Abstract
BackgroundAnimal and human infection with multiple parasite species is the norm rather than the exception, and empirical studies and animal models have provided evidence for a diverse range of interactions among parasites. We demonstrate how an optimal control strategy should be tailored to the pathogen community and tempered by species-level knowledge of drug sensitivity with use of a simple epidemiological model of gastro-intestinal nematodes.MethodsWe construct a fully mechanistic model of macroparasite co-infection and use it to explore a range of control scenarios involving chemotherapy as well as improvements to sanitation.ResultsScenarios are presented whereby control not only releases a more resistant parasite from antagonistic interactions, but risks increasing co-infection rates, exacerbating the burden of disease. In contrast, synergisms between species result in their becoming epidemiologically slaved within hosts, presenting a novel opportunity for controlling drug resistant parasites by targeting co-circulating species.ConclusionsUnderstanding the effects on control of multi-parasite species interactions, and vice versa, is of increasing urgency in the advent of integrated mass intervention programmes.
Highlights
Animal and human infection with multiple parasite species is the norm rather than the exception, and empirical studies and animal models have provided evidence for a diverse range of interactions among parasites
We demonstrate the profound public health implications posed by this popular misconception with a simple mathematical model that simulates the attempted intervention of two cocirculating parasite species
When P1 facilitates the establishment of P2 infection as well as its subsequent fecundity, the pathogens become epidemiologically slaved whereby the disproportionate majority of infections are tethered in co-infections (Figure 2D)
Summary
Animal and human infection with multiple parasite species is the norm rather than the exception, and empirical studies and animal models have provided evidence for a diverse range of interactions among parasites. We demonstrate how an optimal control strategy should be tailored to the pathogen community and tempered by species-level knowledge of drug sensitivity with use of a simple epidemiological model of gastrointestinal nematodes. The one-host one-pathogen paradigm that constitutes the backbone of infectious disease understanding requires expansion to account for this ubiquitous epidemiological setting. A framework is needed for optimising control when an infectious agent constitutes one of many interacting pathogens. Using gastro-intestinal nematode parasites as an illustrative example, we simulate different control strategies and their effects on infection prevalence when there are multiple, interacting parasites. Gastro-intestinal nematodes are direct lifecycle parasites of veterinary and human health significance. Important nematode parasites of livestock include Haemonchus spp., Teladorsagia spp. and Nematodirus
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