Modeling household and community transmission of Ebola virus disease: Epidemic growth, spatial dynamics and insights for epidemic control.

The mechanisms behind the sub-exponential growth dynamics of the West Africa Ebola virus disease epidemic could be related to improved control of the epidemic and the result of reduced disease transmission in spatially constrained contact structures. An individual-based, stochastic network model is used to model immediate and delayed epidemic control in the context of social contact networks and investigate the extent to which the relative role of these factors may be determined during an outbreak. We find that in general, epidemics quickly establish a dynamic equilibrium of infections in the form of a wave of fixed size and speed traveling through the contact network. Both greater epidemic control and limited community mixing decrease the size of an infectious wave. However, for a fixed wave size, epidemic control (in contrast with limited community mixing) results in lower community saturation and a wave that moves more quickly through the contact network. We also found that the level of epidemic control has a disproportionately greater reductive effect on larger waves, so that a small wave requires nearly as much epidemic control as a larger wave to end an epidemic.