Loading [MathJax]/jax/output/SVG/jax.js
Review

Bacillus Calmette-Guerin (BCG): the adroit vaccine

  • Background 

    The Bacillus Calmette-Guerin (BCG) vaccine has been in use for 99 years, and is regarded as one of the oldest human vaccines known today. It is recommended primarily due to its effect in preventing the most severe forms of tuberculosis, including disseminated tuberculosis and meningeal tuberculosis in children; however, its efficacy in preventing pulmonary tuberculosis and TB reactivation in adults has been questioned. Several studies however have found that asides from its role in tuberculosis prevention, the BCG vaccine also has protective effects against a host of other viral infections in humans, an effect which has been termed: heterologous, non-specific or off-target.

    Objectives 

    As we approach 100 years since the discovery of the BCG vaccine, we review the evidence of the non-specific protection offered by the vaccine against viral infections, discuss the possible mechanisms of action of these effects, highlight the implications these effects could have on vaccinology and summarize the recent epidemiological correlation between the vaccine and the on-going COVID-19 pandemic.

    Results 

    Several epidemiological studies have established that BCG does reduce all-cause mortality in infants, and also the time of vaccination influences this effect significantly. This effect has been attributed to the protective effect of the vaccine in preventing unrelated viral infections during the neonatal period. Some of such viral infections that have been investigated include: herpes simplex virus (HSV), human Papilloma virus (HPV), yellow fever virus (YFV), respiratory syncytial virus (RSV) and influenza virus type A (H1N1). These effects are thought to be mediated via induction of innate immune memory as well as heterologous lymphocytic activation. While epidemiological studies have suggested a correlation, the potential protection of the BCG vaccine against COVID-19 transmission and mortality rates is currently unclear. Ongoing clinical trials and further research may shed more light on the subject in the future.

    Conclusion 

    BCG is a multifaceted vaccine, with many numerous potential applications to vaccination strategies being employed for current and future viral infections. There however is a need for further studies into the immunologic mechanisms behind these non-specific effects, for these potentials to become reality, as we usher in the beginning of the second century since the vaccine's discovery.

    Citation: Oluwafolajimi A. Adesanya, Christabel I. Uche-Orji, Yeshua A. Adedeji, John I. Joshua, Adeniyi A. Adesola, Chibuike J. Chukwudike. Bacillus Calmette-Guerin (BCG): the adroit vaccine[J]. AIMS Microbiology, 2021, 7(1): 96-113. doi: 10.3934/microbiol.2021007

    Related Papers:

    [1] Biao Tang, Weike Zhou, Yanni Xiao, Jianhong Wu . Implication of sexual transmission of Zika on dengue and Zika outbreaks. Mathematical Biosciences and Engineering, 2019, 16(5): 5092-5113. doi: 10.3934/mbe.2019256
    [2] Eliza Bánhegyi, Attila Dénes, János Karsai, László Székely . The effect of the needle exchange program on the spread of some sexually transmitted diseases. Mathematical Biosciences and Engineering, 2019, 16(5): 4506-4525. doi: 10.3934/mbe.2019225
    [3] Hamdy M. Youssef, Najat A. Alghamdi, Magdy A. Ezzat, Alaa A. El-Bary, Ahmed M. Shawky . A new dynamical modeling SEIR with global analysis applied to the real data of spreading COVID-19 in Saudi Arabia. Mathematical Biosciences and Engineering, 2020, 17(6): 7018-7044. doi: 10.3934/mbe.2020362
    [4] Daniel Maxin, Fabio Augusto Milner . The effect of nonreproductive groups on persistent sexually transmitted diseases. Mathematical Biosciences and Engineering, 2007, 4(3): 505-522. doi: 10.3934/mbe.2007.4.505
    [5] Darja Kalajdzievska, Michael Yi Li . Modeling the effects of carriers on transmission dynamics of infectious diseases. Mathematical Biosciences and Engineering, 2011, 8(3): 711-722. doi: 10.3934/mbe.2011.8.711
    [6] Abulajiang Aili, Zhidong Teng, Long Zhang . Dynamical behavior of a coupling SEIR epidemic model with transmission in body and vitro, incubation and environmental effects. Mathematical Biosciences and Engineering, 2023, 20(1): 505-533. doi: 10.3934/mbe.2023023
    [7] Shanjing Ren . Global stability in a tuberculosis model of imperfect treatment with age-dependent latency and relapse. Mathematical Biosciences and Engineering, 2017, 14(5&6): 1337-1360. doi: 10.3934/mbe.2017069
    [8] Chandrani Banerjee, Linda J. S. Allen, Jorge Salazar-Bravo . Models for an arenavirus infection in a rodent population: consequences of horizontal, vertical and sexual transmission. Mathematical Biosciences and Engineering, 2008, 5(4): 617-645. doi: 10.3934/mbe.2008.5.617
    [9] Rundong Zhao, Qiming Liu, Huazong Zhang . Dynamical behaviors of a vector-borne diseases model with two time delays on bipartite networks. Mathematical Biosciences and Engineering, 2021, 18(4): 3073-3091. doi: 10.3934/mbe.2021154
    [10] Kazunori Sato . Basic reproduction number of SEIRS model on regular lattice. Mathematical Biosciences and Engineering, 2019, 16(6): 6708-6727. doi: 10.3934/mbe.2019335
  • Background 

    The Bacillus Calmette-Guerin (BCG) vaccine has been in use for 99 years, and is regarded as one of the oldest human vaccines known today. It is recommended primarily due to its effect in preventing the most severe forms of tuberculosis, including disseminated tuberculosis and meningeal tuberculosis in children; however, its efficacy in preventing pulmonary tuberculosis and TB reactivation in adults has been questioned. Several studies however have found that asides from its role in tuberculosis prevention, the BCG vaccine also has protective effects against a host of other viral infections in humans, an effect which has been termed: heterologous, non-specific or off-target.

    Objectives 

    As we approach 100 years since the discovery of the BCG vaccine, we review the evidence of the non-specific protection offered by the vaccine against viral infections, discuss the possible mechanisms of action of these effects, highlight the implications these effects could have on vaccinology and summarize the recent epidemiological correlation between the vaccine and the on-going COVID-19 pandemic.

    Results 

    Several epidemiological studies have established that BCG does reduce all-cause mortality in infants, and also the time of vaccination influences this effect significantly. This effect has been attributed to the protective effect of the vaccine in preventing unrelated viral infections during the neonatal period. Some of such viral infections that have been investigated include: herpes simplex virus (HSV), human Papilloma virus (HPV), yellow fever virus (YFV), respiratory syncytial virus (RSV) and influenza virus type A (H1N1). These effects are thought to be mediated via induction of innate immune memory as well as heterologous lymphocytic activation. While epidemiological studies have suggested a correlation, the potential protection of the BCG vaccine against COVID-19 transmission and mortality rates is currently unclear. Ongoing clinical trials and further research may shed more light on the subject in the future.

    Conclusion 

    BCG is a multifaceted vaccine, with many numerous potential applications to vaccination strategies being employed for current and future viral infections. There however is a need for further studies into the immunologic mechanisms behind these non-specific effects, for these potentials to become reality, as we usher in the beginning of the second century since the vaccine's discovery.



    The World Health Organization defines sexually transmitted diseases (STDs) as various diseases that are transmitted through sexual contact, similar sexual behaviors and indirect contact. The common reasons of STDs are bacteria, yeast and viruses[1]. STDs such as Trichomoniasis, Gonorrhea, Syphilis, Genital Warts and Herpes have become a serious public health problem. Recently, mathematical models of epidemic or population dynamics have been widely used [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20].

    The mathematical models in the early researches of STDs generally assume that both the males and females are evenly mixed, that is, the contacts of all individuals are equal. These models ignore the social and contact structures of the real population. For instance, the number of sexual partners in different individuals may vary[21]. One method described in [22] that includes contact heterogeneity is the core group model. Although this model divides the population into two categories with a large number of sexual contacts and less sexual contact, it is still considered that the individuals are well mixed. Thus this model is not suitable for the spread of disease among the general public and is more suitable for sex workers.

    People gradually have realized the importance of heterogeneous social networks in recent years. The spread of sexually transmitted diseases occurs in social networks based on real human contact. The so-called network contains many nodes representing different individuals in the real system and the edges of the connected nodes representing relationships between individuals. Nodes are often separated into two categories by sexual contacts, and only nodes of the opposite type can be connected. The contacts between the opposite sex are represented by a bipartite network[23].

    Most of the previous models on complex networks assume that disease transmission is a Poisson process, and every individual randomly selects an individual from the population. This assumption implies that the duration of the partnership is very short. The focus of many researches gradually begins to understand the role of some individuals those with many connections in two ways. One is assuming a short-lived partnership (the time of disease transmission is much longer than the duration of the partnership)[24], another is assuming that the network is static (the time of disease transmission is much shorter than the duration of the partnership)[25,26,27,28]. The edge-based compartmental model (EBCM) has the potential to unify these two approaches recently, and allows partnership durations to last from zero to infinity[29,30,31].

    The above models assumed that the initial infection ratio was infinitesimally small. The inapplicability of this assumption was R0<1 or the initial infection rate was not negligible[25]. Miller[32] extended the edge-based compartmental model to arbitrary initial conditions and gave a detailed explanation of the part of the initial proportion infected could not be ignored. This helps to resolve an obvious paradox in early work, that is, if there are too many people initially infected, the number of susceptible people may increase. This also helps to explain a significant small deviation observed between the simulation and theory in the previous paper[25]. This modification makes sense for us to consider vaccination or previous infections. Yan et al.[33] considered the spread of STDs SIR sexually transmitted diseases on bipartite networks representing heterosexual individuals.

    Motivated by [32,33], some sexually transmitted diseases have the latent period but the individuals are less infectivity during the latent period, so we introduce latent compartment in our model and assume that transmission rate of the latent period is zero in this paper. We first assume that the proportion of initial infections is infinitesimally small. Based on this, the qualitative and stability of our model is further considered when the proportion of initial infections is arbitrarily large.

    This paper consists of 6 parts. We derive the edge-based SEIR model for sexually transmitted diseases in section 2. We computer the reproduction number R0 and the final epidemic size of the disease and analyze the local dynamics of the model in consideration of the infinitesimal initial infection rates in section 3. In section 4, we further analyze the dynamical behavior of our model considering a large number of infected individuals at the initial moment. In section 5, we perform some simulations with different initial values on different networks and some sensitivity analysis. The final section of the paper gives some concluding remarks.

    In the section, the network during the epidemic is assumed to be fixed and be of configuration type[34], and disease deaths are ignored. In the network, (PM(k)) and (PF(k)) represent the distribution of male and female individuals, respectively. Following[29,33], We distribute stubs to every men and women according to (PM(k)) and (PF(k)) at random. Further we pick out two stubs attached to individuals of different genders and connect them. We keep repeating the process until no new edge appear. Multiple edges, degree correlation, self loops, and clustering are negligible on the network constructed by this method[33,35].

    In Table 1, we list some variables and parameters. UM(UF) is a male (female) individual being tested which is randomly selected at the initial moment. The proportion of individuals in a certain state in the population is equal to the probability that UM(UF) in this state. We modify UM(UF) so that he does not be transmitted to any of its partners when infected. More discussion about the tested male UM and female UF is in [29,36]. SM,EM,IM,RM and SF,EF,IF,RF are the proportion of the susceptible, exposed, infected, recovered individuals in male and female individuals, respectively. They also are the probabilities of the tested male UM and the tested female UF are susceptible, exposed, infected or recovered, respectively. Other variables and parameters can be found in Table 1.

    Table 1.  The variables and parameters description of the SEIR model.
    Variable/Parameter Definition
     θM/θF The probability that tested male/female individual has not been infected
    by his/her randomly chosen partner yet. Initially, θM(0)=θF(0)=1.
     ϕSFM/ϕSMF The probability that randomly chosen partner of  UM/UF is susceptible,
    and  UM/UF was not infected by the partner before.
     ϕEFM/ϕEMF The probability that randomly chosen partner of  UM/UF is exposed,
    and  UM/UF was not infected by the partner before.
     ϕIFM/ϕIMF The probability that randomly chosen partner of  UM/UF is infectious,
    and  UM/UF was not infected by the partner before.
     ϕRFM/ϕRMF The probability that randomly chosen partner of  UM/UF is recovered,
    and  UM/UF was not infected by the partner before.
     PM(k)/PF(k) The probability of randomly selected male/female having k partners.
     SM(k,0)/SF(k,0) The fraction of males/females have degree k and are susceptible initially.
     ΨM(x)=k=0SM(k,0)PM(k)xk The probability of generating function for the network degree
    distribution PM(k) with considering initial conditions.
     ΨF(x)=k=0SF(k,0)PF(k)xk The probability of generating function for the network degree
    distribution PF(k) with considering initial conditions.
     (1/vM)/(1/vF) Length of the latent period for male/female groups.
     βFM/βMF The transmission rate from a infected female individual to male/from
    a infected male individual to female.
     γM/γF The recovery rate of male/female infected individuals.

     | Show Table
    DownLoad: CSV

    In this section, we assume that individuals in exposed compartment are not infectivity, then deduce a system portraying the spread of sexually transmitted diseases including above variables and parameters. The fraction of the male individuals who are susceptible at time t SM(t) is derived at first. SM(k,0) is the probability which the tested male UM is susceptible and has degree k at t = 0, and θM(t) is the probability that he has not been infected by his partner for a period of time. So we have

    SM(t)=k=0PM(k)θkM(t)SM(k,0)=ΨM(θM(t)).

    So, the proportion of the male individuals who are susceptible at time t is

    SF(t)=k=0PF(k)θkF(t)SF(k,0)=ΨF(θF(t)).

    We can get SM(t) and SF(t) by the equations of θM and θF.

    We can obtain ˙IM=υM(1SMIMRM)γMIM by combining equations ˙IM=υMEMγMIM and SM+EM+IM+RM=1. We also know that RM satisfy ˙RM=γMIM and SM(t)=ΨM(θM(t)), so we can completely define SM,EM,IM and RM assuming θM(t) and initial conditions for RM and IM are known. Similarly, we can completely define SF,EF,IF and RF assuming θF(t) and initial conditions for RF and IF are known.

    If we get the equations of θM and θF, we can close the system. We already know θM(t) is the probability that a tested male individual has not been infected by his randomly chosen partner yet. These partners are made up of susceptible, exposed, infected and recovered females, so we have θM=ϕSFM+ϕEFM+ϕIFM+ϕRFM. Because ϕIFM is the probability of a randomly chosen partner of UM who does not transmit the disease to UM before is infectious at time t, we have

    ddtθM=βFMϕIFM. (2.1)

    Similarly, we have

    ddtθF=βMFϕIMF.

    Now we need to get the equations of ϕIFM and ϕIMF. Because we have the equation θM=ϕSFM+ϕEFM+ϕIFM+ϕRFM. We can find the ϕSFM class, noticing the probability that UM has a female partner who is susceptible at the initial moment is ϕSFM(0) and the probability of the susceptible female has degree k is kPF(k)SF(k,0)jjPF(j)SF(j,0). So her probability of being a susceptible individual after time t is kkPF(k)SF(k,0)θk1FjjPF(j)SF(j,0). Thus we have

    ϕSFM=ϕSFM(0)kkPF(k)SF(k,0)θk1FjjPF(j)SF(j,0)=ϕSFM(0)ΨF(θF)ΨF(1).

    Next we start to calculate the ϕRFM class, From (Figure 1) we notice that only one edge enters the ϕRFM class. We have

    ddtϕRFM=γMϕIFM. (2.2)
    Figure 1.  Flow diagrams of our model.

    Integrating Eq (2.1) and Eq (2.2), we have

    ddtϕRFM=γFβFMddtθM. (2.3)

    Integrating Eq (2.3) from 0 to t yields

    ϕRFM=γF(1θM)βFM+ϕRFM(0).

    So we have

    ϕEFM=θMγF(1θM)βFMϕRFM(0)ϕSFM(0)ΨF(θF)ΨF(1)ϕIFM. (2.4)

    In addition, in the Figure 1 we also notice that there are two edges leaving the class ϕIFM at rates βFM and γF, respectively. And an edge enters the class ϕIFM. We have

    ddtϕIFM=υFϕEFM(γF+βFM)ϕIFM. (2.5)

    At last, the following equation can be obtained,

    ddtϕEFM=ddtϕSFMvFMϕEFM=ϕSFM(0)βMFϕIMFΨF(θF)ΨF(1)vFMϕEFM.

    In summary, our model can be derived to be

    {ddtθM=βFMϕIFM,ddtθF=βMFϕIMF,ddtϕEFM=ϕSFM(0)βMFϕIMFΨF(θF)ΨF(1)υFMϕEFM,ddtϕEMF=ϕSMF(0)βFMϕIFMΨM(θM)ΨM(1)υMFϕEMF,ddtϕIFM=υFϕEFM(γF+βFM)ϕIFM,ddtϕIMF=υMϕEMF(γM+βMF)ϕIMF,SM(t)=k=0PM(k)θkM(t)SM(k,0)=ΨM(θM(t)),SF(t)=k=0PF(k)θkF(t)SF(k,0)=ΨF(θF(t)),dIMdt=υMEMγMIM,dIFdt=υFEFγFIF,EM=1SMRMIM,EF=1SFRFIF. (2.6)

    We can further simplify the model by substituting Eq (2.4) into Eq (2.5), we have

    ddtϕIFM=υF[θMγF(1θM)βFMϕRFM(0)ϕSFM(0)ΨF(θF)ΨF(1)](υF+γF+βFM)ϕIFM.

    Similarly, we have

    ddtϕIMF=υM[θFγM(1θF)βMFϕRMF(0)ϕSMF(0)ΨM(θM)ΨM(1)](υM+γM+βMF)ϕIMF.

    Now we can rewrite the model (2.6) as

    {ddtθM=βFMϕIFM,ddtθF=βMFϕIMF,ddtϕIFM=υF[θMγF(1θM)βFMϕRFM(0)ϕSFM(0)ΨF(θF)ΨF(1)](υF+γF+βFM)ϕIFM,ddtϕIMF=υM[θFγM(1θF)βMFϕRMF(0)ϕSMF(0)ΨM(θM)ΨM(1)](υM+γM+βMF)ϕIMF,SM(t)=k=0PM(k)θkM(t)SM(k,0)=ΨM(θM(t)),SF(t)=k=0PF(k)θkF(t)SF(k,0)=ΨF(θF(t)),dIMdt=υMEMγMIM,dIFdt=υFEFγFIF,EM=1SMRMIM,EF=1SFRFIF. (2.7)

    Considering the following equations of model (2.6) :

    {ddtθM=βFMϕIFM,ddtθF=βMFϕIMF,ddtϕEFM=ϕSFM(0)βMFϕIMFΨF(θF)ΨF(1)υFϕEFM,ddtϕEMF=ϕSMF(0)βFMϕIFMΨM(θM)ΨM(1)υMϕEMF,ddtϕIFM=υFϕEFM(γF+βFM)ϕIFM,ddtϕIMF=υMϕEMF(γM+βMF)ϕIMF. (3.1)

    It is easy to know that (ϕEFM,ϕEMF,ϕIFM,ϕIMF,θM,θF)=(0,0,0,0,1,1) is the disease free equilibrium of system (3.1). We calculate the basic reproduction number R0 by applying the method of the second generation matrix in [37]. In our model (3.1), the classes ϕEFM and ϕEMF act as "exposed" types and the classes ϕIFM and ϕIMF act as "infected" types. Variables θM and θF act as "susceptible" types since they can enter the ϕEFM and ϕEMF classes when the disease breaks out. So we only need to linearize these equations about ϕEFM, ϕEMF, ϕIFM and ϕIMF in (3.1) at the disease free equilibrium (ϕEFM=ϕEMF=ϕIFM=ϕIMF=0), we have

    {ddtϕEFM=ϕSFM(0)βMFϕIMFΨF(1)ΨF(1)υFϕEFM,ddtϕEMF=ϕSMF(0)βFMϕIFMΨM(1)ΨM(1)υMϕEMF,ddtϕIFM=υFϕEFM(γF+βFM)ϕIFM,ddtϕIMF=υMϕEMF(γM+βMF)ϕIMF.

    Applying the method of the second generation matrix, we obtain

    ddt(ϕEFMϕEMFϕIFMϕIMF)=(FV)(ϕEFMϕEMFϕIFMϕIMF),

    where

    F=(000ϕSFM(0)βMFΨF(1)ΨF(1)00ϕSMF(0)βFMΨM(1)ΨM(1)000000000),

    and

    V=(υF0000υM00υF0γF+βFM00υM0γM+βMF).

    Thus,

    FV1=(0ϕSFM(0)βMFΨF(1)(βMF+γM)ΨF(1)0ϕSFM(0)βMFΨF(1)(βMF+γM)ΨF(1)ϕSMF(0)βFMΨM(1)(βFM+γF)ΨM(1)0ϕSMF(0)βFMΨM(1)(βFM+γF)ΨM(1)000000000).

    Hence,

    R0=ρ(FV1)=βFMβMFϕSMF(0)ϕSFM(0)ΨM(1)ΨF(1)(βFM+γF)(βMF+γM)ΨM(1)ΨF(1), (3.2)

    where ρ represents the spectral radius and the R0 is the basic reproduction number. The biological interpretation of ΨM(1)ΨM(1) comes from observing the situation of a random individual's partner VM in the early stages of the epidemic. If VM is infected by that randomly infected female, then ΨM(1)ΨM(1) is the expectant number of other partners VM has (his excess degree). Then βMFβMF+γM is the possibility that an infected male individual transmit the disease to his partner. So we can get ϕSMF(0)βMFΨM(1)(βMF+γM)ΨM(1) is the number of individuals who may be infected by VM. We have a similar result for VF infected with male individual who are randomly infected, that is, ϕSFM(0)βFMΨF(1)(βFM+γF)ΨF(1) is the number of individuals who may be infected by VF. So R0 is the geometric mean of the number of individuals infected with VM and the number of individuals infected with VF, which is consistent with the result we calculated.

    We usually calculate basic reproduction number of the disease at infinitesimal initial values (ϕSFM(0)=ϕSMF(0)=1, ϕRFM(0)=ϕRMF(0)=0), then R0 in Eq (3.2) becomes

    ^R0=βFMβMFΨM(1)ΨF(1)(βFM+γF)(βMF+γM)ΨM(1)ΨF(1).

    Yan et al.[33] derived the basic reproduction number of a new edge-based SIR model of sexually transmitted diseases on bipartite networks. Comparing to that of [33], we know that the R0 of our model is the same. We also note that R0 is symmetric in the parameters describing of male and female properties being consistent with [38].

    The final size relation has been done for various models with small or large initial conditions [38,36]. Motivated by [38,36], the final epidemic size of our model be derived in what follows.

    We set ddtθM=ddtθF=ddtϕIFM=ddtϕIMF=ddtIF=ddtIM=ddtEF=ddtEM=0, so ϕEFM()=ϕEMF()=EF()=EM()=0 and ϕIFM()=ϕIMF()=IF()=IM()=0. From (2.7), we have

    θM=βFMβFM+γF(γFβFM+ϕRFM(0)+ϕSFM(0)ΨF(θF)ΨF(1)),

    and

    θF=βMFβMF+γM(γMβMF+ϕRMF(0)+ϕSMF(0)ΨM(θM)ΨM(1)).

    Since ΨF(θF)ΨF(1)=kkPF(k)SF(k,0)θk1FjjPF(j)SF(j,0) and ΨM(θM)ΨM(1)=kkPM(k)SM(k,0)θk1MjjPM(j)SM(j,0), we have

    θM=βFMβFM+γF(γFβFM+ϕRFM(0)+ϕSFM(0)kkPF(k)SF(k,0)θk1FjjPF(j)SF(j,0))=βFMβFM+γF[γFβFM+ϕRFM(0)+ϕSFM(0)kkPF(k)SF(k,0)jjPF(j)SF(j,0)(βMFβMF+γM)k1(γMβMF+ϕRMF(0)+ϕSMF(0)ΨM(θM)ΨM(1))k1],

    and

    θF=βMFβMF+γM[γMβMF+ϕRMF(0)+ϕSMF(0)kkPM(k)SM(k,0)jjPM(j)SM(j,0)(βFMβFM+γF)k1(γFβFM+ϕRFM(0)+ϕSFM(0)ΨF(θF)ΨF(1))k1].

    Then

    θM()=βFMβFM+γF[γFβFM+ϕRFM(0)+ϕSFM(0)kkPF(k)SF(k,0)jjPF(j)SF(j,0)(βMFβMF+γM)k1(γMβMF+ϕRMF(0)+ϕSMF(0)ΨM(θM())ΨM(1))k1],

    and

    θF()=βMFβMF+γM[γMβMF+ϕRMF(0)+ϕSMF(0)kkPM(k)SM(k,0)jjPM(j)SM(j,0)(βFMβFM+γF)k1(γFβFM+ϕRFM(0)+ϕSFM(0)ΨF(θF())ΨF(1))k1].

    Since we have SM()=ΨM(θM()) and SF()=ΨF(θF()), we can get the final epidemic size with arbitrary initial conditions are

    RM()=1SM()RM(0)=1ΨM(θM())RM(0), (3.3)

    and

    RF()=1SF()RF(0)=1ΨF(θF())RF(0). (3.4)

    We calculate the final epidemic size of the disease at infinitesimal initial values, that is, ϕRFM(0)=ϕRMF(0)=0,ϕSFM(0)=ϕSMF(0)=1,RM(0)=RF(0)=0. Then,

    θM()=βFMβFM+γF[γFβFM+kkPF(k)SF(k,0)jjPF(j)SF(j,0)(βMFβMF+γM)k1(γMβMF+ΨM(θM())ΨM(1))k1],

    and

    θF()=βMFβMF+γM[γMβMF+kkPM(k)SM(k,0)jjPM(j)SM(j,0)(βFMβFM+γF)k1(γFβFM+ΨF(θF())ΨF(1))k1].

    Further we get the final epidemic size at infinitesimal initial values

    RM()=1SM()RM(0)=1ΨM(θM()),

    and

    RF()=1SF()RF(0)=1ΨF(θF()).

    From Eqs (3.2), (3.3) and (3.4), we know that the basic reproduction number and the final size of an epidemic are not related to the length of latent period in the SEIR model without infectivity during the latent period.

    In the section, we investigate the disease equilibrium of our model at the infinitesimal initial conditions, i.e. ϕEFM(0)=ϕIFM(0)=0 and ϕEMF(0)=ϕIMF(0)=0 or ϕSFM(0)+ϕRFM(0)=1 and ϕRMF(0)+ϕSMF(0)=1. We only need to study the equation group consisting of the equations of ϕIFM,ϕIMF,θM and θF in the model (2.7), i.e.

    {ddtϕIFM=υF[θMγF(1θM)βFMϕRFM(0)ϕSFM(0)ΨF(θF)ΨF(1)](υF+γF+βFM)ϕIFM,ddtϕIMF=υM[θFγM(1θF)βMFϕRMF(0)ϕSMF(0)ΨM(θM)ΨM(1)](υM+γM+βMF)ϕIMF,ddtθM=βFMϕIFM,ddtθF=βMFϕIMF. (3.5)

    Noting that ϕIFM,ϕIMF,θM and θF are all probabilities, we only need to consider this system in Ω={(ϕIFM,ϕIMF,θM,θF)|0ϕIFM,ϕIMF,θM,θF1}. It is easy to verify that Ω is a positive invariant set of system (3.5). We have these results in what follows.

    Theorem 1. There is a disease free equilibrium E0(0,0,1,1) in the system (3.5) with infinitesimal infected initial values. Moreover,

    (Ⅰ) if R0<1, the disease free equilibrium E0 is locally asymptotically stable,

    (Ⅱ) if R0>1, there exists only one endemic equilibrium E=(0,0,θM,θF) in which 0<θM,θF<1, and it is locally asymptotically stable.

    Proof. We know that the equilibria need to satisfy the following.

    {υF[θMγF(1θM)βFMϕRFM(0)ϕSFM(0)ΨF(θF)ΨF(1)](υF+γF+βFM)ϕIFM=0,υM[θFγM(1θF)βMFϕRMF(0)ϕSMF(0)ΨM(θM)ΨM(1)](υM+γM+βMF)ϕIMF=0,βFMϕIFM=0,βMFϕIMF=0.

    Now we study system (3.5) in Ω. It is easy to know that E0=(0,0,1,1) is always a disease free equilibrium in the system (3.5). Below we use three steps to complete our proof.

    (1) Noting that for system (3.5) whose initial infection is infinitesimal, the characteristic equation at the disease free equilibrium E0 is

    |υF+βFM+γF+λ0υFυFγFβFMυFϕSFM(0)ΨF(1)ΨF(1)0υM+βMF+γM+λυMϕSMF(0)ΨM(1)ΨM(1)υMυMγMβMFβFM0λ00βMF0λ|=0. (3.6)

    Therefore, Eq (3.6) can be written as

    λ4+a1λ3+a2λ2+a3λ+a4=0,

    where

    a1=βFM+βMF+γF+γM+υF+υM,a2=(βFM+γF)(βMF+γM)+(βFM+βMF+γF+γM)(υF+υM)+υFυM,a3=(βFM+γF)(βMF+γM)(υF+υM)+υFυM(βFM+βMF+γF+γM),a4=[(βFM+γF)(βMF+γM)ϕSMF(0)ϕSFM(0)ΨM(1)ΨM(1)ΨF(1)ΨF(1)βFMβMF]υFυM.

    Applying Routh-Hurwitz criteria, if R0<1, we have βFMβMFϕSMF(0)ϕSFM(0)ΨM(1)ΨF(1)(βFM+γF)(βMF+γM)ΨM(1)ΨF(1)<1, further we can get

    (βFM+γF)(βMF+γM)>ϕSMF(0)ϕSFM(0)ΨM(1)ΨM(1)ΨF(1)ΨF(1)βFMβMF.

    So a4>0, and we have

    b1=a1>0,b2=a1a2a3>0,b3=|a1a301a2a40a1a3|>0,b4=a4b3>0.

    For the sake of clarity, we put the formulae of bi(i=1,2,3,4) in the Appendix A. We can clearly know that the disease free equilibrium E0 is locally asymptotically stable if R0<1.

    (2) We show that there is a unique endemic equilibrium E=(0,0,θM,θF) in which 0<θM,θF<1 when R0>1. Inspired by [33], we know that ϕIFM and ϕIMF are always equal to 0 at the equilibrium and construct the auxiliary function from system (2.7):

    f(θM)=θMβFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)γF+βFMϕRFM(0)βFM+γF,

    where

    θF=βMFϕSMF(0)βMF+γMΨM(θM)ΨM(1)+γM+βMFϕRMF(0)βMF+γM.

    We only need to prove that f(θM) has a unique solution between 0 and 1. It is easy for us to compute that f(0)<0 and f(1)=0, we have

    df(θM)dθM=1βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)dθFdθM=1βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)βMFϕSMF(0)βMF+γMΨM(θM)ΨM(1), (3.7)

    and

    d2f(θM)dθ2M=βFMϕSFM(0)βFM+γFΨ(3)F(θF)ΨF(1)(βMFϕSMF(0)βMF+γMΨM(θM)ΨM(1))2βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)βMFϕSMF(0)βMF+γMΨ(3)M(θM)ΨM(1). (3.8)

    According to d2f(θM)dθ2M0, we find that f(θM) is concave. Therefore df(θM)dθM is monotonically decreasing in the interval (0, 1). We have βFMϕSFM(0)βFM+γFΨF(1)ΨF(1)βMFϕSMF(0)βMF+γMΨM(1)ΨM(1)>1 according R0>1, we also find df(0)dθM=1>0 and df(1)dθM<0 from Eq (3.7). Therefore, we can derive a θM in the interval (0, 1) when R0>1 so that df(θM)dθM=0 according to the intermediate value theorem. Since f(θM) is a concave function in the interval (0, 1), we can get θM to make f(θM) the largest in the interval, so θM(0,1) and f(θM)>f(1)=0. Considering the monotonicity of f(θM), we use the intermediate value theorem to find a θM(0,θM) makes f(θM)=0 and θM is unique on the basis of the increment of f(θM) in (0,θM) and the decrement of f(θM) in (θM,1) (see Figure 2).

    Figure 2.  The simple graph of f(θM) in interval [0, 1] if R0>1.

    (3) We prove that the endemic equilibrium E is locally asymptotically stable in Ω. The characteristic equation at the endemic equilibrium E is

    |υF+βFM+γF+λ0υFυFγFβFMυFϕSFM(0)ΨF(θF)ΨF(1)0υM+βMF+γM+λυMϕSMF(0)ΨM(θM)ΨM(1)υMυMγMβMFβFM0λ00βMF0λ|=0. (3.9)

    Therefore, Eq (3.9) can be written as

    λ4+c1λ3+c2λ2+c3λ+c4=0,

    where

    c1=υF+υM+βFM+βMF+γF+γM,c2=(βFM+γF)(βMF+γM)+(βFM+βMF+γF+γM)(υF+υM)+υFυM,c3=(βFM+γF)(βMF+γM)(υF+υM)+υFυM(βFM+βMF+γF+γM),c4=[(βFM+γF)(βMF+γM)ϕSFM(0)ϕSMF(0)ΨM(θM)ΨM(1)ΨF(θF)ΨF(1)βFMβMF]υFυM.

    Applying Routh-Hurwitz, we have

    d1=c1>0,d2=c1c2c3>0,d3=|c1c301c2c40c1c3|>0,d4=c4d3=[(βFM+γF)(βMF+γM)ϕSFM(0)ϕSMF(0)ΨM(θM)ΨM(1)ΨF(θF)ΨF(1)βFMβMF]υFυMd3=(βFM+γF)(βMF+γM)(1βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)βMFϕSMF(0)βMF+γMΨM(θM)ΨM(1))d3=(βFM+γF)(βMF+γM)df(θM)dθMd3>(βFM+γF)(βMF+γM)df(θM)dθMd3=0.

    For the sake of clarity, we put formulae of di (i=1,2,3,4) in the Appendix B. We can clearly know that the endemic equilibrium E is locally asymptotically stable. The proof is completed.

    We analyze the local dynamics of system (2.7) with larger initial value of infection in this section. The null lines of θM and θF in the model (2.7) are in what follows:

    LM:γF(1θM)βFM+ϕRFM(0)+ϕSFM(0)ΨF(θF)ΨF(1)=0,
    LF:γM(1θF)βMFϕRMF(0)+ϕSMF(0)ΨM(θM)ΨM(1)=0.

    Where ϕRMF(0) and ϕRFM(0) are fixed, as the values of ϕIMF(0) and ϕIFM(0) increase from 0, LM and LF move to the left and down, respectively. We have the following two claims:

    (1) If R0<1, system (2.7) for infinitesimal initial conditions have only one locally asymptotically stable disease free equilibrium E0(0,0,1,1) in Ω. As ϕIMF(0) and ϕIFM(0) gradually increase from 0, the disease free equilibrium E0 moves from (0, 0, 1, 1) to the lower left to an internal point E0=(0,0,θ(0)M,θ(0)F) of Ω in which 0<θ(0)M,θ(0)F<1, and E0 and E0 are consistent in local stability.

    (2) If R0>1, system (2.7) for infinitesimal initial conditions has one locally asymptotically stable endemic equilibrium E=(0,0,θM,θF) and an unstable disease free equilibrium E0(0,0,1,1) in Ω. As ϕIMF(0) and ϕIFM(0) gradually increase from 0, disease free equilibrium E0 moves from (0, 0, 1, 1) to the upper right to an external point E0=(0,0,θ(0)M,θ(0)F) with min{θ(0)M,θ(0)F}>1 (we do not analyze its dynamics since this point is not in Ω), and the endemic equilibrium E moves from (0,0,θM,θF) slightly to the lower left to another internal point E=(0,0,θM,θF) of Ω in which 0<θ()M<θM and 0<θ()F<θF. In addition. The stability of E0 and E is consistent with E0 and E respectively.

    In summary, we give the following theorem for system (2.7) with max{ϕIMF(0),ϕIFM(0)}>0.

    Theorem 2. For our system (2.7) with large initial values of infection.

    (Ⅰ) if R0<1, system has only one disease free equilibrium E0=(0,0,θ(0)M,θ(0)F) of Ω with 0<θ(0)M,θ(0)F<1, and the solution gradually approaches (0,0,θ(0)M,θ(0)F) from (0, 0, 1, 1),

    (Ⅱ) if R0>1, system has only one endemic equilibrium E=(0,0,θM,θF) in Ω, and the solution gradually approaches (0,0,θM,θF) from (0, 0, 1, 1).

    Proof. Similar to the proof of Theorem 1, we show that there is a unique equilibrium in Ω. Since ϕIFM and ϕIMF are always equal to zero at the equilibrium point, we construct the following auxiliary function:

    g(θM)=θMβFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)γF+βFMϕRFM(0)βFM+γF,

    where

    θF=βMFϕSMF(0)βMF+γMΨM(θM)ΨM(1)+γM+βMFϕRMF(0)βMF+γM.

    We only need to prove that there is a unique solution for g(θM) between 0 and 1. Getting g(0)<0 is easy for us, and we have

    dg(θM)dθM=1βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)dθFdθM=1βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)βMFϕSMF(0)βMF+γMΨM(θM)ΨM(1),

    and

    d2g(θM)dθ2M=βFMϕSFM(0)βFM+γFΨ(3)F(θF)ΨF(1)(βMFϕSMF(0)βMF+γMΨM(θM)ΨM(1))2βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)βMFϕSMF(0)βMF+γMΨ(3)M(θM)ΨM(1). (4.1)

    According to d2g(θM)dθ2M0 for all θM0 in Eq (4.1), we find that g(θM) is concave. When the initial infection is arbitrary large, we have

    0<ϕSFM(0)+ϕRFM(0)<1,0<ϕSMF(0)+ϕRMF(0)<1,θM(0)=1,θF(0)=1.

    According to 0<θF<1, we have

    g(1)=1βFMϕSFM(0)βFM+γFΨF(θF)ΨF(1)γF+βFMϕRFM(0)βFM+γF>1βFMϕSFM(0)βFM+γFγF+βFMϕRFM(0)βFM+γF=1βFM(ϕSFM(0)+ϕRFM(0))+γFβFM+γF>0.

    Considering g(θM) is concave when θM0, we use the intermediate value theorem to find that there is a unique ~θM in (0, 1) to make g(~θM)=0. And we have

    ~θF=βMFϕSMF(0)βMF+γMΨM(~θM)ΨM(1)+γM+βMFϕRMF(0)βMF+γM.

    We conclude that our system (2.7) has only one equilibrium ˜E=(0,0,~θM,~θF) in Ω. It is easy to conclude that ˜E is locally asymptotically stable which is similar to the proof process of Theorem 1. And the solutions of our system gradually approach ˜E from (0, 0, 1, 1). The proof is completed.

    Example 1. We assume that both males and females in system (2.7) obey the Poisson distributions given by PM(k)=PF(k)=λkeλk! with λ=5, ϕRFM(0)=ϕRMF(0)=0. We get R0=0.5556<1 and a unique locally asymptotically stable disease free equilibrium E0=(0,0,1,1) in Ω (see Figure 3(a)). Moreover, we also get R0=0.25<1 and a unique locally asymptotically stable disease free equilibrium E0=(0,0,0.9070,0.9071) in Ω (see Figure 4(a)). It is obvious that the solution gradually approaches (0,0,0.9070,0.9071) from (0, 0, 1, 1) as ϕIFM(0) and ϕIMF(0) increase from 0.

    Figure 3.  (a) Phase plane plot of model (2.7) with R0<1, where ϕSMF(0)=ϕSFM(0)=1,ϕIMF(0)=ϕIFM(0)=0,γM=γF=0.8,βFM=βMF=0.1. (b) Phase plane plot of model (2.7) with R0>1, where ϕSMF(0)=ϕSFM(0)=1,ϕIMF(0)=ϕIFM(0)=0,γM=γF=0.2,βFM=βMF=0.1.
    Figure 4.  (a) Phase plane plot of model (2.7) with R0<1, where ϕSMF(0)=ϕSFM(0)=0.4,ϕIMF(0)=ϕIFM(0)=0.4,γM=γF=0.8,βFM=βMF=0.01. (b) Phase plane plot of model (2.7) with R0>1, where ϕSMF(0)=ϕSFM(0)=0.4,ϕIMF(0)=ϕIFM(0)=0.4,γM=γF=0.2,βFM=βMF=0.01.

    We set parameter values and initial values, getting R0=2>1, a disease free equilibrium E0 and the locally asymptotically stable endemic equilibrium E=(0,0,0.6813,0.6813) in Ω (see Figure 3(b). Moreover, we also get R0=1.8>1 and a unique locally asymptotically stable endemic equilibrium E=(0,0,0.6763,0.6765) in Ω (see Figure 4(b)). It is obvious that the solution gradually approaches (0,0,0.6763,0.6765) from (0, 0, 1, 1) as ϕIFM(0) and ϕIMF(0) increase from 0.

    We implement the comparison between stochastic simulations and numerical predictions to our SEIR model on Poisson and scale-free networks in this section. The distributions of Poisson network and scale-free network are given by P(k)=λkeλk!(1k10) and P(k)=(r1)m(r1)kr(3k10), respectively. The average degree of these two networks is 5. For network degree distributions of male and female individuals, we use the configuration model described in Section 2 to generate random contact.

    Our model is defined in a random simulation as follows. The model has no infectivity during the latent period. Once a susceptible male is infected with a rate of βFMiF, where iF is the partner (female) node which he is exposed to, and he first passes through the latent period with an average length of 1/υM, then enters the infectious class. The same is true for female nodes. We define parameters are βFM=βMF=0.01,γF=γM=0.04,υF=υM=0.2. The initial values are ϕEFM(0)=ϕEMF(0)=0.01,ϕIFM(0)=ϕIMF(0)=0.04,ϕRFM(0)=ϕRMF(0)=0.06,EM(0)=EF(0)=500,IM(0)=IF(0)=200,RM(0)=RF(0)=300. If there are no exposed and infected individuals in the networks, the entire spread of epidemic will stop. As we can see from Figures 5 and 6, the prediction of model and average of stochastic simulation fit well on both types of networks with the same average degree. This shows that model we built can accurately simulate the spread of disease.

    Figure 5.  The comparison of system (2.7) prediction value (black lines) with the ensemble averages (red circles) of 100 runs of stochastic simulations (blue lines) on a Poisson bipartite network with NM=NF=5000 and P(k)=λkeλk!(1k10). Disease parameters are βFM=βMF=0.01,γF=γM=0.04,υF=υM=0.2. The initial values are ϕEFM(0)=ϕEMF(0)=0.1,ϕIFM(0)=ϕIMF(0)=0.04,ϕRFM(0)=ϕRMF(0)=0.06,EM(0)=EF(0)=500,IM(0)=IF(0)=200,RM(0)=RF(0)=300.
    Figure 6.  The comparison of system (2.7) prediction value (black lines) with the ensemble averages (red circles) of 100 runs of stochastic simulations (blue lines) on a scale-free bipartite network with P(k)=(r1)m(r1)kr(3k10), where m stands for the minimum number of partners for individuals and r is variable of power law exponent. Let m = 3, r = 3 and NM=NF=5000. Disease parameters are βFM=βMF=0.01,γF=γM=0.04,υF=υM=0.2. The initial values are ϕEFM(0)=ϕEMF(0)=0.1,ϕIFM(0)=ϕIMF(0)=0.04,ϕRFM(0)=ϕRMF(0)=0.06,EM(0)=EF(0)=500,IM(0)=IF(0)=200,RM(0)=RF(0)=300.

    Considering that many sexually transmitted diseases have different proportions of exposed and infectious individuals among male and female populations. We set the initial values of the male population different from the female population on two networks in Figures 7 and 8. We observe that when the initial infection of women is lower than that of men, the peak of female infectious individuals will be higher than that of male. This result is consistent on both Poisson and scale-free networks. We can find that this is consistent with the real situation. When the number of female individuals infected is small initially, the number of male individuals infected by female will be smaller, and finally the peak of male individuals infected is lower than that of female.

    Figure 7.  The comparison of SEIR dynamics by setting the difference between the male initial values and the female initial values on a Poisson bipartite network(P(k)=λkeλk!(1k10)) with 100 runs of stochastic simulations. We set initial values are ϕEFM(0)=0.01,ϕEMF(0)=0.1,ϕIFM(0)=0.004,ϕIMF(0)=0.04,ϕRFM(0)=0.006,ϕRMF(0)=0.06,EM(0)=500,IM(0)=200,RM(0)=300,EF(0)=50,IF(0)=20 and RF(0)=30 with NM=NF=5000. Disease parameters are βFM=βMF=0.01,γF=γM=0.04,υF=υM=0.2.
    Figure 8.  The comparison of SEIR dynamics by setting the difference between the male initial values and the female initial values on scale-free networks (P(k)=(r1)m(r1)kr(4k10)) with 100 runs of stochastic simulations. We set initial values are ϕEFM(0)=0.01,ϕEMF(0)=0.1,ϕIFM(0)=0.004,ϕIMF(0)=0.04,ϕRFM(0)=0.006,ϕRMF(0)=0.06,EM(0)=500,IM(0)=200,RM(0)=300,EF(0)=50,IF(0)=20 and RF(0)=30 with NM=NF=5000. Disease parameters are βFM=βMF=0.01,γF=γM=0.04,υF=υM=0.2.

    In Figures 9-11, we change the initial conditions on the Poisson and the scale-free networks, and observe the dynamics of the model. In Figure 9(a), we change the value of the initial infectious individuals IM(0)(=IF(0)) with RM(0)(=RF(0)) is fixed, observing that the initial values change does not affect the peak arrival time of disease, but it affects the peak size of disease on different networks (i.e. the larger IM(0)(=IF(0)), the greater the peak of the disease). In Figure 9(b), we change the value of the initial recoverers RM(0)(=RF(0)) with IM(0)(=IF(0)) is fixed, observing that the change in the initial values does not affect the disease peak arrival time, but it affects the peak size on different networks (i.e. the larger RM(0)(=RF(0)), the greater the peak of the disease).

    Figure 9.  The comparison of SEIR dynamics by varying the initial infections IM(0)(=IF(0)) on different networks. 100 simulations were performed for each initial infections, and each curve represents the average of 100 random simulations. We set disease parameters are βFM=βMF=0.01,γF=γM=0.04,υF=υM=0.2.
    Figure 10.  Disease parameters are the same as in Figure 9. (a) Contour map of the initial infectious individuals IM(0)(=IF(0)) on a Poisson network. (b) Contour map of the initial infectious individuals IM(0)(=IF(0)) on a scale-free network.
    Figure 11.  Disease parameters are the same as in Figure 9. (a) Contour map of the initial recoverers RM(0)(=RF(0)) on a Poisson network. (b) Contour map of the initial recoverers RM(0)(=RF(0)) on a scale-free network.

    Figure 10(a) and (b) are contour maps of the initial infectious individuals on Poisson and scale-free networks respectively, then we observe that the change in IM(0)(=IF(0)) does not affect the peak arrival time of the infection but affects the peak value with that peak size is proportional to IM(0) and IF(0) on two types of networks. In addition, we also find that the scale-free network has a larger disease peak than the Poisson network in the same initial infections.

    Figure 11(a) and (b) are contour maps of the initial recoverers on Poisson and scale-free networks respectively, then we find that the initial recoverers RM(0)(=RF(0)) affect the peak arrival time on two types of networks. It is obvious that the larger the RM(0) and RF(0) are, the earlier the peak arrives. We also find that the scale-free network has a larger disease peak than the Poisson network in the same initial recoverers.

    From Figure 12, we know that changing the length of the latent period 1/υM(=1/υF) can affects both the peak size of the infection and its arrival time. The shorter the latent period is, the larger the peak value an the earlier the arrival time. So we can take some measures to regulate the length of the latent period to interfere with the spread of the disease.

    Figure 12.  Disease parameters are βFM=βMF=0.01,γF=γM=0.04. (a) Contour map of the length of the latent period 1/υM(=1/υF) on a Poisson network. (b) Contour map of the length of the latent period 1/υM(=1/υF) on a scale-free network.

    Figure 13(a) shows the final epidemic size RM(). Parameters ρ and k represent the ratio of the initial infected and exposed individuals and the average degree of the males and females respectively. We assume that the degree distribution in system (2.7) is subject to the Poisson network (P(k)=λkeλk!(1k20)). We have ΨM(x)=ΨF(x)=eλ(x1) and ΨM(1)=ΨF(1)=λ=k. We set initial values ϕRFM(0)=ϕRMF(0)=0 and parameters βFM=βMF=0.01,γF=γM=0.04,υM=υF=0.2. We have ϕSFM(0)=ϕSMF(0)=1ρ. We can see from the figure that the final epidemic size increases when the average degree k increases, where ρ remains unchanged. And when k remains unchanged, the final epidemic size increases with the increase of ρ. That is, the final epidemic size is proportional to ρ and k.

    Figure 13.  (a) Phase diagram of the SEIR model on a Poisson network (P(k)=λkeλk!(1k20)). The RM is shown as a function of the ratio of the initial infected and exposed individuals ρ and average degree k. (b) Sensitivity analysis. The partial rank correlation coefficients(PRCCs) results for the dependence of R0 on each parameter, and gray rectangles indicate sensitivity between 0.2(-0.4) and 0.4(-0.2).

    In Figure 13(b), we study the effect of each parameter on R0. The PRCCs are calculated with respect to βFM,βMF,γF,γM,ϕSFM(0),ϕSMF(0) and k with 2000 simulations. The input variables are subject to uniform distribution, and the positive and negative signs indicate that the effect is positive or negative, respectively. Sensitivity between 0 and 0.2 indicates that the parameter is weakly correlated, 0.2 to 0.4 is moderately correlated, and above 0.4 is highly correlated. As shown in Figure 13(b), we can see that βFM,βMF,ϕSFM(0) and ϕSMF(0) have a positive influence and are highly correlated on R0, γF and γM have a negative influence and are highly correlated on R0, and k is an insensitive parameter.

    In this paper, we extend an edge-based sexually transmitted SEIR model with no infectivity during the latent period, which the relationship between individuals is described by a bipartite network. We assume that the contact network is static and ignore the birth, death and migration of the population. We derive the basic reproduction number and the implicit formulas of the final epidemic size. We further analyze the dynamics of our model on different initial conditions, and observe the effects of different initial values on disease epidemics numerically. The basic reproduction number is consistent with that of [33] if we assume that transmission rate of the latent period is zero. Furthermore we also find that the length of the latent period is very much related to the arrival time and size of disease peak. How to construct and study the edge-based sexually transmitted models when the contact network is dynamic and the birth, death and migration of the population are considered are interesting. We leave this work in future.

    We are grateful to the anonymous referees and the editors for their valuable comments and suggestions which improved the quality of the paper. This work is supported by the National Natural Science Foundation of China (11861044 and 11661050), and the HongLiu first-class disciplines Development Program of Lanzhou University of Technology.

    The authors declare there is no conflict of interest.



    Conflict of interest



    The authors declare no conflict of interest.

    Author contributions



    All authors conceived and designed the study; performed the literature search and prepares the manuscript. OAA reviewed the initial draft of the manuscript and edited it for intellectual content. All authors have approved the final manuscript for publication.

    [1] Luca S, Mihaescu T (2013) History of BCG vaccine. Maedica (Buchar) 8: 53-58.
    [2] Benévolo-de-Andrade TC, Monteiro-Maia R, Cosgrove C, et al. (2005) BCG Moreau Rio de Janeiro-An oral vaccine against tuberculosis-review. Mem Inst Oswaldo Cruz 100: 459-465. doi: 10.1590/S0074-02762005000500002
    [3] Dagg B, Hockley J, Rigsby P, et al. (2014)  The establishment of sub-strain specific WHO Reference Reagents for BCG vaccine 32: 6390-6395.
    [4] Comstock G (1994) The International tuberculosis campaign: a pioneering venture in mass vaccination and research. Clin Infect Dis 19: 528-540. doi: 10.1093/clinids/19.3.528
    [5] Zwerling A, Behr MA, Verma A, et al. (2011) The BCG World Atlas: A database of global BCG vaccination policies and practices. PLoS Med 8: e1001012. doi: 10.1371/journal.pmed.1001012
    [6] Trunz BB, Fine P, Dye C (2006) Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness. Lancet 367: 1173-1180. doi: 10.1016/S0140-6736(06)68507-3
    [7] Awasthi S, Moin S (1999) Effectiveness of BCG vaccination against tuberculous meningitis. Indian Pediatr 36: 455-460.
    [8] Mangtani P, Abubakar I, Ariti C, et al. (2013) Protection by BCG vaccine against Tuberculosis: a systematic review of randomized controlled trials. Clin Infect Dis 58: 470-80. doi: 10.1093/cid/cit790
    [9] Setia MS, Steinmaus C, Ho CS, et al. (2006) The role of BCG in prevention of leprosy: A meta-analysis. Lancet Infect Dis 6: 162-170. doi: 10.1016/S1473-3099(06)70412-1
    [10] Shann F (2013) Nonspecific effects of vaccines and the reduction of mortality in children. Clin Ther 35: 109-114. doi: 10.1016/j.clinthera.2013.01.007
    [11] Shann F (2010) The non-specific effects of vaccines. Arch Dis Child 95: 662-667. doi: 10.1136/adc.2009.157537
    [12] Kristensen I, Aaby P, Jensen H (2000) Routine vaccinations and child survival: Follow up study in Guinea-Bissau, West Africa. Br Med J 321: 1435-1439. doi: 10.1136/bmj.321.7274.1435
    [13] Roth A, Gustafson P, Nhaga A, et al. (2005) BCG vaccination scar associated with better childhood survival in Guinea-Bissau. Int J Epidemiol 34: 540-547. doi: 10.1093/ije/dyh392
    [14] Garly ML, Martins CL, Balé C, et al. (2003) BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa: A non-specific beneficial effect of BCG? Vaccine 21: 2782-2790. doi: 10.1016/S0264-410X(03)00181-6
    [15] Biering-Sørensen S, Aaby P, Lund N, et al. (2017) Early BCG-Denmark and neonatal mortality among infants weighing <2500 g: A randomized controlled trial. Clin Infect Dis 65: 1183-1190. doi: 10.1093/cid/cix525
    [16] Nankabirwa V, Tumwine JK, Mugaba PM, et al. (2015) Child survival and BCG vaccination: A community based prospective cohort study in Uganda. BMC Public Health 15: 175. doi: 10.1186/s12889-015-1497-8
    [17] Zimmermann P, Finn A, Curtis N (2018) Does BCG vaccination protect against nontuberculous mycobacterial infection? A systematic review and meta-analysis. J Infect Dis 218: 679-687. doi: 10.1093/infdis/jiy207
    [18] Aaby P, Roth A, Ravn H, et al. (2011) Randomized Trial of BCG vaccination at birth to low-birth-weight children: beneficial nonspecific effects in the neonatal period? J Infect Dis 204: 245-252. doi: 10.1093/infdis/jir240
    [19] Biering-Sørensen S, Aaby P, Napirna BM, et al. (2012) Small randomized trial among low-birth-weight children receiving bacillus Calmette-Guéerin vaccination at first health center contact. Pediatr Infect Dis J 31: 306-308. doi: 10.1097/INF.0b013e3182458289
    [20] Stensballe LG, Sørup S, Aaby P, et al. (2017) BCG vaccination at birth and early childhood hospitalisation: A randomised clinical multicentre trial. Arch Dis Child 102: 224-231. doi: 10.1136/archdischild-2016-310760
    [21] Stensballe LG, Nante E, Jensen IP, et al. (2005) Acute lower respiratory tract infections and respiratory syncytial virus in infants in Guinea-Bissau: A beneficial effect of BCG vaccination for girls: Community based case-control study. Vaccine 23: 1251-1257. doi: 10.1016/j.vaccine.2004.09.006
    [22] Wardhana, Datau E, Sultana A, et al. (2011) The efficacy of Bacillus Calmette-Guérin vaccinations for the prevention of acute upper respiratory tract infection in the elderly. Acta Med Indones 43: 185-190.
    [23] Ohrui T, Nakayama K, Fukushima T, et al. (2005) Prevention of elderly pneumonia by pneumococcal, influenza and BCG vaccinations. Japanese J Geriatr 42: 34-36. doi: 10.3143/geriatrics.42.34
    [24] Salem A, Nofal A, Hosny D (2013) Treatment of common and plane warts in children with topical viable bacillus calmette-guerin. Pediatr Dermatol 30: 60-63. doi: 10.1111/j.1525-1470.2012.01848.x
    [25] Podder I, Bhattacharya S, Mishra V, et al. (2017) Immunotherapy in viral warts with intradermal Bacillus Calmette-Guerin vaccine versus intradermal tuberculin purified protein derivative: A double-blind, randomized controlled trial comparing effectiveness and safety in a tertiary care center in Eastern India. Indian J Dermatol Venereol Leprol 83: 411. doi: 10.4103/0378-6323.188651
    [26] Daulatabad D, Pandhi D, Singal A (2016) BCG vaccine for immunotherapy in warts: is it really safe in a tuberculosis endemic area? Dermatol Ther 29: 168-172. doi: 10.1111/dth.12336
    [27] Morales A, Eidinger D, Bruce AW (1976) Intracavitary Bacillus Calmette Guerin in the treatment of superficial bladder tumors. J Urol 116: 180-182. doi: 10.1016/S0022-5347(17)58737-6
    [28] Jackson A, James K (1994) Understanding the most successful immunotherapy for cancer. Immunol 2: 208-215.
    [29] Prescott S, James K, Busuttil A, et al. (1989) HLA—DR Expression by High Grade Superficial Bladder Cancer Treated with BCG. Br J Urol 63: 264-269. doi: 10.1111/j.1464-410X.1989.tb05187.x
    [30] Jackson AM, Alexandroff AB, McIntyre M, et al. (1994) Induction of ICAM 1 expression on bladder tumours by BCG immunotherapy. J Clin Pathol 47: 309-312. doi: 10.1136/jcp.47.4.309
    [31] Meyer J-P, Persad R (2002) Use of bacille Calmette-Guérin in superficial bladder cancer. Postgrad Med J 78.
    [32] Leentjens J, Kox M, Stokman R, et al. (2015) BCG vaccination enhances the immunogenicity of subsequent influenza vaccination in healthy volunteers: A randomized, placebo-controlled pilot study. J Infect Dis 212: 1930-1938. doi: 10.1093/infdis/jiv332
    [33] Ritz N, Mui M, Balloch A, et al. (2013) Non-specific effect of Bacille Calmette-Guérin vaccine on the immune response to routine immunisations. Vaccine 31: 3098-3103. doi: 10.1016/j.vaccine.2013.03.059
    [34] Ota MOC, Vekemans J, Schlegel-Haueter SE, et al. (2002) Influence of Mycobacterium bovis Bacillus Calmette-Guérin on antibody and cytokine responses to human neonatal vaccination. J Immunol 168: 919-925. doi: 10.4049/jimmunol.168.2.919
    [35] Scheid A, Borriello F, Pietrasanta C, et al. (2018) Adjuvant effect of Bacille Calmette-Guérin on hepatitis B vaccine immunogenicity in the preterm and term newborn. Front Immunol 9: 29. doi: 10.3389/fimmu.2018.00029
    [36] Arts RJW, Moorlag SJCFM, Novakovic B, et al. (2018) BCG vaccination protects against experimental viral infection in humans through the induction of cytokines associated with trained immunity. Cell Host Microbe 23: 89-100. doi: 10.1016/j.chom.2017.12.010
    [37] FD A, RN U, CL L (1974) Recurrent herpes genitalis. Treatment with Mycobacterium bovis (BCG). Obs Gynecol 43: 797-805.
    [38] Hippmann G, Wekkeli M, Rosenkranz A, et al. (1992) Nonspecific immune stimulation with BCG in Herpes simplex recidivans. Follow-up 5 to 10 years after BCG vaccination. Wien Klin Wochenschr 104: 200-204.
    [39] Ahmed SS, Volkmuth W, Duca J, et al. (2015) Antibodies to influenza nucleoprotein cross-react with human hypocretin receptor 2. Sci Transl Med 7. doi: 10.1126/scitranslmed.aab2354
    [40] Su LF, Kidd BA, Han A, et al. (2013) Virus-Specific CD4+ Memory-Phenotype T Cells Are Abundant in Unexposed Adults. Immunity 38: 373-383. doi: 10.1016/j.immuni.2012.10.021
    [41] Bernasconi NL, Traggiai E, Lanzavecchia A (2002) Maintenance of serological memory by polyclonal activation of human memory B cells. Science 298: 2199-2202. doi: 10.1126/science.1076071
    [42] Kleinnijenhuis J, Quintin J, Preijers F, et al. (2014) Long-lasting effects of bcg vaccination on both heterologous th1/th17 responses and innate trained immunity. J Innate Immun 6: 152-158. doi: 10.1159/000355628
    [43] Vetskova EK, Muhtarova MN, Avramov TI, et al. (2013) Immunomodulatory effects of BCG in patients with recurrent respiratory papillomatosis. Folia Med 55: 49-54. doi: 10.2478/folmed-2013-0005
    [44] Mathurin KS, Martens GW, Kornfeld H, et al. (2009) CD4 T-Cell-Mediated Heterologous Immunity between Mycobacteria and Poxviruses. J Virol 83: 3528-39. doi: 10.1128/JVI.02393-08
    [45] Kandasamy R, Voysey M, McQuaid F, et al. (2016) Non-specific immunological effects of selected routine childhood immunisations: Systematic review. BMJ 355.
    [46] Netea MG, Joosten LAB, Latz E, et al. (2016) Trained immunity: A program of innate immune memory in health and disease. Science 352: 427. doi: 10.1126/science.aaf1098
    [47] Kleinnijenhuis J, Quintin J, Preijers F, et al. (2012) Bacille Calmette-Guérin induces NOD2-dependent nonspecific protection from reinfection via epigenetic reprogramming of monocytes. Proc Natl Acad Sci USA 109: 17537-17542. doi: 10.1073/pnas.1202870109
    [48] Rathinam VAK, Fitzgerald KA (2010) Inflammasomes and anti-viral immunity. J Clin Immunol 30: 632-637. doi: 10.1007/s10875-010-9431-4
    [49] Allen IC, Scull MA, Moore CB, et al. (2009) The NLRP3 inflammasome mediates in vivo innate immunity to influenza a virus through recognition of viral RNA. Immunity 30: 556-565. doi: 10.1016/j.immuni.2009.02.005
    [50] Thomas PG, Dash P, Aldridge JR, et al. (2009) The intracellular sensor NLRP3 mediates key innate and healing responses to influenza a virus via the regulation of Caspase-1. Immunity 30: 566-575. doi: 10.1016/j.immuni.2009.02.006
    [51] Wu F, Zhao S, Yu B, et al. (2020) A new coronavirus associated with human respiratory disease in China. Nature 579: 265-269. doi: 10.1038/s41586-020-2008-3
    [52] Miller A, Reandelar MJ, Fasciglione K, et al. Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study (2020) .
    [53] Scheid A, Borriello F, Pietrasanta C, et al. (2018) Adjuvant effect of Bacille Calmette-Guérin on hepatitis B vaccine immunogenicity in the preterm and term newborn. Front Immunol 9: 24. doi: 10.3389/fimmu.2018.00029
    [54] Sato H, Jing C, Isshiki M, et al. (2013) Immunogenicity and safety of the vaccinia virus LC16m8δ vector expressing SIV Gag under a strong or moderate promoter in a recombinant BCG prime-recombinant vaccinia virus boost protocol. Vaccine 31: 3549-3557. doi: 10.1016/j.vaccine.2013.05.071
    [55] Yazdanian M, Memarnejadian A, Mahdavi M, et al. (2013) Immunization of mice by BCG formulated HCV core protein elicited higher th1-oriented responses compared to pluronic-F127 copolymer. Hepat Mon 13. doi: 10.5812/hepatmon.14178
    [56] Kim BJ, Kim BR, Kook YH, et al. (2018) Development of a live recombinant BCG expressing human immunodeficiency virus type 1 (HIV-1) gag using a pMyong2 vector system: Potential use as a novel HIV-1 vaccine. Front Immunol 9: 27. doi: 10.3389/fimmu.2018.00027
    [57] Zhou P, Yang X Lou, Wang XG, et al. (2020) A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 579: 270-273. doi: 10.1038/s41586-020-2012-7
    [58] Adesanya OA, Adewale BA, Ebengho IG, et al. (2020) Current knowledge on the pathogenesis of and therapeutic options against SARS-CoV-2: An extensive review of the available evidence. Int J Pathog Res 4: 16-36. doi: 10.9734/ijpr/2020/v4i230108
    [59] Johns Hopkins COVID-19 Map-Johns Hopkins Coronavirus Resource Center (2020) .Available from: https://coronavirus.jhu.edu/map.html.
    [60] Hegarty PK, Service NH, Kamat AM, et al. (2020) BCG vaccination may be protective against Covid-19. medRxiv (March).
    [61] Dayal D, Gupta S (2020) Connecting BCG Vaccination and COVID-19: Additional Data. medRxiv (April).
    [62] Dolgikh S (2020) Further Evidence of a Possible Correlation between the Severity of Covid-19 and BCG Immunization. J Infect Dis Epidemiol 6.
    [63] Sharma A, Kumar Sharma S, Shi Y, et al. (2020) BCG vaccination policy and preventive chloroquine usage: do they have an impact on COVID-19 pandemic? Cell Death Dis 11: 516. doi: 10.1038/s41419-020-2720-9
    [64] Ebina-Shibuya R, Horita N, Namkoong H, et al. (2020) National policies for paediatric universal BCG vaccination were associated with decreased mortality due to COVID-19. Respirology 25: 898-899. doi: 10.1111/resp.13885
    [65] Kinoshita M, Tanaka M (2020) Impact of Routine Infant BCG Vaccination on COVID-19. J Infect 81: 625-633. doi: 10.1016/j.jinf.2020.08.013
    [66] Klinger D, Blass I, Rappoport N, et al. (2020) Significantly improved COVID-19 outcomes in countries with higher bcg vaccination coverage: A multivariable analysis. Vaccines 8: 1-14. doi: 10.3390/vaccines8030378
    [67] Weng CH, Saal A, Butt WWW, et al. (2020) Bacillus Calmette-Guérin vaccination and clinical characteristics and outcomes of COVID-19 in Rhode Island, United States: A cohort study. Epidemiol Infect 148: e140. doi: 10.1017/S0950268820001569
    [68] Kirov S (2020) Association Between BCG Policy is Significantly Confounded by Age and is Unlikely to Alter Infection or Mortality Rates. medRxiv (April).
    [69] Hensel J, McGrail D, McAndrews K, et al. (2020) Exercising caution in correlating COVID-19 incidence and mortality rates with BCG vaccination policies due to variable rates of SARS CoV-2 testing. medRxiv .
    [70] (2020) ClinicalTrials.gov.BCG Vaccination to Protect Healthcare Workers Against COVID-19.National Library of Medicine (U.S.).
    [71] (2020) ClinicalTrials.gov.Reducing Health Care Workers Absenteeism in Covid-19 Pandemic Through BCG Vaccine.National Library of Medicine (U.S.).
    [72] ClinicalTrials.gov. BCG Vaccine for Health Care Workers as Defense Against COVID 19 (2020) .
    [73] (2020) ClinicalTrials.gov.BCG Vaccine in Reducing Morbidity and Mortality in Elderly Individuals in COVID-19 Hotspots.National Library of Medicine (U.S.).
    [74] Adesanya O, Ebengho I (2020) Possible Correlation between Bacillus Calmette Guérin (BCG) Vaccination Policy and SARS-Cov-2 Transmission, Morbidity and Mortality Rates: Implications for the African Continent. J Infect Dis Epidemiol 6: 137.
  • This article has been cited by:

    1. Shuibo Huang, Quasilinear elliptic equations with exponential nonlinearity and measure data, 2020, 43, 0170-4214, 2883, 10.1002/mma.6088
    2. Xin-You Meng, Jiao-Guo Wang, Dynamical analysis of a delayed diffusive predator–prey model with schooling behaviour and Allee effect, 2020, 14, 1751-3758, 826, 10.1080/17513758.2020.1850892
    3. Shuibo Huang, Qiaoyu Tian, Harnack‐type inequality for fractional elliptic equations with critical exponent, 2020, 43, 0170-4214, 5380, 10.1002/mma.6280
    4. Xiangrui Li, Shuibo Huang, Stability and Bifurcation for a Single-Species Model with Delay Weak Kernel and Constant Rate Harvesting, 2019, 2019, 1076-2787, 1, 10.1155/2019/1810385
    5. Hai-Feng Huo, Shuang-Lin Jing, Xun-Yang Wang, Hong Xiang, Modeling and analysis of a H1N1 model with relapse and effect of Twitter, 2020, 560, 03784371, 125136, 10.1016/j.physa.2020.125136
    6. Fei Xiong, Yu Zheng, Weiping Ding, Hao Wang, Xinyi Wang, Hongshu Chen, Selection strategy in graph-based spreading dynamics with limited capacity, 2021, 114, 0167739X, 307, 10.1016/j.future.2020.08.009
    7. Xiongxiong Bao, Stability of periodic traveling waves for nonlocal dispersal cooperative systems in space–time periodic habitats, 2020, 71, 0044-2275, 10.1007/s00033-020-01396-4
    8. Zhan‐Ping Ma, Hai‐Feng Huo, Hong Xiang, Spatiotemporal patterns induced by delay and cross‐fractional diffusion in a predator‐prey model describing intraguild predation, 2020, 43, 0170-4214, 5179, 10.1002/mma.6259
    9. Zhong-Kai Guo, Hong Xiang, Hai-Feng Huo, Analysis of an age-structured tuberculosis model with treatment and relapse, 2021, 82, 0303-6812, 10.1007/s00285-021-01595-1
    10. Teddy Lazebnik, Gaddi Blumrosen, Advanced Multi-Mutation With Intervention Policies Pandemic Model, 2022, 10, 2169-3536, 22769, 10.1109/ACCESS.2022.3149956
    11. Xin-You Meng, Jie Li, Dynamical behavior of a delayed prey-predator-scavenger system with fear effect and linear harvesting, 2021, 14, 1793-5245, 2150024, 10.1142/S1793524521500248
    12. Qian Yang, Hai-Feng Huo, Hong Xiang, Analysis of an edge-based SEIR epidemic model with sexual and non-sexual transmission routes, 2023, 609, 03784371, 128340, 10.1016/j.physa.2022.128340
    13. Kazuki Kuga, Epidemic dynamics for time-dependent transmission rate based on viral load dynamics: multi infection stage EBCM approach, 2022, 2022, 1742-5468, 103501, 10.1088/1742-5468/ac8e59
    14. PANKAJ KUMAR TIWARI, RAJANISH KUMAR RAI, RABINDRA KUMAR GUPTA, MAIA MARTCHEVA, ARVIND KUMAR MISRA, MODELING THE CONTROL OF BACTERIAL DISEASE BY SOCIAL MEDIA ADVERTISEMENTS: EFFECTS OF AWARENESS AND SANITATION, 2022, 30, 0218-3390, 51, 10.1142/S0218339022500024
    15. Xin-You Meng, Tao Zhang, The impact of media on the spatiotemporal pattern dynamics of a reaction-diffusion epidemic model, 2020, 17, 1551-0018, 4034, 10.3934/mbe.2020223
    16. Teddy Lazebnik, Uri Itai, Bounding pandemic spread by heat spread, 2023, 138, 0022-0833, 10.1007/s10665-022-10253-4
    17. Teddy Lazebnik, Ariel Alexi, Comparison of pandemic intervention policies in several building types using heterogeneous population model, 2022, 107, 10075704, 106176, 10.1016/j.cnsns.2021.106176
    18. Juping Zhang, Wenhui Hao, Zhen Jin, The dynamics of sexually transmitted diseases with men who have sex with men, 2022, 84, 0303-6812, 10.1007/s00285-021-01694-z
    19. Maoji Ri, Shuibo Huang, Canyun Huang, Non-existence of solutions to some degenerate coercivity elliptic equations involving measures data, 2020, 28, 2688-1594, 165, 10.3934/era.2020011
    20. Yihao Jiang, Shanshan Chen, Keke Shang, Dynamics of sexually transmitted diseases with multi-pathway transmission and sex-based contact patterns, 2024, 03784371, 130273, 10.1016/j.physa.2024.130273
    21. Kalyan Kumar Pal, Rajanish Kumar Rai, Pankaj Kumar Tiwari, Influences of Media-Induced Awareness and Sanitation Practices on Cholera Epidemic: A Study of Bifurcation and Optimal Control, 2025, 35, 0218-1274, 10.1142/S0218127425500026
  • Reader Comments
  • © 2021 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(6448) PDF downloads(211) Cited by(8)

Figures and Tables

Figures(2)  /  Tables(2)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog