<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd">
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article">
 <front>
  <journal-meta>
   <journal-id journal-id-type="publisher-id">
    ojapps
   </journal-id>
   <journal-title-group>
    <journal-title>
     Open Journal of Applied Sciences
    </journal-title>
   </journal-title-group>
   <issn pub-type="epub">
    2165-3917
   </issn>
   <issn publication-format="print">
    2165-3925
   </issn>
   <publisher>
    <publisher-name>
     Scientific Research Publishing
    </publisher-name>
   </publisher>
  </journal-meta>
  <article-meta>
   <article-id pub-id-type="doi">
    10.4236/ojapps.2025.155096
   </article-id>
   <article-id pub-id-type="publisher-id">
    ojapps-142887
   </article-id>
   <article-categories>
    <subj-group subj-group-type="heading">
     <subject>
      Articles
     </subject>
    </subj-group>
    <subj-group subj-group-type="Discipline-v2">
     <subject>
      Biomedical 
     </subject>
     <subject>
       Life Sciences, Chemistry 
     </subject>
     <subject>
       Materials Science, Computer Science 
     </subject>
     <subject>
       Communications, Engineering, Physics 
     </subject>
     <subject>
       Mathematics
     </subject>
    </subj-group>
   </article-categories>
   <title-group>
    Mathematical Modelling of Conjunctivitis Viral Disease: Case of Burundi
   </title-group>
   <contrib-group>
    <contrib contrib-type="author" xlink:type="simple">
     <name name-style="western">
      <surname>
       Vianney
      </surname>
      <given-names>
       Mbazumutima
      </given-names>
     </name> 
     <xref ref-type="aff" rid="aff1"> 
      <sup>1</sup>
     </xref>
    </contrib>
    <contrib contrib-type="author" xlink:type="simple">
     <name name-style="western">
      <surname>
       Pascaline
      </surname>
      <given-names>
       Nshimirimana
      </given-names>
     </name> 
     <xref ref-type="aff" rid="aff1"> 
      <sup>1</sup>
     </xref>
    </contrib>
    <contrib contrib-type="author" xlink:type="simple">
     <name name-style="western">
      <surname>
       André
      </surname>
      <given-names>
       Dembele
      </given-names>
     </name> 
     <xref ref-type="aff" rid="aff2"> 
      <sup>2</sup>
     </xref>
    </contrib>
    <contrib contrib-type="author" xlink:type="simple">
     <name name-style="western">
      <surname>
       Fabiola
      </surname>
      <given-names>
       Ndayiragije
      </given-names>
     </name> 
     <xref ref-type="aff" rid="aff1"> 
      <sup>1</sup>
     </xref>
    </contrib>
    <contrib contrib-type="author" xlink:type="simple">
     <name name-style="western">
      <surname>
       Léonard
      </surname>
      <given-names>
       Todjihounde
      </given-names>
     </name> 
     <xref ref-type="aff" rid="aff3"> 
      <sup>3</sup>
     </xref>
    </contrib>
   </contrib-group> 
   <aff id="aff1">
    <addr-line>
     aEcole Normale Supérieure, Bujumbura, Burundi
    </addr-line> 
   </aff> 
   <aff id="aff2">
    <addr-line>
     aUniversité des Sciences, Techniques et Technologies de Bamako, Bamako, Mali
    </addr-line> 
   </aff> 
   <aff id="aff3">
    <addr-line>
     aInstitut de Mathématiques et des Sciences Physiques (IMSP), Porto-Novo, Bénin
    </addr-line> 
   </aff> 
   <pub-date pub-type="epub">
    <day>
     09
    </day> 
    <month>
     05
    </month>
    <year>
     2025
    </year>
   </pub-date> 
   <volume>
    15
   </volume> 
   <issue>
    05
   </issue>
   <fpage>
    1366
   </fpage>
   <lpage>
    1377
   </lpage>
   <history>
    <date date-type="received">
     <day>
      14,
     </day>
     <month>
      December
     </month>
     <year>
      2024
     </year>
    </date>
    <date date-type="published">
     <day>
      25,
     </day>
     <month>
      December
     </month>
     <year>
      2024
     </year> 
    </date> 
    <date date-type="accepted">
     <day>
      25,
     </day>
     <month>
      May
     </month>
     <year>
      2025
     </year> 
    </date>
   </history>
   <permissions>
    <copyright-statement>
     © Copyright 2014 by authors and Scientific Research Publishing Inc. 
    </copyright-statement>
    <copyright-year>
     2014
    </copyright-year>
    <license>
     <license-p>
      This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/
     </license-p>
    </license>
   </permissions>
   <abstract>
    In this paper, an SEIR mathematical model of conjunctivitis viral disease is formulated. The disease free equilibrium (DFE) and the endemic equilibrium points are investigated. The basic reproduction number is computed using the next generation matrix method and the local stability of the disease free equilibrium is investigated. This threshold characterizes the growth rate of an epidemic outbreak and shows that if 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
        R
       </mi> 
       <mn>
        0
       </mn> 
      </msub> 
      <mo>
       &lt;
      </mo>
      <mn>
       1
      </mn>
     </mrow> 
    </math> the DFE is locally stable and unstable when 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
        R
       </mi> 
       <mn>
        0
       </mn> 
      </msub> 
      <mo>
       &gt;
      </mo>
      <mn>
       1
      </mn>
     </mrow> 
    </math> . We analyze the sensitivity of the model according to its different parameters. Numerical simulations were performed using the defined parameters to support the theoretical results and compared to one from the real data. The results show the suitability of the chosen model of conjunctivitis viral disease that occurred in Burundi for the investigated period of one month.
   </abstract>
   <kwd-group> 
    <kwd>
     Conjunctivitis
    </kwd> 
    <kwd>
      Basic Reproduction Number
    </kwd> 
    <kwd>
      Sensitivity Index
    </kwd> 
    <kwd>
      Ruth-Hurwitz Criteria
    </kwd>
   </kwd-group>
  </article-meta>
 </front>
 <body>
  <sec id="s1">
   <title>1. Introduction</title>
   <p>For a very long time, humankind has been the target of many different kinds of illnesses with a range of causes. To protect themselves against these diseases, human beings have adapted illnesses by taking preventive or curative measures. These diseases attack different parts of the human body and, fortunately thanks to their ingenuity, humans have been able to develop appropriate countermeasures. Viral conjunctivitis is one of these diseases which have been registered in east Africa region. A lot of research has gone into understanding its origins, its development and how it spreads through the population. Since March 2024, Burundi has faced an epidemic of viral conjunctivitis named also Acute haemorrhagic conjunctivitis (AHC) <xref ref-type="bibr" rid="scirp.142887-1">
     [1]
    </xref>. But this disease has been around for a long time. It was first detected in Ghana in 1969 <xref ref-type="bibr" rid="scirp.142887-2">
     [2]
    </xref>. Conjunctivitis is inflammation of the conjunctiva with three causes such as viral, allergic, and bacterial, but most of the cases results from adenovirus <xref ref-type="bibr" rid="scirp.142887-3">
     [3]
    </xref>. It’s a contagious infectious disease characterized by the rapid onset of eye pain, swollen eyelids, foreign body sensation and excessive redness of the eyes <xref ref-type="bibr" rid="scirp.142887-4">
     [4]
    </xref>. It has been observed that mathematical modeling plays a major role in the understanding of phenomenon. Mathematical modeling, using data, facilitates understanding of how changes can affect results. In combination with data, it helps to explain past behavior, predict and forecast future behavior, and assess how changes may alter these predictions <xref ref-type="bibr" rid="scirp.142887-5">
     [5]
    </xref>. Since its outbreak, mathematical researchers have developed models to help understand and combat its spread, as well as to help decision-makers take appropriate decisions. Reference <xref ref-type="bibr" rid="scirp.142887-6">
     [6]
    </xref> applies a mathematical optimal control model of haemorrhagic conjunctivitis disease to understand its transmission by using two control strategies such as efforts to prevent contact and treatment while reference <xref ref-type="bibr" rid="scirp.142887-7">
     [7]
    </xref> studies the stability of conjunctivitis model with nonlinear incidence term. Authors in <xref ref-type="bibr" rid="scirp.142887-8">
     [8]
    </xref> study the stability of the model and use isolation and hygiene compliance as control strategies in order to reduce conjunctivitis infection and irritants concentration and the associated cost. Reference <xref ref-type="bibr" rid="scirp.142887-9">
     [9]
    </xref> uses as strategies the sick leaves considered as isolation and treatment to study the stability conjunctivitis model. The authors in <xref ref-type="bibr" rid="scirp.142887-10">
     [10]
    </xref> use outbreak data from 2004-2015 in China to estimate the effective reproduction number and assess the efficacy of interventions while the authors in <xref ref-type="bibr" rid="scirp.142887-11">
     [11]
    </xref> study the propagation in western sub-Sahara Africa especially during the Harmattan period in public schools, and use proper sanitation and training of the educators as mitigating strategies. Also, the educational campaign has been used mathematically to study the transmission of conjunctivitis <xref ref-type="bibr" rid="scirp.142887-12">
     [12]
    </xref> while <xref ref-type="bibr" rid="scirp.142887-13">
     [13]
    </xref> proved that if 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         R 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
      <mo>
        ≤ 
      </mo> 
      <mn>
        1 
      </mn> 
     </mrow> 
    </math> then this disease will be eradicated. Authors in reference <xref ref-type="bibr" rid="scirp.142887-14">
     [14]
    </xref> applied the effect of under-reporting and behavior changes on the transmission rate to study the transmission dynamics of conjunctivitis in Mexico.</p>
   <p>The paper is organized as follows. In Section 0, we establish a mathematical model for conjunctivitis viral. In Section 1, we investigate the dynamics of our model while Section 1 computes the basic reproduction number. Stability and sensitivity of the model are analyzed in Section 1 while Section 2 studies numerically the model by using its estimate parameters and the collected real data and also make discussion of the different schema. Finally, We give the conclusion and future perspectives.</p>
  </sec><sec id="s2">
   <title>2. Mathematical Model Formulation</title>
   <p>This section describes compartmental model of conjunctivitis viral and, identify the parameters used in numerical simulations. The human population at time is assumed to be constant because birth rate and death rate of human population are approximately equal. From <xref ref-type="fig" rid="fig1">
     Figure 1
    </xref>, the population is partitioned into four compartments: susceptible individuals 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       S 
     </mi> 
    </math>, exposed human E, Infected individuals I, and recovered individuals 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       R 
     </mi> 
    </math>. The total population at any given time is 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        N 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi>
         t 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        = 
      </mo> 
      <mi>
        S 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi>
         t 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        + 
      </mo> 
      <mi>
        E 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi>
         t 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        + 
      </mo> 
      <mi>
        I 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi>
         t 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        + 
      </mo> 
      <mi>
        R 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi>
         t 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
     </mrow> 
    </math>. The following schema was adapted from <xref ref-type="bibr" rid="scirp.142887-11">
     [11]
    </xref>.</p>
   <p>The parameters are defined in <xref ref-type="table" rid="table1">
     Table 1
    </xref>.</p>
   <fig id="fig1" position="float">
    <label>Figure 1</label>
    <caption>
     <title>Figure 1. Conjunctivitis viral scheme.</title>
    </caption>
    <graphic mimetype="image" position="float" xlink:type="simple" xlink:href="https://html.scirp.org/file/2312913-rId26.jpeg?20250528113004" />
   </fig>
   <table-wrap id="table1">
    <label>
     <xref ref-type="table" rid="table1">
      Table 1
     </xref></label>
    <caption>
     <title>
      <xref ref-type="bibr" rid="scirp.142887-"></xref>Table 1. Baseline parameters used in the model.</title>
    </caption>
    <table class="MsoTableGrid custom-table" border="0" cellspacing="0" cellpadding="0"> 
     <tr> 
      <td class="custom-bottom-td acenter" width="16.17%"><p style="text-align:center">Parameters</p></td> 
      <td class="custom-bottom-td acenter" width="37.35%"><p style="text-align:center">Interpretation</p></td> 
      <td class="custom-bottom-td acenter" width="15.48%"><p style="text-align:center">Values</p></td> 
      <td class="custom-bottom-td acenter" width="15.50%"><p style="text-align:center">Units</p></td> 
      <td class="custom-bottom-td acenter" width="15.50%"><p style="text-align:center">Reference</p></td> 
     </tr> 
     <tr> 
      <td class="custom-top-td acenter" width="16.17%"><p style="text-align:center"> 
        <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
           b 
         </mi> 
        </math></p></td> 
      <td class="custom-top-td acenter" width="37.35%"><p style="text-align:center">Birth rate of human population</p></td> 
      <td class="custom-top-td acenter" width="15.48%"><p style="text-align:center">0.000456</p></td> 
      <td class="custom-top-td acenter" width="15.50%"><p style="text-align:center">day<sup>−</sup><sup>1</sup></p></td> 
      <td class="custom-top-td acenter" width="15.50%"><p style="text-align:center">
        <xref ref-type="bibr" rid="scirp.142887-12">
         [12]
        </xref></p></td> 
     </tr> 
     <tr> 
      <td class="acenter" width="16.17%"><p style="text-align:center"> 
        <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
           ρ 
         </mi> 
        </math></p></td> 
      <td class="acenter" width="37.35%"><p style="text-align:center">Transmission rate of infection</p></td> 
      <td class="acenter" width="15.48%"><p style="text-align:center">0.02</p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">day<sup>−</sup><sup>1</sup></p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">
        <xref ref-type="bibr" rid="scirp.142887-7">
         [7]
        </xref></p></td> 
     </tr> 
     <tr> 
      <td class="acenter" width="16.17%"><p style="text-align:center"> 
        <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
           μ 
         </mi> 
        </math></p></td> 
      <td class="acenter" width="37.35%"><p style="text-align:center">Natural death rate</p></td> 
      <td class="acenter" width="15.48%"><p style="text-align:center">0.04</p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">day<sup>−</sup><sup>1</sup></p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">
        <xref ref-type="bibr" rid="scirp.142887-12">
         [12]
        </xref></p></td> 
     </tr> 
     <tr> 
      <td class="acenter" width="16.17%"><p style="text-align:center"> 
        <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
           δ 
         </mi> 
        </math></p></td> 
      <td class="acenter" width="37.35%"><p style="text-align:center">Outflow rate of exposed subjects to infectious compartment</p></td> 
      <td class="acenter" width="15.48%"><p style="text-align:center">0.3</p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">day<sup>−</sup><sup>1</sup></p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">Assumed</p></td> 
     </tr> 
     <tr> 
      <td class="acenter" width="16.17%"><p style="text-align:center"> 
        <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
           γ 
         </mi> 
        </math></p></td> 
      <td class="acenter" width="37.35%"><p style="text-align:center">Recovery rate</p></td> 
      <td class="acenter" width="15.48%"><p style="text-align:center">0.08</p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">day<sup>−</sup><sup>1</sup></p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">
        <xref ref-type="bibr" rid="scirp.142887-15">
         [15]
        </xref></p></td> 
     </tr> 
     <tr> 
      <td class="acenter" width="16.17%"><p style="text-align:center"> 
        <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
           ϵ 
         </mi> 
        </math></p></td> 
      <td class="acenter" width="37.35%"><p style="text-align:center">Rate of imminity after recovery which is lost and individuals become susceptible again</p></td> 
      <td class="acenter" width="15.48%"><p style="text-align:center">0.01</p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">day<sup>−</sup><sup>1</sup></p></td> 
      <td class="acenter" width="15.50%"><p style="text-align:center">
        <xref ref-type="bibr" rid="scirp.142887-12">
         [12]
        </xref></p></td> 
     </tr> 
    </table>
   </table-wrap>
   <p>The resulting explicit equations are as follows</p>
   <p>
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         </mo> 
         <mrow> 
          <mi>
            μ 
          </mi> 
          <mo>
            + 
          </mo> 
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            ϵ 
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         </mrow> 
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          R 
        </mi> 
        <mo>
          . 
        </mo> 
       </mtd> 
      </mtr> 
     </mtable> 
    </math>(1)</p>
   <p>By normalization, we obtain</p>
   <p>
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          . 
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       </mtd> 
      </mtr> 
     </mtable> 
    </math>(2)</p>
  </sec><sec id="s3">
   <title>3. Analysis of the Dynamical Model</title>
   <p>This section determines the boundary of solutions of the System (2). It also computes the disease free equilibrium and the endemic equilibrium point of the same system.</p>
   <p>Theorem 1. Let 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
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         ( 
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         ) 
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      </mrow> 
     </mrow> 
    </math> be the solution of the model System (2) with initial conditions 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        S 
      </mi> 
      <mo>
        &gt; 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math>, 
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      <mi>
        E 
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        ≥ 
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      <mn>
        0 
      </mn> 
     </mrow> 
    </math>, 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        I 
      </mi> 
      <mo>
        ≥ 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math>, 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        R 
      </mi> 
      <mo>
        ≥ 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math>. The region of epidemiological relevance in the sense of conjunctivitis transmission is given by the set</p>
   <p>
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      <mi>
        Γ 
      </mi> 
      <mo>
        = 
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         { 
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         </mrow> 
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           ) 
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        </mrow> 
        <mo>
          ∈ 
        </mo> 
        <msubsup> 
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           ℝ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mn>
           4 
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        </msubsup> 
        <mo>
          , 
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          N 
        </mi> 
        <mo>
          ≤ 
        </mo> 
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         <mi>
           b 
         </mi> 
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           μ 
         </mi> 
        </mfrac> 
       </mrow> 
       <mo>
         } 
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      </mrow> 
     </mrow> 
    </math>.</p>
   <p>Proof. The total population of the model is 
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        N 
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      <mo>
        = 
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    </math>, therefore we have</p>
   <p>
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        . 
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     </mrow> 
    </math>(3)</p>
   <p>Solving this equation gives</p>
   <p>
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          t 
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        . 
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    </math>(4)</p>
   <p>When 
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        t 
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        → 
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    </math>, 
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    </math> which implies that 
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    </math>. Hence all solutions of the model (2) are bounded and enter the region 
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    </math>. Therefore, 
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    </math> is a positively invariant region. We conclude that every solution of our model remains within the region for all 
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        t 
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    </math>.</p>
   <p>Equating System (2) by zero and solve, we obtain the steady point</p>
   <p>
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                μ 
              </mi> 
             </mrow> 
             <mo>
               ) 
             </mo> 
            </mrow> 
            <mrow> 
             <mo>
               ( 
             </mo> 
             <mrow> 
              <mn>
                1 
              </mn> 
              <mo>
                − 
              </mo> 
              <mi>
                ρ 
              </mi> 
             </mrow> 
             <mo>
               ) 
             </mo> 
            </mrow> 
           </mrow> 
          </mfrac> 
         </mrow> 
         <mo>
           ] 
         </mo> 
        </mrow> 
        <mo>
          . 
        </mo> 
       </mtd> 
      </mtr> 
     </mtable> 
    </math>(5)</p>
   <p>In the absence of the disease, meaning when 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        I 
      </mi> 
      <mo>
        = 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math>, we have the following expression</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         E 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <msup> 
         <mi>
           S 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
        <mo>
          , 
        </mo> 
        <msup> 
         <mi>
           E 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
        <mo>
          , 
        </mo> 
        <msup> 
         <mi>
           I 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
        <mo>
          , 
        </mo> 
        <msup> 
         <mi>
           R 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        = 
      </mo> 
      <msub> 
       <mi>
         E 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mfrac> 
         <mi>
           b 
         </mi> 
         <mi>
           μ 
         </mi> 
        </mfrac> 
        <mo>
          , 
        </mo> 
        <mn>
          0 
        </mn> 
        <mo>
          , 
        </mo> 
        <mn>
          0 
        </mn> 
        <mo>
          , 
        </mo> 
        <mn>
          0 
        </mn> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        . 
      </mo> 
     </mrow> 
    </math>(6)</p>
   <p>In the case where 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        I 
      </mi> 
      <mo>
        ≠ 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math>, we have the endemic disease steady state 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         E 
       </mi> 
       <mn>
         1 
       </mn> 
      </msub> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <msup> 
         <mi>
           S 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
        <mo>
          , 
        </mo> 
        <msup> 
         <mi>
           E 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
        <mo>
          , 
        </mo> 
        <msup> 
         <mi>
           I 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
        <mo>
          , 
        </mo> 
        <msup> 
         <mi>
           R 
         </mi> 
         <mtext>
           * 
         </mtext> 
        </msup> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
     </mrow> 
    </math> where 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msup> 
       <mi>
         S 
       </mi> 
       <mtext>
         * 
       </mtext> 
      </msup> 
      <mo>
        , 
      </mo> 
      <msup> 
       <mi>
         E 
       </mi> 
       <mtext>
         * 
       </mtext> 
      </msup> 
      <mo>
        , 
      </mo> 
      <msup> 
       <mi>
         I 
       </mi> 
       <mtext>
         * 
       </mtext> 
      </msup> 
      <mo>
        , 
      </mo> 
      <msup> 
       <mi>
         R 
       </mi> 
       <mtext>
         * 
       </mtext> 
      </msup> 
     </mrow> 
    </math> are defined in System (5).</p>
  </sec><sec id="s4">
   <title>4. Basic Reproduction Number</title>
   <p>This section computes the basic reproduction number ( 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         R 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
     </mrow> 
    </math>) defined as the average number of secondary infections produced by a typical case of an infection in a population where everyone is susceptible. Using the next generation matrix defined in <xref ref-type="bibr" rid="scirp.142887-16">
     [16]
    </xref> (see also <xref ref-type="bibr" rid="scirp.142887-17">
     [17]
    </xref>), we calculate 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         R 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
     </mrow> 
    </math> for the System (2). Considering 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       X 
     </mi> 
    </math> and 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <msup> 
      <mi>
        X 
      </mi> 
      <mo>
        ′ 
      </mo> 
     </msup> 
    </math> as the vectors representing infected and uninfected compartments respectively, we have</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mfrac> 
       <mrow> 
        <mtext>
          d 
        </mtext> 
        <mi>
          X 
        </mi> 
       </mrow> 
       <mrow> 
        <mtext>
          d 
        </mtext> 
        <mi>
          t 
        </mi> 
       </mrow> 
      </mfrac> 
      <mo>
        = 
      </mo> 
      <mi>
        ℱ 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi mathvariant="double-struck">
         X 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        − 
      </mo> 
      <mi mathvariant="script">
        V 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi mathvariant="double-struck">
         X 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        , 
      </mo> 
     </mrow> 
    </math>(7)</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mfrac> 
       <mrow> 
        <mtext>
          d 
        </mtext> 
        <msup> 
         <mi>
           X 
         </mi> 
         <mo>
           ′ 
         </mo> 
        </msup> 
       </mrow> 
       <mrow> 
        <mtext>
          d 
        </mtext> 
        <mi>
          t 
        </mi> 
       </mrow> 
      </mfrac> 
      <mo>
        = 
      </mo> 
      <mi mathvariant="script">
        W 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi mathvariant="double-struck">
         X 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        , 
      </mo> 
     </mrow> 
    </math>(8)</p>
   <p>where 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi mathvariant="double-struck">
        X 
      </mi> 
      <mo>
        = 
      </mo> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mi>
          X 
        </mi> 
        <mo>
          , 
        </mo> 
        <msup> 
         <mi>
           X 
         </mi> 
         <mo>
           ′ 
         </mo> 
        </msup> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
     </mrow> 
    </math>, 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        ℱ 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi mathvariant="double-struck">
         X 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
     </mrow> 
    </math> represents the vector of in-flows into infected compartments (including new infections) and 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi mathvariant="script">
        V 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi mathvariant="double-struck">
         X 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
     </mrow> 
    </math> is the vector of out-flows. The functions 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       ℱ 
     </mi> 
    </math> and 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi mathvariant="script">
       V 
     </mi> 
    </math> are chosen so that 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        ℱ 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi mathvariant="double-struck">
         X 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        ≥ 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math> and 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi mathvariant="script">
        V 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mi mathvariant="double-struck">
         X 
       </mi> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        ≥ 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math>. We denote the disease free equilibrium by 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mn>
          0 
        </mn> 
        <mo>
          , 
        </mo> 
        <mover accent="true"> 
         <msup> 
          <mi>
            X 
          </mi> 
          <mo>
            ′ 
          </mo> 
         </msup> 
         <mo>
           ¯ 
         </mo> 
        </mover> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
     </mrow> 
    </math>. Replacing in Equation (7), we have 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        ℱ 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mn>
          0 
        </mn> 
        <mo>
          , 
        </mo> 
        <mover accent="true"> 
         <msup> 
          <mi>
            X 
          </mi> 
          <mo>
            ′ 
          </mo> 
         </msup> 
         <mo>
           ¯ 
         </mo> 
        </mover> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        = 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math> and 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi mathvariant="script">
        V 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mn>
          0 
        </mn> 
        <mo>
          , 
        </mo> 
        <mover accent="true"> 
         <msup> 
          <mi>
            X 
          </mi> 
          <mo>
            ′ 
          </mo> 
         </msup> 
         <mo>
           ¯ 
         </mo> 
        </mover> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        = 
      </mo> 
      <mn>
        0 
      </mn> 
     </mrow> 
    </math>.</p>
   <p>The next generation matrix is given by 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        F 
      </mi> 
      <msup> 
       <mi>
         V 
       </mi> 
       <mrow> 
        <mo>
          − 
        </mo> 
        <mn>
          1 
        </mn> 
       </mrow> 
      </msup> 
     </mrow> 
    </math>, where</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        F 
      </mi> 
      <mo>
        = 
      </mo> 
      <msub> 
       <mrow> 
        <mrow> 
         <mrow> 
          <mrow> 
           <mo>
             ( 
           </mo> 
           <mrow> 
            <mfrac> 
             <mrow> 
              <mo>
                ∂ 
              </mo> 
              <mi>
                ℱ 
              </mi> 
             </mrow> 
             <mrow> 
              <mo>
                ∂ 
              </mo> 
              <mi>
                X 
              </mi> 
             </mrow> 
            </mfrac> 
           </mrow> 
           <mo>
             ) 
           </mo> 
          </mrow> 
         </mrow> 
         <mo>
           | 
         </mo> 
        </mrow> 
       </mrow> 
       <mrow> 
        <mrow> 
         <mo>
           ( 
         </mo> 
         <mrow> 
          <mn>
            0 
          </mn> 
          <mo>
            , 
          </mo> 
          <mover accent="true"> 
           <msup> 
            <mi>
              X 
            </mi> 
            <mo>
              ′ 
            </mo> 
           </msup> 
           <mo>
             ¯ 
           </mo> 
          </mover> 
         </mrow> 
         <mo>
           ) 
         </mo> 
        </mrow> 
       </mrow> 
      </msub> 
      <mtext>
          
      </mtext> 
      <mtext>
          
      </mtext> 
      <mtext>
        and 
      </mtext> 
      <mtext>
          
      </mtext> 
      <mtext>
          
      </mtext> 
      <mi>
        V 
      </mi> 
      <mo>
        = 
      </mo> 
      <msub> 
       <mrow> 
        <mrow> 
         <mrow> 
          <mrow> 
           <mo>
             ( 
           </mo> 
           <mrow> 
            <mfrac> 
             <mrow> 
              <mo>
                ∂ 
              </mo> 
              <mi mathvariant="script">
                V 
              </mi> 
             </mrow> 
             <mrow> 
              <mo>
                ∂ 
              </mo> 
              <mi>
                X 
              </mi> 
             </mrow> 
            </mfrac> 
           </mrow> 
           <mo>
             ) 
           </mo> 
          </mrow> 
         </mrow> 
         <mo>
           | 
         </mo> 
        </mrow> 
       </mrow> 
       <mrow> 
        <mrow> 
         <mo>
           ( 
         </mo> 
         <mrow> 
          <mn>
            0 
          </mn> 
          <mo>
            , 
          </mo> 
          <mover accent="true"> 
           <msup> 
            <mi>
              X 
            </mi> 
            <mo>
              ′ 
            </mo> 
           </msup> 
           <mo>
             ¯ 
           </mo> 
          </mover> 
         </mrow> 
         <mo>
           ) 
         </mo> 
        </mrow> 
       </mrow> 
      </msub> 
      <mo>
        . 
      </mo> 
     </mrow> 
    </math></p>
   <p>The basic reproduction number 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         R 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
     </mrow> 
    </math> is the spectral radius of the matrix 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        F 
      </mi> 
      <msup> 
       <mi>
         V 
       </mi> 
       <mrow> 
        <mo>
          − 
        </mo> 
        <mn>
          1 
        </mn> 
       </mrow> 
      </msup> 
     </mrow> 
    </math>. From System of equations (2), we define matrices 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       F 
     </mi> 
    </math> and 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       V 
     </mi> 
    </math> as follows:</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        F 
      </mi> 
      <mo>
        = 
      </mo> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mtable> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mfrac> 
             <mrow> 
              <mn>
                1 
              </mn> 
              <mo>
                − 
              </mo> 
              <mi>
                ρ 
              </mi> 
             </mrow> 
             <mi>
               μ 
             </mi> 
            </mfrac> 
           </mrow> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
         </mtr> 
        </mtable> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
     </mrow> 
    </math>(9)</p>
   <p>and</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        V 
      </mi> 
      <mo>
        = 
      </mo> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mtable> 
         <mtr> 
          <mtd> 
           <mi>
             μ 
           </mi> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mfrac> 
             <mrow> 
              <mn>
                1 
              </mn> 
              <mo>
                − 
              </mo> 
              <mi>
                ρ 
              </mi> 
             </mrow> 
             <mi>
               μ 
             </mi> 
            </mfrac> 
           </mrow> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mi>
              μ 
            </mi> 
            <mo>
              + 
            </mo> 
            <mi>
              δ 
            </mi> 
           </mrow> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mo>
              − 
            </mo> 
            <mi>
              δ 
            </mi> 
           </mrow> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mi>
              γ 
            </mi> 
            <mo>
              + 
            </mo> 
            <mi>
              μ 
            </mi> 
           </mrow> 
          </mtd> 
         </mtr> 
        </mtable> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        . 
      </mo> 
     </mrow> 
    </math>(10)</p>
   <p>Computing 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msup> 
       <mi>
         V 
       </mi> 
       <mrow> 
        <mo>
          − 
        </mo> 
        <mn>
          1 
        </mn> 
       </mrow> 
      </msup> 
     </mrow> 
    </math>, we obtain</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msup> 
       <mi>
         V 
       </mi> 
       <mrow> 
        <mo>
          − 
        </mo> 
        <mn>
          1 
        </mn> 
       </mrow> 
      </msup> 
      <mo>
        = 
      </mo> 
      <mfrac> 
       <mn>
         1 
       </mn> 
       <mrow> 
        <mrow> 
         <mo>
           ( 
         </mo> 
         <mrow> 
          <mi>
            μ 
          </mi> 
          <mo>
            + 
          </mo> 
          <mi>
            δ 
          </mi> 
         </mrow> 
         <mo>
           ) 
         </mo> 
        </mrow> 
        <mrow> 
         <mo>
           ( 
         </mo> 
         <mrow> 
          <mi>
            γ 
          </mi> 
          <mo>
            + 
          </mo> 
          <mi>
            μ 
          </mi> 
         </mrow> 
         <mo>
           ) 
         </mo> 
        </mrow> 
       </mrow> 
      </mfrac> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mtable> 
         <mtr> 
          <mtd> 
           <mrow> 
            <mfrac> 
             <mrow> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mi>
                  μ 
                </mi> 
                <mo>
                  + 
                </mo> 
                <mi>
                  δ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mi>
                  γ 
                </mi> 
                <mo>
                  + 
                </mo> 
                <mi>
                  μ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
             </mrow> 
             <mi>
               μ 
             </mi> 
            </mfrac> 
           </mrow> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mo>
              − 
            </mo> 
            <mfrac> 
             <mrow> 
              <mi>
                δ 
              </mi> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mn>
                  1 
                </mn> 
                <mo>
                  − 
                </mo> 
                <mi>
                  δ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
             </mrow> 
             <mrow> 
              <msup> 
               <mi>
                 μ 
               </mi> 
               <mn>
                 2 
               </mn> 
              </msup> 
             </mrow> 
            </mfrac> 
           </mrow> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mo>
              − 
            </mo> 
            <mfrac> 
             <mrow> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mn>
                  1 
                </mn> 
                <mo>
                  − 
                </mo> 
                <mi>
                  ρ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mi>
                  μ 
                </mi> 
                <mo>
                  + 
                </mo> 
                <mi>
                  δ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
             </mrow> 
             <mrow> 
              <msup> 
               <mi>
                 μ 
               </mi> 
               <mn>
                 2 
               </mn> 
              </msup> 
             </mrow> 
            </mfrac> 
           </mrow> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mi>
              γ 
            </mi> 
            <mo>
              + 
            </mo> 
            <mi>
              μ 
            </mi> 
           </mrow> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mi>
             δ 
           </mi> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mi>
              μ 
            </mi> 
            <mo>
              + 
            </mo> 
            <mi>
              δ 
            </mi> 
           </mrow> 
          </mtd> 
         </mtr> 
        </mtable> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        . 
      </mo> 
     </mrow> 
    </math>(11)</p>
   <p>The next generation matrix is then given by</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        F 
      </mi> 
      <msup> 
       <mi>
         V 
       </mi> 
       <mrow> 
        <mo>
          − 
        </mo> 
        <mn>
          1 
        </mn> 
       </mrow> 
      </msup> 
      <mo>
        = 
      </mo> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mtable> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mfrac> 
             <mrow> 
              <mi>
                δ 
              </mi> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mn>
                  1 
                </mn> 
                <mo>
                  − 
                </mo> 
                <mi>
                  ρ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
             </mrow> 
             <mrow> 
              <mi>
                μ 
              </mi> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mi>
                  γ 
                </mi> 
                <mo>
                  + 
                </mo> 
                <mi>
                  μ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mi>
                  μ 
                </mi> 
                <mo>
                  + 
                </mo> 
                <mi>
                  δ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
             </mrow> 
            </mfrac> 
           </mrow> 
          </mtd> 
          <mtd> 
           <mrow> 
            <mfrac> 
             <mrow> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mn>
                  1 
                </mn> 
                <mo>
                  − 
                </mo> 
                <mi>
                  ρ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
             </mrow> 
             <mrow> 
              <mi>
                μ 
              </mi> 
              <mrow> 
               <mo>
                 ( 
               </mo> 
               <mrow> 
                <mi>
                  γ 
                </mi> 
                <mo>
                  + 
                </mo> 
                <mi>
                  μ 
                </mi> 
               </mrow> 
               <mo>
                 ) 
               </mo> 
              </mrow> 
             </mrow> 
            </mfrac> 
           </mrow> 
          </mtd> 
         </mtr> 
         <mtr> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
          <mtd> 
           <mn>
             0 
           </mn> 
          </mtd> 
         </mtr> 
        </mtable> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        . 
      </mo> 
     </mrow> 
    </math>(12)</p>
   <p>From Equation (12), we calculate the basic reproduction number given by</p>
   <p>
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         R 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
      <mo>
        = 
      </mo> 
      <mi>
        ρ 
      </mi> 
      <mrow> 
       <mo>
         ( 
       </mo> 
       <mrow> 
        <mi>
          F 
        </mi> 
        <msup> 
         <mi>
           V 
         </mi> 
         <mrow> 
          <mo>
            − 
          </mo> 
          <mn>
            1 
          </mn> 
         </mrow> 
        </msup> 
       </mrow> 
       <mo>
         ) 
       </mo> 
      </mrow> 
      <mo>
        = 
      </mo> 
      <mfrac> 
       <mrow> 
        <mi>
          δ 
        </mi> 
        <mrow> 
         <mo>
           ( 
         </mo> 
         <mrow> 
          <mn>
            1 
          </mn> 
          <mo>
            − 
          </mo> 
          <mi>
            ρ 
          </mi> 
         </mrow> 
         <mo>
           ) 
         </mo> 
        </mrow> 
       </mrow> 
       <mrow> 
        <mi>
          μ 
        </mi> 
        <mrow> 
         <mo>
           ( 
         </mo> 
         <mrow> 
          <mi>
            μ 
          </mi> 
          <mo>
            + 
          </mo> 
          <mi>
            γ 
          </mi> 
         </mrow> 
         <mo>
           ) 
         </mo> 
        </mrow> 
        <mrow> 
         <mo>
           ( 
         </mo> 
         <mrow> 
          <mi>
            μ 
          </mi> 
          <mo>
            + 
          </mo> 
          <mi>
            δ 
          </mi> 
         </mrow> 
         <mo>
           ) 
         </mo> 
        </mrow> 
       </mrow> 
      </mfrac> 
      <mo>
        . 
      </mo> 
     </mrow> 
    </math>(13)</p>
  </sec><sec id="s5">
   <title>5. Stability and Sensitivity of the Model</title>
   <p>In this section, the stability of the model is treated and the sensitivity of the basic reproduction number is analyzed.</p>
   <sec id="s5_1">
    <title>5.1. Stability Analysis of the Model</title>
    <p>This subsection treats the stability of the model (2) using the disease-free equilibrium and endemic equilibrium point. It computes the eigenvalues of the Jacobian matrix 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          J 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math> at each steady point and analyze their signs.</p>
    <p>First, we use the DFE defined in Equation (6) to show that the system of Equations (2) is locally asymptotically stable. The eigenvalues are the solutions of the characteristic equation</p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mrow> 
        <mo>
          | 
        </mo> 
        <mrow> 
         <mi>
           J 
         </mi> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <msub> 
            <mi>
              E 
            </mi> 
            <mi>
              i 
            </mi> 
           </msub> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mo>
           − 
         </mo> 
         <mi>
           λ 
         </mi> 
         <mi>
           I 
         </mi> 
        </mrow> 
        <mo>
          | 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mn>
         0 
       </mn> 
       <mo>
         , 
       </mo> 
      </mrow> 
     </math>(14)</p>
    <p>with 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mi>
         J 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <msub> 
          <mi>
            E 
          </mi> 
          <mi>
            i 
          </mi> 
         </msub> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
      </mrow> 
     </math> the Jacobian matrix at a given steady state 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          E 
        </mi> 
        <mi>
          i 
        </mi> 
       </msub> 
       <mo>
         , 
       </mo> 
       <mi>
         i 
       </mi> 
       <mo>
         = 
       </mo> 
       <mn>
         0 
       </mn> 
       <mo>
         , 
       </mo> 
       <mn>
         1 
       </mn> 
      </mrow> 
     </math> and 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
        I 
      </mi> 
     </math> is defined as the identity matrix of dimension 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mn>
         3 
       </mn> 
       <mo>
         × 
       </mo> 
       <mn>
         3 
       </mn> 
      </mrow> 
     </math>.</p>
    <p>Theorem 2. The disease free equilibrium (DFE) is locally stable if 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
       <mo>
         &lt; 
       </mo> 
       <mn>
         1 
       </mn> 
      </mrow> 
     </math> and unstable if 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
       <mo>
         &gt; 
       </mo> 
       <mn>
         1 
       </mn> 
      </mrow> 
     </math></p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mi>
         J 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <msub> 
          <mi>
            E 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mtable> 
          <mtr> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               μ 
             </mi> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                μ 
              </mi> 
             </mfrac> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 μ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 δ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                μ 
              </mi> 
             </mfrac> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mi>
              δ 
            </mi> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 γ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 μ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
            </mrow> 
           </mtd> 
          </mtr> 
         </mtable> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         . 
       </mo> 
      </mrow> 
     </math>(15)</p>
    <p>Its characteristic equation is defined as follows:</p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mrow> 
        <mo>
          | 
        </mo> 
        <mrow> 
         <mi>
           J 
         </mi> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <msub> 
            <mi>
              E 
            </mi> 
            <mn>
              0 
            </mn> 
           </msub> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mo>
           − 
         </mo> 
         <mi>
           λ 
         </mi> 
         <mi>
           I 
         </mi> 
        </mrow> 
        <mo>
          | 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mrow> 
        <mo>
          | 
        </mo> 
        <mrow> 
         <mtable> 
          <mtr> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               μ 
             </mi> 
             <mo>
               − 
             </mo> 
             <mi>
               λ 
             </mi> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                μ 
              </mi> 
             </mfrac> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 μ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 δ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               λ 
             </mi> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                μ 
              </mi> 
             </mfrac> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mi>
              δ 
            </mi> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 γ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 μ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               λ 
             </mi> 
            </mrow> 
           </mtd> 
          </mtr> 
         </mtable> 
        </mrow> 
        <mo>
          | 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mn>
         0. 
       </mn> 
      </mrow> 
     </math>(16)</p>
    <p>After some algebraic calculations, we obtain</p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           λ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mrow> 
        <mo>
          [ 
        </mo> 
        <mrow> 
         <msup> 
          <mi>
            λ 
          </mi> 
          <mn>
            2 
          </mn> 
         </msup> 
         <mo>
           + 
         </mo> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             δ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mn>
             2 
           </mn> 
           <mi>
             μ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             γ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mi>
           λ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             δ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             μ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             γ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             μ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mo>
           − 
         </mo> 
         <mfrac> 
          <mrow> 
           <mi>
             δ 
           </mi> 
           <mrow> 
            <mo>
              ( 
            </mo> 
            <mrow> 
             <mn>
               1 
             </mn> 
             <mo>
               − 
             </mo> 
             <mi>
               ρ 
             </mi> 
            </mrow> 
            <mo>
              ) 
            </mo> 
           </mrow> 
          </mrow> 
          <mi>
            μ 
          </mi> 
         </mfrac> 
        </mrow> 
        <mo>
          ] 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mn>
         0. 
       </mn> 
      </mrow> 
     </math>(17)</p>
    <p>Thus, 
     <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          λ 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <mtext>
           
       </mtext> 
       <mo>
         = 
       </mo> 
       <mo>
         − 
       </mo> 
       <mi>
         μ 
       </mi> 
       <mtext>
           
       </mtext> 
       <mo>
         &lt; 
       </mo> 
       <mtext>
           
       </mtext> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math> and 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msup> 
        <mi>
          λ 
        </mi> 
        <mn>
          2 
        </mn> 
       </msup> 
       <mtext>
           
       </mtext> 
       <mo>
         + 
       </mo> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mtext>
             
         </mtext> 
         <mn>
           2 
         </mn> 
         <mi>
           μ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           γ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mi>
         λ 
       </mi> 
       <mo>
         + 
       </mo> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           γ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         − 
       </mo> 
       <mfrac> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mn>
             1 
           </mn> 
           <mo>
             − 
           </mo> 
           <mi>
             ρ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
        </mrow> 
        <mi>
          μ 
        </mi> 
       </mfrac> 
       <mo>
         = 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math>. Let 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msup> 
        <mi>
          λ 
        </mi> 
        <mn>
          2 
        </mn> 
       </msup> 
       <mo>
         + 
       </mo> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <mi>
         λ 
       </mi> 
       <mo>
         + 
       </mo> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math> with 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <mi>
         δ 
       </mi> 
       <mo>
         + 
       </mo> 
       <mn>
         2 
       </mn> 
       <mi>
         μ 
       </mi> 
       <mo>
         + 
       </mo> 
       <mi>
         γ 
       </mi> 
      </mrow> 
     </math> and 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           γ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         − 
       </mo> 
       <mfrac> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mn>
             1 
           </mn> 
           <mo>
             − 
           </mo> 
           <mi>
             ρ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
        </mrow> 
        <mi>
          μ 
        </mi> 
       </mfrac> 
      </mrow> 
     </math>. Writing 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
      </mrow> 
     </math> in term of 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math>, we have 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           γ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mn>
           1 
         </mn> 
         <mo>
           − 
         </mo> 
         <msub> 
          <mi>
            R 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
      </mrow> 
     </math>.</p>
    <p>From the criteria of Ruth-Hurwitz <xref ref-type="bibr" rid="scirp.142887-18">
      [18]
     </xref> for the stability of the systems, if 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <mo>
         &gt; 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math> and 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         &gt; 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math>, then the eigenvalues are negative. It is obvious that 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <mo>
         &gt; 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math> and 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          a 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         &gt; 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math> if 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
       <mo>
         &lt; 
       </mo> 
       <mn>
         1 
       </mn> 
      </mrow> 
     </math>. Therefore, the DFE is asymptotically stable.</p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mi>
         J 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <msub> 
          <mi>
            E 
          </mi> 
          <mn>
            1 
          </mn> 
         </msub> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mtable> 
          <mtr> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               μ 
             </mi> 
             <mo>
               − 
             </mo> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                I 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                S 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mrow> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                I 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 μ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 δ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                S 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mi>
              δ 
            </mi> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 γ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 μ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
            </mrow> 
           </mtd> 
          </mtr> 
         </mtable> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         . 
       </mo> 
      </mrow> 
     </math>(18)</p>
    <p>Computing the eigenvalues associated to 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mi>
         J 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <msub> 
          <mi>
            E 
          </mi> 
          <mn>
            1 
          </mn> 
         </msub> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
      </mrow> 
     </math>, we have</p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mrow> 
        <mo>
          | 
        </mo> 
        <mrow> 
         <mi>
           J 
         </mi> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <msub> 
            <mi>
              E 
            </mi> 
            <mn>
              1 
            </mn> 
           </msub> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mo>
           − 
         </mo> 
         <mi>
           λ 
         </mi> 
         <mi>
           I 
         </mi> 
        </mrow> 
        <mo>
          | 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mrow> 
        <mo>
          | 
        </mo> 
        <mrow> 
         <mtable> 
          <mtr> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               μ 
             </mi> 
             <mo>
               − 
             </mo> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                I 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
             <mo>
               − 
             </mo> 
             <mi>
               λ 
             </mi> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                S 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mrow> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                I 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 μ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 δ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               λ 
             </mi> 
            </mrow> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mfrac> 
              <mrow> 
               <mn>
                 1 
               </mn> 
               <mo>
                 − 
               </mo> 
               <mi>
                 ρ 
               </mi> 
              </mrow> 
              <mi>
                b 
              </mi> 
             </mfrac> 
             <msup> 
              <mi>
                S 
              </mi> 
              <mtext>
                * 
              </mtext> 
             </msup> 
            </mrow> 
           </mtd> 
          </mtr> 
          <mtr> 
           <mtd> 
            <mn>
              0 
            </mn> 
           </mtd> 
           <mtd> 
            <mi>
              δ 
            </mi> 
           </mtd> 
           <mtd> 
            <mrow> 
             <mo>
               − 
             </mo> 
             <mrow> 
              <mo>
                ( 
              </mo> 
              <mrow> 
               <mi>
                 γ 
               </mi> 
               <mo>
                 + 
               </mo> 
               <mi>
                 μ 
               </mi> 
              </mrow> 
              <mo>
                ) 
              </mo> 
             </mrow> 
             <mo>
               − 
             </mo> 
             <mi>
               λ 
             </mi> 
            </mrow> 
           </mtd> 
          </mtr> 
         </mtable> 
        </mrow> 
        <mo>
          | 
        </mo> 
       </mrow> 
       <mo>
         = 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math></p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mo>
         ⇔ 
       </mo> 
       <msup> 
        <mi>
          λ 
        </mi> 
        <mn>
          3 
        </mn> 
       </msup> 
       <mo>
         + 
       </mo> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <msup> 
        <mi>
          λ 
        </mi> 
        <mn>
          2 
        </mn> 
       </msup> 
       <mo>
         + 
       </mo> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mi>
         λ 
       </mi> 
       <mo>
         + 
       </mo> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          3 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <mn>
         0 
       </mn> 
       <mo>
         , 
       </mo> 
      </mrow> 
     </math></p>
    <p>where</p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <mn>
         2 
       </mn> 
       <mi>
         μ 
       </mi> 
       <mo>
         + 
       </mo> 
       <mi>
         γ 
       </mi> 
       <mo>
         + 
       </mo> 
       <mi>
         δ 
       </mi> 
       <mo>
         + 
       </mo> 
       <mi>
         μ 
       </mi> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
       <mo>
         , 
       </mo> 
      </mrow> 
     </math></p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <mi>
         μ 
       </mi> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
       <mrow> 
        <mo>
          [ 
        </mo> 
        <mrow> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             δ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             μ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
         <msub> 
          <mi>
            R 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             δ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             μ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
        </mrow> 
        <mo>
          ] 
        </mo> 
       </mrow> 
       <mo>
         − 
       </mo> 
       <mi>
         δ 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mn>
           1 
         </mn> 
         <mo>
           − 
         </mo> 
         <mi>
           ρ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         , 
       </mo> 
      </mrow> 
     </math></p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          3 
        </mn> 
       </msub> 
       <mo>
         = 
       </mo> 
       <msup> 
        <mrow> 
         <mo stretchy="false">
           ( 
         </mo> 
         <mi>
           μ 
         </mi> 
         <msub> 
          <mi>
            R 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
         <mo stretchy="false">
           ) 
         </mo> 
        </mrow> 
        <mn>
          2 
        </mn> 
       </msup> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           γ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         − 
       </mo> 
       <mi>
         μ 
       </mi> 
       <mi>
         δ 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mn>
           1 
         </mn> 
         <mo>
           − 
         </mo> 
         <mi>
           ρ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         . 
       </mo> 
      </mrow> 
     </math></p>
    <p>The above eigenvalues are negative in the case where 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mi>
          i 
        </mi> 
       </msub> 
       <mo>
         , 
       </mo> 
       <mi>
         i 
       </mi> 
       <mo>
         = 
       </mo> 
       <mn>
         1 
       </mn> 
       <mo>
         , 
       </mo> 
       <mn>
         2 
       </mn> 
       <mo>
         , 
       </mo> 
       <mn>
         3 
       </mn> 
      </mrow> 
     </math> fulfill the conditions of Routh-Hurwitz. One can verify that:</p>
    <p>It is clear that 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
      </mrow> 
     </math> is positive. For having 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         &gt; 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math>, it must satisfy 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mi>
         μ 
       </mi> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
       <mrow> 
        <mo>
          [ 
        </mo> 
        <mrow> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             δ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             μ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
         <msub> 
          <mi>
            R 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             δ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             μ 
           </mi> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
        </mrow> 
        <mo>
          ] 
        </mo> 
       </mrow> 
       <mo>
         &gt; 
       </mo> 
       <mi>
         δ 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mn>
           1 
         </mn> 
         <mo>
           − 
         </mo> 
         <mi>
           ρ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
      </mrow> 
     </math>. For 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          1 
        </mn> 
       </msub> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          2 
        </mn> 
       </msub> 
       <mo>
         − 
       </mo> 
       <msub> 
        <mi>
          c 
        </mi> 
        <mn>
          3 
        </mn> 
       </msub> 
       <mo>
         &gt; 
       </mo> 
       <mn>
         0 
       </mn> 
      </mrow> 
     </math> to be verified, we have 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msup> 
        <mrow> 
         <mrow> 
          <mo>
            ( 
          </mo> 
          <mrow> 
           <mi>
             μ 
           </mi> 
           <msub> 
            <mi>
              R 
            </mi> 
            <mn>
              0 
            </mn> 
           </msub> 
          </mrow> 
          <mo>
            ) 
          </mo> 
         </mrow> 
        </mrow> 
        <mn>
          2 
        </mn> 
       </msup> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           δ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mi>
           γ 
         </mi> 
         <mo>
           + 
         </mo> 
         <mi>
           μ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
       <mo>
         &gt; 
       </mo> 
       <mi>
         μ 
       </mi> 
       <mi>
         δ 
       </mi> 
       <mrow> 
        <mo>
          ( 
        </mo> 
        <mrow> 
         <mn>
           1 
         </mn> 
         <mo>
           − 
         </mo> 
         <mi>
           ρ 
         </mi> 
        </mrow> 
        <mo>
          ) 
        </mo> 
       </mrow> 
      </mrow> 
     </math>. Therefore the Routh-Hurwitz criteria is satisfied and the endemic equilibrium point is locally asymptotically stable.</p>
   </sec>
   <sec id="s5_2">
    <title>5.2. Parameter Sensitivity Analysis</title>
    <p>Sensitivity analysis shows how changing values of independent variables have an impact on particular dependent variables <xref ref-type="bibr" rid="scirp.142887-19">
      [19]
     </xref>. It helps to distinguish different parameters that have a high effect on the basic reproduction number 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math> when they are changed, and should be taken in consideration when intervention strategies are applied.</p>
    <p>Definition 5.1. We defined the normalized forward sensitivity index of 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math> <xref ref-type="bibr" rid="scirp.142887-8">
      [8]
     </xref> which is differentiable with respect to a given parameter 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
        Φ 
      </mi> 
     </math>, by</p>
    <p>
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msubsup> 
        <mi>
          ϒ 
        </mi> 
        <mi>
          Φ 
        </mi> 
        <mrow> 
         <msub> 
          <mi>
            R 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
        </mrow> 
       </msubsup> 
       <mo>
         = 
       </mo> 
       <mfrac> 
        <mrow> 
         <mo>
           ∂ 
         </mo> 
         <msub> 
          <mi>
            R 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
        </mrow> 
        <mrow> 
         <mo>
           ∂ 
         </mo> 
         <mi>
           Φ 
         </mi> 
        </mrow> 
       </mfrac> 
       <mfrac> 
        <mi>
          Φ 
        </mi> 
        <mrow> 
         <msub> 
          <mi>
            R 
          </mi> 
          <mn>
            0 
          </mn> 
         </msub> 
        </mrow> 
       </mfrac> 
       <mo>
         . 
       </mo> 
      </mrow> 
     </math>(19)</p>
    <p>Using Definition 5.1, we have</p>
    <p>
     <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"> <mtable columnalign="left"> 
       <mtr> 
        <mtd> 
         <msubsup> 
          <mi>
            ϒ 
          </mi> 
          <mi>
            δ 
          </mi> 
          <mrow> 
           <msub> 
            <mi>
              R 
            </mi> 
            <mn>
              0 
            </mn> 
           </msub> 
          </mrow> 
         </msubsup> 
         <mo>
           = 
         </mo> 
         <mn>
           1 
         </mn> 
         <mo>
           − 
         </mo> 
         <mfrac> 
          <mi>
            δ 
          </mi> 
          <mrow> 
           <mrow> 
            <mo>
              ( 
            </mo> 
            <mrow> 
             <mi>
               μ 
             </mi> 
             <mo>
               + 
             </mo> 
             <mi>
               δ 
             </mi> 
            </mrow> 
            <mo>
              ) 
            </mo> 
           </mrow> 
           <mrow> 
            <mo>
              ( 
            </mo> 
            <mrow> 
             <mn>
               1 
             </mn> 
             <mo>
               − 
             </mo> 
             <mi>
               ρ 
             </mi> 
            </mrow> 
            <mo>
              ) 
            </mo> 
           </mrow> 
          </mrow> 
         </mfrac> 
         <mo>
           , 
         </mo> 
        </mtd> 
       </mtr> 
       <mtr> 
        <mtd> 
         <msubsup> 
          <mi>
            ϒ 
          </mi> 
          <mi>
            ρ 
          </mi> 
          <mrow> 
           <msub> 
            <mi>
              R 
            </mi> 
            <mn>
              0 
            </mn> 
           </msub> 
          </mrow> 
         </msubsup> 
         <mo>
           = 
         </mo> 
         <mo>
           − 
         </mo> 
         <mfrac> 
          <mi>
            ρ 
          </mi> 
          <mrow> 
           <mn>
             1 
           </mn> 
           <mo>
             − 
           </mo> 
           <mi>
             ρ 
           </mi> 
          </mrow> 
         </mfrac> 
         <mo>
           , 
         </mo> 
        </mtd> 
       </mtr> 
       <mtr> 
        <mtd> 
         <msubsup> 
          <mi>
            ϒ 
          </mi> 
          <mi>
            γ 
          </mi> 
          <mrow> 
           <msub> 
            <mi>
              R 
            </mi> 
            <mn>
              0 
            </mn> 
           </msub> 
          </mrow> 
         </msubsup> 
         <mo>
           = 
         </mo> 
         <mo>
           − 
         </mo> 
         <mfrac> 
          <mi>
            γ 
          </mi> 
          <mrow> 
           <mi>
             μ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             γ 
           </mi> 
          </mrow> 
         </mfrac> 
         <mo>
           , 
         </mo> 
        </mtd> 
       </mtr> 
       <mtr> 
        <mtd> 
         <msubsup> 
          <mi>
            ϒ 
          </mi> 
          <mi>
            μ 
          </mi> 
          <mrow> 
           <msub> 
            <mi>
              R 
            </mi> 
            <mn>
              0 
            </mn> 
           </msub> 
          </mrow> 
         </msubsup> 
         <mo>
           = 
         </mo> 
         <mo>
           − 
         </mo> 
         <mfrac> 
          <mrow> 
           <mn>
             2 
           </mn> 
           <mi>
             μ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             γ 
           </mi> 
          </mrow> 
          <mrow> 
           <mi>
             μ 
           </mi> 
           <mrow> 
            <mo>
              ( 
            </mo> 
            <mrow> 
             <mi>
               μ 
             </mi> 
             <mo>
               + 
             </mo> 
             <mi>
               γ 
             </mi> 
            </mrow> 
            <mo>
              ) 
            </mo> 
           </mrow> 
          </mrow> 
         </mfrac> 
         <mo>
           − 
         </mo> 
         <mfrac> 
          <mn>
            1 
          </mn> 
          <mrow> 
           <mi>
             μ 
           </mi> 
           <mo>
             + 
           </mo> 
           <mi>
             δ 
           </mi> 
          </mrow> 
         </mfrac> 
         <mo>
           . 
         </mo> 
        </mtd> 
       </mtr> 
      </mtable> 
     </math>(20)</p>
    <p>From <xref ref-type="table" rid="table2">
      Table 2
     </xref>, the positive sign means that 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math> will increase as the parameters increase while the negative signs indicate the decrease in 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math> as the parameters decrease. Furthermore, parameter with positive sign index means that an increase or decrease in the values of this parameter will lead to an increase or decrease in 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math>. Also, the parameters with negative sign indices indicate that increasing or decreasing the values will decrease (or increase) 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math>. We can see from <xref ref-type="table" rid="table2">
      Table 2
     </xref> the parameters that have the most effect on 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <msub> 
        <mi>
          R 
        </mi> 
        <mn>
          0 
        </mn> 
       </msub> 
      </mrow> 
     </math>, and consequently on the entire model, are: 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
       <mi>
         δ 
       </mi> 
       <mo>
         , 
       </mo> 
       <mi>
         γ 
       </mi> 
      </mrow> 
     </math> and 
     <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
        μ 
      </mi> 
     </math>.</p>
    <table-wrap id="table2">
     <label>
      <xref ref-type="table" rid="table2">
       Table 2
      </xref></label>
     <caption>
      <title>
       <xref ref-type="bibr" rid="scirp.142887-"></xref>Table 2. Sensitivity of 

       <math display="inline" xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
  
         <msub> 
   
          <mi>
           
    R
   
          </mi> 
   
          <mn>
           
    0
   
          </mn> 
  
         </msub> 
 
        </mrow>

       </math> evaluated to its parameter values given in Expression (13).</title>
     </caption>
     <table class="MsoTableGrid custom-table" border="0" cellspacing="0" cellpadding="0"> 
      <tr> 
       <td class="custom-bottom-td acenter" width="50.00%"><p style="text-align:center">Parameters</p></td> 
       <td class="custom-bottom-td acenter" width="50.00%"><p style="text-align:center">Sensitivity index</p></td> 
      </tr> 
      <tr> 
       <td class="custom-top-td acenter" width="50.00%"><p style="text-align:center"> 
         <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
            δ 
          </mi> 
         </math></p></td> 
       <td class="custom-top-td acenter" width="50.00%"><p style="text-align:center">+0.099</p></td> 
      </tr> 
      <tr> 
       <td class="acenter" width="50.00%"><p style="text-align:center"> 
         <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
            ρ 
          </mi> 
         </math></p></td> 
       <td class="acenter" width="50.00%"><p style="text-align:center">−0.02</p></td> 
      </tr> 
      <tr> 
       <td class="acenter" width="50.00%"><p style="text-align:center"> 
         <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
            μ 
          </mi> 
         </math></p></td> 
       <td class="acenter" width="50.00%"><p style="text-align:center">−0.416</p></td> 
      </tr> 
      <tr> 
       <td class="acenter" width="50.00%"><p style="text-align:center"> 
         <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
            γ 
          </mi> 
         </math></p></td> 
       <td class="acenter" width="50.00%"><p style="text-align:center">−0.66</p></td> 
      </tr> 
     </table>
    </table-wrap>
   </sec>
  </sec><sec id="s6">
   <title>6. Numerical Simulations and Discussion</title>
   <p>We carry out numerical simulations to compare our model with the results of the real data obtained from Kamenge University Hospital Center (CHUK). The data were collected from February 13th, 2024 which corresponds to the starting point of our simulations (day 0), when the CHUK alerts the new virus with already 9 confirmed cases in one day up to March 25th, 2024. During our survey, 310 new cases have been reported in one month (30 days). Note that, according to the specialist, the conjunctivitis viral doesn’t cause any death but destabilizes the eye capacity of seeing.</p>
   <p>We show that our conjunctivitis model describes well the real data of daily confirmed cases during one month outbreak. The following list is the number of infected cases who went to consult the ophthalmologist at Kamenge University Hospital Center per day: [9, 2, 10, 3, 11, 19, 29, 16, 26, 16, 14, 17, 9, 19, 10, 8, 11, 7, 20, 14, 11, 5, 6, 2, 2, 4, 3, 2, 3, 2] represented by the blue line on <xref ref-type="fig" rid="fig2">
     Figure 2
    </xref> and <xref ref-type="fig" rid="fig3">
     Figure 3
    </xref>.</p>
   <fig id="fig2" position="float">
    <label>Figure 2</label>
    <caption>
     <title>Figure 2. Number of confirmed cases per day. The blue line corresponds to the real data obtained from CHUK while the red line has been obtained by solving numerically the System of equations (2) where the parameters are taken from <xref ref-type="table" rid="table1">
       Table 1
      </xref>.</title>
    </caption>
    <graphic mimetype="image" position="float" xlink:type="simple" xlink:href="https://html.scirp.org/file/2312913-rId257.jpeg?20250528113006" />
   </fig>
   <fig id="fig3" position="float">
    <label>Figure 3</label>
    <caption>
     <title>Figure 3. Infected cases per day (a) obtained by increasing of 0.01 at each parameter that appears into Expression (13) of 

      <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
  
        <msub> 
   
         <mi>
          
    R
   
         </mi> 
   
         <mn>
          
    0
   
         </mn> 
  
        </msub> 
 
       </mrow>

      </math> or by decreasing those parameters (b) where the original values are in <xref ref-type="table" rid="table1">
       Table 1
      </xref>.</title>
    </caption>
    <graphic mimetype="image" position="float" xlink:type="simple" xlink:href="https://html.scirp.org/file/2312913-rId258.jpeg?20250528113006" />
   </fig>
   <p>
    <xref ref-type="fig" rid="fig3(a)">
     Figure 3(a)
    </xref>, <xref ref-type="fig" rid="fig3(b)">
     Figure 3(b)
    </xref> have been obtained by adjusting the most sensitive parameters to the basic reproduction number i.e.: 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <mi>
        δ 
      </mi> 
      <mo>
        , 
      </mo> 
      <mi>
        γ 
      </mi> 
      <mo>
        , 
      </mo> 
      <mi>
        μ 
      </mi> 
     </mrow> 
    </math> and 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       ρ 
     </mi> 
    </math> while keeping fixed the others parameters that do not appear in the 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         R 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
     </mrow> 
    </math> expression. Those figures shows that not only their change has the effect on the reproduction number but also the impact is evident and detected on the infected red curve.</p>
   <p>By increasing the parameters influencing the number of basic reproduction by 0.01, we can see on <xref ref-type="fig" rid="fig3(a)">
     Figure 3(a)
    </xref> that the red curve representing the number of infected cases per day found numerically reaches its maximum on the fifth day, with the maximum number around 28 cases lower than that shown in <xref ref-type="fig" rid="fig2">
     Figure 2
    </xref>, which is estimated at 30 infected cases. Moreover, between days 25 and 30, the curve found by the real data and that found numerically are very close to each other and tend to converge on the time axis, indicating the immediate extinction of the disease. In <xref ref-type="fig" rid="fig3(b)">
     Figure 3(b)
    </xref>, by reducing the parameters influencing the basic reproduction number, we can see that the maximum number of infection is found on the tenth day, estimated at 22 cases. Between days 25 and 30, there is a remarkable gap, which means that in this situation, the number of infected will be under control beyond 30 days, hence the persistence of the disease.</p>
  </sec><sec id="s7">
   <title>7. Conclusion</title>
   <p>In this paper, an SEIR mathematical model of conjunctivitis viral disease has been formulated. The basic reproduction number for the model has been calculated and explored as a key parameter in understanding the dynamics of disease. Stability of the model has been studied and the sensitivity analysis was performed, which showed that 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mrow> 
      <msub> 
       <mi>
         R 
       </mi> 
       <mn>
         0 
       </mn> 
      </msub> 
     </mrow> 
    </math> is highly sensitive to the infected rate of 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       E 
     </mi> 
    </math> class 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       δ 
     </mi> 
    </math>, recovery rate 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       γ 
     </mi> 
    </math>, death rate 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       μ 
     </mi> 
    </math> and the transmission rate of infection 
    <math xmlns="http://www.w3.org/1998/Math/MathML"> <mi>
       ρ 
     </mi> 
    </math>. Numerical results are performed in Section 2 where estimated parameters have been confronted with the real data. These results show that our model fits enough the real data of daily infected cases from conjunctivitis viral disease as shown in <xref ref-type="fig" rid="fig2">
     Figure 2
    </xref>, which reflects the reality in Burundi, especially in Bujumbura town. These results would be useful for the decision-makers and to the health NGO or health authorities to know better the parameters that need to be controlled than others in order to mitigate the transmission of the disease. Our model can also be adjusted and used to study the transmission of the conjunctivitis viral disease in other regional countries where the outbreaks have been noted. In the future, this model can be improved by including control measures and the compartment of the infected cases who have taken treatment without a medical prescription.</p>
  </sec><sec id="s8">
   <title>Acknowledgements</title>
   <p>The authors would like to thank the anonymous reviewers and the Kamenge University Teaching Hospital for authorizing access to data on conjunctivitis patient.</p>
  </sec>
 </body><back>
  <ref-list>
   <title>References</title>
   <ref id="scirp.142887-ref1">
    <label>1</label>
    <mixed-citation publication-type="other" xlink:type="simple">
     (2024) Le Renouveau du Burundi. MINISANTE: Déclaration sur l’épidémie de conjonctivité virale. &gt;http://lerenouveau.bi/minisante-declaration-sur-lepidemie-de-conjonctivite-virale/ 
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