Abstract
The spread of methicillin-resistant strains of Staphylococcus aureus (MRSA) in health-care settings has become increasingly difficult to control and has since been able to spread in the general community. The prevalence of MRSA within the general public has caused outbreaks in groups of people in close quarters such as military barracks, gyms, daycare centres and correctional facilities. Correctional facilities are of particular importance for spreading MRSA, as inmates are often in close proximity and have limited access to hygienic products and clean clothing. Although these conditions are ideal for spreading MRSA, a recent study has suggested that recurrent epidemics are caused by the influx of colonized or infected individuals into the correctional facility. In this paper, we further investigate the effects of community dynamics on the spread of MRSA within the correctional facility and determine whether recidivism has a significant effect on disease dynamics. Using a simplified hotspot model ignoring disease dynamics within the correctional facility, as well as two metapopulation models, we demonstrate that outbreaks in correctional facilities can be driven by community dynamics even when spread between inmates is restricted. We also show that disease dynamics within the correctional facility and their effect on the outlying community may be ignored due to the smaller size of the incarcerated population. This will allow construction of simpler models that consider the effects of many MRSA hotspots interacting with the general community. It is suspected that the cumulative effects of hotspots for MRSA would have a stronger feedback effect in other community settings.