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Review 3: "Estimating the Reproduction Number and Transmission Heterogeneity from the Size Distribution of Clusters of Identical Pathogen Sequences"

Reviewers find the proposed method to be novel and validated with synthetic and historical epidemic data. However, they expressed concerns about the uncertainty in quantifying the magnitude of the estimation bias and the validity of this method in the case of an outbreak.

Published onMar 13, 2024
Review 3: "Estimating the Reproduction Number and Transmission Heterogeneity from the Size Distribution of Clusters of Identical Pathogen Sequences"
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Estimating the reproduction number and transmission heterogeneity from the size distribution of clusters of identical pathogen sequences
Estimating the reproduction number and transmission heterogeneity from the size distribution of clusters of identical pathogen sequences
Description

Abstract Quantifying transmission intensity and heterogeneity is crucial to ascertain the threat posed by infectious diseases and inform the design of interventions. Methods that jointly estimate the reproduction number R and the dispersion parameter k have however mainly remained limited to the analysis of epidemiological clusters or contact tracing data, whose collection often proves difficult. Here, we show that clusters of identical sequences are imprinted by the pathogen offspring distribution, and we derive an analytical formula for the distribution of the size of these clusters. We develop and evaluate a novel inference framework to jointly estimate the reproduction number and the dispersion parameter from the size distribution of clusters of identical sequences. We then illustrate its application across a range of epidemiological situations. Finally, we develop a hypothesis testing framework relying on clusters of identical sequences to determine whether a given pathogen genetic subpopulation is associated with increased or reduced transmissibility. Our work provides new tools to estimate the reproduction number and transmission heterogeneity from pathogen sequences without building a phylogenetic tree, thus making it easily scalable to large pathogen genome datasets.Significance statement For many infectious diseases, a small fraction of individuals has been documented to disproportionately contribute to onward spread. Characterizing the extent of superspreading is a crucial step towards the implementation of efficient interventions. Despite its epidemiological relevance, it remains difficult to quantify transmission heterogeneity. Here, we present a novel inference framework harnessing the size of clusters of identical pathogen sequences to estimate the reproduction number and the dispersion parameter. We also show that the size of these clusters can be used to estimate the transmission advantage of a pathogen genetic variant. This work provides crucial new tools to better characterize the spread of pathogens and evaluate their control.

RR:C19 Evidence Scale rating by reviewer:

  • Potentially informative. The main claims made are not strongly justified by the methods and data, but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt. Decision-makers should consider this evidence only with a thorough understanding of its weaknesses, alongside other evidence and theory. Decision-makers should not consider this actionable, unless the weaknesses are clearly understood and there is other theory and evidence to further support it.

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Review: In this manuscript, the author proposes a method to model the number of offspring with identical genomes with an epidemiological transmission cluster. The main claim is that this method can be used to more efficiently estimate transmission heterogeneity such as superspreading.

While the mathematical underpinnings of the model seem correct, its practical applicability and generalizability appear to be limited due to certain assumptions and conditions.

Firstly, the model's foundational assumption that transmission links, or the path through which individuals infect others, are precisely known, poses a substantial limitation. This assumption is notably strong and somewhat unrealistic. The influence of the assumption of fully known transmission links necessitates a rigorous examination. 

Secondly, the reliability of the model's parameter estimates—specifically, the basic reproduction number (R0) and the dispersion parameter (k)—is contingent upon their lower values. The model's capacity to provide unbiased estimates diminishes with higher values of R0 and k.

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