Bayesian epidemic alignment for causal evaluation of seasonal infectious-disease interventions

Abstract

Seasonal infectious-disease interventions are commonly evaluated with interrupted time-series or pre--post designs that align epidemics by calendar week. When epidemic onset, speed or peak timing differs between seasons, such comparisons confound a shift in epidemic phase with a change in disease burden. We propose a Bayesian causal count model in which season-specific affine transformations map calendar time to a latent epidemic clock, and intervention effects are estimated on that clock rather than on the calendar. The alignment is a model component rather than a preprocessing step, so uncertainty about epidemic timing propagates into every causal contrast. The model uses a negative-binomial observation distribution, hierarchical area, season and area-season effects, a shrunk Fourier epidemic curve, and a continuous programme-intensity exposure. Posterior g-computation yields prevented cases, prevented fractions, peak attenuation and epidemic displacement, under both a controlled contrast and a dynamic contrast that propagates disease history within each arm. A two-tier simulation study evaluates bias, root mean squared error, interval coverage and parameter recovery under stable timing, epidemic-clock variation, intensity-dependent ascertainment and area-level confounding. We illustrate the framework using open Catalan primary-care surveillance and respiratory syncytial virus immunisation data, with explicit attention to the overlap in programme intensity that identifies the effect.