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Transactions in GIS, 2012, ():

Review Article

Spatial Approaches to Modeling

Dispersion of Communicable
Diseases A Review
Ling Bian
Department of Geography
University at Buffalo

Abstract
The dispersion of communicable diseases in a population is intrinsically spatial. In
the last several decades, a range of spatial approaches has been devised to model
epidemiological processes; and they differ significantly from each other. A review of
spatially oriented epidemiological models is necessary to assess advances in spatial
approaches to modeling disease dispersion and to help identify those most appropriate for specific research goals. The most notable difference in the design of these
spatially oriented models is the scale and mobility of the modeling unit. Using two
criteria, this review identifies six types of spatially oriented models. These include:
(1) population-based wave models, (2) sub-population models, (3) individual-based
cellular automata models, (4) mobile sub-population models, (5) individual-based
spatially implicit models, and (6) individual-based mobile models. Each model type
is evaluated in terms of its design principles, assumptions, and intended applications.
For the evaluation of design, four aspects of design principles are discussed: the
modeling unit, the interaction between the modeling units, the spatial process, and
the temporal process utilized in a design. Insights gained from this review can be
useful for devising much-needed spatially and temporally oriented strategies to
forecast, prevent, and control communicable diseases.

1 Introduction
Communicable diseases are transmitted from individual to individual. Efforts to develop
models to forecast epidemics of these diseases can be traced back to the 18th century
(Blower 2004). The last several decades have seen the most dynamic period of modeling
development. While the temporal dynamics of epidemics have always been a primary
Address for correspondence: Ling Bian, Department of Geography, University at Buffalo, Amherst,
NY 14261, USA. E-mail: lbian@buffalo.edu
2012 Blackwell Publishing Ltd
doi: 10.1111/j.1467-9671.2012.01329.x

L Bian

focus of most models, attempts have also been made to model spatial dynamics in
epidemic processes, as the spread of communicable diseases through a population is
intrinsically both a spatial and temporal process. Geographers have led these attempts,
creating explicit conceptual frameworks to describe spatial processes. Increasingly,
researchers in other disciplines have, to varying degrees, incorporated spatial considerations into their models, especially with advances in Geographic Information Science
(GIScience). The spatial dynamics of epidemics can now be readily represented, although
some efforts are more explicit than others. A range of spatial approaches have been
devised and they differ significantly from each other, possibly due to their roots in a
diverse range of disciplines and a timespan of several decades when theories and methods
advanced rapidly. A review is necessary to evaluate the characteristics of these spatial
approaches, to help identify those most appropriate for specific research goals, and to
further our ability to forecast, prevent, and control these diseases. This review categorizes
and evaluates designs of spatial approaches incorporated in epidemiological models with
an emphasis on more recent developments.
The most notable difference in the design of these spatially oriented models is the
scale of the modeling unit, which directly affects the spatial representation of many
aspects of model design and operation. Further, the mobility of these modeling units is a
salient difference that separates certain model designs from others, especially from the
perspective of spatial modeling. Using these two criteria, this review identifies six types
of models that incorporate spatial considerations. These include: (1) population-based
wave models, (2) sub-population models, (3) individual-based cellular automata models,
(4) mobile sub-population models, (5) individual-based spatially implicit models, and (6)
individual-based mobile models. These model types are first identified using these two
criteria and then by a chronology of their development, based on the time period when
discussion of the model type was most active in the literature.
Each model type is evaluated in terms of its design principles, assumptions, and
intended applications. For the evaluation of design, four aspects of design principles are
discussed: the modeling unit, the interaction between the modeling units, the spatial
process, and the temporal process utilized in a design. The assumptions and applications
are discussed with respect to these four principles. In addition, before the six types of
spatially oriented models are evaluated, classic non-spatial epidemiological models are
reviewed first. These classic models are the foundation of modern epidemiology, from
which many spatially oriented models are extended or derived. The review of classic
models is also organized by their design principles, assumptions, and applications.
The model design, instead of the model implementation, is the central issue of this
review because it is the conceptual design that guides model implementations. Often the
latter can be quite independent of a model design as implementation concerns change
according to the computing environment. In addition, the model design identifies paradigmatic shifts in modeling concepts. The review is drawn from a variety of research
articles, ranging from those that are commentary or critique oriented, to design or
method oriented, to case study oriented. Spatial considerations are expressed in these
articles to various degrees, and at times not at all. This review extracts spatial considerations from these articles whether they are explicitly described or implicitly alluded to.
Further, not all of the articles that have used a spatial design are included in this review,
as its goal is rather to distill primary spatial approaches from the literature than to offer
statistics from all relevant articles. The spatial approaches reviewed here focus on those
that address communicable diseases, i.e. the diseases transmitted between individuals
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Spatial Modeling of Communicable Diseases

through close contact or proximity, such as flu, measles, and foot and mouth disease,
among many others.

2 Classic Models
Classic models refer to the population-based, temporally dynamic, mathematical epidemiological models. They are non-spatial models whose primary focus is the temporal
dynamic of epidemic processes. These models use a population-based approach with a
population divided into a limited number of segments. The simplest division consists of
three mutually exclusive segments. One segment includes those individuals who are
susceptible to the disease (S). A second segment is comprised of those that are infectious
and can spread the disease to the susceptible individuals (I). The remaining segment refers
to those that are recovered from a previous infection (R) (Kermack and McKendrick
1927, Anderson and May 1991). The three population-segment models are commonly
known as SIR models where the population segments are the modeling unit.
At any given time, a number of individuals are moved from the susceptible segment
into the infectious segment, and in the mean time, a number of individuals are moved
from the infectious into the recovered segment. Assuming that these changes are continuous, a differential equation set is typically used to express the dynamics:

dS dt = SI ,

(1)

dI dt = SI gI

(2)

dR dt = gI

(3)

where S, I, and R denote the susceptible, infectious, and recovered segments, respectively,
b is the infection coefficient and g is the recovery rate. The differential equation set
describes the temporal dynamics of an epidemic by estimating the size of the three
population segments through the course of an epidemic. The size of S, I, and R is available
or can be estimated from observed information. The parameters, such as b and g, are the
unknowns in the equation set. During the modeling, the observed number of new daily (or
other time periods) infection cases is plotted against time. The size of the infectious
population segment tends to rise after an epidemic begins and then declines after reaching
its peak. By adjusting the value of the parameters, the curve that is formulated by the
equation set is fitted to the observed number of infections through the course of an
epidemic. Values for the parameters are then derived for subsequent analysis to decipher
their implications in the epidemic process. As the population segment is the modeling unit,
the values of these parameters are usually estimated as an average over the entire segment.
SIR models are the simplest of a family of population-based models. More complex
models may take additional considerations into account. The three population segments
can be further divided into a greater number of smaller segments. The infectious segment,
for example, has been further divided into two population segments, those who are
exposed to an infection (E) and those who are infected and become infectious (I), while
the S and R segments are kept unchanged. The four segments construct a SEIR model
that is also a basic form of this family of models. A variety of complexities have been
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L Bian

introduced into the basic deterministic framework of SIR models. The basic modeling
framework, however, has remained the same throughout the history of modern epidemiology (Anderson and May 1991). At the core of the design is the use of aggregated
population segments as the modeling unit and a focus on the temporal dynamic of
epidemics. This type of model does not consider spatial dynamics at all and employs a
fundamentally non-spatial modeling approach. There is also no explicit consideration of
the interactions between population segments.
In addition to their temporally continuous assumption, a series of other assumptions
are embedded in these models regarding individuals. Several such explicit and implied
assumptions are relevant to this discussion. First, all individuals within a population
segment are assumed to be identical. Second, all individuals interact with all other
individuals, the so-called homogeneous mixing assumption. Spatially oriented
assumptions are not explicitly discussed, but perhaps can be inferred. Individuals in a
homogeneously mixed population may also have a homogeneous spatial distribution,
and are immobile to allow the model to be executed (see the discussion of a wave model
in a later section).
The deterministic approach and a small number of parameters of these models allow
for a simple modeling process. These models can reasonably approximate the observed
dynamics of an epidemic and assess the collective state of a populations health. Classic
population models have been used for well over a century, and they have been the
foundation for modern epidemiology.

2.1 Population-Based Wave Models

In the 1980s, geographers proposed a spatial framework for epidemiological models that
explicitly considers the spatial dispersion of infectious diseases (Cliff and Ord 1981, Cliff
et al. 1986). A simple form of these spatial models is a three-ring wave model. The first
infection case occurs at the center of a space and spreads outwards in all directions in a
wave-like form. The infectious population segment is on the crest of the wave, the
susceptible segment is in front of the crest, and the recovered segment is behind the crest.
At a given time, the three population segments form a three-ring pattern. The second or
middle ring is the infectious segment, the outer ring is the susceptible segment, and the
recovered ring is at the center of the space around the starting point. The location of the
three population segments, or the three rings, changes dynamically as the infectious wave
spreads through the space (Cliff and Ord 1981, Cliff et al. 1986, Rhodes and Anderson
1997).
The three-ring wave models project the three population segments described in
classic models into space, thus extending their temporally focused and non-spatial
model framework into the spatial dimension. Except for considerations specifically
intended for spatial modeling needs, the wave models inherit all the design principles
of classic models in terms of their use of a population segment as the modeling unit,
the exclusion of the interactions between the modeling units, and their temporal modeling capability. All the assumptions of classic models regarding individuals are also
adopted verbatim, i.e. individuals are identical, homogeneously mixed, homogeneously
distributed, and immobile.
Diseases, as a phenomenon, move across space, but each individual who becomes
infected and subsequently transmits the disease remains immobile. The mobility of
diseases is represented as changes in the health states (susceptible, infectious, or recovered)
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of these immobile individuals much like the modeling of water waves, in which individual
water molecules vibrate vertically with zero horizontal motion, while the wave moves
forward. The motion of disease waves can be modeled in a similar fashion.
Population-based wave models mark the beginning of spatially explicit epidemiological models. These models have a spatially oriented, explicit conceptual framework that
could be implemented by the spatial analysis methods available at the time, for example,
the cellular automata method (Tobler 1970) and subsequently the micro-simulation
method (Amrhein and MacKinnon 1988). This seminal design has had a long lasting
influence on the spatial modeling approaches adopted in many generations of epidemiological models.
In the past decade, population-based models have drawn increasing criticism. It is
argued that the homogeneity assumptions in these models inherently limit the usefulness
of population-based models in explaining the observed heterogeneity in disease transmission, spatially as well as temporally (Holmes 1997, Koopman and Lynch 1999, Fuks
and Lawniczak 2001, Arita et al. 2003, Dye and Gay 2003, Francesconi et al. 2003,
Meyers et al. 2003, Galvani 2004, Koopman 2004, Kretzschmar et al. 2004, Galvani and
May 2005, Watts et al. 2005). The strength of these models, however, remains their
ability to predict the health outcome at the population level. This is because the design
principles and assumptions associated with these models are intended for modeling at
this very level. One application for population-based wave models is for pandemics
where a disease sweeps through a large space like a wave, such as the 19181920 Spanish
flu that spread globally (Holmes 1997).

3 Sub-Population Models
Sub-population models divide a population into a substantial number of subpopulations, where a sub-population is the basic modeling unit. The later 1990s saw a
surge in the development of this type of model. These models attempt to increase
heterogeneity in a population in order to produce more realistic results than those
produced by classic models. A population may be divided into a greater number of
smaller sub-populations using different criteria. Those models that divide a population
based on spatial considerations are called spatially structured models (Szymanski and
Caraco 1994, Lloyd 1995, Ferguson et al. 1997, Grenfell and Harwood 1997, Rhodes
and Anderson 1997, Torres-Sorando and Rodriguez 1997, Keeling 2000).
Most spatially structured models divide space into regular grid cells. Each cell
contains a sub-population; thus a sub-population is spatially registered. The subpopulation models are a straightforward derivative of classic models. Except for a finer
scaled modeling unit, the sub-population models use the same design principles as
population-based wave models to represent spatial and temporal processes, whilst
appearing to be developed independently of the population-based wave models. With an
increased number of modeling units, the interactions between them are added to these
models, although the mechanism of interaction is usually not explicitly explained.
Diseases pass between sub-populations through between-cell interactions and ultimately
move across space, while the cells remain immobile. In addition, sub-population models
inherit the assumptions of classic models at the sub-population level. Within a cell,
individuals are assumed to be identical, homogeneously mixed, homogeneously distributed, and immobile.
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The breakdown of a population into finer-scaled modeling units and the interactions
between these units distinguish the sub-population models from the populationbased wave models, although the homogeneous mixing assumption and the associated
deterministic approach remain within a cell. This change adds spatial heterogeneity into
the estimation of a populations health and has had a major impact on many aspects of
epidemiological modeling. With certain limitations, the sub-population models bring the
modeling results to a more realistic level (Ferguson et al. 1997, Grenfell and Harwood
1997, Keeling 2000). Because of the intra-cell homogeneity assumption, sub-population
models are well suited for modeling disease dispersion between high-density, immobile
communities (Rhodes and Anderson 1997). Alternatively, these models are also well suited
for modeling disease transmission in livestock, such as localized breakouts of foot and
mouth disease among cattle and sheep on farms. Cattle and sheep are homogeneously
mixed sub-populations on individual farms, and the disease disperses through adjacent
farms and long jumps between them (Keeling et al. 2001, Doran and Laffan 2005).
Almost a decade later, especially after much discussion over the limitations of classic
models, a variety of model designs have been proposed for sub-population models. One
such revision refines the transmission between cells by explicitly allowing exchange of
individuals or chance of interaction between cells (or other types of basic spatial units)
(Doran and Laffan 2005, Watts et al. 2005, Colizza et al. 2007, Mao and Bian 2010).
Disease transmission between cells is modeled using probability-driven or rule-based
approaches. Another revision is to add heterogeneity in individuals within a cell (or other
spatial units) according to the probability density function of certain characteristics of
sub-populations (e.g. population size, household size, and age structure). Individuals in
a cell are collectively represented according to these statistics (Ferguson et al. 2006).
Interactions between cells and the mobility of individuals are also represented by statistical probabilities. These revisions, which mostly began around the middle of the last
decade, have kept a sub-population as the modeling unit. However, to various degrees
they have either incorporated stochastic interaction processes between sub-populations
or altered the homogeneity assumptions held in the original sub-population models.

4 Individual-based Cellular Automata Models

Individual-based cellular automata models (Holmes 1997) can be considered an extension of classic models. While also developed in the later part of the 1990s, cellular
automata models have departed further from classic models (including population-based
wave models) than sub-population models have. This model type also divides space into
cells, but a cell is intended to represent a discrete individual instead of an aggregation of
many identical individuals.
The design principles of these models are quite independent of classic models
(including population-based wave models). In addition to using an individual as the
modeling unit, the interactions between units are explicitly represented. A cell interacts
with a finite number of adjacent cells. The spatial and temporal spread of diseases is then
represented by localized transmissions that begin from an infectious cell and spreads to
adjacent susceptible cells. This type of model also facilitates long distance dispersions
as well by establishing new foci of transmission at locations that are a certain distance
away from already infected cells (the so called leapfrogging in the cellular automata
literature).
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These design principles break several assumptions held by classic models (including
population-based wave models), especially the homogeneous mixing assumption. In
individual-based cellular automata models, individuals differ from one another and each
has an explicit spatial location. An individual interacts only with a limited number of
other individuals. Although the homogeneous distribution and immobility assumptions
are still held, the unique individual and finite local interaction assumptions make the
individual-based cellular automata models a considerable departure from classic models
(including population-based wave models). As a result, the estimated health outcomes
may differ (Holmes 1997).
For a spatial representation of disease transmission, the individual-based cellular
automata models adopt a typical rule-based cellular automata modeling approach. This
approach is fundamentally different from the deterministic approach used in the two
aforementioned types of models. Instead of using a single equation set to describe the
behavior of an entire population or a subpopulation, cellular automata models focus on
transmissions at a local level that collectively contribute to a dispersion pattern at the
population level. Because of the immobility assumption and the adjacent transmission
rule, these models are intended to model disease transmissions between immobile
individuals, such as plants (Holmes 1997).
From population-based wave models, sub-population models, to individual-based
cellular automata models, the modeling unit changes from a population segment to a
group of identical individuals and then a unique individual, respectively. Along with the
change in modeling unit is the finer scale of spatial representation. Despite this change,
the modeling units remain immobile in all three types of models. It is through a change
in the health state of individuals, rather than a change in their location (see discussion
of the wave models in Section 2.1), that diseases, as a phenomenon, move across
space.
Figure 1 shows a two-criteria space to identify the six model types. The vertical axis
represents the scale of modeling unit from a coarse scale at the bottom to a fine scale at
the top. The horizontal axis represents the mobility of these modeling units with increasing mobility towards the right. Population-based wave models, sub-population models,
to individual-based cellular automata models, respectively, are placed from the bottom to
the top along the scale of modeling unit axis, to represent an increasingly finer modeling
unit. Along the mobility axis, all three types of models are placed at the left most position
because of the immobility of their modeling units.

5 Mobile Sub-Population Models

Mobile sub-population models are another derivative of classic models (SmallmanRaynor and Cliff 2001). Most typical of this type are the transfer diffusion models
developed around the turn of the 21st century (e.g. Smallman-Raynor and Cliff 2001).
These models use a sub-population as the modeling unit, the same design as in subpopulation models, but these units are mobile. The interactions between sub-populations
are explicit and unique, bearing little resemblance to the interaction principle used in
sub-population models or population-based wave models.
These models identify one or more sub-populations as the source of infection. With
time, these infected sub-populations may move to different locations. At new locations,
an infected sub-population may merge with other non-infected sub-populations or split
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Modeling
Unit

Individual

Individual-based cellular Individual-based spatially

implicit models
automata models

Individual-based mobile
models

Subpopulation

Sub-population models

Mobile sub-population
models

Population

Population-based wave
models

Mobility

Figure 1 Positions of the six model types in the scale-mobility space. The color scheme
represents health states: blue = susceptible, red = infectious, green = recovered

itself into several smaller infected sub-populations before it subsequently moves, splits, or
merges again. In this way, diseases are transmitted across space through time. Because
these models tend to focus on where the merged or split units move to, the location of a
unit is always explicitly represented. Despite this distinct design, the mobile subpopulation models use identical assumptions as sub-population models and populationbased wave models at the sub-population level, except for the immobility assumption.
Specifically, individuals within a sub-population are identical, homogeneously mixed,
and homogeneously distributed. Mobile sub-population models also inherit the same
deterministic approach used in classic models (including population-based wave models)
and sub-population models.
The mobility assumption brings to mobile sub-population models the flexibility to
model both spatial and temporal dynamics as observed in epidemic processes. Because of
the homogeneity assumption held in a sub-population, these models are most effective if
applied to mobile and high density populations, such as military or refugee camps.
Infected military units, for example, as mobile sub-populations, may be transferred to a
central location where they join other units. Subsequently some of the newly infected
units at the central location may be transferred to other locations to join other units, and
consequently diffuse a communicable disease across space (Smallman-Raynor and Cliff
2001).
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Spatial Modeling of Communicable Diseases

6 Individual-Based Spatially Implicit Models

Individual-based and spatially implicit models present a significantly distinct modeling
framework from those of classic models, although both originated from the same research
community. The most typical example of this type is the discrete individual transmission
model developed toward the end of the 1990s (Ghani et al. 1997, Keeling 1999, Koopman
and Lynch 1999). The basic concepts underlying these models are two-fold. First,
individuals differ from one another and this simple fact should be the basic assumption for
epidemiological studies. Second, individualized interactions and infection play a vital role
in disease dispersion through a population (Koopman 2004).
The essential design of these models lies in the emphasis on unique individuals and the
interactions between them. The use of an individual as the modeling unit is similar to
individual-based cellular automata models, but is developed independently. Each individual interacts with a limited number of other individuals in a social network, though not
necessarily those that are spatially adjacent. These individualized finite interactions
through social networks provide a mechanism for the transmission of disease through a
population across space and through time. The dynamics of an epidemic depend on the
structure of social networks. Commonly considered factors may include, for example, the
number of individuals with whom an individual interacts, the frequency and length of the
interaction, and the cross-connections within a group of individuals (Ghani et al. 1997).
The structure of social networks consequently determines how diseases propagate through
a population. Because the primary focus of these models is on the social connection, the
spatial dynamics in disease transmission is not always explicitly expressed.
In addition to the departure from the identical individuals and homogeneous mixing
assumptions, the homogeneous distribution and immobile individual assumptions are
not necessarily held for these models, either. The finite interactions not only break the
homogeneous mixing assumption, but also indirectly break the homogeneous distribution assumption, as individuals interact only at certain locations rather than all locations.
Further, these individuals may travel to different locations in order to interact with each
other. The explicitly expressed heterogeneity in individuals and in their interactions
makes it effective and necessary to use a stochastic approach in modeling the disease
transmission. In other words, the dispersion pattern at the population level may emerge
collectively from dynamic local processes.
Most of these models have been developed primarily for modeling sexually transmitted diseases and usually involve a finite number of individuals (Kretzschmar and
Morris 1996, Ghani et al. 1997, Adams et al. 1998, van der Ploeg et al. 1998, Welch
et al. 1998, Koopman and Lynch 1999). Although spatially oriented considerations are
indirectly implied, this type of model holds a critical position in the evolution of the
spatial design of epidemiological models because of its unequivocal focus on unique
individuals and their individualized behaviors (interaction and infection). These models
also served as an important stepping-stone for the later development of their spatial
extensions, the individual-based mobile models.

7 Individual-based Mobile Models

The last type of model to be evaluated is individual-based mobile models that emerged
around the middle of the last decade (Bian 2004, Dibble and Fieldman 2004, Eubank
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et al. 2004, Huang et al. 2004, Dunham 2005, Ferguson et al. 2005, Longini et al. 2005,
Cooley et al. 2008, Lee et al. 2008, Yang and Atkinson 2008, Yang et al. 2008, Perez and
Dragicevic 2009, Xu and Sui 2009, Rakowski et al. 2010, Salath et al. 2010, Mao and
Bian 2011). This model type is a spatial extension of individual-based spatially implicit
models.
These models account for the heterogeneity in all four design principles, i.e. in
individuals as the modeling unit, the interactions between them, the spatial process, and
the temporal process. For modeling disease transmission, these models tend to explore
the concept of time geography (Hgerstrand 1970, Pred 1977, Lenntorp 1978, Lytnen
1998, Kwan 1999, Miller 2005) and network theory (Watts and Strogatz 1998, Keeling
1999, Albert et al. 2000, Keeling and Eames 2005, Bian and Liebner 2007) in representing spatial and temporal dynamics. Individuals daily (or other time periods) travel
trajectories are represented as spatial-temporal lifelines. These lifelines intersect at different locations, such as homes, workplaces, and service places where individuals interact
with each other. The intersected lifelines form a social network. Diseases spread through
this network by two mechanisms, the interactions between individuals at a location and
individuals travel between locations in order to interact with other individuals (Bian
2004, Miller 2005). Because the location and time of both the interactions and movements between them are explicitly represented, the spatial dynamics of disease transmission can be explicitly modeled. These models can reveal a range of spatial and temporal
heterogeneities in disease transmission, depending on the structure of a social network
(Bian and Liebner 2007).
All assumptions underlying the individual-based mobile models are opposite to those
in classic models (including population-based wave models). Specifically, individuals
are unique, interact with only a finite number of other individuals, are heterogeneously
distributed, and mobile. This model type almost exclusively uses a stochastic modeling
approach that lets localized interactions and transmission to collectively contribute to a
dynamic spatial pattern at the population level.
Because the location and mobility of individuals are explicitly registered, this model
type is powerful for estimating the temporal speed and spatial extent of an epidemic. The
distinctive focus on unique individuals makes individual-based mobile models applicable
to modeling vulnerability to health threats at the individual level. The population scope
can range from hundreds of individuals in a workplace, hundreds of thousands in a
community, to millions in a region (Eubank et al. 2004, Cooley et al. 2008, Yang and
Atkinson 2008, Mao and Bian 2011, Stehl et al. 2011).
Still in their infancy, individual-based mobile models face many challenges. The
individual assumption, for example, requires a great amount of detailed information
about individuals that may not be available. Health status and other data at the individual level are collected under restricted guidelines due to privacy concerns. To compensate for the scarcity of such data, surrogate data have been used to estimate many
aspects of individual attributes and behaviors. Most recently, efforts have been made to
investigate individualized contact behavior at a high spatial and temporal resolution
using wireless devices and social media information (Crandall et al. 2010, Salath et al.
2010, Stehl et al. 2011). Findings from these studies are invaluable for the design of
individual-based mobile models. The availability of on-line information and methods to
harvest this information add much utility to this type of model. For example, by
analyzing individuals on-line health-seeking behavior, an epidemic can be tracked within
a shorter period of time than through conventional case reporting channels and at a
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Spatial Modeling of Communicable Diseases

11

reasonable level of accuracy (Ginsburg et al. 2009). Despite many challenges, individualbased mobile models may hold great potential to eventually forecast spatial and temporal
dynamics of an epidemic in real time by incorporating this information.
The mobility assumption used in the last three types of models brings flexibility,
although to various degrees, to the modeling of heterogeneity and dynamics in disease
transmission. Unlike the first three types of models in which the dispersion of diseases is
represented by the change in the health state of immobile modeling units, the last three
models explicitly change the location of modeling units. Unlike modeling the spread of
disease as passing waves, as represented in the first three types of models, the modeling
of the spread in the latter three types of models can be considered similar to that for the
motion of discrete objects. A sub-population or an individual can be readily represented
as an object. When the object moves, its parts (e.g. all individuals in a mobile subpopulation), its attributes (e.g. the health state), and its behaviors (e.g. interaction and
infection) move with it. This representation allows the modeling unit to move freely in
space, thus portraying the dynamic nature of infection sources, interactions, and disease
transmission.
In Figure 1, mobile sub-population models hold an identical position as the subpopulation models along the modeling unit axis, as both types of models use a subpopulation as the modeling unit. Along the mobility axis, mobile sub-population models
are further to the right because their modeling unit is mobile. Individual-based spatially
implicit models are placed at the same position as individual-based cellular automata
models along the modeling unit axis, but further to the right along the mobility axis
because of the implied mobility of its modeling unit. Individual-based mobile models are
placed at the upper right most corner of the two-criteria space, because of its fine-scaled
modeling unit and its high degree of mobility. Table 1 compares the six types of models
in terms of their assumptions, design principles, and intended applications.

8 Modeling Unit, Mobility, and Stochasticity

The modeling units for the spatial dispersion of communicable diseases remained at the
population level from the early attempts in the 18th century to the middle 1990s. The
other two modeling units, sub-population and individual, came along in the decade that
followed. The evolution from population- to individual-based epidemiological models
reflects recent developments in several fields, such as computing sciences. Rapid
improvements in computing power can now support the modeling of a significantly
larger number of individuals than in the recent past. Related to this computing power is
the development of computing theories, such as object-orientation, that provide the
theoretical support for the individualized representation (Wegner 1990, Bian 2004).
Further, renewed interest in network theory (Watts and Strogatz 1998, Albert et al.
2000) has supported the modeling of individualized interactions. Theoretical frameworks and computation methods developed in GIScience have also allowed for the
representation of spatial dynamics of epidemics at an ever-increasing level of sophistication (Bian 2007). These advances have facilitated the ultimate break from the homogeneous mixing assumption used in population-based and sub-population-based models,
and the embracing of the heterogeneous interaction assumption seen in individual-based
models.
The breakdown of a population into fine-scaled modeling units is necessary but not
sufficient to support the representation of mobility. Only when the modeling units are
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implied
homogeneous
implied immobility

Distribution

explicit

an entire
population
pandemics

Applications
Intended
population
Disease

passing wave

Temporal process

Interaction
between units
Spatial process

Design Principles
Modeling unit

population
segment
none

homogeneous

Mixing

Mobility

homogeneous

Population-Based
Wave Models

high-density immobile
populations
diseases that affect
livestock

explicit

adjacent cell
transmission

implied

sub-population

homogeneous within
a sub-population
homogeneous within
a sub-population
homogeneous within
a sub-population
immobile

Sub-Population
Models

diseases that affect

plants

immobile individuals

adjacent cell and

leapfrog
transmission
explicit

explicit

individual

immobile

homogeneous

finite interaction

unique

Individual-Based
Cellular Automata
Models

high-density mobile
populations
diseases that affect
military camps

local and long

distance
transmission
explicit

explicit

sub-population

homogeneous within
a sub-population
homogeneous within
a sub-population
homogeneous within
a sub-population
mobile

Mobile
Sub-Population
Models

sexually transmitted
diseases

connected individuals

explicit

lifeline and social

network

explicit

individual

implied mobile

heterogeneous

finite interaction

unique

Individual-Based
Spatially Implicit
Models

A comparison of the six models in terms of assumptions, design principles, and intended applications

Assumptions
Individuals

Table 1

all that affects

individuals

all individuals

explicit

lifeline and social

network

explicit

individual

mobile

heterogeneous

finite interaction

unique

Individual-Based
Mobile Models

12
L Bian

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spatially registered and registered to multiple locations is it possible to represent the

dynamically located sources of disease transmission and, consequently, the heterogeneity
in disease dispersion. This level of mobility representation is achieved mostly during the
last decade following the rapid development of GIScience.
Associated with the fine scaled modeling units and their mobility is the increased use
of stochastic modeling approaches (Koopman 2004). A fine-scaled modeling unit may
not be a sufficient factor to require stochastic approaches. The key is whether a modeling
unit is treated as a unique entity. It would be difficult to use an equation set to describe
unique modeling units and their heterogeneous attributes and behaviors, especially the
interactions between them. In comparison, stochastic approaches have considerable
advantages for modeling these heterogeneities and probability-driven complex infection
processes. For example, the original sub-population models are able to maintain the
deterministic approach at the sub-population level. Once a sub-population is treated as
a unique entity, the stochastic approaches are deployed. This is evidenced by the adoption
of stochastic approaches in revised versions of sub-population models (see Section 3).

9 Spatial and Temporal Representation and Implementation

Researchers from a range of disciplines have contributed to the development of the
spatial approaches incorporated in epidemiological models. These disciplines include
epidemiology, ecology, geography, computer science, mathematics and physics, among
others. Their varied disciplinary roots bring different perspectives to model design (as
discussed in earlier sections) and implementation considerations. Also, due to the diversity of the articles included in this review (commentary-critique, design-method, and case
study), not all of them involve implementation considerations. Further, developed at
different periods over a time span of more than two decades, the implementation
considerations of these models are inevitably affected by theories and methods available
at the time. Proprietary software packages, in-house customized software packages, and
freeware have contributed to the implementation of these spatial approaches at any given
time. These packages have been originally developed either for epidemiological modeling
purposes that have incorporated spatial considerations or as GIS software that can be
used to support epidemiological modeling. Given these diverse issues, it might be impossible to evaluate the implementation and operation concerns of the six types of models.
It is appropriate, however, to evaluate how space and time can be represented according
to the design principles of these models, using theories and methods available at the
present time.
The field and object views are perhaps one of the most important theoretical
developments in GIScience (Goodchild 1992, Cova and Goodchild 2002, Bian 2007).
The inclusive object-field dichotomy offers a profound framework to guide the representation of spatial phenomena, whether they are discrete object-like or continuous
field-like entities. The two types of GIS data models, raster and vector, can be used to
represent both object-like and field-like phenomena, depending on the intended purpose,
scale, and convention (Couclelis 1992, Bian 2007).
With regard to the six types of models discussed above, raster data models are most
effective to support population-based wave models, sub-population models, and
individual-based cellular automata models. This is because their spatial arrangement is in
the form of regular grid cells, and each cell is treated as a basic modeling unit. Closely
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L Bian

associated with raster data models is the cellular automata modeling approach. This
approach changes the attribute of a cell based on the current state of the cell and its
surrounding cells according to a set of pre-determined rules (Couclelis 1989, Clarke et al.
1997). It is most powerful when used to model spatial transmission under the influence
of adjacent cells in these three types of models. For modeling long distance dispersion,
however, raster data models and the cellular automata approach are not always as
effective as the vector data model, although leapfrogging has been incorporated in the
cellular automata approach. The immobility of the cells limits the ability of this type of
model in representing free motion (Tischendorf 1997, Bian 2003), especially if attempting to represent interactions in the form of a network.
Vector data models are most effective for mobile sub-population models, individualbased spatially implicit models, and individual-based mobile models because of the
mobility of their modeling units. Vector data models allow for the representation of free
motion in space, thus they are effective in representing mobile individuals and mobile
sub-populations, and ultimately the spatial dynamics of an epidemic. In comparison to
raster data models, vector data models are more complex and require sophisticated
spatial data management capabilities. Proprietary software packages can normally meet
this need but they lack the ability to support complex spatial operations. Additional
programming tools are often required, typically in-house software packages or freeware,
in order to integrate with GIS packages in a working model.
The agent-based spatial modeling approach has been increasingly popular in epidemiological modeling. In addition to possessing attributes, the agents may have many
behaviors, such as executing actions, interacting with other agents, perceiving its environment, and acting in response to both other agents and their environment (Jennings
and Wooldridge 1996, OSullivan and Haklay 2000, Brown and Xie 2006, Sengupta and
Sieber 2007, Tang and Bennett 2010). Agent-based modeling is applicable to nearly all of
the six types of models reviewed above. An agent can be an individual in the three
individual-based models, or a sub-population in the two sub-population models. It is
more advantageous, however, if agents represent unique modeling units, be it unique
individuals or unique sub-populations.
Temporal representation has always been explicitly expressed since the beginning of
epidemiological model development, yet the representation of temporal change has
remained simple. Time is normally represented as time steps with regular intervals,
depending on the intended temporal resolution of a model, although an increasingly finer
temporal resolution is used in more recent models.

10 Conclusions
A review of spatial approaches incorporated in epidemiological models helps assess the
current state of our knowledge of, and ability to model, the spatial dynamics of epidemics. In less than three decades, approaches to modeling the dispersion of communicable
diseases have progressed from population-based wave models at one corner of the
two-criteria space to individual-based mobile models at the opposite corner (Figure 1).
During this time, the schools of thought, design principles, and computation methods
behind these approaches have evolved and diversified. It may be true that all models are
wrong, but some are useful (Box and Draper 1987). Each model type has its own role in
contributing to the development of health policies (McKenzie 2004).
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Insights gained from these evaluations can be valuable to devise much-needed

spatially and temporally oriented strategies to control and prevent communicable diseases. The implementation of pre-infection strategies (e.g. vaccinations) and postinfection strategies (e.g. quarantine) can be better located and timed towards those
individuals and communities considered most vulnerable. Well targeted strategies may
reduce the adverse economic and social impacts often brought by mass vaccination and
quarantine.
The six types of models are categorized according to the scale and mobility of
modeling units in order to identify and evaluate major approaches to modeling spatial
dynamics in epidemic processes. Epidemiological models that incorporate spatial
approaches are certainly not limited to these six types. For example, it is possible to use
deterministic approaches in an individual-based mobile model (Reluga et al. 2011). The
measure of scale and mobility can be continuous as well and a model may be placed
anywhere in the two-criteria space. The revised versions of sub-population models are
examples that may not fit into any of six distinct types, as their design principles and
assumptions differ from one another. This will remain true as models continue to evolve
and diversify.

Acknowledgements
The valuable comments and suggestions provided by three anonymous reviewers are
gratefully acknowledged.

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