Game Tracks Infectious Diseases

by Donna Hesterman

It may seem like a macabre game of tag, but it’s actually an innovative tool for teaching the fundamentals of epidemiology – the science of how infectious diseases move through a population.

University of Florida biologist Juliet Pulliam is among an international team of scientists who teach a workshop annually in South Africa that helps epidemiologists improve mathematical models they use to study outbreaks of diseases like cholera, AIDS and malaria.

Pulliam and colleague Steve Bellan from the University of California, Berkeley created the game in 2010 as a teaching aid for the workshop. The exercise has proven so effective in demonstrating concepts in epidemiology that a discussion of the game is presented in the journal PLoS Biology.

In the game they call “Muizenberg Mathematical Fever,” players simulate a real-life epidemic by passing around pieces of paper that say, “You have been infected,” followed by instructions for propagating the disease. The drill has become a cornerstone of the annual training they offer at the African Institute for Mathematical Sciences in Muizenberg, South Africa.

“Infectious disease modeling is an established field of study in bio-mathematics,” said Pulliam, a biologist at UF’s Emerging Pathogens Institute and co-author of the paper.

But there has been a tendency in the past for mathematicians doing that sort of work to operate separately from practitioners on the ground who track diseases as they are spreading, she said. The game was meant to convince all players on the epidemiology field that teamwork is the better approach.

“This is about the importance of collaboration,” said Bellan, lead author of the study and an ecologist at the University of California, Berkeley. “No one can be an expert in everything.”

“The two sides typically meet up somewhere along the line during the process of an epidemiological study,” he said. “We just want to see more scientists working together from the start.”

To that end, Bellan, Pulliam, and six scientists from South Africa, Canada and the United States offer two-week clinics every year at the African Institute for Mathematical Sciences. The clinics are meant to immerse epidemiological number crunchers more fully into the human aspects of how disease spreads. John Hargrove, former director of the South African Center of Epidemiological Modeling and Analysis, started the clinics in 2006.

But since 2010 classes have had a very different experience than previous groups, because the game changed everything.

“We were sitting in the office the night before the clinic began, talking about how someone had shown up sick one year and gotten everyone else sick,” Pulliam said. “And then Steve said something about how cool it would be if we had captured data from that outbreak for use in the workshop.”

The discussion sparked the idea to create a similar scenario in real time by creating a fictitious disease. “We pieced it together in about an hour,” Bellan said.

The drill produced an outbreak with data that looked like a real epidemic – so much so, that many students chose to work with the game’s data rather than actual data from field studies.

They found that familiarity with the process for collecting data greatly improved their ability to customize mathematical models so that they accurately represented how a disease was moving through a population.

“And that’s exactly what we wanted them to get out of the workshop,” she said.

Juliet Pulliam,