Covert Communication for Wireless Networks with Full-Duplex Multiantenna Relay

In this work, we investigated a covert communication method in wireless networks, which is realized by multiantenna full-duplex single relay. In the first stage, the source node sends covert messages to the relay, and the relay uses a single antenna to send interference signals to the adversary node to protect the covert information being transmitted. In the second stage, the relay decodes and forwards the covert information received in the first stage; at the same time, the relay uses zero-forcing beamforming to send interference signals to the warden to ensure covert transmission. The detection error rate, transmission outage probability, maximum effective covert rate, and other performance indicators are derived in two stages, and the total performance of the system is derived and analyzed. Then, the performance indicators are verified and analyzed by simulation. Our analysis shows that the maximum effective covert rate of using the characteristics of multiantenna to interfere with Willie in the second stage is taken as the total covert performance of the system, and the transmission interruption probability is significantly less than that of the first stage, so the corresponding maximum effective concealment efficiency will be greater.

Towards soil-transmitted helminths transmission interruption: The impact of diagnostic tools on infection prediction in a low intensity setting in Southern Mozambique

World Health Organization goals against soil-transmitted helminthiases (STH) are pointing towards seeking their elimination as a public health problem: reducing to less than 2% the proportion of moderate and heavy infections. Some regions are reaching WHO goals, but transmission could rebound if strategies are discontinued without an epidemiological evaluation. For that, sensitive diagnostic methods to detect low intensity infections and localization of ongoing transmission are crucial. In this work, we estimated and compared the STH infection as obtained by different diagnostic methods in a low intensity setting. We conducted a cross-sectional study enrolling 792 participants from a district in Mozambique. Two stool samples from two consecutive days were collected from each participant. Samples were analysed by Telemann, Kato-Katz and qPCR for STH detection. We evaluated diagnostic sensitivity using a composite reference standard. By geostatistical methods, we estimated neighbourhood prevalence of at least one STH infection for each diagnostic method. We used environmental, demographical and socioeconomical indicators to account for any existing spatial heterogeneity in infection. qPCR was the most sensitive technique compared to composite reference standard: 92% (CI: 83%– 97%) for A. lumbricoides, 95% (CI: 88%– 98%) for T. trichiura and 95% (CI: 91%– 97%) for hookworm. qPCR also estimated the highest neighbourhood prevalences for at least one STH infection in a low intensity setting. While 10% of the neighbourhoods showed a prevalence above 20% when estimating with single Kato-Katz from one stool and Telemann from one stool, 86% of the neighbourhoods had a prevalence above 20% when estimating with qPCR. In low intensity settings, STH estimated prevalence of infection may be underestimated if based on Kato-Katz. qPCR diagnosis outperformed the microscopy methods. Thus, implementation of qPCR based predictive maps at STH control and elimination programmes would disclose hidden transmission and facilitate targeted interventions for transmission interruption.

Beamforming Design and Covert Performance Analysis for Full-Duplex Multiantenna System

In this work, a wireless covert communication system with full-duplex (FD) multiantenna receiver is considered. In order to improve the convert performance of the wireless communication system in the FD mode, a scheme based on selection combining/zero forcing beamforming (SC/ZFB) is proposed. More specifically, a covert message receiver with a FD multiantenna uses the zero forcing beamforming method to transmit randomly varying noise power to the adversary while receiving covert information from the sender. Firstly, we derive the optimal detection threshold and the corresponding closed expression of the minimum detection error rate of the warden. Secondly, the transmission interruption probability is explored to measure the communication reliability between the sender and the receiver of the covert message. Finally, the throughput performance of the covert communication system is analyzed under random geometry. Our analysis shows that the proposed SC/ZFB scheme can achieve the positive effective convert rate while interfering with the detection of the warden as much as possible. It is worth noting that the increase of the number of antennas and the power of covert message transmission can improve the convert performance of the system.

Vacation Queueing Model for Performance Evaluation of Multiple Access Information Transmission Systems without Transmission Interruption

We consider a MAP/PH/1-type queueing system with server vacations as a model that is useful for the analysis of multiple access systems with polling discipline without transmission interruption. Vacation of the server corresponds to the service providing competitive information flows to the polling system. In this paper, we consider a vacation queueing model under pretty general assumptions about the probabilistic distributions describing the behavior of the system and the realistic assumption, in many real-world systems, that ongoing service cannot be terminated ahead of schedule. We derive the criterion of the stable operation of the system and the stationary distributions of the system states and the waiting time. An illustrative numerical example is presented.

Cost-effectiveness analysis of the integrated control strategy for schistosomiasis japonica in a lake region of China: a case study

Background Schistosomiasis japonica remains an important public health concern due to its potential to cause severe outcomes and long-term sequelae. An integrated control strategy implemented in the Peoples’ Republic of China has been shown to be effective to control or interrupt the transmission of schistosomiasis. The objective of this study is to estimate the disease burden of schistosomiasis and assess the cost-effectiveness of the integrated control strategy focused on different major interventions at three stages for schistosomiasis control in a lake setting, to provide reference for policy making or planning. Methods Annual cost data of schistosomiasis control during 2009–2019 were obtained from the control program implementers in Jiangling County, Hubei Province, China. Economic costs are provided in constant 2009 Chinese Yuan (CNY). Epidemiological data of schistosomiasis were collected from the Jiangling county station for schistosomiasis control. Disease burden of schistosomiasis was assessed by calculating years of life lost (YLLs) owing to premature death, years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs were calculated as the sum of YLLs and YLDs. We then conducted a rudimentary cost-effectiveness analysis by determining the ratio by dividing the difference between the average cost of integrated control strategy at transmission control (2013–2016) or transmission interruption (2017–2019) and the average cost at stage of infection control (2009–2012) with the difference between the DALYs of schistosomiasis at different control stages. Descriptive statistics on the costs and DALYs were used in the analysis. Results The total economic costs for schistosomiasis control in Jiangling County from 2009 to 2019 were approximately CNY 606.88 million. The average annual economic costs for schistosomiasis prevention and control at stages of infection control (2009–2012), transmission control (2013–2016), and transmission interruption (2017–2019) were approximately CNY 41.98 million, CNY 90.19 million and CNY 26.06 million respectively. The overall disease burden caused by schistosomiasis presented a downward trend. Meanwhile, the disease burden of advanced cases showed an upward trend with the DALY increased from 943.72 to 1031.59 person-years. Most disease burden occurred in the age group over 45 years old (especially the elderly over 60 years old). Taking the infection control stage as the control, the incremental cost-effectiveness ratio of integrated control strategy was CNY 8505.5 per case averted, CNY 60 131.6 per DALY decreased at transmission control stage and CNY −2217.6 per case averted, CNY −18 116.0 per DALY decreased at transmission interruption stage. Conclusions The disease burden of schistosomiasis decreased significantly with the implementation of the integrated prevention and control strategy. Surveillance and management on elder population should be strengthened to decrease diseases burden. There remains a need for well-conducted studies that examine the long-term cost-effectiveness of the integrated control strategy for schistosomiasis. Graphic Abstarct

Cost-effectiveness Analysis of the Integrated Control Strategy for Schistosomiasis Japonica in Lake Region of China: a Jiangling Case Study

Background: Under the condition of low epidemic level and limited funding, it is urgent to carry out health economic evaluation on the integrated schistosomiasis control strategy currently implemented in lake region in order to rationally allocate and utilize health resources and maximize benefits. The objective of this study is to provide reference for understanding the effectiveness of the integrated control strategy and adjusting prevention and control strategies or measures. Methods: The investment in schistosomiasis control and disability adjusted life years （DALYs）caused by schistosomiasis were calculated. Incremental cost-effectiveness ratio (ICER) was conducted through calculating the incremental cost of every additional case averted, the incremental cost of every additional DALY averted through implementation of the integrated schistosomiasis control at different control stages in Jiangling County. Results: The total expenditure for schistosomiasis control in Jiangling County from 2009 to 2019 was 607 million Chinese yuan (CNY). The average annual costs for schistosomiasis prevention and control in stages of morbidity control (2009-2012), transmission control (2013-2016), and transmission interruption (2017-2019) were 41.98 million CNY，90.19 million CNY and 26.06 million CNY respectively. The overall disease burden caused by schistosomiasis presented a downward trend. Meanwhile, the disease burden of advanced cases showed an upward trend with the DALY increased from 943.72 to1031.59 person-years. Most disease burden occurred in the age group over 45 years old (especially the elderly over 60 years old). Taking the morbidity control stage as an analysis control, incremental cost-effectiveness analysis (ICEA) showed that the cost increased by 8505.5 CNY and decreased by 2217.6 CNY respectively to avert one additional case in transmission control stage and transmission interruption stage respectively in Jiangling County. Correspondingly, to avert one additional DALY, the cost increased by 73937.6 CNY and decreased by 21508.6 CNY respectively. Conclusions: As the epidemic declines, the integrated prevention and control strategy is more cost-effective. Surveillance and management on elder population should be strengthened to avert higher diseases burden.

Serious limitations of the current strategy to control Soil-Transmitted Helminths and added value of Ivermectin/Albendazole mass administration: A population-based observational study in Cameroon

Background Soil-transmitted helminth (STH) infections remain a public health concern in sub-Saharan Africa. School-based mass drug administration (MDA) using the anthelminthic drug Mebendazole/Albendazole have succeeded in controlling morbidity associated to these diseases but failed to interrupt their transmission. In areas were filarial diseases are co-endemic, another anthelminthic drug (Ivermectin) is distributed to almost the entire population, following the community-directed treatment with ivermectin (CDTI) strategy. Since Ivermectin is a broad spectrum anthelmintic known to be effective against STH, we conducted cross-sectional surveys in two health districts with very contrasting histories of Ivermectin/Albendazole-based PC in order to investigate whether CDTI might have contributed in STH transmission interruption. Methodology Cross-sectional surveys were conducted in two health districts with similar socio-environmental patterns but with very contrasting CDTI histories (Akonolinga health district where CDTI was yet to be implemented vs. Yabassi health district where CDTI has been ongoing for two decades). Stool samples were collected from all volunteers aged >2 years old and analyzed using the Kato-Katz technique. Infections by different STH species were compared between Akonolinga and Yabassi health districts to decipher the impact of Ivermectin/Albendazole-based MDA on STH transmission. Principal findings A total of 610 and 584 participants aged 2–90 years old were enrolled in Akonolinga and Yabassi health districts, respectively. Two STH species (Ascaris lumbricoides and Trichuris trichiura) were found, with prevalence significantly higher in Akonolinga health district (43.3%; 95% CI: 38.1–46.6) compared to Yabassi health district (2.5%; 95% CI: 1.1–5.1) (chi-square: 90.8; df: 1; p < 0.001). Conclusion/significance These findings (i) suggest that Mebendazole- or Albendazole-based MDA alone distributed only to at-risk populations might not be enough to eliminate STH, (ii) support the collateral impact of Ivermectin/Albendazole MDA on A. lumbricoides and T. trichiura infections, and (iii) suggest that Ivermectin/Albendazole-based PC could accelerate STH transmission interruption.

Baseline patterns of infection in regions of Benin, Malawi and India seeking to interrupt transmission of soil transmitted helminths (STH) in the DeWorm3 trial

Global efforts to control morbidity associated with soil-transmitted helminth infections (STH) have focused largely on the targeted treatment of high-risk groups, including children and pregnant women. However, it is not clear when such programs can be discontinued and there are concerns about the sustainability of current STH control programs. The DeWorm3 project is a large multi-country community cluster randomized trial in Benin, India and Malawi designed to determine the feasibility of interrupting the transmission of STH using community-wide delivery of mass drug administration (MDA) with anthelmintics over multiple rounds. Here, we present baseline data and estimate key epidemiological parameters important in determining the likelihood of transmission interruption in the DeWorm3 trial. A baseline census was conducted in October-December 2017 in India, November-December 2017 in Malawi and in January-February 2018 in Benin. The baseline census enumerated all members of each household and collected demographic data and information on occupation, assets, and access to water, sanitation and hygiene (WASH). Each study site was divided into 40 clusters of at least 1,650 individuals per cluster. Clusters were randomized to receive twice yearly community-wide MDA with albendazole (GSK) targeting eligible individuals of all ages (20 clusters), or to receive the standard-of-care deworming program targeting children provided in each country. In each site, a randomly selected group of 150 individuals per cluster (6,000 total per site) was selected from the baseline census using stratified random sampling, and each individual provided a single stool sample for analysis of STH infection using the Kato-Katz technique. Study site, household and individual characteristics were summarized as appropriate. We estimated key epidemiological parameters including the force of infection and the degree of parasite aggregation within the population. The DeWorm3 sites range in population from 94,969 to 140,932. The population age distribution varied significantly by site, with the highest proportion of infants and young children in Malawi and the highest proportion of adults in India. The baseline age- and cluster-weighted prevalence, as measured by Kato-Katz, varied across sites and by species, Baseline hookworm prevalence in India was 21.4% (95% CI: 20.4–22.4%), while prevalence of Ascaris and Trichuris by Kato-Katz was low (0.1% and 0.3% overall). In Malawi, the overall age- and cluster-weighted STH prevalence was 7.7% (95% CI: 7.1–8.4%) predominantly driven by hookworm infections (7.4%) while Ascaris (0.1%) and Trichuris (0.3%) infections were rare. In Benin, the overall age- and cluster-weighted prevalence was significantly lower (5.6%, 95% CI: 5.1–6.2%) and Ascaris (2.0%, 95% CI: 1.6–2.3%) was more common than in other sites. Ascaris infections were more likely to be moderate- or heavy-intensity (43.7%, unweighted) compared to hookworm (5.0%). The force of infection for hookworm was highest in adults in India and Malawi but appeared relatively stable across age groups in Benin. These data demonstrate the significant variability between the sites in terms of demography, socio-economic status and environmental characteristics. In addition, the baseline prevalence and intensity data from DeWorm3 suggest that each site has unique epidemiologic characteristics that will be critical in determining correlates of achieving STH transmission interruption in the DeWorm3 trial. Trial registration: The trial was registered at ClinicalTrials.gov (NCT03014167).

Mass campaigns combining antimalarial drugs and anti-infective vaccines as seasonal interventions for malaria control, elimination and prevention of resurgence: a modelling study

Background The only licensed malaria vaccine, RTS,S/AS01, has been developed for morbidity-control in young children. The potential impact on transmission of deploying such anti-infective vaccines to wider age ranges, possibly with co-administration of antimalarial treatment, is unknown. Combinations of existing malaria interventions is becoming increasingly important as evidence mounts that progress on reducing malaria incidence is stalling and threatened by resistance. Methods Malaria transmission and intervention dynamics were simulated using OpenMalaria, an individual-based simulation model of malaria transmission, by considering a seasonal transmission setting and by varying epidemiological and setting parameters such as transmission intensity, case management, intervention types and intervention coverages. Chemopreventive drugs and anti-infective vaccine efficacy profiles were based on previous studies in which model parameters were fitted to clinical trial data. These intervention properties were used to evaluate the potential of seasonal mass applications of preventative anti-infective malaria vaccines, alone or in combination with chemoprevention, to reduce malaria transmission, prevent resurgence, and/or reach transmission interruption. Results Deploying a vaccine to all ages on its own is a less effective intervention strategy compared to chemoprevention alone. However, vaccines combined with drugs are likely to achieve dramatic prevalence reductions and in few settings, transmission interruption. The combined mass intervention will result in lower prevalence following the intervention compared to chemoprevention alone and will increase chances of interruption of transmission resulting from a synergistic effect between both interventions. The combination of vaccine and drug increases the time before transmission resurges after mass interventions cease compared to mass treatment alone. Deploying vaccines and drugs together requires fewer rounds of mass intervention and fewer years of intervention to achieve the same public health impact as chemoprevention alone. Conclusions Through simulations we identified a previously unidentified value of deploying vaccines with drugs, namely the greatest benefit will be in preventing and delaying transmission resurgence for longer periods than with other human targeted interventions. This is suggesting a potential role for deploying vaccines alongside drugs in transmission foci as part of surveillance-response strategies.