Inapparent infections shape the transmission heterogeneity of dengue.

Transmission heterogeneity, whereby a disproportionate fraction of pathogen transmission events result from a small number of individuals or geographic locations, is an inherent property of many, if not most, infectious disease systems. For vector-borne diseases, transmission heterogeneity is inferred from the distribution of the number of vectors per host, which could lead to significant bias in situations where vector abundance and transmission risk at the household do not correlate, as is the case with dengue virus (DENV). We used data from a contact tracing study to quantify the distribution of DENV acute infections within human activity spaces (AS), the collection of residential locations an individual routinely visits, and quantified measures of virus transmission heterogeneity from two consecutive dengue outbreaks (DENV-4 and DENV-2) that occurred in the city of Iquitos, Peru. Negative-binomial distributions and Pareto fractions showed evidence of strong overdispersion in the number of DENV infections by AS and identified super-spreading units (SSUs): i.e. AS where most infections occurred. Approximately 8% of AS were identified as SSUs, contributing to more than 50% of DENV infections. SSU occurrence was associated more with DENV-2 infection than with DENV-4, a predominance of inapparent infections (74% of all infections), households with high Aedes aegypti mosquito abundance, and high host susceptibility to the circulating DENV serotype. Marked heterogeneity in dengue case distribution, and the role of inapparent infections in defining it, highlight major challenges faced by reactive interventions if those transmission units contributing the most to transmission are not identified, prioritized, and effectively treated.

Environmental stochasticity and intraspecific competition influence the population dynamics of Culex quinquefasciatus (Diptera: Culicidae).

BACKGROUND: Members of the Culex pipiens complex (Cx. pipiens quinquefasciatus in Southern USA) play a critical role in the spillover of urban arboviruses such as West Nile virus or St. Louis encephalitis virus. Field studies have shown strong correlation between the periodicity of rainfall events and larval proliferation. However, mechanistic determinants driving this relationship are poorly understood. We hypothesize that rainfall events decrease strain from intraspecific competition through the associated reduction of immature density and the introduction of detritus. RESULTS: To address our hypothesis, we used laboratory competition experiments to inform a deterministic matrix projection model consisting of an age-structured larval matrix coupled with a stage-structured adult mosquito matrix. Rain events were simulated in a competition-based metabolic age model and compared to a null model including environmental variability. Variable rain delays in two-event simulations showed optimal proliferation occurring with rain delays between 16 and 21 days when including density-dependent effects. CONCLUSIONS: These results are comparable to the pattern observed in natural populations, indicating that Cx. quinquefasciatus proliferation rates can be modeled mechanistically as a density-dependent system. The empirical understanding of density-dependence as it relates to environmental stochasticity provides a theoretical platform for the study of larval dynamics and the impact of larval control in this medically relevant disease vector.

Driving it Home: Leading with an Interprofessional Collaborative Team Approach in Home Care.

As a prime example of the value of an interprofessional approach to care advocated by Orchard and colleagues earlier in this issue (Orchard 2017a, 2017b), the following case study profiles one highly effective interprofessional New Brunswick-based team which cares for clients and families in their homes; a model which has been functional and extremely successful for more than three decades and remains unparalleled in Canada.

Calibrated flux measurements reveal a nanostructure-stimulated transcytotic pathway.

Transport of therapeutic agents across epithelial barriers is an important element in drug delivery. Transepithelial flux is widely used as a measure of transit across an epithelium, however it is most typically employed as a relative as opposed to absolute measure of molecular movement. Here, we have used the calcium switch approach to measure the maximum rate of paracellular flux through unencumbered intercellular junctions as a method to calibrate the flux rates for a series of tracers ranging in 0.6-900kDa in size across barriers composed of human colon epithelial (Caco-2) cells. We then examined the effects of nanostructured films (NSFs) on transepithelial transport. Two different NSF patterns were used, Defined Nanostructure (DN) 2 imprinted on polypropylene (PP) and DN3 imprinted on polyether ether ketone (PEEK). NSFs made direct contact with cells and decreased their barrier function, as measured by transepithelial resistance (TER), however cell viability was not affected. When NSF-induced transepithelial transport of Fab fragment (55kDa) and IgG (160kDa) was measured, it was unexpectedly found to be significantly greater than the maximum paracellular rate as predicted using cells cultured in low calcium. These data suggested that NSFs stimulate an active transport pathway, most likely transcytosis, in addition to increasing paracellular flux. Transport of IgG via transcytosis was confirmed by immunofluorescence confocal microscopy, since NSFs induced a significant level of IgG endocytosis by Caco-2 cells. Thus, NSF-induced IgG flux was attributable to both transcytosis and the paracellular route. These data provide the first demonstration that transcytosis can be stimulated by NSFs and that this was concurrent with increased paracellular permeability. Moreover, NSFs with distinct architecture paired with specific substrates have the potential to provide an effective means to regulate transepithelial transport in order to optimize drug delivery.