Bistability and complex bifurcation diagrams generated by waning and boosting of immunity

Abstract: We investigate an epidemiological model that incorporates waning of immunity at the individual level and boosting of the immune system upon re-exposure to the pathogen. When immunity is fully restored upon boosting, the system can be expressed as an SIRS-type model with discrete and distributed delays. We conduct a numerical bifurcation analysis varying the boosting force and the maximum period of immunity (in the absence of boosting), while keeping other parameters fixed at values representative of a highly infectious disease like pertussis. The stability switches of the endemic equilibrium, identified numerically, are validated using an established analytical approach, confirming that the equilibrium is unstable in a bounded parameter region, and stable outside this region. Using recently developed continuation methods for models with discrete and distributed delays, we explore periodic solutions and their bifurcations. Our analysis significantly extends previous findings and reveals a rich dynamical landscape, including catastrophic bifurcations of limit cycles, torus bifurcations, and bistability regions where two stable periodic solutions coexist, differing in amplitude and period. These complex bifurcations have critical public health implications: perturbations--such as non-pharmaceutical interventions--can shift the system between attractors, leading to long-term consequences from short-term measures.