the number of infectious individuals increase [22]. It also can be used to describe the crowding effect of infectious individuals [23]. There are three types of incidence functions g(I)=βIq1/(1+dIq2) based on the values of q1 and q2 [22, 24]: (i) unbounded incidence function: q1>q2; (ii) saturated incidence function: q1=q2; and (iii) nonmonotone incidence function: q1<q2. In the literature, these types have been used in different scenarios. For example, the authors in [22] consider a nonmonotone incidence rate to represent the psychological effect with q1=1 and q2=2. In [23], a saturated incidence rate is considered with q1=q2=2. For more details and examples, we refer the reader to [24] and references within. In this paper, we consider a general form of an nonmonotone infection force function g(I), in the sense that g(I) is increasing when the population of infectious I is small and decreasing when I is large. From a biological point of view, this can be interpreted as the “psychological effect”, that is, when a disease is spreading among a population and the number of infective individuals becomes large, the behavior of the population may tend toward reducing the number of contacts among individuals per unit time [22].

In the real world, the latent period may vary from days, as in influenza A H1N1 [25], to years, as in AIDS [26]. The latent period has a profound effect on the generation time, which is defined as the time period between a case becoming infected and its subsequent infection of another case [27]. Thus, the latent period has an influence on the epidemic growth [28]. The purpose of the work is to investigate the dynamical behavior of a time-delayed SEIR model with continuous imperfect-vaccine and discuss the effect of the latent period on the epidemic. The paper is organized as follows. In the next section, we present the mathematical model and the study its well-posedness. Then, in Sect. 3, we calculate the effective reproduction number RE. In Sect. 4, we use various methods, such as the Lyapunov functional technique and the method of fluctuations, to establish the global stability of the disease-free equilibrium when RE<1. Then, in Sect. 5, we study the system persistence when RE>1. Moreover, we use the semi-discretization method of order one to study the local stability of endemic equilibrium. In Sect. 6, we discuss the critical vaccination coverage that is required to eliminate the disease. In Sect. 7, we consider an application to influenza transmission. Numerically, we also study the local and global sensitivities of RE, discuss the stability of the endemic equilibrium and examine the sensitivity of model solutions. Finally, we discuss our results in Sect. 8.

Mathematical model and the well-posedness property

Motivated by [29], we let N(t) be the total population at time t and divide it into five classes: S(t) is the susceptible population, V(t) is the population of vaccinated individuals, E(t) is the population of individuals who are infected but not yet infectious (exposed class), I(t) is the infected population and R(t) is the recovered population. We assume there is a recruitment rate into the population and the natural death rate is the same for all the compartments. We make the following assumptions to describe the interaction among the five classes:

  • When the susceptible individuals receive a vaccine, they move from class S to V. On the other side, the infected individuals in S move to the exposed class E with transmission rate β and remain there for a certain latent period τ (see e.g., [30]);

  • The vaccine is not perfect, in the sense that, the individuals in V are not on a fully protective level. Consequently, when the vaccinated individuals become infected, they move into E for τ period with a reduced transmission rate ξβ, where ξ[0,1] is the reduction coefficient [30]. When individuals gain immunity, they move into the class R [17];

  • After the latent period τ, infected individuals become infectious and move from E to I. Then when they recover, they move to R. Individuals in R may lose immunity at rate α and become susceptible again, that is, they move to the class S (i.e., the vaccine is continuous).

These assumptions lead to the following system of delay differential equations:

dSdt=Λ-βS(t)I(t)f(I(t))-μ+ψS(t)+αR(t),dVdt=ψS(t)-ξβV(t)I(t)f(I(t))-(μ+η)V(t),dEdt=β(S(t)+ξV(t))I(t)f(I(t))-β(S(t-τ)+ξV(t-τ))I(t-τ)f(I(t-τ))e-τμ-μE(t),dIdt=β(S(t-τ)+ξV(t-τ))I(t-τ)f(I(t-τ))e-μτ-(μ+γ)I(t),dRdt=ηV(t)+γI(t)-(μ+α)R(t). 2

The term e-μτ represents the probability for individuals to survive the latent period [t-τ,t], see e.g., [3]. The population flux among the five compartments is given in Fig. 1 and a description of the parameters is given in Table 1.

Fig. 1.

Fig. 1

The flow diagram for system (2)

Table 1.

Parameter description of the system (2)

Parameter Description
Λ Recruitment rate of susceptible humans
β Effective contact rate
ψ Vaccination coverage rate
μ Natural mortality rate
α Loosing immunity
ξ The vaccine efficacy is ϵ=1-ξ
1/η The immunity development period
τ Latent period
γ Recovery rate

Denote the infection force function by βI/f(I). Following [16, 31], we assume that the infection force function decreases when the number of infectious individuals increases since the individuals tend to reduce the number of contacts among them per unit time when they are under intervention policies. Consequently, we consider the following assumptions: graphic file with name 11071_2020_5825_Figa_HTML.jpg

Here, ζ is the critical level of invectives, that is, the incidence rate is increasing when I(0,ζ] and it is decreasing when I>ζ. Notice that the nonlinear incidence rate has the form β(S+ξV)If(I).

Consider the Banach space C:=C([-τ,0),R5) with the maximum norm

ϕ=i=15maxθ-τ,0ϕi(θ),ϕ=(ϕ1,ϕ2,ϕ3,ϕ4,ϕ5)C.

Then C+:=C([-τ,0],R+5) is a normal cone of C and the interior of C is not empty. Let r>0 and u=(u1,u2,u3,u4,u5):[-τ,r)R5 be a continuous function. For t0, define utC by ut(θ)=(u1(t+θ),u2(t+θ),u3(t+θ),u4(t+θ),u5(t+θ)) for all θ[-τ,0].

The initial data set for system (2) is in form:

X=ϕC+:ϕ3(0)=-τ0βϕ3(s)(ϕ1(s)+ξϕ4(s))fϕ3(s)eμsds

where the form for ϕ3(0) follows from the implicit solution of E(t) in system (2) which has form:

E(t)=t-τtβI(θ)(S(θ)+ξV(θ))fI(θ)e-μ(t-θ)dθ. 3

The following theorem shows the nonnegativity and boundedness of system (2).

Theorem 2.1

Let ϕX. Then, system (2) has an ultimately bounded unique non-negative solution (S(t), V(t) , E(t), I(t), R(t)) for t0 in C. Furthermore, the region

Γ=S(t),V(t),E(t),I(t),R(t)R+5:S(t)+V(t)+E(t)+I(t)+R(t)=Λμ

is a positive invariant set and globally attractive set for (2).

Proof

For any ϕX, we define G(ϕ)=(G1(ϕ),G2(ϕ),G3(ϕ),G4(ϕ),G5(ϕ))T, where

G1(ϕ)=Λ-βϕ1(0)ϕ4(0)f(ϕ4(0))-(μ+ψ)ϕ1(0)+αϕ5(0),G2(ϕ)=ψϕ1(0)-βξϕ2(0)ϕ4(0)f(ϕ4(0))-(μ+η)ϕ2(0),G3(ϕ)=βϕ1(0)+ξϕ2(0)ϕ4(0)f(ϕ4(0))-βϕ1(-τ)+ξϕ2(-τ)ϕ4(-τ)f(ϕ4(-τ))e-μτ-μϕ3(0),G4(ϕ)=βϕ1(-τ)+ξϕ2(-τ)ϕ4(-τ)f(ϕ4(-τ))e-μτ-(μ+γ)ϕ4(0),G5(ϕ)=ηϕ2(0)+γϕ4(0)-(μ+α)ϕ5(0)

G(ϕ) is continuous and Lipschitz in ϕ in each compact set in R×X because X is closed in C and for any ϕX. Thus, there is a unique solution u(t,ϕ) of system (2) through (0,ϕ) on its maximal interval [0, r) of existence [32, Theorem 2.2.3].

Let ϕX, if ϕ4(0)=0, then F4(ϕ)0. Consequently, Fi(ϕ)0 when ϕi(0)=0 for i=1,2,5. Hence, it follows from [33, Theorem 5.2.1] that for i=1,2,4,5, the solutions S(t), V(t), I(t) and R(t) are non-negative for all t[0,r). Consequently, from (3) we obtain E(t)0.

Notice that

dN(t)dt=Λ-μN(t). 4

Thus, N(t)=Λμ is globally asymptotically stable on (4). Hence, by the comparison arguments [34, Lemma 1.2], we have that S(t), V(t), E(t), I(t) and R(t) are bounded on t[0,r). Thus, r= [32, Theorem 2.3.1], and hence, all the solutions are globally and ultimately bounded.

The general solution of (4) can be written as

N(t)=Λμ-Λμ-N(0)e-μt.

Therefore, when N(0)Λμ, we have N(t)Λμ, and hence, the set Γ is positive invariant. Moreover, if N(0)>Λμ, then

limtN(t)=Λμ.

Consequently, the set Γ is the globally attractive set for (2).

The effective reproduction number RE

In system (2), when E(t)=I(t)0, the disease-free equilibrium is E0=S0,V0,0,0,R0 always exists where

S0=Λ(α+μ)(η+μ)μα(η+μ+ψ)+(η+μ)(μ+ψ),V0=Λψ(α+μ)μα(η+μ+ψ)+(η+μ)(μ+ψ),R0=ηΛψμα(η+μ+ψ)+(η+μ)(μ+ψ). 5

The equations for the diseased classes E and I in the linearized system of (2) about E0 can be rewritten as

ddtY(t)=M1Y(t-τ)-M2Y(t), 6

where

Y(t)=E(t)I(t),M1=0-β(S0+ξV0)e-μτ0β(S0+ξV0)e-μτ,M2=μ-β(S0+ξV0)0γ+μ.

Let Y0=y1,y2T be the number of classes E(t) and I(t) at t=0, then from (6) the distribution of the remaining population of classes E(t) and I(t) at time t>0 is

Y(t)=e-M2tY0.

The total number of newly infected individuals is

Y¯=τM1Y(t-τ)dt=τM1e-M2(t-τ)Y0dt=M1M2-1Y0

due to the nonsingularity of the matrix M2. Then it follows that, the next infection operator is

M0=M1M2-1=0-β2(S0+ξV0)2e-μτγμ+μ20β(S0+ξV0)e-μτγ+μ.

In the literature (see e.g., [35]), the reproduction number RE for system (2) is the spectral radius of the matrix M0, which is

RE:=βS0e-μτμ+γ+βξV0e-μτμ+γ=βΛ(α+μ)(η+μ+ξψ)e-μτμ(γ+μ)(α(η+μ+ψ)+(η+μ)(μ+ψ)). 7

Since we introduce a vaccination program in system (2), RE is called the effective reproduction number which gives the actual number of secondary infections per infectious person at any time [16, 36]. Biologically, 1μ+γ is the time spent as an infectious individual and e-μτ is the survival rate of infected individual in latent period. Hence, first\second term of RE gives the number of secondary infections of susceptible\vaccinated individuals that one infected individual can produce in a disease-free population S0\V0.

Stability of the disease-free equilibrium

When RE is less than unity, the epidemiological interpretation is that an epidemic cannot develop and eventually the disease dies out. On the other hand, when RE>1, the population of infected host grows and an outbreak occurs. In this section, we establish the global stability of E0 when RE<1 .

As we mentioned in Sect. 3, E0 exists for all parameters values. The following result indicates the instability and local stability of E0 in (2). See [35, Theorem 2.1 and Corollary 2.1].

Theorem 4.1

If RE>1, the disease-free equilibrium E0 is unstable for system (2), and it is locally asymptotically stable if RE<1.

Since the equations of S, V, I and R are decoupled in (2), it suffices to study the following system:

dSdt=Λ-βS(t)I(t)f(I(t))-μ+ψS(t)+αR(t),dVdt=ψS(t)-ξβV(t)I(t)f(I(t))-(η+μ)V(t),dIdt=β(S(t-τ)+ξV(t-τ))I(t-τ)f(I(t-τ))e-μτ-(μ+γ)I(t),dRdt=ηV(t)+γI(t)-(μ+α)R(t), 8

with initial data (ϕ1,ϕ2,ϕ4,ϕ5)C([-τ,0],R+4).

To obtain the global stability of E0 in (2), first, we prove the following results, Theorems 4.2 and 4.3, by using the Lyapunov functional technique, the method of fluctuations and the theory of limiting systems and chain transitive sets.

Theorem 4.2

Consider the system

dSdt=Λ-μ+ψS(t)+αR(t),dVdt=ψS(t)-(μ+η)V(t),dRdt=ηV(t)-(μ+α)R(t). 9

with (S(0),V(0),R(0))R+3 where S(0)=ϕ1(0), V(0)=ϕ2(0) and R(0)=ϕ5(0). Then, the equilibrium point (S0,V0,R0) is globally attractive in (9), that is,

limtS(t),V(t),R(t)=S0,V0,R0.

Proof

It is easy to check that S0+V0+R0=Λμ. Define a Lyapunov function U:=U(S,V,R) as

U=12Λμ-S-V-R2.

Then, U(S0,V0,R0)=0, U(S,V,R)>0 for (S,V,R)(S0,V0,R0) and

dUdt=-dSdt+dVdt+dRdtΛμ-S-V-R=-Λ-μS-μV-μRΛμ-S-V-R=-μΛμ-S-V-R20.

It follows from (9) that the largest invariant set in the set of dUdt=0 is (S0,V0,R0). By the LaSalle’s invariance principle [37], (S0,V0,R0) is globally attractive, that is,

limtS(t),V(t),R(t)=S0,V0,R0.

Theorem 4.3

When RE<1, then equilibrium point (S0,V0,0,R0) is global attractive in (8) for any (ϕ1,ϕ2,ϕ4,ϕ5)C([-τ,0],R+4).

Proof

Since limtN(t)=Λμ, we have

R(t)=Λμ-S(t)+V(t)+E(t)+I(t)Λμ-S(t)+V(t)+I(t).

Now, we show that the limit supremum of I(t) is zero in (8) as t when RE<1 by using the method of fluctuations [38, 39]. Let

S=lim suptS(t),V=lim suptV(t),I=lim suptI(t).

Claim 1

When RE<1, then I=0 in (8).

For i=1,2,3, there exist three sequences αn(i) as n [39, Lemma 4.2], such that

limnS(αn(1))=SanddSdtt=αn(1)=0,n1,limnV(αn(2))=VanddVdtt=αn(2)=0,n1.limnI(αn(3))=IanddIdtt=αn(3)=0,n1.

Hence, when n1 and n, it follows from (8) that

0=dSdtt=αn(1)=Λ-βSlimnI(αn(1))f(I(αn(1)))-μ+ψS+αR(αn(1))Λ-μ+ψS+αΛμ-αS(αn(1))+V(αn(1))+I(αn(1))Λμ+αμ-μ+ψS. 10

Since

(μ+ψ)(μ+η)αη+μ+ψ+(μ+ψ)(μ+η)<1

it follows from (10) that S<S0. From the equation of V in (8), we have

0=dVdtt=αn(2)=ψlimnS(αn(2))-ξβVlimnI(αn(2))f(I(αn(2)))-(η+μ)VψS-(η+μ)V. 11

Since V0=ψS0μ+γ, we have V<V0. Moreover, the last equation in (8) leads to

0=dIdtt=αn(3)=βlimnS(αn(3)-τ)+ξV(αn(3)-τ)If(I)e-μτ-(μ+γ+δ)IβS+ξVIf(I)e-μτ-(μ+γ+δ)I. 12

From (Q1), we have 1=f(0)f(I), and hence,

0βS+ξVIe-μτ-(μ+γ+δ)IβS0+ξV0e-μτ-(μ+γ+δ)I.

Thus, 0(μ+γ+δ)RE-1I. Since RE<1, we have RE-1<0, and hence, I=0 because I(t)0. This proves Claim 1.

It follows from Claim 1 that

limtI(t)=0

when RE<1, and hence, the system (8) is asymptotic to the limiting system (9).

Recall that (S0,V0,R0) is globally attractive in the limiting system (9), see Theorem 4.2. To lift the dynamics of the limiting system (9) to the main system (8), we use the theory of internally chain transitive sets to prove

limtS(t),V(t),I(t)=S0,V0,0.

Let (ϕ1,ϕ2,ϕ4,ϕ5)C([-τ,0],R+4) and ω=ω(ϕ1,ϕ2,ϕ4,ϕ5) be the omega limit set for the solution semi-flow zt(ϕ1,ϕ2,ϕ4,ϕ5) of (8). Hence, ω is an internally chain transitive set for zt, see e.g., [35, Lemma 1.2.1]. Thus, ω={(S0,V0)}×ω^×{R0} for some ω^R. Since zt(ω)=ω, for all t0, we have

zt(S0,V0,I^,R0)=(S0,V0,z^t(I^),R0)

where z^t is the solution semi-flow associated with the equation

dIdt=β(S0+ξV0)I(t-τ))e-μτ-(μ+γ+δ)I(t). 13

Notice that ω^ becomes an internally chain transitive set for z^t (z^t(ω^)=ω^) because ω is an internally chain transitive set for zt.

Claim 2

When RE<1, then limtI(t)=0 in (13).

Suppose the solutions of (13) take the form I(t)=ceλt where λ satisfies the characteristic equation

λ+(μ+γ+δ)-β(S0+ξV0)e-μτe-λτ=0. 14

Assume there exists a zero in (14) with Re(λ) then

λ+(μ+γ+δ)=β(S0+ξV0)e-μτe-λτλμ+γ+δ+1=REe-λτ,

which is a contradiction because

λμ+γ+δ+1>1andREe-λτ<1

when RE<1. Thus, all roots have negative real part. Therefore, limtI(t)=0. This proves Claim 2.

Let Ws(0) be the stable manifold of 0, then it follows from Claim 2 that ω^Ws(0). Hence by [35, Theorem 1.2.1] we have ω^=0. Therefore, we have ω=(S0,V0,0,R0), and hence

limtS(t),V(t),I(t),R(t)=S0,V0,0,R0,

i.e., S0,V0,0,R0 is globally attractive in system (8).

The following result shows the global stability of E0 for system (2).

Theorem 4.4

When RE<1, the disease-free equilibrium E0 is globally asymptotically stable for system (2) in X .

Proof

It follows from Theorem 4.3, the integral form of E(t) in (3) and the reverse Fatou lemma (see e.g., [40]) that

limsupt+E(t)=limsupt+t-τtβI(θ)(S(θ)+ξV(θ))fI(θ)e-μ(t-θ)dθ=limsupt+0τβI(t-θ)(S(t-θ)+ξV(t-θ))fI(t-θ)e-μθdθlimsupt+0τβI(t-θ)(S(t-θ)+ξV(t-θ))fI(t-θ)dθ0τlimsupt+βI(t-θ)(S(t-θ)+ξV(t-θ))fI(t-θ)dθ=0. 15

Thus, limtE(t)=0. Hence,

limtS(t),V(t),E(t),I(t),R(t)=S0,V0,0,0,R0.

Since E0 is the local stability when RE<1, see Theorem 4.1, we obtain that E0 is globally asymptotically stable in (2) when RE<1.

Uniform persistence

In this section, we prove the persistence of system (2) when RE>1. Define

X1:={ϕX:ϕ4(0)>0}X1:={ϕX:ϕ4(0)=0}=X\X1.

Here X1 is the set of states without disease presence. The following results demonstrate the uniform persistence of the disease state in (2) with respect to X1.

Theorem 5.1

If RE>1, then the disease class I(t) is uniformly persistent in (2), i.e., there is a positive number κ1>0 such that

lim inftI(t)κ1

with ϕX1.

Proof

Fix a small 0<σ1. Since S(t)+ξV(t)f(I(t))S0+ξV0 as (S,V,I)(S0,V0,0), in a neighborhood of (S0,V0,0), we have

S0+ξV0-σ<S(t)+ξV(t)f(I(t))<S0+ξV0+σ. 16

Claim 3

There exists an ϵ(σ):=ϵ, such that for any ϕX1

lim suptut(ϕ)-E0ϵ.

By contradiction, suppose that |ut(ψ)-E0<ϵ for some ψX1. Thus, there exists t0>0 such that S(t)-S0<ϵ, V(t)-V0<ϵ and I(t)<ϵ for t>t0+τ. Hence, (16) is satisfied.

From the fourth equation of (2), we have

dIddt>β(S0+ξV0-σ)e-μτI(t-τ)-(μ+γ+δ)I(t). 17

For sufficiently small σ, the equation obtained from (17), by replacing > with =, is quasimonotone. Hence, it suffices to study the real roots of the characteristic equation ( [33, Theorem 5.5.1])

Δ1(λ):=λ+(μ+γ+δ)-β(S0+ξV0-σ)e-μτe-λτ=0. 18

Let σ=0. Then, Δ1(0)=(μ+γ+δ)(1-RE)<0 when RE>1. Notice that Δ1 is continuous, increases for λ>0 and goes to when λ. Hence, there exists a positive root λ^>0 satisfying (18). Let λ0(σ) be the principle eigenvalue. Then, λ0(0)>0, and hence, due the continuity of λ0, λ0(σ)>0 for sufficiently small σ>0. Thus, there exists a solution U(t)=ceλ0(σ)t with c>0. Since I(t)0 for t>0, by the comparison theorem [33, Theorem 5.1.1], there exists a small K>0 such that I(t)Kceλ0(σ)t for all tt0+m. Thus, I(t) as t due to the positivity of λ0(σ), which is a contradiction to the boundedness of (2). This proves Claim 3.

Let ω1(ϕ) be the omega limit set of the orbit ut(ϕ) through ϕX and define

M={ϕX:ut(ϕ)X,t0}.

Claim 4

{ω1(ϕ):ϕM}={E0}.

Let ϕM, i.e., I(t)0. Then, from the equation of E in (2), we have

limtE(t)=0.

By using idea of limiting systems and the theory of internally chain transitive sets, see the proofs of Theorems 4.2 and 4.3, it follows that

limtS(t),V(t),R(t)=S0,V0,R0,

and hence,

limtS(t),V(t),E(t),I(t),R(t)=S0,V0,0,0,R0,

Thus, {ω1(ϕ):ϕM}={E0}. This proves Claim 4.

Let ϕX and define a continuous function p:XR+ by p(ϕ)=ϕ4(0). Therefore, p-1(0,)X1 and p(ut(ϕ))>0 for all t>0 whenever p(ϕ)>0. It follows from Claim 4 that any forward orbit of ut in M converges to E0. Let WsE0 is the stable manifold of E0. Then it follows from that Claim 3 that WsE0X=, and hence, there is no cycle in M from E0 to E0. By [41], there exists κ1>0 such that lim inftI(t)κ1 for all ϕX1, which implies the uniform persistence.

Furthermore, we can prove the uniform persistence of system (2) with respect to X1.

Theorem 5.2

If RE>1, then the system (2) is uniformly persistent in (2), i.e., there is a positive number κ2>0 such that every solution in system (2) with ϕX1 satisfies

lim inftS(t),V(t),E(t),I(t),R(t)κ2,κ2,κ2,κ2,κ2.

Proof

From Theorems 2.1 and 5.1, we have κ1I(t)Λ/μ. Consequently, from the first equation of (2) and (Q1), we have

dSdtΛ-βΛ/μf(Λ/μ)+ψ+μS(t). 19

When we replace by = in (19),

κ^1=Λf(Λ/μ)βΛ/μ+μ+ψf(Λ/μ)

is globally asymptotically stable in (19). Hence, by applying the comparison arguments [34, Lemma 1.2], we have S(t)κ^1. Parallely, from the equations of V and R in (2) we have

V(t)κ^2andR(t)κ^3,

respectively, where

κ^2=ψκ^1f(Λ/μ)βξΛ/μ+η+μf(Λ/μ)andκ^3=ηκ^2+γκ1μ+α.

It follows from Theorem 5.1 and the integral form of E(t) in (3) that

liminft+E(t)=liminft+t-τtβI(θ)(S(θ)+ξV(θ))fI(θ)e-μ(t-θ)dθ=liminft+0τβI(t-θ)(S(t-θ)+ξV(t-θ))fI(t-θ)e-μθdθliminft+0τβIκ1(κ^2+ξκ^2)f(Λ/μ)e-μθdθ=βIκ1(κ^2+ξκ^2)1-e-μτμf(Λ/μ):=κ^4. 20

Choose κ2=min{κ1,κ^1,κ^2,κ^3,κ^4}. This completes the proof.

Endemic equilibrium and its stability region

Since C([-τ,0],R+4) is a convex set and the system (8) is ultimately bounded and uniformly persistent with respect to X1 when RE>1, it follows from [42, Theorem 3.1] that (8) has at least a positive equilibrium point (S,V,I,R) when RE>1. Consequently, the system (2) has the positive equilibrium point E1=(S,V,E,I,R). The value of E can be found from the integral form of E(t) in (3). It is not possible to derive an explicit formula for the components of E1 or guarantee its uniqueness due to the presence of the exponential terms in the model.

Regarding the stability of E1, a self-contained proof seems to have a tedious calculation due to the fourth-order transcendental characteristic equation. However, we use the semi-discretization method of order one to study the linear stability of the endemic equilibrium [43, 44].

Let RE>1 and assume that E1 exists. By setting x=(S,V,E,I,R)-E1, the linearized system of (2) about E1 is

dx(t)dt=Ax(t)+Bx(t-τ) 21

where x(t)=(x1(t),x2(t),x3(t),x4(t),x5(t))T and

A=-βIf(I)-μ-ψ00βISf(I)f(I)2-βSf(I)αψ-ξβIf(I)-η-μ0ξβIVf(I)f(I)2-ξβVf(I)0βIf(I)ξβIf(I)-μ-βI(S+ξV)f(I)f(I)2+β(S+ξV)f(I)0000-γ-μ00η0γ-α-μ,B=0000000000-βIe-μτf(I)-ξβIe-μτf(I)0βI(S+ξV)e-μτf(I)f(I)2-β(S+ξV)e-μτf(I)0βIe-μτf(I)ξβIe-μτf(I)0-βI(S+ξV)e-μτf(I)f(I)2+β(S+ξV)e-μτf(I)000000.

Now, define the solution operator U:CC of (21) by

xt(·,ϕ)=U(t)ϕ. 22

When all of the nonzero elements of the spectrum of the monodromy operator U (the Floquet multipliers of system (21)) are within the unit circle of the complex plane, the zero solution of (21) is stable. While when one or more of the Floquet multipliers are on the unit circle and the rest of them are inside the unit circle, the zero solution may undergo a bifurcation [45].

To study the location of the Floquet multipliers, we use the semi-discretization method which is an efficient numerical method based on a special kind of discretization technique with respect to the past effects only [46]. By employing this method, we define a Floquet transition matrix, which is an approximation to the infinite-dimensional monodromy operator U corresponding to the linear delayed system (21). Usually, the semi-discretization method is used to study the linear stability when the system is non-autonomous (contains time-dependent periodic delays or coefficients functions). However, since system (21) is autonomous, we can choose an arbitrary period [43]. Consequently, we assume a period T for the system (21), and hence, the length of the discretization interval is h=T/K where K is the number of subintervals of [0, T]. Let ti=ih. Then, in each discretization interval [ti,ti+1], the first-order semi-discretization approximate the delayed term x(t-τ) by the Lagrange first-order polynomial

x(t-τ)δ0(t)x(ti-r)+δ1(t)x(ti-r+1), 23

where

δ0(t)=τ+(i-r+1)h-th,δ1(t)=t-(i-r)h-τh

and r=int(τ/h+1/2) with int denoting the integer-part function, see [43, 44]. The scheme of the approximation in (23) is shown in Fig. 2, and more details are provided in [44, Chapter 3].

Fig. 2.

Fig. 2

Approximation of the delayed term x(t-τ) is shown by the gray dashed line. Here xi=x(ti)

Consequently, system (21) can be approximated by a system of ordinary differential equations

dxdt=Ax(t)+Bδ0(t)x(ti-r)+δ1(t)x(ti-r+1),t[ti,ti+1] 24

where i=0,,K-1. By using the variation of constants formula, the general solution of (24) can be written as

Xt=eA(t-ti)X(ti)+titeA(t-s)Bδ0(t)x(ti-r)+δ1(t)x(ti-r+1)ds.

Using the notation x(ti)=xi, when t=ti+1. Then, the solution over one discrete step can be formulated as

xi+1=Pxi+Ri,0xi-r+Ri,1xi-r+1,

where P=eAh and

Ri,0=0hτ-(r-1)h-sheA(h-s)dsB,Ri,1=0hs+rh-τheA(h-s)dsB. 25

If A-1 exists, then (25) can be written as

Ri,0=A-1+1hA-2-τ-(r-1)hA-1I-eAhB,Ri,1=-A-1+1h-A-2-τ-rhA-1I-eAhB.

Now, we define the augmented state vector as

zi=xi,xi-1,,xi-rT. 26

Combining zi and (24) leads to the discrete map

zi+1=Gizi

where Gi is the coefficient matrix of the form

graphic file with name 11071_2020_5825_Equ87_HTML.gif

Utilizing that T=Kh and applying (26) K times with initial state z0 gives the monodromy mapping

zK=Φz0. 27

where

Φ=GK-1GK-2G0 28

which represents a finite-dimensional approximation of the monodromy operator U associated with E1 of (2). The rate of convergence for the first-order semi-discretization method is O(h3).

When all the eigenvalues of Φ are inside the unit circle of the complex plane, then E1 is asymptotically stable. While when one or more of the eigenvalues are on the unit circle and the rest of them are inside the unit circle, E1 may undergo a bifurcation [45]. In the numerical simulations, Sect. 7.4, we implement the above algorithm to construct an approximate stability region for E1. We notice that when E1 is unstable, the model exhibits periodic oscillations as it is expected from SIRS models with delay [47].

The critical vaccination coverage

In this section, we discuss the critical vaccination coverage rate that eliminates the disease. Let RE(ψ):=RE. When the vaccination is absent, i.e., ψ=0, the effective reproduction number becomes

R0:=RE(0)=βΛ(α+μ)(η+μ)e-μτμ(γ+μ)(α(η+μ)+μ(η+μ)). 29

In fact R0 is so-called the basic reproduction number which is the average number of secondary cases arising from one infectious individual in a totally susceptible population [48, 49]. In the case of R0, everyone is susceptible while in RE not all contacts will become infected due immunity, hence, RE is less than R0 from epidemiological point of view. Notice that, RE(ψ) can be written as

RE(ψ)=(α+μ)(η+μ+ξψ)α(η+μ+ψ)+(η+μ)(μ+ψ)R0.

Thus,

RE():=limψRE(ψ)=ξ(α+μ)α+η+μR0.

Since

dRE(ψ)dψ=-(η+μ)((1-ξ)(μ+α)+η)(α(η+μ+ψ)+(η+μ)(μ+ψ))(η+μ+ξψ)RE(ψ)<0,

we have that ξ(α+μ)α+η+μR0RER0, and hence, R0<1 implies RE<1, but the reverse is not true.

Now, we find the critical level of vaccination to eradicate of the disease when R0>1. Assume R0>1, then

RE()<1ξ(α+μ)α+η+μR0<1ξ<α+η+μα+μ×1R0:=ξε>ε:=1-α+η+μα+μ×1R0.

Obviously ϵ increases as R0 increases. Hence, when ϵ (the vaccine efficacy) is not large enough when R0 is high, the disease may not be eradicated even if everybody gets the vaccine. That is, RE(ψ) cannot become below 1 when ψ becomes high, see Fig.  3.

Fig. 3.

Fig. 3

Plot of ε as a function of R0

Lemma 1

Assume R0>1. Then, there exists

ψ=(R0-1)μ+ηR0ξ-ξ=(R0-1)μ+ηR0ξ+ϵ-1>0

such that RE(ψ)=1. Furthermore, RE(ψ)>(<)1 when ψ<(>)ψ.

Biologically, Lemma 1 indicates that ψ is the vaccination coverage rate to eradicate of the disease.

From V0 and Theorem 2.1, we have

V0=Λμ×ψ(α+μ)α(η+μ+ψ)+(η+μ)(μ+ψ)=N(t)×ψ(α+μ)α(η+μ+ψ)+(η+μ)(μ+ψ).

Hence,

V0N(t)=ψ(α+μ)α(η+μ+ψ)+(η+μ)(μ+ψ). 30

Hence, in a disease-free population, the proportion of vaccinated individuals is

ψ(α+μ)α(η+μ+ψ)+(η+μ)(μ+ψ). 31

Therefore, when R0>1, the critical proportion of the population that should be vaccinated when the vaccination is imperfect and ψ=ψ is given by

ρε=(R0-1)μ+η(α+μ)(R0-1)μ+η(α+η+μ)+R0ξ+ε-1(α+μ)(η+μ). 32

Figure 4a and b shows the contour plot of ρε in R0ϵ- and τϵ-plane, respectively. We notice that when ϵ is fixed, ρε increases as R0 increases. While τ does not have a noticeable effect on the value of ρε. Also, the figures are consistent with that fact that ρεε0.

Fig. 4.

Fig. 4

The contour plot of ρε. Parameters values are similar to those in Fig. 5

Numerical simulations

In this section, firstly, we fit the model with data of influenza patients as a case study. Secondly, we study the local and global sensitivity of RE with respect to the parameters of system (2). Thirdly, we discuss the stability of endemic equilibrium. Finally, we investigate the sensitivity system of the system (2) with respect to main parameters.

Through this section, we take

f(I)=1+0.001I5.

Case study

We use the system (2) to simulate the data of influenza patients (weekly percentage) in North Carolina from January to April, 2011 [50]. A range for (2) parameters is given in Table 2. Figure 5 shows that the numerical solution of (2) provides a good agreement with the real data.

Table 2.

Parameter value ranges of the system (2)

Parameter Range Reference
β [0.390, 0.432] per day [25]
ψ [0.371, 0.436] [51]
α Six months [52]
ξ [0.4, 0.81] [53]
1/η Two weeks [54]
τ [1, 4] [55]
Infectious period (1/γ) [3, 7] days [55]

Fig. 5.

Fig. 5

Weekly percentage of influenza patients in North Carolina from January to April, 2011 [50] compared to the simulation results of the system (2). Parameters: β=0.196 per week, γ=2, α=16 weeks, η=0.5 per week, Λ=100, μ=0.1, ξ=0.3, ψ=0.4, τ=0.143 week. Initial functions: S(θ)=100, I(θ)=1, V(θ)=E(θ)=R(θ)=0 for θ[-0.143,0]

Local sensitivity of RE

The local sensitivity analysis of RE provides insight into the proportional change in RE responding to a small variation of a single parameter p at one time. The normalized forward sensitivity index of RE (elasticity of RE) measures such relative change in RE, denoted by ΥpRE, and defined as [56, 57]:

ΥpRE:=REp×pRE. 33

From the explicit formula of RE in (7), we derive an analytical expression for ΥpRE to each parameter described in Table 1. From (7) and (33), we have

ΥΛRE=ΥβRE=1,ΥψRE=-ψη(η+μ)(1-ξ)(α+μ)(α(η+μ+ψ)+(η+μ)(μ+ψ))(η+μ+ξψ)<0,ΥμRE=-μτ-1-μ(α+η+2μ+ψ)α(η+μ+ψ)+(η+μ)(μ+ψ)+μα+μ-μγ+μ+μη+μ+ξψ,ΥηRE=-ηψ(α(ξ-1)+ξ(μ+ψ))(α(η+μ+ψ)+(η+μ)(μ+ψ))(η+μ+ξψ),ΥγRE=-γγ+μ<0,ΥαRE=(αηψ)(α+μ)(α(η+μ+ψ)+(η+μ)(μ+ψ))<0,ΥτRE=-μτ<0. 34

First, we notice for the parameters Λ and β, the sensitivity indices ΥΛRE and ΥβRE are independent of any other parameters; hence, they are locally and globally valid. Also, both parameters are equally important for RE because ΥΛRE=ΥβRE=1. Consequently, when Λ or β increases by 100%, then RE increases by 100%. For the other parameters p{ψ,μ,ξ,η,τ,γ,δ}, they have different impacts on RE due to the different absolute value of the forward sensitivity indices ΥpRE in (34). We use the values in Table 2 to calculate numeric values for ΥpRE, see Fig. 6. For example, when ψ increases by 100%, RE decreases by 86% while when α increases by 100%, RE increases by 5%; hence, due to absolute value of the sensitivity index we have ϕ is more important for RE. From Fig. 6, we notice that the order of parameters from the highest importance to the lowest is μ, Λ(and β), ψ, γ, τ, α, ξ and η.

Fig. 6.

Fig. 6

Local sensitivity indices of RE

Global sensitivity of RE

When there are large perturbations in all parameters, global sensitivity analysis is typically used which includes sampling a given range of parameter values [58]. We use the Latin Hypercube Sampling (LHS) design and Partial Rank Correlation Coefficient (PRCC) analysis technique to provide good insight on global sensitivity of RE on the uncertainties in its parameters [59]. The PRCC values vary in the interval [-1,1] such that there is a perfect negative\positive correlation when the value is -1\1, also, the PRCC value is statistically significant when |PRCC value|>0.5. Figure 7 shows PRCC values of RE where the parameters sampling are produced from LHS with uniform distribution over the parameter values in Table 2 with 1,000,000 samples. We notice from Fig. 7 that the most influential parameters on RE, ordered from highest to lowest, are γ, ξ, β, η, τ, ψ and α.

Fig. 7.

Fig. 7

PRCC results, the orange boxes represent the partial rank correlation coefficients of RE. The small figures in the right side and bottom show the PRCC scatter plots

Stability of E1

In this section, we fix

Λ=300,η=1,μ=0.13,ξ=α=0.01.

We use the package SemiDiscretizationMethod.jl on Julia to implement the algorithm in Sect. 5.1 and construct an approximate stability region for E1 in two parameters space. Figure 8 shows the stability charts in βγ-plane, βψ-plane and γψ-plane. In Fig. 8b, when ψ is fixed in the interval [0.4, 0.6] and β increases, a stability switches occur where endemic equilibrium losses its stability and then becomes stable for larger β, see Fig. 9a. While when β is fixed and ψ increases, a Hopf bifurcation occurs and the endemic equilibrium losses its stability and becomes unstable, see Fig. 9b. The latter case also occurs when β or ψ is fixed and γ increases, see Fig. 8a and c.

Fig. 8.

Fig. 8

Stability chart for the endemic equilibrium E1 obtained by semi-discretization method for h=0.1, where stable region is the green area and unstable region is the gray area

Fig. 9.

Fig. 9

One-parameter bifurcation diagrams with β, ψ and τ. We fix γ=0.09

Figure 9c shows a one-parameter bifurcation diagram, by varying the value of τ. For small τ, the endemic equilibrium E1 is stable (Fig. 10a). By increasing the value of τ, E1 loses the stability and a Hopf Bifurcation occurs around τ2.94. For τ>2.94, a unique stable periodic solution of system (2) exists (Fig. 10c). In Fig. 10, we plot the phase portrait of the system (2) with different initial condition and various value of τ, we notice that system (2) exhibits global asymptotic stability behavior when RE>1.

Fig. 10.

Fig. 10

Row 1: phase portrait of the system (2) with different initial condition and various value of τ. Row 2: the eigenvalues of the matrix Φ in (28) and the roots of the characteristic equation corresponding to E1. β=0.9,γ=0.09 and ψ=0.2 The endemic equilibrium E1 is a (912.618, 161.509, 1.30009, 42.5669, 1181 b (905.814, 160.301, 4.02373, 39.9422, 1170.68) c (901.278, 159.496, 5.77535, 38.4905, 1164)

Sensitivity of model solutions

The sensitivity system of (2) with respect to a parameter p{ψ,μ,ξ,η,τ,γ,α} is given by the partial derivative of X=(S,V,E,I,R)T with respect to p, denoted by Xp=Xp. Define f(S,V,E,I,R):=dXdt, then by the Chain Rule and Clairaut’s Theorem, we have

dXpdt=dfdXXp+fp,Xp(0)=X0(p)p.

The semi-relative sensitivity for X is represented by pXp, while the logarithmic sensitivity is represented by pXpX. The detailed method is given in [60].

Figures 11 and 12 show the semi-relative and logarithmic sensitivity curves for SVI and R with respect to the parameter β, ψ, α and τ. From Figs. 11 and 12, we can interpret that the perturbation of τ has a big influence over S, V, I and R. For t(0,10), a remarkable positive affect of the parameter β occurs on I and R, while an opposite affect appears on the variables S and V. Moreover, at t4(7), we notice that both parameters τ and β have the largest effects on S and V (I and R). The perturbation of ψ and α has a noticeable positive affect on V and R.

Fig. 11.

Fig. 11

The semi-relative sensitivity curves of SVI and R with respect to the parameter β, ψ, α and τ

Fig. 12.

Fig. 12

The logarithmic sensitivity curves of SVI and R with respect to the parameter β, ψ, α and τ

Finally, since the function f(I) is independent of the value of RE, we consider f(I)=1+dIq and study the influence of the parameters d and q on the solution of the system (2). In Fig. 13, the sensitivity solution curves show that d and q have a positive influences on S and V and a negative affects on I. The influence of q is relatively higher than that of d. More precisely, q has an oscillatory influence on {S,V,I,R}. There are small affects (around zero) of d on the four variables.

Fig. 13.

Fig. 13

The semi-relative (row 1) and logarithmic (row 2) sensitivity curves for SVI and R with respect to the parameter d (red) and q (green) in f(I)=1+dIq

Conclusions

Nowadays, epidemiological modeling plays a key role in providing strategies for the prevention and control of many communicable diseases. Vaccination, meanwhile, is considered to be one of the most favored and effective methods of mitigation and elimination of epidemics. In the paper, we have studied infectious disease transmission dynamics in the presence of an imperfect vaccine by a stage-structured mathematical model. To interpret the “psychological effect” when an infectious disease being spread in a population, we have considered a general nonmonotone nonlinear incidence rate function. We have shown that the solutions of the proposed model exist (uniquely determined) and they are nonnegative and bounded, that is, the model is biologically well-posed.

Due to the existence of time delay, we have used the method in [35] to obtain an explicit expression for the effective reproduction number (RE) which gives the actual number of secondary infections per infectious person at any time [16, 36]. Then we have obtained the threshold dynamics of the system with respect to RE: (i) we have shown that the disease-free equilibrium is globally stable when RE<1; and (ii) we have discussed the system persistence and the coexistence of endemic equilibrium when RE>1. Then, we have used the semi-discretization method to analyze the linear stability of the endemic equilibrium. Also, we have discussed the critical vaccination coverage rate that is required to eliminate the disease and the critical proportion of the population (ρϵ) that should be vaccinated when the vaccination is imperfect. We have not noticed any influence of the latent time τ on ρϵ when the vaccine efficacy ϵ is fixed. However, we have observed that the value of ρϵ increases as R0 increases when ϵ is fixed. The quantity R0 is the value of RE when the vaccination rate ψ is zero. Furthermore, through the theoretical analysis, we have found that when ϵ is not large enough and R0 is high, the disease may not be eradicated even if everybody gets the vaccine. In other words, RE cannot become below the unity even when ψ becomes high.

Through the numerical simulations:

  • We have fitted the model with data of influenza patients as a case study. We have noticed that at the peak level of infection, nearly 6% of the population is infected;

  • We have carried out global and local sensitivities analysis for RE. We have found that the latent time τ has a noticeable effect on RE. Regarding the vaccination parameters, ψ and the reduction coefficient (ξ), they both have an opposite effect on the value of RE, ψ has a negative influence while ξ has a positive one;

  • We have constructed an approximate stability region for the endemic equilibrium E1 and noticed that when E1 loses its stability, a unique stable periodic solution exists via Hopf Bifurcation. For example, for small τ, the endemic equilibrium is stable and as the value of τ increases, E1 loses the stability and a Hopf Bifurcation occurs and a unique stable periodic solution exists. Moreover, we have observed that the model exhibits global asymptotic stability behavior when RE>1.

  • The semi-relative and logarithmic sensitivities curves have shown that the perturbation of τ has a big influence over the variables {S,V,I,R}.

  • Although RE is independent of the function f, the sensitivity curves of the model solutions have shown f has a noticeable effect on the behavior of the solution.

For further work, it will be interesting to consider the “asymptomatic carriers”. These carriers are individuals who have been infected and are able to transmit their illness without showing any symptoms [3]. For certain infectious diseases, asymptomatic carriers are a potential source for transmission such as Typhoid Fever, HIV and, most recently, the COVID-19.

Acknowledgements

The author would like to thank the referees for their careful reading and helpful suggestions.

Compliance with ethical standards

Conflict of interest

The author declares that he has no conflict of interest.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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