Evolution of Acute Infections and the Invasion-Persistence Trade-Off
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vol. 173, no. 4 the american naturalist april 2009 Evolution of Acute Infections and the Invasion-Persistence Trade-Off Aaron A. King,1,2,* Sourya Shrestha,3 Eric T. Harvill,4 and Ottar N. Bjørnstad2,5 1. Departments of Ecology and Evolutionary Biology and Mathematics, University of Michigan, Ann Arbor, Michigan 48109; 2. Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892; 3. Applied and Interdisciplinary Mathematics Program, University of Michigan, Ann Arbor, Michigan 48109; 4. Department of Veterinary Sciences, Penn State University, University Park, Pennsylvania 16803; 5. Departments of Entomology and Biology, Penn State University, University Park, Pennsylvania 16803 Submitted April 7, 2008; Accepted September 16, 2008; Electronically published February 20, 2009 for biosecurity. Understanding the conditions that favor abstract: We seek to understand the conditions favoring the evo- the evolution toward acute and highly contagious path- lution of acute, highly transmissible infections. Most work on the life-history evolution of pathogens has focused on the transmission- ogens is therefore of obvious interest. A related question virulence trade-off. Here we focus on a distinct trade-off that op- concerns the conditions that allow continued circulation erates, even among avirulent pathogens, between a pathogen’s speed and persistence of such strains. Understanding these issues of invasion and its ability to persist in a finite host population. Other is tantamount to understanding the evolutionary forces authors have shown how this invasion-persistence trade-off can lead shaping the life histories of pathogens. to intermediate pathogen attack rates but have done so only by Life-history theory has proven to be of great value for imposing trade-offs between the pathogen’s transmissibility and the duration of the infectious period. Here we delve deeper, by linking explaining and predicting optimal patterns of virulence in a model of within-host pathogen dynamics—in which pathogen life- pathogens (Antia et al. 1994; Lenski and May 1994; Frank history parameters figure directly—to an epidemiological model at 1996). For example, the classic trade-off theory predicts the population level. We find that a key determinant of the evolu- that a virulent pathogen may kill its host so fast, or stim- tionary trajectory is the shape of the dose-response curve that relates ulate such a strong immune response, that it may have within-host pathogen load to between-host transmission. In partic- little time to transmit to a secondary host (May and An- ular, under the usual assumption of proportionality we find that derson 1983). A more commensalistic pathogen, by con- pathogens tend to evolve to the edge of their own extinction. Under more realistic assumptions, a critical host population size exists, trast, may have so low a within-host multiplication rate above which highly acute pathogens are buffered from extinction. that it fails to shed sufficiently many propagules to en- Our study is motivated by the emergence of acuteness in two human gender infection in recipient hosts. This trade-off can lead pathogens, Bordetella pertussis and Bordetella parapertussis, which in- to an intermediate optimal host-exploitation rate with as- dependently evolved from an ancestor, Bordetella bronchiseptica, char- sociated intermediate infectious period and degree of acterized by chronic (nonacute) infection of wildlife. In contrast to acuteness. In this model, evolution is assumed to favor life the plethora of models that predict evolution of more aggressive pathogens in larger or denser populations, the invasion-persistence histories that maximize the basic reproductive ratio, R0, trade-off also operates for frequency-dependent pathogens. under the trade-off between the transmission rate and the infectious period. This theory has garnered important em- Keywords: acute infection, trade-off, evolution of infectious disease, pirical support (Fenner 1983; Messenger et al. 1999). How- pathogen evolution, dose response, Bordetella. ever, as pointed out by Antia et al. (1994), Frank (1996), and Gilchrist and Sasaki (2002), it is one thing to postulate a particular transmission-virulence trade-off and deduce Introduction the corresponding optimal life-history traits, but it is quite Rapidly transmitting pathogens that cause acute disease another to deduce the trade-off from its basis in within- are among the most important public health concerns host dynamics and the biology of transmission. Moreover, worldwide because of their high burden of mortality and the transmission-virulence trade-off cannot explain dif- morbidity, their violent outbreaks, and their implication ferences in infectious period among equally virulent pathogens. * Corresponding author; e-mail: [email protected]. For pathogens that replicate within hosts, transmit be- Am. Nat. 2009. Vol. 173, pp. 446–455. ᭧ 2009 by The University of Chicago. tween them, and spread among local host populations 0003-0147/2009/17304-50363$15.00. All rights reserved. within metapopulations, selection may happen and trade- DOI: 10.1086/597217 offs may occur at several different levels (Keeling 2000; Evolution of Acute Infections 447 Figure 1: A, Within-host pathogen dynamics for three different r values. Also shown are the corresponding nonseasonal epidemic curves for the linear-transmission model (B), delayed-transmission model (C), and saturating-transmission model (D). Parameters a, d, and k are set to the values shown in table 1;g p 10Ϫ4 and p 0 . In general, increasing acuteness eventually leads to elevated risk of stochastic extinction. Gilchrist and Sasaki 2002; Boots et al. 2004; van Balle- an intermediate acuteness. Here, we remove the restriction gooijen and Boerlijst 2004; Gilchrist and Coombs 2006). of equal R0 and replace the oversimple SIR framework with Arising at the level of the host population, the “invasion- a more mechanistic model of within-host pathogen dy- persistence” trade-off, described by Grenfell (2001), me- namics. In effect, we parameterize pathogen fitness in diates a balance between a strain’s infectious period and terms more directly related to pathogen life history. This its instantaneous rate of transmission. Over the short term, allows us to predict the direction of pathogen life-history an acute strain with short infectious period and high trans- evolution as a function of host population structure and mission rate has the evolutionary advantage in that it will the coupling between pathogen load and transmission po- spread more rapidly through a population than a strain tential (the dose-response curve) without the need for ar- with a longer infectious period and lower instantaneous tificial restrictions on parameters. transmission rate (Grenfell 2001). However, epidemics of Keeling (2000) examined the mathematical underpin- the more transmissible strain will exhibit more violent nings of the invasion-persistence trade-off in infinite meta- fluctuations and suffer greater risk of extinction—reflected populations. He showed that, in competition between a in a higher critical community size (Bartlett 1956; Keeling highly transmissible but extinction-prone strain and a and Grenfell 1997)—than those of their less transmissible strain that is less prone to extinction but is also less trans- equivalents. Thus, short-term invasion advantage comes missible, evolution may favor either strain, depending on at the cost of diminished intermediate-term persistence. within-patch relative competitive ability, patch-level rela- Grenfell (2001), using a simple susceptible-infectious- tive extinction rate, and degree of stochasticity (itself re- recovered (SIR) formalism and under the artificial restric- lated to patch size). Here, we examine the dependence of tion that competing strains shared an identical basic re- these parameters on more basic parameters that govern productive ratio (R0), showed that evolution would favor pathogen life history and the coupling of within-host path- 448 The American Naturalist Table 1: Model parameters Model, parameter Symbol Value Within-host model: Parasite growth rate r 10–130 Kill rate of the immune response k 3.5 Baseline production rate of immune response a 1 Death rate of immune response d .5 Immune response recruitment rate g .5–1.5 # 10Ϫ4 Transmission models: Ϫ3 Transmissibility factor, linear model q1 10 # Ϫ3 Transmissibility factor, delayed model q2 1.5 10 3 Transmissibility factor, saturating model q3 10 Delayed-transmission coefficient s 25 Delay constant a∗ .1 Saturation constant P∗ 5 # 105 Between-host model: Host mortality rate m .02 Seasonality amplitude 0–1 ogen dynamics to between-host transmission. With respect is followed sometimes by longer-lasting mild symptoms to the latter, the almost invariable practice in the literature and eventually by complete systemic clearance. According has been to assume that instantaneous transmission rate to the World Health Organization, these two bacteria is simply proportional to within-host pathogen load. Here caused 140 million cases of whooping cough in 2002. We we show that even small deviations from this assumption ask why acute infections are favored in some hosts whereas can have profound consequences on the ability of the op- more commensal infections are favored in others. What timal life-history strategy to persist. In particular, when evolutionary advantage can these acute strains possess that transmission depends nonlinearly on pathogen load, we compensates for the