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Special Issue in Memory of Abdul-Aziz Yakubu

Global dynamics of discrete mathematical models of tuberculosis

&
Article: 2323724 | Received 30 Aug 2023, Accepted 21 Feb 2024, Published online: 17 Mar 2024

Abstract

In this paper, we develop discrete models of Tuberculosis (TB). This includes SEI endogenous and exogenous models without treatment. These models are then extended to a SEIT model with treatment. We develop two types of net reproduction numbers, one is the traditional R0 which is based on the disease-free equilibrium, and a new net reproduction number R0(E) based on the endemic equilibrium. It is shown that the disease-free equilibrium is globally asymptotically stable if R0 1 and unstable if R0>1. Moreover, the endemic equilibrium is locally asymptotically stable if R0(E)<1<R0.

MATHEMATICS SUBJECT CLASSIFICATIONS:

1. Introduction

Tuberculosis (TB) remains a formidable global health challenge, affecting millions of individuals across the globe. The disease's complex transmission dynamics and its ability to persist in various populations have spurred the need for a comprehensive understanding of TB and effective control measures. Mathematical modelling has emerged as a powerful tool to gain insights into the intricate dynamics of TB transmission and evaluate potential interventions. The foundations of mathematical epidemiology based on compartmental models are due to Sir Ronald Ross, who gave the first mathematical model of malaria transmission in 1911 [Citation1].

In this research paper, we embark on a thorough exploration of the global dynamics of discrete mathematical models of Tuberculosis.

We investigate both SEI (Susceptible-Exposed-Infectious) and SEIT (Susceptible-Exposed-Infectious-Treated) models with endogenous and exogenous components to elucidate the complexities of TB transmission and its implications for global public health.

Once someone is exposed, TB bacteria can live in the human or animal body for years if not decades without any symptoms, called latent TB infection. In fact, many people who have latent TB never develop the infectious disease, but they still test positive, though not infectious, meaning they cannot spread TB bacteria to others. To elaborate the progression from exposed to infected, TB bacteria enter the lungs, then as blood circulates, transporting them–of course, because the lungs oxygenate blood and/or cells–to other parts of the body, they infect a kidney, the spine or brain, which are generally not transmissible. TB bacteria turns into an active infection if the immune system cannot stem the growth rate. Common symptoms of tuberculosis are chest pain, weight loss, fever, a persistent cough that may contain blood, etc.

Nevertheless, active TB infection can be treated by prolonged use of antibiotics. In 1943, Selman Waksman, Elizabeth Bugie, and Albert Schatz developed streptomycin, the first antibiotic, whereas rest and sunlight were prescribed in sanatoriums to alleviate TB. It was later abandoned because it induces permanent hearing loss, tinnitus, dizziness, and vertigo [Citation2].

Now, four drugs are used in therapy: isoniazid (1951), pyrazinamide (1952), ethambutol (1961), and rifampin (1966) [Citation3]. They remain the most common treatment for TB (CDC).

With that said, another difficulty is that many strains of TB are drug-resistant. We conclude the SEIT model is sufficient to describe the transmission pattern of tuberculosis. However, the reality is that while models assume we have access to complete data on TB cases, every active infection is not reported. Moreover, since latent TB carriers exhibit no symptoms, their exact number is far more difficult to estimate, and treatment often goes half-done because of its length or duration [Citation4]. Above all, tuberculosis is a disease of poverty, which is not difficult to predict given that nations with higher living standards report fewer cases of TB.

For decades it has been assumed that postprimary tuberculosis is usually caused by the reactivation of endogenous infection rather than by a new, exogenous infection. However, Exogenous reinfection appears to be a major cause of postprimary tuberculosis after a previous cure in an area with a high incidence of this disease. This finding emphasizes the importance of achieving cures and of preventing anyone with infectious tuberculosis from exposing others to the disease.

TB has plagued humanity for millennia, shaping historical narratives and leaving a profound impact on societies worldwide. Known as ”consumption” and ”phthisis” in different periods, TB was associated with suffering and mortality, and its impact can be traced through historical artifacts, art, and literature. The 19th century witnessed a devastating rise in TB-related deaths in Europe and North America, leading to the establishment of specialized sanatoriums and hospitals to combat the disease. In 1882, Robert Koch's groundbreaking discovery of Mycobacterium tuberculosis, the causative agent of TB, marked a pivotal moment in the understanding and diagnosis of the disease. This came at a time when 1/7 of people in the United States and Europe were killed by TB.

Medical advancements in the 20th century, particularly the discovery of antibiotics like streptomycin and isoniazid, provided hope for TB control. TB incidence declined in many developed countries, fostering optimism for the possibility of eradicating TB altogether. However, the emergence of drug-resistant strains and the co-epidemic of HIV/AIDS in the latter half of the century rekindled the urgency to combat TB globally, particularly in resource-limited settings.

Mathematical models have played an indispensable role in shaping our understanding of TB transmission dynamics. Early deterministic SEI models, introduced in the mid-20th century, captured the basic interactions between susceptible, exposed, and infectious individuals. These models provided valuable insights into the importance of latent infections in TB spread and the potential impact of public health interventions.

To validate and refine mathematical models, empirical data from diverse populations and countries have been instrumental. Epidemiological studies have provided crucial insights into the prevalence, incidence, and transmission patterns of TB in various regions [Citation5–7].

High-burden countries, such as India, China, and South Africa, have contributed critical data to understand the impact of TB in densely populated regions with varying healthcare infrastructures. These countries have faced challenges in controlling the disease due to factors such as limited access to healthcare, poverty, and crowded living conditions [Citation8,Citation9].

Low-burden countries, including the United States, Canada, and several European nations, have contributed data showcasing successful TB control strategies. These success stories emphasize the importance of well-established healthcare systems, effective contact tracing, and widespread access to treatment in curbing TB transmission [Citation10].

Furthermore, cross-country data comparisons have revealed differences and similarities in TB transmission dynamics across different settings. The World Health Organization (WHO) compiles global TB data, providing valuable insights into the burden of the disease and the effectiveness of control efforts in different regions [Citation11].

In Section 2, an SEI compartmental model without treatment is presented in two formulations: endogenous and exogenous. In Section 3, we focus on the Disease-Free Equilibrium (DFE), calculating the net reproduction number, R0, and exploring both its local and global stability dynamics. Section 4 delves into the fundamentals of the Endemic Equilibrium (EE), examining its existence, uniqueness, and the associated net reproduction number. The local stability of the EE is rigorously proved in Section 5. Sections 6 through 8 are dedicated to the exogenous SEI model. Specifically, in Section 6, we discuss the net reproduction number and assess the local and global stability of the DFE. Section 7 turns our attention to the existence and uniqueness of the EE, further elucidating its related reproduction number. Section 8 reaffirms the local stability of the EE within the exogenous context. In Section 9, we pivot to the SEI compartmental model with treatment, the SEIT, following a structure similar to Section 3. Section 10 parallels the discussions in Section 5, but within the SEIT framework, proving the local stability of its EE. Section 11 presents open challenges and theoretical conjectures, posing intriguing questions for future investigations. Finally, Section 12 offers concluding remarks, summarizing our key findings andinsights.

2. The SEI compartmental model (with no treatment)

In this section, we define both endogenous (non-exogenous) and exogenous SEI compartmental models.

The host population is divided into the following epidemiological classes or subgroups: susceptibles (S), exposed (E, infected but not infectious), and infectious (I). N(t)=S(t)+E(t)+I(t) denotes the total population.

Let Λ be the recruitment rate of the population, d be the natural death rate, γ be the death rate caused by the disease, and the mean exposed period is 1α where α>0 is the rate of loss of latency. In nearly 5–10 % of susceptible people, latent TB may be activated due to immune evasion by Mtb from intracellular phagosome within the macrophage, perpetrating TB [Citation12]. Naturally, it is assumed that 0α<1, 0γ<1, 0d<1 [Citation13].

Assuming there is exogenous reinfection, the disease dynamics may be represented by the following system of difference equations (see the Flowchart Figure ).

Figure 1. Flowchart of both SEI Compartment Models (with no treatment) The chart flow of the endogenous (non-exogenous) model is obtained by deleting the arrow whose interior is coloured in orange.

Figure 1. Flowchart of both SEI Compartment Models (with no treatment) The chart flow of the endogenous (non-exogenous) model is obtained by deleting the arrow whose interior is coloured in orange.
(1) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N(t))S(t)+r1(1d)E(t)+r2(1d)I(t)E(t+1)=μ1(1d)(1φ1(I(t)/N(t)))S(t)+μ2(1d)φ2(I(t)/N(t))E(t)+(1d)(1αr1μ2)E(t)I(t+1)=(1d)αE(t)+μ2(1d)(1φ2(I(t)/N(t)))E(t)+(1d)(1γr2)I(t)(1) where r1 and r2 are the rates of recovering people from Exposed and Infectious, 0r1,r2<1.

The fraction of susceptibles that escape the infection at time t is (1d)μ1φ1(I(t)/N) where φ1(I/N) is the escape function, and μ1, 0μ1<1 is the level of infection. It is known that even after heavy exposure to TB, some individuals do not develop M. tuberculosis infection and innate immunity probably account for this natural protection or early clearance of M. tuberculosis. BCG vaccination also appears to play a significant role [Citation14]. Therefore, asymptotically, this fraction is bounded below by (1d)(1μ1). Hence in the same time interval, the fraction of susceptibles that did not escape from the infection is (1d)μ1(1φ(I/N)) (see the Flowchart Figure ).

The term μ2(1d)φ2(I(t)/N(t)) models the exogenous reinfection rates with μ2 representing the level of reinfection, 0μ21. About 5–10 % of infected people, Mtb can be reactivated and propagated to transmit TB [Citation14]. When there is no exogenous infection, we have μ2=0, and the system reduces to (2) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N(t))S(t)+r1(1d)E(t)+r2(1d)I(t)E(t+1)=μ1(1d)(1φ1(I(t)/N(t)))S(t)+(1d)(1αr1)E(t)I(t+1)=(1d)αE(t)+(1d)(1γr2)I(t)(2) The flowchart of both models is displayed in Figure .

Now N(t+1)=Λ+(1d)N(t)γ(1d)I. Then 0<N(t)Λd and if we assume that γ=0, then N(t)Λd as t.

We now make the following two assumptions:

  • A1:0<α+r1+μ2<1,0μ1<1,0<γ+r2<1,0d<1

  • A2: We assume that the functions φi(I/N) satisfies the following assumptions:

  1. φi(I(t)/N(t)) is continuously differentiable for I(t)0.

  2. 0φi1, for I(t)0.

  3. φi(0)=1, φi(I(t)/N(t))<0 for I(t)0.

In [Citation15], the contact between susceptibles and infected individuals is assumed to be a Poisson process given by φi(I(t)/N)=eβiI(t)/N(t), βi>0, i = 1, 2, where βi is called the transmission coefficient which will be used here.

Let us recall that the threshold parameter R0 is called the net reproduction number (or basic reproduction number or ratio) and is defined as the expected number of infections produced by a single infectious individual introduced into a susceptible population. Consequently, when R0<1, it is expected to imply that the number of infections will decrease over time and the disease will eventually die out. However, when R0>1, a disease outbreak will occur.

3. Endogenous (non-exogenous) SEI compartmental model (with no treatment)

3.1. Net reproduction number R0

To compute the traditional reproduction number R0 we are going to use the next-generation matrix approach [Citation15]. We remind that in the non-exogenous case μ2=0.

Let X0=(E,I)T, X1=ST, X=(X0,X1)R+3. Hence system (Equation2) may be written as (3) X0(t+1)=G0(X(t))X1(t+1)=G1(X(t))(3) where G0(X(t))=(E(t+1)I(t+1))=F(t)+T(t), and G1(X(t))=S(t+1), where F(t)=(μ1(1d)(1φ1(I(t)/N(t))S(t)0)=(F1(t)F2(t))is the vector of new infections that survive in the time interval [0,t], and T(t)=((1d)(1αr1)E(t)α(1d)E(t)+(1d)(1γr2)I(t))=(T1(t)T2(t))is the vector of all other transitions.

Next, we compute the Jacobian matrix of T(t) and F(t) at the disease-free equilibrium (DFE) E0=(0,0,S)=(0,0,N) F(t)|(0,0,S)=(F1(t)EF1(t)IF2(t)EF2(t)I)=(0μ1β1(1d)00)T(t)|(0,0,S)=(T1(t)ET1(t)IT2(t)ET2(t)δI)=(1d)(1αr1)0α(1d)(1d)(1γr2)).Now the basic reproduction number is given by R0(E0)=ρ((F(IT))1), where ρ denotes the spectral radius of a matrix [Citation15–17]. F(IT)1=(μ1αβ1(1d)(1(1d)(1αr1))(1(1d)(1γr2))0μ1β1(1d)1(1d)(1γr2)0).Hence (4) R0(E0)=μ1αβ1(1d)(1(1d)(1αr1))(1(1d)(1γr2)).(4)

3.2. Local stability of DFE of the endogenous model

Theorem 3.1

The DFE (E0) of system (Equation2) is locally asymptotically stable if R0(E0)<1 and a saddle if R0(E0)>1.

Proof.

Jacobian matrix of system (Equation2) at E0 represented by J(E0) is given by (5) J(E0)=(1dr1(1d)r2(1d)μ1β10(1d)(1αr1)μ1β1(1d)0α(1d)(1d)(1γr2))(5) The first eigenvalue of the Jacobian matrix is λ1=1d<1. The remaining two eigenvalues are the eigenvalues of the matrix (6) A=((1d)(1αr1)μ1β1(1d)α(1d)(1d)(1γr2)),(6) We now use the determinant-trace criteria to show that the two eigenvalues of this matrix lie inside the unit disk [Citation18,Citation19].

Now determinant det(A)=(1d)2(1αr1)(1γr2)μ1αβ1(1d)2, and trace tr(A)=(1d)(1αr1)+(1d)(1γr2)

Since R0(E0)<1, it follows that det(A)<1.

Moreover, det(A)>tr(A)1. Since tr(A)>0, det(A)>|tr(A)|1.

Hence, all the eigenvalues of the Jacobian matrix are inside the unit disk; thus, the DFE is locally asymptotically stable.

Next, we consider the case when R0=1. In this case, the first eigenvalue is λ1=1d<1. Now det(A)=tr(A)1. By Theorem (4.5) in [Citation19], the remaining two eigenvalues are λ2=1 and λ3=det(A)=tr(A)1=(1d)(1(α+r1)+1(γ+r2))1. Hence |λ3|<1. Thus at R0=1, the system would go through transcritical bifurcation or exchange of stability.

If R0>1, then one may show that det(A)<tr(A)1, and det(A)>tr(A)1. Hence, the DFE is unstable. More precisely, the DFE is a saddle since λ1=1d<1, λ2>1, and 0<λ3<1.

3.3. Global stability of DFE of the endogenous system via Liapunov functions

In this section, we are going to use the LaSalle invariance theorem [Citation18,Citation20] stated below.

Theorem 3.2

LaSalle Invariance Principle

Consider the difference equation (7) x(t+1)=F(x(t))(7) where F:R+nR+n is continuous on a subset G of R+n. Suppose there is a Liapunov function V:GR such that V is continuous on the closure G¯ of G. Let E={x:ΔV(x(t))=0} and M be the largest positively invariant subset of E. Assume that for every point xG, its orbit O(x) is bounded and is a subset of G. Then there exists cR such that for every xG, ω(x)MV1(c).

Consider the equation X1(t+1)=G1(0,x1(t))=Λ+(1d)S(t) The equilibrium point X1=Λd is globally asymptotically stable since

limtS(t)=limt(1d)t(S0Λd)+Λd=Λd Consider the matrix B=(IT)1FThen λ=αβ1μ1(1(1d)(1αr1))(1(1d)(1γr2)) is an eigenvalue of B. The corresponding eigenvector of B is given by W=(1,α(1d)1(1d)(1γr2))T. Define a Liapunov function as V(X0,X1)=WT(IT)1X0with X0R+2|{0}.

Now let f(X0,X1)=(F+T)X0G0(X0,X1). Then X0(t+1)=(F+T)X0(t)f(X0(t),X1(t)) since G0(0,X1)=0, f(0,X1)=0.

Theorem 3.3

Assume that R01. Then the disease-free equilibrium X=(0,X1) of the endogenous system (Equation2) is globally asymptotically stable.

Proof.

Now ΔV(X0,X1)=V(G0(X0,X1),G1(X0,X1))V(X0,X1)=WT(IT)1X0(t+1)WT(IT)1X0(t)=WT(IT)1(F+t)X0(t)WT(IT)1f(X0(t),X1(t))WT(IT)1X0(t)=WT(IT)1(TI+F+I)X0(t)WT(IT)1f(X0(t),X1(t))WT(IT)1X0(t)=WT(1+R0)X0(t)WT(IT)1f(X0(t),X1(t))since R01 and WT(IT)1f(X0(t),X1(t))0. It follows that ΔV(X0,X1)0.

By the LaSalle Invariance Principle, X(t)=(X0(t)X1(t)) approaches the largest positively invariant subset M of the set E={XR+3|ΔV(X)=0}, where M={(0,X1)|X1R+2}. Hence the only invariant set M is the disease-free equilibrium (0,X1)T. Therefore the disease-free equilibrium is globally asymptotically stable. Hence the only invariant set in M is the disease-free equilibrium (0,X1)T. Therefore the disease-free equilibrium is globally asymptotically stable.

Remark 3.4

It should be noted that global stability when R0<1 was proved in [Citation21].

4. Existence and uniqueness of the endemic equilibrium of the endogenous model

4.1. case γ=0, r1=r2=0

4.1.1. Existence

In this section, we investigate the dynamics of the endogenous model (Equation2) with γ=0. In this case limtN(t)=N=Λ/d. Then System (Equation2) becomes (8) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N(t))S(t)+r1(1d)E(t)+r2(1d)I(t)E(t+1)=μ1(1d)(1φ1(I(t)/N(t)))S(t)+(1d)(1αr1)E(t)I(t+1)=(1d)αE(t)+(1d)(1r2)I(t)(8) This system is asymptotic to the following system, where N(t) is replaced by N. (9) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N)S(t)+r1(1d)E(t)+r2(1d)I(t)E(t+1)=μ1(1d)(1φ1(I(t)/N)S(t)+(1d)(1αr1)E(t)I(t+1)=(1d)αE(t)+(1d)(1r2)I(t)(9) We will now focus our attention on the analysis of System (Equation9)

Proposition 4.1

Assume that r1=r2=0, and γ=0. Then every equilibrium point E=(S,E,I) of model (Equation9) is of the form E=(S,ΛdS(d+ααd),(1d)α(ΛdS)d(d+ααd)) with S solution of (10) d(d+ααd)Nln[(1d)μ1S(μ1+dμ1d)SΛ]+(1d)αβ1dS=(1d)αβ1Λ,(10) This equation can also be written as (11) d(d+ααd)N[(1d)ln(S)ln[(μ1+dμ1d)SΛ]]+(1d)αβ1dS=(1d)αβ1Λd(d+α+αd)Nln((1d)μ1),(11)

Proof.

Consider S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)eβ1(I(t)/N)S(t)when S(t+1)=S(t),

one has: (12) (1d)μ1eβ1INS=Λ+(μ1+dμ1d)S(12) then if μ1>0, β1>0 and S>0 eβ1IN=Λ+(μ1+dμ1d)S(1d)μ1Sor (13) ln[eβ1IN]=ln[Λ+(μ1+dμ1d)S(1d)μ1S]β1IN=ln[Λ+(μ1+dμ1d)S(1d)μ1S]I=Nβ1ln[Λ+(μ1+dμ1d)S(1d)μ1S](13) Consider now E(t+1)=(1d)μ1(1eβ1(I(t)/N))S(t)+(1d)(1α)E(t)when E(t+1)=E(t), one has: 0=μ1(1d)(1eβ1IN)S(d+ααd)EFrom (Equation12) it comes: (14) 0=μ1S+Λμ1SdS(d+ααd)E(d+ααd)E=ΛdSE=ΛdS(d+ααd)(14) Consider now I(t+1)=(1d)αE(t)+(1d)I(t)when I(t+1)=I(t), one has: (15) 0=(1d)αEdII=(1d)αEdI=(1d)α(ΛdS)d(d+ααd)(15) Equaling (Equation15) to (Equation13) it comes d(d+ααd)Nln[(1d)μ1S(μ1+dμ1d)SΛ]+(1d)αβ1dS=(1d)αβ1Λ,

4.1.2. Uniqueness

Theorem 4.2

Assume that r1=r2=0, γ=0 and R0>1. Then there exists a unique endemic equilibrium point E=(S,E,I) of System (Equation9)

Proof.

Consider the function (16) f(x)=d(d+ααd)Nln[(1d)μ1x(μ1+dμ1d)xΛ]+(1d)αβ1dx,(16) which is only defined for x>Λμ1+dμ1d.

Its derivative is: (17) f(x)=d(d+ααd)NΛx[(μ1+dμ1d)xΛ]+(1d)αβ1d,(17) and its second derivative is: (18) f′′(x)=d(d+ααd)NΛ[2(μ1+dμ1d)xΛ]x2[(μ1+dμ1d)xΛ]2,(18) which is always positive because from (Equation11) (μ1+dμ1d)SΛ>0, i.e. (μ1+dμ1d)xΛ>0, hence Λ<(μ1+dμ1d)x<2(μ1+dμ1d)x In addition 0α<1 and 0d<1 implies that αd<d hence d+ααd>0. Therefore f(x) is convex and f(x) is always increasing.

The equation (19) f(x)=(1d)αβ1Λ,(19) which represents the intersection of a convex curve with and horizontal straight line, and can have either zero, one, or two solutions. Clearly, x=N satisfies equation (Equation19), which gives us the disease equilibrium point (S,0,0). Therefore this equation can have only one or two solutions. Moreover, if R0=1, and since N=Λ/d, it follows that (20) f(N)=d(d+ααd)dΛμ1Λ+dd(d+ααd)μ1=0,(20) Therefore the tangent to the convex curve is horizontal, and, consequently, there is only one point of intersection between the horizontal line and the curve which is the DFE.

It is easy to verify that if R0>1 or αβ>d(d+α)μ, then f(N)>0 and, consequently, there is an equilibrium point on the left-hand side intersection between the convex curve and the horizontal straight line, with S<N. This proves the existence and uniqueness of the endemic equilibrium point if R0>1.

4.2. Reproduction number computed using the DFE or the endemic equilibrium

We consider the endogenous model with γ=0 and φ1(I(t)/N)=eβ1I(t)/N, (21) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)eβiI(t)/NS(t)+r1(1d)E(t)+r2(1d)I(t)E(t+1)=μ1(1d)(1eβiI(t)/N)S(t)+(1d)(1αr1)E(t)I(t+1)=α(1d)E(t)+(1d)(1r2)I(t)(21) We are going to use the next-generation matrix approach [Citation15]. Let X0=(E,I)T, X1=ST, X=(X0,X1)R+3. Hence system (Equation21) may be written as (22) X0(t+1)=G0(X(t))X1(t+1)=G1(X(t))(22) where G0(X(t))=(E(t+1)I(t+1))=F(t)+T(t), and G1(X(t))=S(t+1), where is the vector of all other transitions. F(t)=(μ1(1d)((1eβiI(t)/NS(t)0)=(F1(t)F2(t))is the vector of new infections that survive in the time interval [0,t], and T(t)=((1d)(1r1α)E(t)α(1d)E(t)+(1d)(1r2)I(t))=(T1(t)T2(t))Let T(t) and F(t) be the Jacobian matrices of T(t) and F(t), respectively, at the endemic equilibrium E=(E,I,S). Then F(IT)1=(0(1d)μ1β1eβ1I/NSN00)×(1(1(1d)(1αr1))α(1(1d)(1αr1))(1(1d)(1r2))011(1d)(1γr2))=(μ1αβ1(1d)eβ1I/NSN(1(1d)(1αr1))(1(1d)(1r2)))0(1d)μ1αβ1eβ1I/NSN(1(1d)(1r2))0) (23) R0(E)=(1d)μ1αβ1eβ1I/NN(1(1d)(1αr1))(1(1d)(1r2))S.(23) Using (Equation12) it is equivalent to (24) R0(E)=αβ1[(μ1+d+r1)SΛ]N(d+α+r1)(d+γ+r2)(24)

Remark 4.3

At the DFE E0=(0,0,S), one has S=N, I=0, then R0(E0)=(1d)μ1αβ1(1(1d)(1αr1))(1(1d)(1γr2)) as computed in Section 3.

4.3. Existence and uniqueness in the case γ=0, r10,r20

Next, we are going to use the implicit function theorem for systems to show the existence of the endemic equilibrium in the case r10, r20, and γ=0. But before stating the theorem we introduce a few notations and a definition.

Definition 4.4

Let U be an open set in Rm+n and suppose that F;URn is a vector function F(x,y), F=(F1,F2,Fn), where x=(x1,x2xn), y=(x1,x2ym). We define the n×m and the n×n matrices ΔxF and ΔyF by the formulas ΔxF=(F1x1F1x2F1xmF2x1F2x2F2xmFnx1Fnx2Fnxm).

Theorem 4.5

Implicit Function Theorem [Citation22]

Let G be an open set in Rm+n containing the point (a,b). Suppose that F:URn is continuous and has first partial derivatives in G such that F(a,b)=0 and detΔyF(a,b)0. Then there exist δ>0 and η>0 such that for every xB(a,δ) there exists a unique yB(b,η) with F(x,y)=0.

5. Local stability of the endemic equilibrium of the endogenous system

Assume that γ=0. Then limtN(t)=N=Λ/dIn this case, the endogenous system (Equation2) is asymptotic to the system (25) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N)S(t)+r1(1d)E(t)+r2(1d)I(t)E(t+1)=μ1(1d)(1φ1(I(t)/N))S(t)+(1d)(1αr1)E(t)I(t+1)=α(1d)E(t)+(1d)(1r2)I(t)(25)

Theorem 5.1

Assume that γ=0 and R0(E)<1<R0(E0). Then for sufficiently small r1 and r2 the endemic equilibrium of the endogenous system (Equation25) is locally asymptotically stable.

Proof.

The Jacobian matrix of system (Equation2) at E is given by (26) B=JF(E)=((1μ1)(1d)+μ1(1d)eβ1INr1(1d)μ1(1d)(1eβ1IN)(1d)(1αr1)0α(1d)r2(1d)μ1(1d)β1SNeβ1INμ1(1d)β1SNeβ1IN(1d)(1r2)).(26) To find the eigenvalues of B=JF(E), we solve the characteristic equation det(BλI)=0 |(1μ1)(1d)+μ1(1d)eβ1INλr1(1d)μ1(1d)(1eβ1IN)(1d)(1αr1)λ0α(1d)r2(1d)μ1(1d)β1SNeβ1INμ1(1d)β1SNeβ1IN(1d)(1r2)λ|=0Now adding the first row and the third row to the second row we get |(1μ1)(1d)+μ1(1d)eβ1INλr1(1d)1dλ1dλ0α(1d)r2(1d)μ1(1d)β1SNeβ1IN1dλ(1d)(1r2)λ|=0Factoring out 1dλ, we see that the first eigenvalue is λ1=1d<1. The remaining eigenvalues are solutions to the characteristic equation |(1μ1)(1d)+μ1(1d)eβ1INλr1(1d)110α(1d)r2(1d)μ1(1d)β1SNeβ1IN1(1d)(1r2)λ|=0The characteristic equation may be written as p(λ)=λ2+a1λ+a0,where We now apply the Jury test to show that the remaining two eigenvalues are inside the unit disk.

Using the assumption R0(E)<1<R0(E0), one may show that p(1)>0, p(1)>0, and a0<1. Therefore, the endemic equilibrium is locally asymptotically stable.

In the case γ0, we need the following perturbation theorem [Citation23]

Theorem 5.2

Consider the system x(t+1)=F(x(t),η)=Fη, where η={η1,η2,,ηm}, where F:U×GU is continuous, URn, GRm. Let x0 be the interior equilibrium point of F0(x). Assume that the spectral radius ρ(JF(x0))<1. Then there exists δ>0 and a unique x(η)U for ηB(η0,δ) such that F(x,η))=x and Ft(z)x(η)) as t for all zU.

The final step in our analysis is to use the theory of the limiting equation. Let R+n denote the cone of nonnegative vectors in Rn and let int( R+n) and (R+n) denote the interior and the boundary of R+n, respectively. Let F, Ft:R+nR+n to be continuous functions for all tZ+. Assume that

A1: Ft converges uniformly to F as t.

Then x(0)R+n implies that the solutions of the nonautonomous difference equation (27) x(t+1)=Ft(x(t)),(27) satisfies x(t)R+n, for all tZ+ where x=(x1,x2,,xn)R+n.

The same is true for solutions of the limiting equation (28) x(t+1)=F(x(t)),(28) where we assume

A2: ft:int(R+n)int(R+n).

Here, it is always true that x(0)int(R+n) implies that the solutions of the nonautonomous difference Equation (Equation27) satisfies x(t)int(R+n), for all tZ+.

Theorem 5.3

[Citation24,Citation25]

Assume A1 and A2 and the limiting equation has an equilibrium point xR+n. Then

(i)

if xint(R+n), and if it is locally asymptotically stable as an equilibrium point of the limiting equation, then x is locally asymptotically fixed point of the nonautonomous Equation (Equation27).

Based on this asymptotic theory we have the following final result on the local asymptotic stability of the system (Equation2)

Theorem 5.4

Assume that R0(E)<1<R0(E0). Then for sufficiently small r1, r2, and γ, the endemic equilibrium of the system (Equation2) is locally asymptotically stable.

5.1. Net reproduction number R0 of the exogenous model

We are going to use the next-generation matrix approach [Citation15,Citation26]. Let X0=(E,I)T, X1=ST, X=(X0,X1)R+3. Hence system (Equation2) may be written as (29) X0(t+1)=G0(X(t))X1(t+1)=G1(X(t))(29) where G0(X(t))=(E(t+1)I(t+1))=F(t)+T(t), and G1(X(t))=S(t+1), where F(t)=(μ1(1d)(1φ1(I(t)/N(t)))S(t)+μ2(1d)φ2(I(t)/N)E(t)0)=(F1(t)F2(t))is the vector of new infections that survive in the time interval [0,t], and T(t)=((1d)(1αr1μ2)E(t)α(1d)E(t)+μ2(1d)(1φ2(I(t)/N))E(t)+(1d)(1γr2)I(t))=(T1(t)T2(t))is the vector of all other transitions.

Next, we compute the Jacobian matrix of T(t) and F(t) at the disease-free equilibrium (DFE) E0=(0,0,S) F(t)|(0,0,S)=(F1(t)EF1(t)IF2(t)EF2(t)I)=(μ2(1d)μ1(1d)β1SN00)=(μ2(1d)μ1(1d)β100)T(t)|(0,0,S)=(T1(t)ET1(t)IT2(t)ET2(t)δI)=((1d)(1αr1μ2)0α(1d)(1d)(1γr2)).Now the basic reproduction number is given by R0(E0)=ρ(F(IT))1), where ρ denotes the spectral radius of a matrix [Citation15–17]. (30) R0(E0)=μ2(1d)1(1d)(1αr1μ2))+μ1(1d)2αβ1(1αr1μ2)(1(1d)(1αr1μ2)).(30)

Lemma 5.5

The basic reproduction number of the endogenous model is less (greater) than 1 if and only if the basic reproduction number of the exogenous model is less (greater) than 1. Moreover, they are equal if one of them is equal to 1.

Proof.

The proof is straightforward and will be omitted.

5.2. Local stability of DFE of the exogenous system

Theorem 5.6

The DFE (E0) of System (Equation1) is locally asymptotically stable if R0(E0)<1 and a saddle if R0(E0)>1

Proof.

The Jacobian matrix of system (Equation1) at E0 represented by J(E0) is given by J(E0)=((1d)r1(1d)r2(1d)μ1(1d)β10(1d)(1αr1μ2)μ1(1d)β10α(1d)(1d)(1γr2))The first eigenvalue of the Jacobian matrix is λ1=1d<1. The remaining two eigenvalues are the eigenvalues of the matrix A=((1d)(1αr1μ2)μ1(1d)β1α(1d)(1d)(1γr2)), The proof that the DFE is locally asymptotically stable if R0(E0)<1, and unstable if R0(E0)>1, is similar to the proof of Theorem (3.1) and will be omitted. Moreover if R0(E0)=1, one may show that det(A)=|tr(A)|1. Consequently, the eigenvalues of A are given by λ2=1 and λ3=tr(A)=(1d)(2αr1r2γμ2. By assumption A1, it follows that 0<λ3<1. Assume now that R0(E0)>1. Then det(A)<tr(A)1 and det(A)>tr(A)1. Hence, the DFE is unstable. More precisely, the DFE is a saddle since λ1=1d<1, λ2>1, and 0<λ3<1.

5.3. Global stability of DFE of the exogenous system via Liapunov functions

Theorem 5.7

Assume that R01. Then the disease-free equilibrium X=(0,X1) of the exogenous system (Equation1) is globally asymptotically stable.

The proof is similar to the proof of Theorem 3.3 and will be omitted

6. Local stability of the endemic equilibrium of the exogenous system

Theorem 6.1

Assume that R0(E)<1<R0(E0). Then for sufficiently small r1, r2, μ2 and γ, the endemic equilibrium of the system (Equation1) is locally asymptotically stable.

The proof is similar to the proof of Theorem 5.4 and will be omitted.

7. The SEIT compartmental model (with treatment)

After one unit of time, a susceptible individual can be infected through contact with the infectious and enter the latent or exposed class, still be in the susceptible class, or die. A latent individual may become infectious and enter the infectious class, get tested and, subsequently, be treated, pass into the treated class, stay in the latent class, or die. An infected can be treated and enter the treated or recovered class, stay in the infectious class, or die. According to [Citation17], an infected may also revert to exposed status. A treated individual can recover by effective treatment or regress back to the exposed class, stay in the treated/recovered class, or die. Many researchers have expounded that certain features of TB dynamics, such as slow transmission and complicated parameter estimation, require updated methods. The ambiguity of the SEIT model derives from people in the infectious compartment getting treatment. Some proportion q move to the recovered class, while a proportion p does not complete treatment and relapse to the latent class, which causes an influx of exposed individuals that may be interpreted as new infections. Consequently, we have two options: (1) view the relapse term pr2I as new infections or (2) view the relapse term as existing infections [Citation4]. The data presented in [Citation4] chronicles the re-emergence of tuberculosis during the 1980s, coinciding with the HIV/AIDS epidemic. TB rates began to rise from a low of 22,201 cases in 1985, accelerating in the early 1990s and peaking at 26,673 in 1992. Rates of latent TB have always been high among injecting drug users, and NIDA (National Institute on Drug Abuse) [Citation27] studies demonstrate that HIV infection, which is also prevalent among intravenous drug users, can activate latent TB. Lack of access to TB therapy or failure to complete a full course of treatment due to costs additionally contributes to active TB development and transmission. A 2018 report by Ma et al. [Citation4] states that TB incidence in San Francisco peaked between 1991 and 1993 because of the TB/HIV co-epidemic, which produced a high estimated reproductive number of around 2.1. As may be seen in the chart flow Figure , the SEIT model is given below. (31) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N(t))S(t)E(t+1)=μ1(1d)(1φ1(I(t)/N(t))S(t)+μ2(1d)φ2(I(t)/N(t))E(t)+μ3(1d)(1φ3(I(t)/N(t))T(t)+(1d)(1αr1μ2)E(t)+p(1d)r2I(t)I(t+1)=α(1d)E(t)+μ2(1d)(1φ2(I(t)/N(t))E(t)+(1d)(1r2γ)I(t)T(t+1)=r1(1d)E(t)+q(1d)r2I(t)+μ3)(1d)φ3(I(t)/N(t))T(t)+(1μ3)(1d)T(t)(31) where φi(I/N)=eβiI/N, i=1,2,3, and p + q = 1)

Figure 2. Chartflow of the exogenous model with treatment.

Figure 2. Chartflow of the exogenous model with treatment.

Assuming γ=0, then N(t+1)=Λ+(1d)N(t) and thus the equilibrium N(t)Λ/d=N Hence, we may study the above system with N(t) replaced by N and we have the limiting equation (32) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N)S(t)E(t+1)=μ1(1d)(1φ1(I(t)/N)S(t)+μ2(1d)φ2(I(t)/N)E(t)+μ3(1d)(1φ3(I(t)/N)T(t)+(1d)(1αr1μ2)E(t)+p(1d)r2I(t)I(t+1)=α(1d)E(t)+μ2(1d)(1φ2(I(t)/N)E(t)+(1d)(1r2)I(t)T(t+1)=r1(1d)E(t)+q(1d)r2I(t)+μ3(1d)φ3(I(t)/N)T(t)+(1μ3)(1d)T(t)(32)

7.1. The computation of R0(E0)

We are going to use the next-generation matrix approach [Citation15]. Let X0=(E,I)T, X1=(S,T)T, X=(X0,X1)R+4. Hence system (Equation34) may be written as (33) X0(t+1)=G0(X(t))X1(t+1)=G1(X(t))(33) where G0(X(t))=(E(t+1)I(t+1))=F(t)+T(t), and G1(X(t))=(S(t+1)T(t+1)), where F(t)=(μ1(1d)(1φ1(I(t)/N)S(t)+μ3(1d)(1φ3(I(t)/N))T(t)+pr2I(t)μ2(1φ2(I(t)/N)E(t))=(F1(t)F2(t))is the vector of new infections that survive in the time interval [0,t], and T(t)=((1dαr1)E(t)+μ2φ2(I(t)/N)E(t)αE(t)+(1dr2γ)I(t))=(T1(t)T2(t))is the vector of all other transitions.

Next, we compute the Jacobian matrix of T(t) and F(t) at the disease-free equilibrium (DFE) E0=(0,0,0,S) F(t)|(0,0,S,0)=(F1(t)EF1(t)IF2(t)EF2(t)E)=(0pr2(1d)+μ1(1d)β100)T(t)|(0,0,S,0)=(T1(t)ET1(t)IT2(t)ET2(t)δI)=((1d)(1αr1)μ2(1d)0α(1d)(1d)(1γr2)).Now the basic reproduction number is given by R0=ρ(F(IT)1), where ρ denotes the spectral radius of a matrix [Citation15–17].

Hence R0=α(1d)2(μ1β1+pr2)(1(1d)(1αr1)μ2(1d))(1(1d)(1γr2)). The expression gives the number of secondary infections that one infected will produce in an entirely susceptible population during its lifespan.

The statement in blue below needs to be revised

As it happens, β1S+β2T is the number of secondary infections that one infected individual will produce in a unit of time. If the population is entirely susceptible, then T = 0. The lifespan of an infectious individual is 1/(d+γ+r2). However, only a fraction α/(d+α+r1) survives the exposed period and moves to infected status. The fraction (αpr2)/(d+α+r1)(d+γ+r2) gives the infected individuals who relapse, survive the exposed period, and become infectious again.

7.2. Local stability of DFE of the SEIT model

Theorem 7.1

The DFE (E0) of system (Equation31) is locally asymptotically stable if R0(E0)<1 and unstable if R0(E0)>1.

Proof.

The Jacobian matrix of system (Equation34) at E0 represented by J(E0) is given by J(E0)=(d+10μ1β1001dαr1μ2pr2+μ1β100α1dγr200r1qr21d)The first eigenvalue of the Jacobian matrix is λ1=λ4=1d<1. The remaining two eigenvalues are the eigenvalues of the matrix A=(1dαr1μ2pr2+μ1β1α1dγr2),We now use the determinant-trace criteria to show that the two eigenvalues of this matrix lie inside the unit disk [Citation18,Citation19]. One may show that the eigenvalues of A are inside the unit disk if R0<1 and unstable if R0>1 Now if R0=1, then det(A)=tr(A)1. This implies that λ2=1 and |λ3|<1 and the system goes through transcritcal bifurcation.

Next, we state the global stability result of DFE.

Theorem 7.2

Assume that R01. Then the DFE of (Equation31) is globally asymptotically stable.

Proof.

The proof is similar to the proof of Theorem 3.1 and will be omitted

7.3. Reproduction number computed using the endemic equilibrium

Assuming γ=0, then N(t+1)=Λ+(1d)N(t) and thus the equilibrium N(t)Λ/d=N. We also assume that μ2=0. Hence, we may study the above system with N(t) replaced by N and we have the limiting equation (34) S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)φ1(I(t)/N)S(t)E(t+1)=μ1(1d)(1φ1(I(t)/N)S(t)+μ3(1d)(1φ3(I(t)/N)T(t)+(1d)(1αr1)E(t)+p(1d)r2I(t)I(t+1)=α(1d)E(t)+(1d)(1r2)I(t)T(t+1)=r1(1d)E(t)+q(1d)r2I(t)+μ3(1d)φ3(I(t)/N)T(t)+(1μ3)(1d)T(t)(34) Let X0=(E,I)T, X1=(S,T)T, X=(X0,X1)R+4. Hence system (Equation34) may be written as (35) X0(t+1)=G0(X(t))X1(t+1)=G1(X(t))(35) where G0(X(t))=(E(t+1)I(t+1))=F(t)+T(t), and G1(X(t))=(S(t+1)T(t+1)), where F(t)=(μ1(1d)(1φ1(I(t)/N)S(t)+μ3((1d)1φ3(I(t)/N)T(t)+pr2(1d)I(t)0)=(F1(t)F2(t))is the vector of new infections that survive in the time interval [0,t], and T(t)=((1d)(1αr1)E(t)α(1d)E(t)+(1d)(1r2)I(t))=(T1(t)T2(t))is the vector of all other transitions.

Next, we compute the Jacobian matrix of T(t) and F(t) at the endemic equilibrium (EE) E0=(E,I,S,T) F(t)|(E,I,S,T)=(F1(t)EF1(t)IF2(t)EF2(t)E)=(0(1d)(pr2+μ1β1φ1(I/N)S/N+μ3β1φ3(I/N)T/N)00)T(t)|(E,I,S,T)=(T1(t)ET1(t)IT2(t)ET2(t)δI)=((1d)(1αr1μ2)0α(1d)(1d)(1r2)).Now the basic reproduction number is given by R0(E)=ρ(F(IT))1), where ρ denotes the spectral radius of a matrix [Citation15–17]. Hence R0(E)=α(1d)2(pr2+μ1β1φ1(I/N)S/N+μ3β1φ3(I/N)T/N))(d+α+r1+μ2)(d+r2+γ)+αμ2β2φ2(I/N)T/N. The expression gives the number of secondary infections that one infected will produce in an entirely susceptible population during its lifespan. This expression reduces to the net reproduction number based on the disease-free equilibrium.

8. Existence of the endemic equilibrium of the SEIT compartmental model (with treatment)

8.1. case γ0, μ10, r10, r20, μ2=0, μ3=0

Proposition 8.1

Assume that γ0, μ10, r10, r20, μ2=0 and μ3=0. Then every equilibrium point E=(S,E,I,T) of model (Equation34) is of the form (36) E=(S,(d+r2dr2)(ΛdS)L1,α(1d)(ΛdS)L1,L2(ΛdS)L1)(36) with S solution of (37) L1Nln[μ1(1d)S(μ1+dμ1d)SΛ]+αβ1(1d)dS=(1d)αβ1Λ,(37) with L1=[[(1d)(α+r1)+d](d+r2dr2)α(1d)2pr2], and L2=[r1(d+r2dr2)+(1d)qr2α].

This equation can also be written as (38) L1N[ln(S)ln[(μ1+d)SΛ]]+αβ1dS=αβ1ΛL1Nln(μ1),(38)

Proof.

Consider S(t+1)=Λ+(1μ1)(1d)S(t)+μ1(1d)eβ1(I(t)/N)S(t)when S(t+1)=S(t),

one has: (39) (1d)μ1eβ1INS=Λ+(μ1+dμ1d)S(39) then if μ1>0, β1>0 and S>0 eβ1IN=Λ+(μ1+dμ1d)S(1d)μ1Sor (40) ln[eβ1IN]=ln[Λ+(μ1+dμ1d)S(1d)μ1S]β1IN=ln[Λ+(μ1+dμ1d)S(1d)μ1S]I=Nβ1ln[Λ+(μ1+dμ1d)S(1d)μ1S](40) Consider now E(t+1)=(1d)μ1(1eβ1(I(t)/N))S(t)+(1d)(1αr1)E(t)+(1d)pr2I(t)when E(t+1)=E(t), one has: 0=μ1(1d)(1eβ1IN)S[(1d)(α+r1)+d]E+(1d)pr2I(t)From (Equation39) it comes: (41) 0=μ1(1d)S+Λ(μ1+dμ1d)S[(1d)(α+r1)+d]E+(1d)pr2I(t)[(1d)(α+r1)+d]E+(1d)pr2I(t)=ΛdS(41) Consider now I(t+1)=α(1d)E(t)+(1d)(1r2)I(t)when I(t+1)=I(t), one has: (42) 0=α(1d)E(d+r2dr2)IE=(d+r2dr2)Iα(1d)(42) inserting (Equation42) in (Equation41) we obtain: (43) [(1d)(α+r1)+d](d+r2dr2)I(1d)α(1d)pr2I=ΛdS(43) or (44) [[(1d)(α+r1)+d](d+r2dr2)α(1d)2pr2]I(1d)α=ΛdS(44) thus, as L1=[[(1d)(α+r1)+d](d+r2dr2)α(1d)2pr2] (45) I=α(1d)(ΛdS)L1(45) Equaling (Equation40) to (Equation45) it comes (46) α((ΛdS)L1=Nβ1ln[Λ+(μ1+dμ1d)S(1d)μ1S]d)(46) or (47) L1Nln[(1d)μ1S(μ1+dμ1d)SΛ]+(1d)αβ1dS=(1d)αβ1Λ(47) Considering now the fourth equation of (Equation34) (48) T(t+1)=(1d)r1E(t)+(1d)qr2I(t)+(1d)T(t)(48) when T(t+1)=T(t),

It comes (49) T=(1d)(r1E+qr2I)d(49) or (50) T=[r1(d+r2dr2)+(1d)qr2α]Id(1d)α(50) or (51) T=[r1(d+r2dr2)+(1d)qr2α](ΛdS)L1(51) or, as L2=[r1(d+r2dr2)+(1d)qr2α] (52) T=L2(ΛdS)L1(52)

8.2. Existence and uniqueness of the endemic equilibrium

Theorem 8.2

Assume that γ0, μ10, r10, r20, μ2=0, μ3=0 and R0>1. Then there exists a unique endemic equilibrium point E=(S>0, E0, I0, T0) of system (Equation34)

Proof.

Consider the function (53) f(x)=L1Nln[(1d)μ1x(μ1+dμ1d)xΛ]+(1d)αβ1dx,(53) which is only defined for x>Λμ1+d.

Its derivative is: (54) f(x)=L1NΛx[(μ1+dμ1d)xΛ]+(1d)αβ1d,(54) and its second derivative is: (55) f′′(x)=L1NΛ[2(μ1+dμ1d)xΛ]x2[(μ1+dμ1d)xΛ]2,(55) which is always positive because from (Equation11) (μ1+dμ1d)SΛ>0, i.e. (μ1+dμ1d)xΛ>0,

hence Λ<(μ1+dμ1d)x<2(μ1+dμ1d)x and L1>0 because L1=[[(1d)(α+r1)+d](d+r2dr2)α(1d)2pr2] it is known that 0<r2<1, the other parameters being positive, L1 must be >0.

Therefore f(x) is convex and f(x) is always increasing.

The equation (56) f(x)=(1d)αβ1Λ,(56) which represents the intersection of a convex curve with and horizontal straight line, and can have either zero, one, or two solutions.

Clearly, x=N satisfies Equation (Equation56), which gives us the disease equilibrium point (S,0,0,0). Therefore this equation can have only one or two solutions. Moreover, if R0=1, and since N=Λ/d, it follows that (57) f(N)=(d+γ)(d+α)dΛμ1Λ+d(d+γ)(d+α)μ1=0,(57) Therefore the tangent to the convex curve is horizontal, and, consequently, there is only one point of intersection between the horizontal line and the curve which is the DFE.

It is easy to verify that if R0>1 or αβ1>d(d+α)μ, then 1 f(N)>0 and, consequently, there is an equilibrium point on the left-hand side intersection between the convex curve and the horizontal straight line, with S<N. This proves the existence and uniqueness of the endemic equilibrium point if R0>1.

9. Local stability of the endemic equilibrium of the SEIT compartmental model (with treatment)

Assume that μ2=r1=r2=γ=0. This implies that limtT(t)=limt(φ3(I(t)/N)+1μ3d)tT(0)=0 In this case, the system (Equation34) is equivalent to the SEI model (58) S(t+1)=Λ+(1μ1d)S(t)+μ1φ1(I(t)/N)S(t)E(t+1)=μ1(1φ1(I(t)/N)S(t)+(1dα)E(t)I(t+1)=αE(t)+(1d)I(t)(58)

Theorem 9.1

Assume that μ2=μ3=r1=r2=0. and R0(E)<1<R0(E0). Then for sufficiently small r1, r2, and μ2, the endemic equilibrium of the system (Equation34) is locally asymptotically stable.

Proof.

The Jacobian matrix of system (Equation2) at E is given by (59) B=JF(E)=(1(μ1+d)+μ1eβ1INr1r2μ1β1SNeβ1INμ1(1eβ1IN)1dαr1μ1β1SNeβ1IN0α1dr2).(59) To find the eigenvalues of B=JF(E), we solve the characteristic equation det(BλI)=0 |1(μ1+d)+μ1eβ1INλ0μ1β1SNeβ1INμ1(1eβ1IN)1dαλ00α1dλ|=0Now adding the first row and the third row to the second row we get |1(μ1+d)+μ1eβ1INλ0μ1β1SNeβ1IN1dλ1dλ1dλ0α1dλ|=0Factoring out 1dλ, we see that the first eigenvalue is λ1=1d<1. The remaining eigenvalues are solutions of the characteristic equation |1(μ1+d)+μ1eβ1INλ0μ1β1SNeβ1IN1110α1dλ|=0The characteristic equation may be written as p(λ)=λ2+a1λ+a0We now apply the Jury test to show that the remaining two eigenvalues are inside the unit disk. Since R0(E)<1 it is easy to show that p(1)>0 and p(1)>0. One may show that the constant term a0<1. Therefore, the endemic equilibrium is locally asymptotically stable.

The final general result now follows.

Theorem 9.2

Assume that μ20, r10, r20,andγ0, and R0(E)<1<R0(E0). Then for sufficiently small r1, r2, γ, and μ2, the endemic equilibrium of the system (Equation31) is locally asymptotically stable.

Proof.

Using Theorems 5.3 and 5.2 theorems, one may mimic the proof of Theorem 5.4.

10. Numerical simulation

10.1. Numerical simulationala

The population of India is 1,426,086,000 and the growth rate d = 0.0081. What is approximately sure: the number of exposed 40% of the population = 570,434,000.

Case I: SEI converges toward EE, SEIT converges toward DFE. From Table , we have:

Table 1. Shows that, with the given values of the parameters, the SEI is epidemic, while the SEIT model is disease-free.

SEI Exogenous model

N = 1, 426, 086, 000 in 2023 (1.426086×109) (population of India)

Λ=11,551,297, d = 0.0081, α=0.00081, β1=β2=1.5, μ1=0.05, μ2=0.042, γ=0.0002, r1=0.0016, r2=0.0048

SEIT model

Same values +β3=1.5, μ3=0.08, p = 0.8, q = 1−p = 0.2

Case II: SEI and SEIT converge toward EE. From Table , we have:

Table 2. shows that, with the given values of the parameters, both the SEI and SEIT are endemic.

SEI Exogenous model

N = 1, 426, 086, 000 in 2023 (1.426086×109) (population of India)

Λ=11,551,297, d = 0.0081, α=0.00081, β1=β2=2.5, μ1=0.05, μ2=0.04, γ=0.0002

r1=0.0025, r2=0.002

SEIT model

Same values +β3=0.1, μ3=0.008, p = 0.8, q = 1−p = 0.2

11. Conclusion and open problems

From Table , one can see that if a population's treatment level is sufficiently high, the disease dies out, while with no treatment, the disease becomes endemic.

From Table , one can see that if a population's treatment level is low, the disease becomes endemic with and without treatment. However, it should be noted that the number of infections in the SEIT model is 153 million less than in the SEI model. Finally, we state a couple of open problems that will be addressed in the future.

  • We conjecture that local asymptotic stability of the endemic equilibrium for both SEI and SEIT models implies global asymptotic stability.

  • The investigation of the bifurcation when R0(E)=1 is still an open problem.

Disclosure statement

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Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

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