Untangling the stranglehold through mathematical modelling of Streptococcus equi subspecies equi transmission.

Strangles, a disease caused by infection with Streptococccus equi subspecies equi (S. equi), is endemic worldwide and one of the most frequently diagnosed infectious diseases of horses. Recent work has improved our knowledge of key parameters of transmission dynamics, but important knowledge gaps remain. Our aim was to apply mathematical modelling of S. equi transmission dynamics to prioritise future research areas, and add precision to estimates of transmission parameters thereby improving understanding of S. equi epidemiology and quantifying the control effort required. A compartmental deterministic model was constructed. Parameter values were estimated from current literature wherever possible. We assessed the sensitivity of estimates for the basic reproduction number on the population scale to varying assumptions for the unknown or uncertain parameters of: (mean) duration of carriership (1∕γC), relative infectiousness of carriers (f), proportion of infections that result in carriership (p), and (mean) duration of immunity after natural infection (1∕γR). Available incidence and (sero-)prevalence data were compared to model outputs to improve point estimates and ranges for these currently unknown or uncertain transmission-related parameters. The required vaccination coverage of an ideal vaccine to prevent major outbreaks under a range of control scenarios was estimated, and compared available data on existing vaccines. The relative infectiousness of carriers (as compared to acutely ill horses) and the duration of carriership were identified as key knowledge gaps. Deterministic compartmental simulations, combined with seroprevalence data, suggest that 0.05<fˆ<0.5 and that the duration of protective immunity after infection is likely 4-6 years. The presence of carriers alone may suffice to keep S. equi endemic in a population, implying that carriers cannot be ignored in control efforts. Weekly screening of herds for signs of strangles could be sufficient to ensure R < 1, provided all horses are screened for carriership post-infection. In some of worst-case scenarios, vaccination alone would not suffice to prevent major outbreaks from occurring. A stochastic agent-based model was also constructed and validated, and used to simulate a remount depot, to evaluate whether historical incidence data of recurrence of strangles within individuals could be explained without the assumption that one in four horses fail to mount a lasting immune response. These simulations demonstrated that the observed data could have occurred without that assumption.