A MATHEMATICAL MODEL OF CHOLERA TRANSMISSION WITH

SATURATED TREATMENT

BY

IDOWU FAITH ANUOLUWAPO

MTH/2018/034

A PROJECT SUBMITTED TO THE DEPARTMENT OF MATHEMATICS,

FACULTY OF SCIENCE, OBAFEMI AWOLOWO UNIVERSITY, ILE-IFE,
OSUN STATE, NIGERIA IN PARTIAL FULFILMENT OF THE
REQUIREMENTS OF THE AWARD OF BACHELORS OF SCIENCE (B.SC.
HONS) DEGREE IN MATHEMATICS.

AUGUST, 2024
 CERTIFICATION

I certify that Idowu Faith Anuoluwapo has fulfilled all requirements for the award of a B.
Sc. (Hons) degree in Mathematics. This project is the result of the research work carried
out by him under my supervision during his undergraduate studies in the Department of
Mathematics, Obafemi Awolowo University, Ile-Ife, Nigeria.

Dr A.A Aderogba Date

Project Supervisor

Prof M.O. Olatinwo Date

Head of Department

i
 DEDICATION

I dedicate this work to God Almighty, and also to my Parent Pastor (MrMrs Idowu) for
their support.

ii
 ACKNOWLEDGEMENT

First and foremost, I am profoundly grateful to God Almighty for

His infinite wisdom, guidance, and strength throughout this journey.

His grace has been my anchor, and His blessings have made this

work possible. I extend my optimum gratitude to my project

supervisor, Dr A.A Aderogba, for his invaluable guidance, insightful

feedback, and unwavering support. His mentorship has been

instrumental in shaping this work, and I am truly honored to have

had the opportunity to learn under his expert supervision. I am also

immensely thankful to the Church of God for their support and

prayers, which have been a source of encouragement and strength

for me throughout this project. My heartfelt thanks go to my

parents, whose love, sacrifice, and unwavering belief in me have

always been my greatest motivation. Their constant support has

been the foundation of all my achievements. And also, to my

coursemates (the Mathemagicians); thank you for what you do.

Finally, I would like to express my appreciation to everyone who has

contributed to this project, in one way or another, your support,

iii
whether big or small has played a crucial role in the completion of

this work, and I am deeply thankful for each of you.

iv
 ABSTRACT

Cholera remains a significant public health concern, particularly in regions with inade-
quate water and sanitation infrastructure. This project presents a mathematical model to
analyze the transmission dynamics of cholera, incorporating the concept of saturated treat-
ment. The model is based on the SEIR (Susceptible-Exposed-Infected-Recovered) framework,
extended to include a treatment function that reflects the diminishing returns of treatment
efforts as the number of infected individuals increases.
The model aims to capture the impact of limited healthcare resources on the control
of cholera outbreaks, where treatment efficacy decreases as the demand for medical care
exceeds available capacity. By considering factors such as infection rates, recovery rates, and
treatment saturation, the model provides insights into the conditions under which cholera
can be effectively controlled or eradicated.
After thorough analysis, the dissertation reveals that timely and adequate treatment
significantly reduces the burden of cholera. However, when healthcare resources are over-
whelmed, the effectiveness of treatment diminishes, leading to more extensive outbreaks.
The dissertation also highlights the potential impact of vaccination campaigns. By incorpo-
rating vaccination into the model, it is shown that targeted immunization, combined with
robust treatment protocols, can drastically reduce the number of infections and prevent future
epidemics.
The results emphasize the need for early intervention, improved healthcare infrastructure,
and sustained vaccination efforts to control cholera. A combined approach of treatment,
vaccination, and enhanced water, sanitation, and hygiene (WASH) practices is essential for
reducing the spread of cholera and mitigating its impact on vulnerable populations. This
research offers valuable guidance for public health strategies aimed at cholera prevention and
control, underscoring the critical role of integrated disease management in combating cholera
outbreaks.

v
Contents

CERTIFICATION i

DEDICATION ii

ACKNOWLEDGEMENT iv

ABSTRACT v

1 Introduction 1
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.1 Impact on Public Health . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.2 Definition of Terms: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Discussion of Compartmental Models: . . . . . . . . . . . . . . . . . . . . . . 4
1.4 Reason for Choosing the SEIR Model . . . . . . . . . . . . . . . . . . . . . . 5
1.5 Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2 Literature Review 6
2.1 Historical Perspective of Cholera . . . . . . . . . . . . . . . . . . . . . . . . 6
2.1.1 The First Pandemic (1817–1824) . . . . . . . . . . . . . . . . . . . . 6
2.1.2 The Second Pandemic (1829–1851) . . . . . . . . . . . . . . . . . . . 6
2.1.3 The Third Pandemic (1852–1860) . . . . . . . . . . . . . . . . . . . . 7
2.1.4 The Fourth and Fifth Pandemics (1863–1923) . . . . . . . . . . . . . 7

vi
 2.1.5 The Sixth Pandemic (1899–1923) . . . . . . . . . . . . . . . . . . . . 7
2.1.6 The Seventh Pandemic (1961–present) . . . . . . . . . . . . . . . . . 8
2.1.7 Cholera in the 21st century . . . . . . . . . . . . . . . . . . . . . . . 8
2.2 Epidemiology of Cholera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3 Methodology 10
3.1 Application of the SEIR Model . . . . . . . . . . . . . . . . . . . . . . . . . 10
3.2 Assumptions in the SEIRS Model with Vaccination and Treatment Factors . 11
3.3 Equilibrium Point of SEIRS Model . . . . . . . . . . . . . . . . . . . . . . . 14
3.4 Stability Analysis of SEIRS Model for Free disease . . . . . . . . . . . . . . 17
3.5 Stability Analysis of the Endemic Equilibrium using Lyapunov Stability Theorem 19
3.5.1 1. Define the Lyapunov Function . . . . . . . . . . . . . . . . . . . . 19
3.5.2 2. Compute the Time Derivative of the Lyapunov Function . . . . . . 20
3.6 Basic Reproduction Number . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

4 Analysis of Cholera Outbreaks 23

5 Observations & Conclusions 27

5.0.1 Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
5.0.2 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

vii
Chapter 1

Introduction

1.1 Introduction

Cholera is an acute diarrheal disease caused by the bacterium Vibrio cholerae. The disease
primarily spreads through contaminated water and food, and its impact has been devastating
across various regions (Harris, 2012). The transmission of cholera remains a significant public
health concern due to its rapid spread and the severe consequences for affected populations
(Reidl, 2002). Once ingested, the bacteria colonize the small intestine and produce cholera
toxin. This toxin disrupts the normal ion transport processes in the intestinal lining, leading
to the secretion of large volumes of water and electrolytes into the intestinal lumen (Finkel-
stein, 1996). The result is profuse, watery diarrhea, which can lead to severe dehydration
and electrolyte imbalance (Davis, 2009). The incubation period for cholera ranges from a
few hours to five days (glass, 1992). Symptoms include severe watery diarrhea (often de-
scribed as ”rice-water stools”), vomiting, rapid heart rate, loss of skin elasticity, dry mucous
membranes, and low blood pressure (Walter, 2010). Cholera remains a global health threat,
particularly in regions with inadequate water and sanitation infrastructure (Waldor, 2010).
The World Health Organization (WHO) estimates that there are 1.3 to 4 million cases of
cholera annually, resulting in 21,000 to 143,000 deaths worldwide (WHO, 2010). The true

1
burden of cholera is likely higher due to under-reporting and misdiagnosis (Miller, 2012).

1.1.1 Impact on Public Health

Cholera, as a highly infectious disease, has had a profound and often devastating impact on
public health systems worldwide. The recurrent nature of cholera outbreaks, especially in re-
gions with inadequate water and sanitation infrastructure, underscores the ongoing challenge
it poses to global health (Semenza, 2007). The impact of cholera is not evenly distributed
across the globe. Countries in sub-Saharan Africa and Southeast Asia bear the brunt of
cholera outbreaks, with these regions accounting for the majority of reported cases and
deaths (Ramamurthy, 2020). Factors such as poverty, political instability, and inadequate
access to clean water and sanitation services exacerbate the vulnerability of these populations
to cholera (Griffith, 2020). For instance, the 2010 cholera outbreak in Haiti, which occurred
after a devastating earthquake, resulted in over 800,000 cases and nearly 10,000 deaths, mak-
ing it one of the most severe outbreaks in recent history (Frerichs, 2016). The rapid spread
of the disease was facilitated by the collapse of the country’s infrastructure, highlighting
the critical role that public health systems play in controlling infectious diseases (Cravioto,
2011). Cholera disproportionately affects vulnerable populations, including children under
five, pregnant women, and individuals with compromised immune systems (Jenkins, 2013).
Malnutrition, common in regions where cholera is endemic, further increases susceptibility to
the disease (Moore, 2010). In many cases, the fatality rate is highest among these vulnerable
groups, compounding the social and economic impact on affected communities (Rebaudet,
2013). Efforts to control cholera have led to significant advancements in public health prac-
tices, including the development of oral rehydration therapy (ORT), which has dramatically
reduced cholera-related mortality (Mah, 2011). However, challenges remain, particularly in
achieving widespread access to clean water, sanitation, and healthcare services (Bartram,
2010). In regions where these basic necessities are lacking, cholera continues to thrive, high-
lighting the importance of sustained public health interventions (Mintz, 2001). The global

2
health community has recognized the need for a multi-faceted approach to cholera control,
which includes not only emergency response to outbreaks but also long-term strategies to
improve water, sanitation, and hygiene (WASH) infrastructure (Childers, 2015). The WHO’s
Global Task Force on Cholera Control has set an ambitious goal to reduce cholera deaths by
90% by 2030 (WHO, 2017).

1.2 Definition of Terms:

Public Health: The science and practice of protecting and improving the health of popu-
lations through organized community efforts, including disease prevention, health education,
and the promotion of healthy lifestyles.
Sanitation Infrastructure: The systems and facilities that ensure the safe disposal of
human waste and promote hygiene. This includes toilets, latrines, sewage systems, and clean
water supply networks.
WASH: An acronym for Water, Sanitation, and Hygiene. It represents a critical area of
public health that focuses on ensuring access to clean water, proper sanitation facilities, and
hygiene practices to prevent disease.
Compartmental Models: Mathematical models used in epidemiology that divide the
population into distinct groups, or compartments, based on disease status (e.g., Susceptible,
Infected). These models help simulate the spread of infectious diseases.
SIR Model: A basic compartmental model that divides the population into three com-
partments: Susceptible (S), Infected (I), and Recovered (R). It is used to model diseases
where recovery leads to immunity.
SEIR Model: An extension of the SIR model that includes an Exposed (E) compart-
ment. This compartment represents individuals who have been infected but are not yet
infectious, accounting for the incubation period of the disease.
Incubation Period: The period between exposure to an infection and the appearance

3
of the first symptoms. For cholera, this period can range from a few hours to five days.

1.3 Discussion of Compartmental Models:

Compartmental models are essential tools in epidemiology because they allow researchers to
predict how diseases will spread within a population, assess the impact of interventions, and
identify potential strategies for controlling outbreaks.
SIR Model: The SIR model is one of the simplest and most widely used compartmental
models. It assumes that the population is divided into three compartments: Susceptible
(S), Infected (I), and Recovered (R). Individuals move from the Susceptible compartment
to the Infected compartment when they contract the disease, and then to the Recovered
compartment after they have been treated, at which point they are assumed to be immune.
However, the SIR model does not account for the incubation period, which is a critical factor
in the transmission dynamics of many diseases, including cholera.
SEIR Model: The SEIR model improves upon the SIR model by adding an Exposed
(E) compartment. This compartment represents individuals who have been exposed to the
pathogen but are not yet infectious. The inclusion of the Exposed compartment allows the
model to account for the incubation period, making it more realistic for diseases like cholera,
where there is a delay between exposure and the onset of symptoms.
The model divides the population into four compartments:
Susceptible (S): Individuals who are at risk of contracting cholera but are not yet
infected.
Exposed (E): Individuals who have been exposed and are in the incubation period but
are not yet infectious.
Infected (I): Individuals who have contracted cholera and are capable of transmitting
the disease to others.
Recovered (R): Individuals who have recovered from cholera and have developed im-

4
munity, at least temporarily.

1.4 Reason for Choosing the SEIR Model

:
The SEIR model was chosen for this research because it more accurately reflects the
transmission dynamics of cholera, which has a distinct incubation period. By including the
Exposed compartment, the SEIR model captures the period during which individuals are
infected but not yet symptomatic or infectious. This is crucial for understanding the spread
of cholera and for predicting the potential impact of public health interventions.
The SEIR model also allows for the incorporation of other important factors, such as
the effect of public health interventions like vaccination and treatment, into the analysis.
This makes it a valuable tool for simulating different scenarios and for planning strategies to
control cholera outbreaks.

1.5 Objective

The primary objective of this research project is to provide a comprehensive analysis of

cholera, its contemporary impacts, the factors contributing to its spread, and the application
of the SEIR (Susceptible, Exposed, Infected, Recovered) model to understand and predict
outbreaks. By examining cholera through these lenses, the project aims to contribute to
a deeper understanding of the disease and inform future public health strategies for its
prevention and control.

5
Chapter 2

Literature Review

2.1 Historical Perspective of Cholera

2.1.1 The First Pandemic (1817–1824)

The first cholera pandemic began in 1817 in the Ganges Delta of India, a region that remains
one of the disease’s endemic zones. This initial outbreak spread rapidly along trade routes to
other parts of Asia, including China and Southeast Asia, and eventually reached the Middle
East, East Africa, and the Mediterranean coast (ReidlandKlose, 2002). The movement of
British troops and trade ships played a crucial role in the spread of the disease. During
this pandemic, the world began to recognize the severity and global threat posed by cholera
(GlassandBlack, 1992).

2.1.2 The Second Pandemic (1829–1851)

The second cholera pandemic extended the reach of the disease into Europe and the Americas,
with particularly severe outbreaks in Russia, Hungary, Germany, and the United Kingdom.
In 1832, cholera crossed the Atlantic Ocean, arriving in Canada and the United States,
where it caused widespread fear and significant mortality. The 1832 outbreak in Paris, for
example, claimed over 20,000 lives (Sack et al., 2004). This pandemic also led to the first

6
attempts at systematic public health responses, including quarantine measures and sanitation
improvements (Snow, 1855).

2.1.3 The Third Pandemic (1852–1860)

The third pandemic is notable for being the most deadly, with a particularly severe impact
in Russia, where it is estimated that over one million people died (Nelson et al., 2009). This
pandemic also spread across Asia, Europe, North America, and Africa. During this period,
the link between cholera and contaminated water was increasingly recognized, particularly
after the famous 1854 Broad Street cholera outbreak in London (Snow, 1855). This outbreak
led Dr. John Snow to identify a contaminated public water pump as the source of the disease,
marking a significant advance in the understanding of cholera transmission and laying the
groundwork for modern epidemiology (Finkelstein, 1996).

2.1.4 The Fourth and Fifth Pandemics (1863–1923)

The fourth and fifth pandemics saw the continued global spread of cholera, with major
outbreaks occurring in Europe, Africa, and Asia (DavisandWaldor, 2009). These pandemics
were characterized by the disease’s persistence in endemic regions, as well as its spread to
new areas through trade and military movements (Kaper et al., 1995). The fifth pandemic,
which lasted until the early 20th century, saw improvements in public health infrastructure
and the beginning of water treatment processes in Europe and North America, leading to a
decline in cholera cases in these regions (Colwell, 1996).

2.1.5 The Sixth Pandemic (1899–1923)

The sixth pandemic primarily affected Asia and Eastern Europe, with India once again being
severely impacted. During this period, the British colonial government in India implemented
several public health measures, including improved sanitation and the introduction of cholera
vaccines, though these efforts were not universally successful (MillerandFeachem, 2001). The

7
sixth pandemic was less deadly in Western Europe and North America due to advances in
water treatment and sanitation, which had been implemented in response to earlier outbreaks
(WHO, 2010).

2.1.6 The Seventh Pandemic (1961–present)

The seventh pandemic, which began in 1961 in Indonesia, is caused by the El Tor biotype of
Vibrio cholerae (ReidlandKlose, 2002). This pandemic spread rapidly across Asia, Africa, and
South America, where it remains a significant public health issue today (Griffith et al., 2020).
Unlike previous pandemics, which were largely contained within specific regions after a few
years, the seventh pandemic has persisted for decades, with endemic regions still experiencing
regular outbreaks. This period has seen significant advancements in the understanding and
treatment of cholera, including the development of oral rehydration therapy (ORT), which
has greatly reduced mortality rates (BartramandCairncross, 2010). However, the persistence
of cholera in many parts of the world underscores the ongoing challenges related to water
and sanitation infrastructure (RamamurthyandNandy, 2020).

2.1.7 Cholera in the 21st century

In the 21st century, cholera remains a global health threat, particularly in regions with poor
access to clean water and sanitation (WHO Global Task Force on Cholera Control, 2017). Ma-
jor outbreaks have occurred in countries like Zimbabwe (2008–2009) and Haiti (2010–2018),
where a cholera outbreak following a devastating earthquake led to over 800,000 cases and
nearly 10,000 deaths (Cravioto et al., 2011). These outbreaks highlight the vulnerability of
populations in post-disaster settings and the importance of rapid public health responses
(FrerichsandKeim, 2016). Cholera has had a profound impact on Nigeria throughout its
history, from its introduction during the 19th century pandemics to the recurring outbreaks
of the 20th and 21st centuries (MahandBlanchard, 2011). The country’s experience with
cholera highlights the ongoing challenges faced by many low- and middle-income countries in

8
controlling the disease, particularly in the context of rapid urbanization, conflict, and inade-
quate infrastructure (Mintz et al., 2001). Understanding this history is crucial for informing
future public health strategies aimed at preventing and controlling cholera in Nigeria and
beyond (SemenzaandNichols, 2007).

2.2 Epidemiology of Cholera

The epidemiology of cholera has been extensively studied, with research focusing on under-
standing the transmission dynamics and identifying the most vulnerable populations. Cholera
is predominantly a waterborne disease, with Vibrio cholerae bacteria spreading through con-
taminated water and food sources.
Studies have shown that cholera outbreaks often coincide with periods of social and
political instability, natural disasters, and inadequate infrastructure, which exacerbate the
conditions for the bacteria to thrive.
Key interventions, such as the development of oral rehydration therapy (ORT), which
has drastically reduced cholera mortality rates, are discussed in detail. The review also
considers the role of international organizations like the World Health Organization (WHO)
in coordinating global efforts to control cholera, particularly in high-risk regions.
In this Dissertation, we formulate a mathematical model that captures some essential
dynamics of cholera transmission with vaccination, sanitation and saturation treatment as
control strategies in limiting the disease.

9
Chapter 3

Methodology

In this research, we used the SEIRS model (Susceptible, Exposed, Infected, Recovered) which
is used to simulate the spread of cholera and to predict the outcomes of different intervention
strategies. The model is applied to real-world data to assess its effectiveness in predicting
cholera outbreaks and guiding public health decisions. The steps taken to achieve the research
objectives are as follows: Develop a mathematical model for the spread of cholera disease
based on the SEIRS model with vaccination and treatment factor; Determine the equilibrium
point of the model, the point of disease-free equilibrium and endemic; Analyze the stability
of the equilibrium point of the model; and find the basic reproduction number.

3.1 Application of the SEIR Model

The SEIR model is a compartmental model used in epidemiology to simulate the spread of
infectious diseases. In this study, the SEIR model is adapted to analyze the transmission
dynamics of cholera. We discussed the formation of SEIRS model based on the assumptions
made. Furthermore, the equilibrium point of the model is then analyzed, which is further
interpreted in real life problems. The model divides the population into four compartments:
Susceptible (S): Individuals who are at risk of contracting cholera but are not yet infected.
Exposed (E): Individuals who have been exposed and are in the incubation period but

10
are not yet infectious.
Infected (I): Individuals who have contracted cholera and are capable of transmitting the
disease to others.
Recovered (R): Individuals who have recovered from cholera and have developed immu-
nity, at least temporarily.
The SEIR model is used to evaluate the effectiveness of different intervention strategies,
such as vaccination campaigns, improvements in water and sanitation infrastructure, and
emergency response measures. By simulating these interventions, the study assesses their
impact on reducing the spread of cholera and mitigating its effects. A sensitivity analysis
is conducted to identify the most critical factors influencing the spread of cholera. This
involves varying the parameters of the SEIR model to determine which factors have the
greatest impact on the model’s outcomes. The results of the sensitivity analysis inform
recommendations for public health policy and intervention design.

3.2 Assumptions in the SEIRS Model with Vaccination

and Treatment Factors

1. The number of individuals in each subpopulation within a time period is denoted by

S(t), E(t), I(t), and R(t), with the total population given by the proportion S(t) +
E(t) + I(t) + R(t) = N (t).

2. Deaths that occur in each class (Susceptible, Exposed, Infected, or Recovered) are only
due to natural causes.

3. The rates of birth and death are assumed to be equal.

4. Individuals in the Susceptible class become infected with cholera upon contact with the
stool of an individual from the Infected class.

5. Exposed individuals will eventually progress to the Infected class.

11
 6. The incubation period of cholera is assumed to be 1-4 days.

7. Treatment is administered to individuals in the Exposed class.

8. Individuals recovering from cholera are assumed to become susceptible again.

9. Newborns in the Susceptible, Exposed, Infected, and Recovered classes are assumed to
be susceptible to cholera and enter the Susceptible class.

10. Infected individuals can recover from cholera at a rate denoted by γ.

11. It is assumed that vaccination is administered after an outbreak, meaning there is

immediate control through vaccination. Vaccines are only administered to individuals
in the Susceptible class.

SEIRS Model with Vaccination and Treatment Factors

β SI
N α γ/(1 − I)
S E I R

Figure 3.1: SEIRS Model with Recovery and Susceptibility

Based on Figure 3.21, the SEIRS model with vaccination and treatment factors is obtained
as follows:
The system of differential equations is given by:

12
 dS βSI
= bN + σR − − vS − µS
dt N
dE βSI
= − αE − µE
dt N  
dI γ
= αE − µI − I
dt 1−I
 
dR γ
= I + vS − σR − µR
dt 1−I

Given the initial conditions:

S(0) = S0 ≥ 0, (3.1)

E(0) = E0 ≥ 0, (3.2)

I(0) = I0 ≥ 0, (3.3)

R(0) = R0 ≥ 0, (3.4)

and
S(t), E(t), I(t), R(t) = N,

where:

1. N : the total number of individuals in the population,

2. b : the rate of birth in the population,

3. µ : the rate of death in the population,

4. β : the rate of transmission of the disease,

5. α : the rate of disease infectivity,

6. γ : the rate of cure of the disease,

7. σ : the rate at which individuals return to being vulnerable,

13
 8. v : the ratio of the number of individuals who received the vaccine,

γ
9. 1+I
: represents the saturated treatment rate.

3.3 Equilibrium Point of SEIRS Model

The system of equations is given by:

βSI
bN + σR − − vS − µS = 0 (1)
N
βSI
− αE − µE = 0 (2)
N  
γ
αE − µI − I=0 (3)
1+I
 
γ
I + vS − σR − µR = 0 (4)
1+I

If I = 0, then the equations (5), (6), (7), and (8) as follows:

bN + σR
S= , (5)
v+µ
E = 0, (6)

I = 0, (7)
vS
R= . (8)
σ+µ

Inputing equation (8) into equation (5), Then

bN (σ + µ)
S= (9)
(v + µ)(σ + µ) − σv

Inputing equation (9) into equation (8), Then

14
 vbN (σ + µ)
R= (10)
(v + µ)(σ + µ) − σv

The equilibrium point for the free disease of Cholera is given by:

 
bN (σ + µ) vbN
E0 = , 0, 0,
(v + µ)(σ + µ) − σv (v + µ)(σ + µ) − σv

Equilibrium Points for the Endemic Scenario in the SEIRS

Model

If I ̸= 0,
To find the equilibrium points, we set the time derivatives to zero.
From equation (2),

βSI
E= (11)
N (α + µ)

From equation (3),

γ
αE = µI + I (12)
1+I

Inputing equation (11) into equation (12), Then

σβS − N αµ − N αγ − N µγ + N µ2
I=−
αβS − N αµ − N µ2

Let

σβS − N αµ − N αγ − N µγ + N µ2
I∗ = − (12)
αβS − N αµ − N µ2

15
 So, therefore,
I = I∗

Then,

βSI ∗
E= (13)
α+µ

From equation (1),

bN 2 + N σR
S= (3.5)
βI + vN + µN

From equation (4),

γ(I ∗ )2 β + γvN I + µN γI + vbN 2 + vbN 2 I ∗

R= (3.6)
(1 + I ∗ ) [(σ + µ)(βI ∗ + vN + µN ) − vN σ]

Let
γ(I ∗ )2 β + γvN I + µN γI + vbN 2 + vbN 2 I ∗
R∗ =
(1 + I ∗ ) [(σ + µ)(βI ∗ + vN + µN ) − vN σ]

So, therefore
R = R∗

Then,

bN 2 + N σR∗
S= (3.7)
βI + vN + µN

The equilibrium point of endemic state of Cholera is given by:

Ee = (S, E, I ∗ , R∗ ) (3.8)

16
Endemic Equilibrium (Ee )

For an endemic state where cholera persists within the population, the equilibrium points
are:

N (σ + µ) µI ∗ (1 + I ∗ ) + γI ∗
S∗ = × (3.9)
β α(1 + I ∗ )

µI ∗ (1 + I ∗ ) + γI ∗
E∗ = (3.10)
α(1 + I ∗ )

α[γ(1 + I ∗ ) − γI ∗ ]
I∗ = (3.11)
(µ − γ)I ∗

I ∗ (v + µ) (µ(1 + I ∗ ) + γ) (σ + µ)(N + β)
R∗ = × × − bN (3.12)
σ σ(1 + I ∗ ) β

(where I ∗ are real quadratic equation).

3.4 Stability Analysis of SEIRS Model for Free disease

The stability analysis is determined based on the eigenvalues and the Jacobian matrix ob-
tained from the linearization method.
The Jacobian matrix in the neighborhood of E0 is:

 
∂f1 ∂f1 ∂f1 ∂f1
 ∂S ∂E ∂I ∂R 
 ∂f ∂f2 ∂f2 ∂f2 

 2
 ∂S ∂E ∂I ∂R 
J(E0 ) =  
 ∂f3 ∂f3 ∂f3 ∂f3 
 ∂S ∂E ∂I ∂R 
 
∂f4 ∂f4 ∂f4 ∂f4
∂S ∂E ∂I ∂R

17
 −βb(σ + µ)
 
−v − µ 0 σ
 (v + µ)(σ + µ) − σv 
βb(σ + µ)
 
 0 −α − µ 0 
 
J(E0 ) = 
 (v + µ)(σ + µ) − σv 

 0 σ −µ 0 
 
 
v 0 0 −σ − µ

To find the eigenvalues λ1 , λ2 , λ3 , and λ4 of the Jacobian matrix J, we solve the charac-
teristic equation:

det(J(E0 ) − λI) = 0

Subtract λI from J:

−βb(σ + µ)
 
−v − µ − λ 0 σ
 (v + µ)(σ + µ) − σv 
βb(σ + µ)
 
0 −α − µ − λ 0
 
 
J − λI = 
 (v + µ)(σ + µ) − σv 

0 σ −µ − λ 0
 
 
 
v 0 0 −σ − µ − λ

The determinant of the matrix J − λI is:

−βb(σ + µ)
−v − µ − λ 0 σ
(v + µ)(σ + µ) − σv
βb(σ + µ)
0 −α − µ − λ 0
det(J − λI) = (v + µ)(σ + µ) − σv =0
0 σ −µ − λ 0
v 0 0 −σ − µ − λ

 
βb(σ + µ)
(−v − µ − λ) [(−σ − µ − λ)(−α − µ − λ)(−µ − λ)] − σ(−σ − µ − λ)
(v + µ)(σ + µ) − σv

18
   
βb(σ + µ)
− σ (α + µ + λ)(v)(−µ − λ) + σv =0
(v + µ)(σ + µ) − σv

 
 −µ 
 
 

 −µ − σ − v 

 −αµ2 −αµσ−αµv−2µ3 −2µ2 σ−2µ2 v+√α2 µ4 +2α2 µ3 σ+2α2 µ3 v+α2 µ2 σ2 +2α2 µ2 σv+α2 µ2 v2
 

 1 
 2 µ(µ+σ+v) 
 
 3 2 2 2 σv+4bβµσ 3 +4bβµσ 2 v


 + 4bβµ σ+8bβµ σ +4bβµ
µ(µ+σ+v)



 √ 

 1 αµ2 +αµσ+αµv+2µ3 +2µ2 σ+2µ2 v+ α2 µ4 +2α2 µ3 σ+2α2 µ3 v+α2 µ2 σ2 +2α2 µ2 σv+α2 µ2 v2
 −2

 µ(µ+σ+v) 

 
3 2 2 2 σv+4bβµσ 3 +4bβµσ 2 v
+ 4bβµ σ+8bβµ σ +4bβµ
µ(µ+σ+v)

(λ represents the eigenvalues.)

The stability of the disease-free equilibrium (DFE) is determined by the signs of the
eigenvalues λ1 , λ2 , λ3 , and λ4 .

1. Stable Disease-Free Equilibrium (DFE): If all eigenvalues λi are negative, the

DFE is stable, indicating the disease will die out if the system is near this equilibrium.

2. Unstable Disease-Free Equilibrium (DFE): If any eigenvalue is positive, the DFE

is unstable, suggesting the disease could spread even from a small initial infection.

If the system reaches a steady state with constant infection levels, it means the disease
is either eradicated or at an endemic equilibrium.

3.5 Stability Analysis of the Endemic Equilibrium us-

ing Lyapunov Stability Theorem

3.5.1 1. Define the Lyapunov Function

Consider a quadratic Lyapunov function defined as:

19
 1
α1 (S − S ∗ )2 + α2 (E − E ∗ )2 + α3 (I − I ∗ )2 + α4 (R − R∗ )2

V (S, E, I, R) =
2

where α1 , α2 , α3 , α4 are positive constants, and (S ∗ , E ∗ , I ∗ , R∗ ) are the equilibrium values.

3.5.2 2. Compute the Time Derivative of the Lyapunov Function

The time derivative of V (S, E, I, R) along the trajectories of the SEIR model is given by:

dV ∂V dS ∂V dE ∂V dI ∂V dR
= + + +
dt ∂S dt ∂E dt ∂I dt ∂R dt

Substituting the SEIR model equations:

   
dV ∗ βSI ∗ βSI
= α1 (S − S ) bN + σR − − vS − µS + α2 (E − E ) − αE − µE
dt N N

   
∗ γI ∗ γI
+α3 (I − I ) αE − µI − + α4 (R − R ) + vS − σR − µR
1−I 1−I

3. Simplify the Time Derivative

At the equilibrium point (S ∗ , E ∗ , I ∗ , R∗ ), where dS

dt
= dE
dt
= dI
dt
= dR
dt
= 0, the time derivative
simplifies to:

dV
= α1 −v(S − S ∗ )2 − µ(S − S ∗ )2 + α2 −α(E − E ∗ )2 − µ(E − E ∗ )2
   
dt

γI ∗ (I − I ∗ )2
 
∗ 2
− µ(I − I ) + α4 −σ(R − R∗ )2 − µ(R − R∗ )2
 
+α3 − ∗ 2
(1 − I )

20
4. Analyze Stability

Local Stability:

• If dV
dt
< 0 for all (S, E, I, R) near the equilibrium point (except at the equilibrium
itself), then the equilibrium is locally asymptotically stable.

• If dV
dt
≤ 0 and dV
dt
= 0 only at the equilibrium, then the equilibrium is globally asymp-
totically stable.

Conclusion:
dV
If dt
< 0 in the vicinity of the endemic equilibrium, this indicates that the equilibrium
is locally asymptotically stable, meaning the disease will persist in the population if R0 >
dV
1. If dt
≤ 0 and only equals zero at the equilibrium, then the equilibrium is globally
asymptotically stable, implying that the disease remains endemic in the population.

3.6 Basic Reproduction Number

The reproduction numbers can be derived by isolating terms involving v (for vaccination)
and γ (for treatment).
The characteristic equation used to analyze the stability of the disease-free equilibrium
(DFE) point is:

 
βσ(bN + σR)
(σ + µ + λ)(µ − γ + λ) − (σ − µ − λ) = 0
N (v + µ)

To find the reproduction numbers, follow these steps:

1. Set λ = 0

Setting λ = 0 in the characteristic equation to focus on the disease-free equilibrium:

21
  
βσ(bN + σR)
(σ + µ)(µ − γ) − (σ − µ) = 0
N (v + µ)

2. Solve for the Basic Reproduction Number (R0)

Let:

βσ(bN + σR)
A = (σ + µ)(µ − γ) −
N (v + µ)

Set A = 0:

βσ(bN + σR)
(σ + µ)(µ − γ) =
N (v + µ)

R0 is given by:

βσ
R0 =
µ(µ − γ)

3. Vaccination Reproduction Number (Rv )

The vaccination reproduction number Rv is derived by adjusting for the vaccination rate v:

βσ
Rv = βσ
µ(µ − γ + N (v+µ) )

4. Treatment Reproduction Number (Rt)

The treatment reproduction number Rt is derived by adjusting for the treatment rate γ:

βσ
Rt = γ
µ(µ − γ + N (v+µ) )

22
Chapter 4

Analysis of Cholera Outbreaks

Detailed Results and Conclusions: Cholera Outbreak

Analysis

Mathematical Modeling

The SEIRS model, incorporating factors such as vaccination and treatment, was utilized to
understand the dynamics of cholera within a population. This model divides the population
into four compartments: Susceptible (S), Exposed (E), Infected (I), and Recovered (R). Key
assumptions included a constant total population and specific rates for birth, death, and
disease transmission.

Equilibrium Points

Disease-Free Equilibrium (E0 )

The disease-free equilibrium is defined by the absence of cholera infection, where E = 0 and
I = 0. The susceptible population S and recovered population R at this equilibrium point
are given by:
bN (σ + µ)
S= (9)
(v + µ)(σ + µ) − σv

23
 E=0

I=0

vbN (σ + µ)
R= (10)
(v + µ)(σ + µ) − σv

At E0 , the disease is absent, and the system is stable if the basic reproduction number R0 < 1.
This indicates that if the transmission rate is low or vaccination coverage is high, the disease
can be eradicated.

Endemic Equilibrium (Ee )

For an endemic state where cholera persists within the population, the equilibrium points
are:

bN 2 + N σR∗
S=
βI + vN + µN

βSI ∗
E=
α+µ

σβS − N αµ − N αγ − N µγ + N µ2
I∗ = − (12)
αβS − N αµ − N µ2

γ(I ∗ )2 β + γvN I + µN γI + vbN 2 + vbN 2 I ∗

R∗ =
(1 + I ∗ ) [(σ + µ)(βI ∗ + vN + µN ) − vN σ]

These expressions show the steady-state values for each compartment under endemic
conditions. The presence of non-zero E and I indicates that the disease is maintained in the
population.

24
Impact of Vaccination and Treatment

4.0.0.0.1 Vaccination: The model revealed that increasing the vaccination rate (v) ef-
fectively decreases the susceptible population (S) and reduces the transmission rate. Vac-
cination acts as a preventative measure, lowering the risk of an outbreak by reducing the
number of susceptible individuals who can contract and spread the disease.

4.0.0.0.2 Treatment: Treatment was found to decrease the duration of infectiousness

and improve recovery rates. The model showed that effective treatment reduces the number
of individuals in the infected compartment (I) and helps to control the spread of the disease.
However, reinfection remains a risk, emphasizing the need for ongoing intervention.

Sensitivity Analysis

The sensitivity analysis demonstrated that the stability of the equilibrium points is highly
influenced by parameters such as the transmission rate (β), recovery rate (γ), and vaccination
rate (v). Higher transmission rates require more aggressive vaccination strategies to maintain
stability. Conversely, lower recovery rates or ineffective treatment can lead to persistent
disease.

Jacobian Matrix Analysis

The Jacobian matrix, derived from the SEIRS model, was used to analyze the stability of
equilibrium points. By calculating the eigenvalues (λ) of the Jacobian matrix, we assessed the
nature of equilibrium stability. The eigenvalues provide insight into whether the equilibrium
points are stable or unstable.
For the disease-free equilibrium (E0 ), the eigenvalues λ1 , λ2 , λ3 , λ4 indicated stability when
the basic reproduction number R0 was less than 1. If any eigenvalue had a positive real part,
it would imply instability and potential for an outbreak.

25
 For the endemic equilibrium (Ee ), the eigenvalues confirmed the persistence of the disease
in the population under certain conditions. The eigenvalues showed whether the disease could
persist or would eventually be eradicated.

Conclusion

The SEIRS model with vaccination and treatment provides a robust framework for under-
standing cholera dynamics. The analysis indicates that effective vaccination and treatment
strategies are crucial for controlling and potentially eradicating cholera.
Continuous monitoring and adaptation of public health interventions are necessary to
address outbreaks and maintain disease control. The mathematical modeling and stability
analysis offer valuable insights into the dynamics of cholera and help guide public health
strategies to mitigate its impact.

26
Chapter 5

Observations & Conclusions

5.0.1 Observations

The cholera outbreak analysis using the SEIRS model with vaccination and treatment factors
provides critical insights into the dynamics of cholera spread and control. Here, we summarize
the key observations drawn from the model and its implications:

5.0.1.0.1 Dynamics of Cholera Spread The SEIRS model effectively captured the
dynamics of cholera transmission. The model revealed that the disease can spread rapidly
through the population if not controlled effectively. The susceptible population (S) plays a
crucial role in the transmission of cholera, as individuals in this compartment are at risk of
becoming exposed (E) and subsequently infected (I).

5.0.1.0.2 Impact of Vaccination Vaccination emerged as a highly effective interven-

tion in controlling the outbreak. By increasing the vaccination rate (v), the model showed a
significant reduction in the susceptible population. This reduction in S lowers the transmis-
sion rate of the disease and helps in maintaining a stable, disease-free equilibrium (E0 ). The
results underscore the importance of high vaccination coverage in preventing outbreaks and
controlling the spread of cholera.

27
5.0.1.0.3 3. Role of Treatment Treatment plays a vital role in reducing the duration of
infectiousness and improving recovery rates. The model highlighted that timely and effective
treatment reduces the number of individuals in the infected compartment (I), thus mitigat-
ing the spread of the disease. However, the potential for reinfection remains a challenge,
emphasizing the need for sustained treatment efforts alongside vaccination.

5.0.1.0.4 Sensitivity to Parameters The sensitivity analysis demonstrated that the

model’s stability is highly dependent on several parameters, including the transmission rate
(β), recovery rate (γ), and vaccination rate (v). Variations in these parameters can signif-
icantly impact the model’s predictions. For instance, higher transmission rates necessitate
more aggressive vaccination strategies to keep the disease under control.

5.0.2 Conclusions

The findings from the cholera outbreak analysis offer valuable insights into managing and
controlling cholera. The SEIRS model with vaccination and treatment provides a robust
framework for understanding the disease dynamics and evaluating public health strategies.
The following conclusions can be drawn:

5.0.2.0.1 Effective Control Measures To effectively control cholera outbreaks, it is

crucial to implement a combination of vaccination and treatment strategies. The model shows
that increasing vaccination rates can substantially lower the number of susceptible individuals
and reduce the overall transmission of the disease. Concurrently, effective treatment reduces
the infectious period and supports recovery.

5.0.2.0.2 Importance of Continuous Monitoring The analysis underscores the im-

portance of continuous monitoring and adjustment of public health interventions. Given the
sensitivity of the model to various parameters, regular updates and assessments of vaccination
coverage, treatment effectiveness, and disease transmission rates are essential for maintaining

28
control over cholera outbreaks.

5.0.2.0.3 Framework for Future Research The SEIRS model provides a foundation
for future research on cholera and similar infectious diseases. By refining the model and
incorporating real-time data, researchers and public health officials can better predict and
manage outbreaks. The model’s flexibility allows for the inclusion of additional factors and
interventions, making it a valuable tool for ongoing disease control efforts.

5.0.2.0.4 Policy Implications The results have significant implications for public health
policy. Policymakers should prioritize vaccination programs and ensure that treatment facil-
ities are adequately equipped to handle cholera cases. Additionally, public health campaigns
to raise awareness about cholera prevention and the importance of vaccination can further
support outbreak control efforts.
In summary, the cholera outbreak analysis highlights the effectiveness of vaccination and
treatment in controlling the disease. By understanding and applying these insights, public
health authorities can enhance their strategies to combat cholera and protect vulnerable
populations.

29
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