Possibility and Causes of Backward

Bifurcation in a Cholera Model

Sandeep Sharma and Nitu Kumari

Abstract Backward bifurcation in an epidemiological model is a phenomenon in

which the model possesses stable endemic equilibria together with a stable
disease-free equilibrium. Till now, this phenomenon has been observed in a number
of epidemic models. In this work, we investigate the possibility of backward
bifurcation in a cholera model. We also explore the role of various factors, which
induce backward bifurcation in other epidemic models. We believe the present
work provides an insight of the dynamics of a cholera model and possible causes of
backward bifurcation in the same.

1 Introduction

Occurrence of various infectious diseases (like dengue, tuberculosis, cholera) posed

a major challenge in front of the modern society. The event of infectious disease
results in huge loss of lives and other resources. Despite our increased under-
standing of infectious diseases and development of medical sciences, the infectious
diseases caused millions of deaths and disabilities across the globe. Hence, people
from different corners of science and medicine are working to find some robust
mechanism to prevent the spread of infectious diseases. Compartmental mathe-
matical models have emerged as a useful tool in this direction. The information
provided by these models helps in reducing or eliminating the epidemics. However,
the success of an epidemic model to predict the future course of the epidemic lies in
the assumptions involved in the formulation of the model.
Waterborne diseases (e.g., cholera, typhoid, hepatitis) are outcome of scarcity of
safe drinking water. The possibility of multiple transmission of disease makes the
study of waterborne disease more challenging. Among all the diseases which
belong to the class of waterborne diseases, cholera attracts more attention. This

S. Sharma
N. Kumari (&)

School of Basic Sciences, Indian Institute of Technology Mandi,
Mandi 175001 Himachal Pradesh, India
e-mail: nitu@iitmandi.ac.in

© Springer Nature Singapore Pte Ltd. 2018 673

M.K. Singh et al. (eds.), Applications of Fluid Dynamics, Lecture Notes
in Mechanical Engineering, https://doi.org/10.1007/978-981-10-5329-0_51
674 S. Sharma and N. Kumari

accounts to 3–5 million cholera cases and 100,000–120,000 deaths around the
globe.
Cholera is caused by the bacterium Vibrio cholera. The bacteria enter into the
human body through ingestion of contaminated water and food. Cholera can
transmit directly, from human to human, and also indirectly, from environment to
human. At primary stage, there may be no symptoms of the infection but in long
term, it may turn fatal and cause leg cramps, vomiting, and watery diarrhea (Mwasa
and Tchuenche 2011). In the absence of proper treatment, the infection results in
circulatory collapse, rapid dehydration, and death within 12–24 h (Sanchez et al.
1994). Despite several efforts, cholera is still an endemic in many parts of the world
(Safi et al. 2013). Accounts to this, a number of mathematical models are proposed
and analyzed to comprehend the dynamics of cholera. To study the spread of 1973
cholera in Mediterranean, a mathematical model was proposed and analyzed by
Capasso and Fontana (1979). In Codeço (2001), an extension of the general SIR
epidemic model is proposed by incorporating environmental component to under-
stand the dynamics of cholera. Hartley et al. (2005) extended the model proposed in
Codeço (2001) by introducing the concept of hyperinfectivity. The mathematical
model proposed in Mukandavire et al. (2011) considers both human-to-human and
environment-to-human transmission of cholera to study the patterns of disease
transmission in Zimbabwe. The model proposed in Mwasa and Tchuenche (2011),
and Posny et al. (2015) investigate the role of public health interventions to prevent
the spread of epidemics. As vaccination is a significant tool to reduce the size of the
epidemic, therefore a number of models pertaining to cholera address the role of
vaccination on the spread of cholera (Safi et al. 2013; Zhou et al. 2012; Zhou and
Cui 2011). The use of disinfectants is another potential method to prevent the
spread of cholera. Hence, mathematical models are also used to study the impact of
disinfectants on the dynamics of cholera (Misra and Singh 2012; Misra et al. 2012).
The manuscript is organized in four sections. A survey on possible causes of
backward bifurcation in epidemic models is performed in Sect. 2. The existence of
backward bifurcation is explored in Sect. 3. The manuscript ends with a conclusion
of our study in Sect. 4.

2 Backward Bifurcation

The basic reproduction number helps us to comprehend the dynamics of a com-

partmental epidemic model. In general, the diseases can be eliminated (or
disease-free equilibrium will be stable) by making R0 \1:, while disease persists in
the population (or endemic equilibrium will be stable) if R0 [ 1. But for some
model, the dynamics will be more complicated. In such models, an stable endemic
equilibrium exists even when R0 \1. This phenomenon is termed as backward
bifurcation. In other words, in case of backward bifurcation, making R0 < 1 does
not ascertain that the disease will eliminate. An extensive detail on backward
bifurcation can be found in Brauer (2004, 2011) and Dushoff et al. (1998).
Possibility and Causes of Backward Bifurcation in a Cholera Model 675

The schematic diagram of forward bifurcation and backward bifurcation is given in

Figs. 1 and 2, respectively. In short, we can conclude that the study of backward
bifurcation is necessary due to the following two facts:
(i) The control of disease requires more efforts whenever the backward bifurca-
tion occurs. This particular reason relates it directly to the health management
programs implemented by the authorities.
(ii) The backward bifurcation gives rise to more complicated dynamics and thus
requires more mathematical efforts to deal with the particular model.

Fig. 1 Forward bifurcation

Fig. 2 Backward bifurcation

676 S. Sharma and N. Kumari

Due to the above-mentioned reasons, the possibility of backward bifurcation

have been explored in different epidemic models of tuberculosis (Gerberry 2016;
Chavez and Song 2004; Buonomo and Lacitignola 2010), malaria (Chitnis et al.
2006; Buonomo and Vargas-De-León 2013; Mukandavire et al. 2009), Chlamydia
trachomatis (Sharomi and Gumel 2011a, b, 2009), and dengue (Garba et al. 2008).
Apart from this, the backward bifurcation also exists for model with different
epidemiological phenomena such as vaccination (Arino et al. 2003; Buonomo and
Lacitignola 2011; Zaleta and Hernandez 2000; Sharomi et al. 2007), types of
transmission rate (Buonomo and Lacitignola 2012; Alexander and Moghadas
2004), and types of treatment functions (Wang 2006; Zhang and Liu 2008).

3 Backward Bifurcation in Cholera Model

As we have discussed in Sect. 1, the dynamics of cholera is complicated due to the

possibility of multiple transmission pathways. To inculcate this, a number of
mathematical models are proposed to capture the dynamics of cholera. Despite this,
backward bifurcation is generally absent in the cholera model. A number of vac-
cination models exhibit backward bifurcation. But, the same is not true for cholera
models with vaccination (discussed in 1).
In particular, the model studied in Zhou et al. (2012) seems a suitable candidate
for backward bifurcation, as it consists of both saturation transmission rate and
imperfect vaccination.

dS bSB
¼ ð1  qÞA   /S þ hV  l1 S
dt ðK þ BÞ
dV rbVB
¼ qA  þ /S  hV  l1 V
dt ðK þ BÞ
ð1Þ
dI bSB rbVB
¼ þ  ð d þ a þ l1 Þ
dt ðK þ BÞ ðK þ BÞ
dB
¼ gI  l2 B
dt

The details of assumptions and parameters of the model can be find in Zhou et al.
(2012).
The model possesses two equilibrium points, namely disease free and endemic.
The disease-free equilibrium point is given as E0 ¼ ðS0 ; V 0 ; 0; 0Þ where,

A½h þ ð1  qÞl1  Að/ þ ql1 Þ

S0 ¼ and V0 ¼ :
l1 ðl1 þ h þ /Þ l1 ðl1 þ h þ /Þ
Possibility and Causes of Backward Bifurcation in a Cholera Model 677

For the model (1), the basic reproduction number is obtained as

gbA½h þ ð1  qÞl1 þ r/ þ rl1 q

Rv ¼
Kl1 l2 ðl1 þ h þ /Þðl1 þ a þ d Þ

Moreover, the existence of endemic equilibrium has been established by the

following quadratic equation

A1 I 2 þ A2 I þ A3 ¼ 0

where,


A1 ¼ l2 ðl1 þ d þ aÞ l21 þ l1 h þ l1 / þ l1 b þ l1 br þ b2 r þ bh þ b/r


A2 ¼ Kl1 2l21 þ 2l1 h þ 2l1 / þ bl1 þ b/r þ bh þ l1 rb
 Abrðrb þ l1 rq þ l1 þ h þ /r  ql1 Þ
A3 ¼ Kl1 l2 ðl1 þ d þ aÞðl1 þ h þ /Þð1  Rv Þ

There is possibility of backward bifurcation when A2 \0 and Rv \1. But, in

Sect. 5 of Zhou et al. (2012), it is shown that both conditions are not satisfied
simultaneously. This is probably due the absence of the reinfection.
Similarly, the other vaccination models proposed in Safi et al. (2013) and Cui
et al. (2014) do not exhibit backward bifurcation, while the other analogous generic
vaccination models (e.g., Brauer 2004; Arino et al. 2003; Buonomo and Lacitignola
2011) depict the existence of backward bifurcation. From this discussion, it appears
that the backward bifurcation may not be possible in cholera model. But, the
cholera model with saturated recovery proposed in Zhou et al. (2017) shows the
existence of backward bifurcation.
We proceed with a short discussion of the model presented in Zhou et al. (2017).
The model is;

dS bSB cI
¼A  l1 S þ rI þ
dt K þB bþI
dI bSB cI
¼  ðr þ l1 þ dÞI  ð2Þ
dt K þ B bþI
dB
¼ gI  l2 B
dt

The existence of endemic equilibrium has been established by the following

quadratic equation

P1 I 2 þ P2 I þ P3 ¼ 0
678 S. Sharma and N. Kumari

Here,


P1 ¼ g l1 r þ l21 þ bd þ bl1 þ l1 d
P2 ¼ Kl1 l2 r þ Kl1 l2 d þ Kl21 l2 þ gl1 bb þ gdbb þ bgrl1
þ l21 bg þ l1 dgb þ Abg
P3 ¼ Kl1 l2 ðbl1 þ c þ rb þ dbÞð1  R0 Þ

Motivated from this, we propose a new model with saturated removal rate b cIþ I as
follows

dS bSB
¼A  dS
dt K þB
dI bSB cI
¼  ðr þ d þ dÞI 
dt K þ B bþI ð3Þ
dR cI
¼ þ rI  dR
dt bþI
dB
¼ gI  lB
dt

In the model (3), A represents the total recruitment rate (including immigrants and
newborns). KbSBþ B is the disease transmission rate, where K is the concentration of the
bacteria that yields 50% chance of catching infection. The model also involves natural
recovery rate r. The natural death rate d is same for individuals of each compartment,
while the disease-related death rate is d. η is the rate at which infected population
contribute to the concentration of bacteria. The natural decay rate of the bacteria is µ.
The basic difference between models (2) and (3) is movement of the recovered
individuals. In model (2), the recovered individuals join the susceptible class and
may again get infected, while in model (3) recovered individuals join the removed
class and do not become infected, once recovered. Similar studies are available in
literature on generic compartmental models (Wang 2006, 2009).

Now, we obtain the disease-free equilibrium point as E 0 ¼ Ad ; 0; 0 : Next, we
calculate the basic reproduction number of the model using the next-generation
matrix method given by Van den Driessche and Watmough (2002) as

Agbb
R0 ¼
Kld ðrb þ bd þ db þ cÞ

The existence of endemic equilibrium is established by the following quadratic

equation

AI 2 þ BI þ C ¼ 0
Possibility and Causes of Backward Bifurcation in a Cholera Model 679

where,


A ¼ g dr þ d 2 þ bd þ bd þ dd þ br
B ¼ gbbd þ gbbd þ gbbr þ gbc þ lKd 2 þ lKdd þ lKdr
þ gbd 2 þ gbdd þ gbdr þ gcd  Abg
C ¼ Kld ðbd þ c þ rb þ dbÞð1  R0 Þ

Here, we state the following result for the existence of endemic equilibrium
Theorem 3.1 The proposed model system (3) has
(i) a unique endemic equilibrium whenever R0 [ 1;
(ii) a unique endemic equilibrium whenever R0 ¼ 1 and B < 0;
(iii) two endemic equilibriums if R0 \1, B < 0 and B2  4AC [ 0;
(iv) no endemic equilibrium otherwise.
Now, we discuss graphically the possibility of the backward bifurcation in
Fig. 3.
The infectious population at equilibria versus R0 shows a backward bifurcation
when Rc \R0 \1, leading to the existence of multiple endemic equilibria. The
saddle-node bifurcation occurs at R0 ¼ Rc , where the stable endemic equilibria
collide with other unstable endemic equilibria.
Although reinfection is not involved here, still the model shows the possibility of
the backward bifurcation.

Fig. 3 Bifurcation diagram of the model system (3)

680 S. Sharma and N. Kumari

4 Conclusion

The phenomena of backward bifurcation poses a serious health challenge as

bringing R0 below unity is not enough to eradicate the disease. Due to this, it is a
general tendency to avoid the backward bifurcation while modeling the disease, if
possible. But, the study performed in Gerberry (2016) made some contradictory
remarks to this general belief. The study observes that the factors (e.g., vaccination)
implemented to eliminate the disease increase the size of the region where the
backward bifurcation occurs. However, the number of infected individuals reduces
significantly in the presence of such interventions. The discussion on backward
bifurcation on cholera model yields that saturated recovery/treatment cause back-
ward bifurcation. This makes the scenario worse whenever the spread of cholera
takes place. Given the situation of the complicated dynamics and rapid spread of
cholera, efforts should be made to prevent the existence of backward bifurcation.
Moreover, the factors which induce the backward bifurcation in cholera model are
limited treatment capacity which in no case reduces the size of the epidemic as
discussed in Gerberry (2016).
Thus, present study brought forth an important fact that whenever the cholera
outbreak occurs, we should enforce maximum possible medical arrangements to
reduce the size of the epidemics. Such actions preclude the existence of backward
bifurcation and will also reduce the mortalities.

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