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The effect of assortative mixing on stability of low helminth transmission levels and on the impact of mass drug administration: Model explorations for onchocerciasis

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  • Anneke S de Vos
  • Wilma A Stolk
  • Sake J de Vlas
  • Luc E Coffeng

Abstract

Background: Stable low pre-control prevalences of helminth infection are not uncommon in field settings, yet it is poorly understood how such low levels can be sustained, thereby challenging efforts to model them. Disentangling possible facilitating mechanisms is important, since these may differently affect intervention impact. Here we explore the role of assortative (i.e. non-homogenous) mixing and exposure heterogeneity in helminth transmission, using onchocerciasis as an example. Methodology/Principal findings: We extended the established individual-based model ONCHOSIM to allow for assortative mixing, assuming that individuals who are relatively more exposed to fly bites are more connected to each other than other individuals in the population as a result of differential exposure to a sub-population of blackflies. We used the model to investigate how transmission stability, equilibrium microfilarial (mf) prevalence and intensity, and impact of mass drug administration depend on the assumed degree of assortative mixing and exposure heterogeneity, for a typical rural population of about 400 individuals. The model clearly demonstrated that with homogeneous mixing and moderate levels of exposure heterogeneity, onchocerciasis could not be sustained below 35% mf prevalence. In contrast, assortative mixing stabilised onchocerciasis prevalence at levels as low as 8% mf prevalence. Increasing levels of assortative mixing significantly reduced the probability of interrupting transmission, given the same duration and coverage of mass drug administration. Conclusions/Significance: Assortative mixing patterns are an important factor to explain stable low prevalence situations and are highly relevant for prospects of elimination. Their effect on the pre-control distribution of mf intensities in human populations is only detectable in settings with mf prevalences

Suggested Citation

  • Anneke S de Vos & Wilma A Stolk & Sake J de Vlas & Luc E Coffeng, 2018. "The effect of assortative mixing on stability of low helminth transmission levels and on the impact of mass drug administration: Model explorations for onchocerciasis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 12(10), pages 1-15, October.
  • Handle: RePEc:plo:pntd00:0006624
    DOI: 10.1371/journal.pntd.0006624
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    References listed on IDEAS

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    1. Ganna Rozhnova & Maarten F Schim van der Loeff & Janneke C M Heijne & Mirjam E Kretzschmar, 2016. "Impact of Heterogeneity in Sexual Behavior on Effectiveness in Reducing HIV Transmission with Test-and-Treat Strategy," PLOS Computational Biology, Public Library of Science, vol. 12(8), pages 1-20, August.
    2. Simon J O’Hanlon & Hannah C Slater & Robert A Cheke & Boakye A Boatin & Luc E Coffeng & Sébastien D S Pion & Michel Boussinesq & Honorat G M Zouré & Wilma A Stolk & María-Gloria Basáñez, 2016. "Model-Based Geostatistical Mapping of the Prevalence of Onchocerca volvulus in West Africa," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 10(1), pages 1-36, January.
    3. Joël Mossong & Niel Hens & Mark Jit & Philippe Beutels & Kari Auranen & Rafael Mikolajczyk & Marco Massari & Stefania Salmaso & Gianpaolo Scalia Tomba & Jacco Wallinga & Janneke Heijne & Malgorzata Sa, 2008. "Social Contacts and Mixing Patterns Relevant to the Spread of Infectious Diseases," PLOS Medicine, Public Library of Science, vol. 5(3), pages 1-1, March.
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