title: Latent coinfection and the maintenance of strain diversity.
abstract: Technologies for strain differentiation and typing have made it possible to detect genetic diversity of pathogens, both within individual hosts and within communities. Coinfection of a host by more than one pathogen strain may affect the relative frequency of these strains at the population level through complex within- and between-host interactions; in infectious diseases that have a long latent period, interstrain competition during latency is likely to play an important role in disease dynamics. We show that SEIR models that include a class of latently coinfected individuals can have markedly different long-term dynamics than models without coinfection, and that coinfection can greatly facilitate the stable coexistence of strains. We demonstrate these dynamics using a model relevant to tuberculosis in which people may experience latent coinfection with both drug sensitive and drug resistant strains. Using this model, we show that the existence of a latent coinfected state allows the possibility that disease control interventions that target latency may facilitate the emergence of drug resistance.
authors.affiliation: Department of Engineering Mathematics, University of Bristol, Bristol, UK. ccolijn@gmail.com
authors.forename: Caroline
authors.initials: C
authors.lastname: Colijn
authors.forename: Ted
authors.initials: T
authors.lastname: Cohen
authors.forename: Megan
authors.initials: M
authors.lastname: Murray
mesh_terms: D050936:Basic Reproduction Number; D044822:Biodiversity; D003141:Communicable Diseases / Q000188:drug therapy / Q000382:microbiology*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D054884:Host-Pathogen Interactions / Q000187:drug effects / Q000276:immunology; D006801:Humans; D015994:Incidence; D055256:Infectious Disease Incubation Period; D008954:Models, Biological; D009161:Mycobacterium / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D017711:Nonlinear Dynamics; D012641:Selection, Genetic; D013045:Species Specificity; D014376:Tuberculosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D017735:Virus Latency / Q000502:physiology