Identifying potential sources and routes of disease movement at the
landscape-scale can be useful to targeting resources for interventions. While observing the movement of infected
individuals is rare, the landscape consequences of frequent movement can bee
seen in the frequency of outbreaks or, conversely, the duration of disease
absence. Bharti et al BHARTI 2010 analyzed the duration of measles fade-out lengths
in Niger and found that measles was more frequently introduced to population
centers that had large population sizes and were well connected to the road
network. Thus, these areas may disproportionately contribute to the dynamics of
regional persistence and warrant prioritization for control and monitoring.
In a parallel analysis, Bharti et al BHARTI 2011 showed that those districts
that were hot-spots for measles introduction also had more frequent outbreaks
of meningococcal meningitis. Thus, while environmental conditions are
frequently cited as the predominant driver of meningitis outbreaks Harrison 2009 the spatial distribution of outbreaks, and the similarity to the
spatial pattern of measles outbreaks, is consistent with a role human movement
in triggering outbreaks.