Noisy periodicity in tropical respiratory disease dynamics

Infectious disease surveillance systems in tropical countries show that respiratory disease incidence generally manifests as year-round activity with weak fluctuations and irregular seasonality. Previously, using a ten-year time series of influenza-like illness (ILI) collected from outpatient clinics in Ho Chi Minh City (HCMC), Vietnam, we found a combination of nonannual and annual signals driving these dynamics, but with unknown mechanisms. In this study, we use seven stochastic dynamical models incorporating humidity, temperature, and school term to investigate plausible mechanisms behind these annual and nonannual incidence trends. We use iterated filtering to fit the models and evaluate the models by comparing how well they replicate the combination of annual and nonannual signals. We find that a model including specific humidity, temperature, and school term best fits our observed data from HCMC and partially reproduces the irregular seasonality. The estimated effects from specific humidity and temperature on transmission are nonlinearly negative but weak. School dismissal is associated with decreased transmission, but also with low magnitude. Under these weak external drivers, we hypothesize that stochasticity makes a strong sub-annual cycle more likely to be observed in ILI disease dynamics. Our study shows a possible mechanism for respiratory disease dynamics in the tropics. When the external drivers are weak, the seasonality of respiratory disease dynamics is prone to the influence of stochasticity. Author Summary: Although the mechanisms driving seasonality of respiratory disease dynamics have been well-studied in temperate regions, they are unknown in the tropics. In this study, we used a 10-year influenza-like-illness (ILI) daily-reporting data set collected from outpatient clinics in Ho Chi Minh City (HCMC) in Vietnam to investigate the mechanisms associated with annual and nonannual (∼215 days) periodic patterns in the data. By comparing seven mechanistic models against the data, we showed that the mechanism that best explains respiratory disease dynamics in HCMC is a stochastic susceptible-infected-recovered-susceptible (SIRS) model weakly driven by external drivers including specific humidity, temperature, and school term. The nonannual cycle's duration is consistent with the inferred duration of immunity of the model. By showing the nonannual cycle as strong as in the data is only observed in stochastic model, we showed that the observed respiratory disease dynamics in HCMC is under the influence of stochasticity when external drivers are weak.