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Abstract
Heterogeneity in transmission is a challenge for infectious disease dynamics and control. An 80-20 “Pareto” rule has been proposed to describe this heterogeneity whereby 80% of transmission is accounted for by 20% of individuals, herein called super-spreaders. It is unclear, however, whether super-spreading can be attributed to certain individuals or whether it is an unpredictable and unavoidable feature of epidemics. Here, we investigate heterogeneous malaria transmission at three sites in Uganda and find that super-spreading is negatively correlated with overall malaria transmission intensity. Mosquito biting among humans is 90-10 at the lowest transmission intensities declining to less than 70-30 at the highest intensities. For super-spreaders, biting ranges from 70-30 down to 60-40. The difference, approximately half the total variance, is due to environmental stochasticity. Super-spreading is thus partly due to super-spreaders, but modest gains are expected from targeting super-spreaders.
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Details
; Greenhouse, Bryan 6 ; Drakeley, Chris 7
; Arinaitwe, Emmanuel 8 ; Staedke, Sarah G 7 ; Gething, Peter W 2 ; Eckhoff, Philip 9 ; Reiner, Robert C, Jr 10
; Hay, Simon I 10
; Dorsey, Grant 6 ; Kamya, Moses R 11 ; Lindsay, Steven W 12 ; Grenfell, Bryan T 13 ; Smith, David L 10
1 Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Department of Veterinary Medicine, Cambridge University, Cambridge, UK
2 Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
3 Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK; RTI International, Washington, DC, USA; Epidemiology and Public Health Division, School of Medicine, University of Nottingham, Nottingham, UK
4 Infectious Diseases Research Collaboration, Kampala, Uganda
5 Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, University of California, San Francisco, CA, USA
6 Department of Medicine, University of California, San Francisco, CA, USA
7 London School of Hygiene & Tropical Medicine, London, UK
8 Infectious Diseases Research Collaboration, Kampala, Uganda; London School of Hygiene & Tropical Medicine, London, UK
9 Institute for Disease Modeling, Bellevue, WA, USA
10 Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
11 School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
12 School of Biological and Biomedical Sciences, Durham University, Durham, UK
13 Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA; Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA




