Disentangling the effects of exposure and susceptibility on transmission of the zoonotic parasite Schistosoma mansoni.

For all parasites, transmission is composed of two processes: host contact with parasites ('exposure') and risk of infection given such contact ('susceptibility'). Classic models, such as mass action (density-dependent) transmission, lump these processes together. However, separating these processes could enhance predictions for disease dynamics, especially for free-living parasites. Here, we outline three transmission models that partition exposure and susceptibility. Using data from a study of Schistosoma mansoni (trematode) infections in Biomphalaria glabrata snails, we competed these three models against four alternative models, including the mass action model (which lumps exposure and susceptibility). The models that separately accounted for exposure and susceptibility best predicted prevalence across the density gradients of hosts and parasites, outperforming all other models based on Akaike information criterion. When embedded into a dynamic epidemiological model, the exposure-explicit models all predicted lower equilibrium densities of infected snails and human-infectious cercariae. Thus, population-level epidemiological models that utilize the classic mass action transmission model might overestimate human risk of schistosomiasis. More generally, the presented approach for disentangling exposure and susceptibility can distinguish between behavioural and immunological resistance, identify mechanisms of 'disease dilution' and provide a more complete dissection of drivers of parasite transmission.