Abstract
AbstractAntigenic diversity is a key factor underlying the complex epidemiology of Plasmodium falciparum malaria. Within-host clonal antigenic variation limits host exposure to the parasite’s antigenic repertoire, while the high degree of diversity at the population-level requires multiple exposures for hosts to acquire anti-disease immunity. This diversity is predominantly generated through mitotic and meiotic recombination between individual genes and multi-gene repertoires and is therefore expected to respond dynamically to changes in transmission and immune selection. We hypothesised that this coupling creates a positive feedback mechanism whereby infection and disease transmission promotes the generation of diversity, which itself facilitates immune evasion and hence further infection and transmission. To investigate the link between diversity and malaria prevalence in more detail we developed an individual-based model in which antigenic diversity emerges as a dynamic property from the underlying transmission processes. We show that the balance between stochastic extinction and the generation of new antigenic variants is intrinsically linked to within-host and between-host immune selection, which in turn determines the level of diversity that can be maintained in a given population. We further show that the transmission-diversity feedback can lead to temporal lags in the response to natural or intervention-induced perturbations in transmission rates. These results will add to our understanding of the epidemiological dynamics of P. falciparum malaria in different transmission settings and will have important implications for monitoring and assessing the effectiveness of disease control efforts.
Publisher
Cold Spring Harbor Laboratory