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Diagnostic testing and the evolution of detection avoidance by pathogens
Jason Wood1, Ben Ashby1,2,3
1Department of Mathematical Sciences, University of Bath, Bath, UK.
Evolution, Medicine, and Public Health
|May 16, 2025
Summary
Pathogen variants can evade diagnostic tests, posing a public health challenge. Mathematical modeling reveals that imperfect testing compliance and intermediate testing frequency can unexpectedly drive the evolution of diagnostic test avoidance.
Area of Science:
- Epidemiology
- Evolutionary Biology
- Public Health
Background:
- Diagnostic testing is crucial for managing infectious diseases.
- Emerging pathogen variants can escape detection, challenging public health surveillance.
- Examples include variants of *Plasmodium falciparum* (malaria), *Chlamydia trachomatis*, and SARS-CoV-2.
Purpose of the Study:
- To investigate the evolutionary dynamics of diagnostic test avoidance in pathogens.
- To determine how testing frequency, compliance, and isolation efficacy influence the evolution of detection avoidance.
- To identify conditions under which diagnostic testing selects for avoidance versus pathogen extinction.
Main Methods:
- Utilized a mathematical modeling approach.
- Explored the interplay between diagnostic testing frequency, compliance rates, and isolation effectiveness.
- Derived theoretical thresholds for selection of diagnostic test avoidance or pathogen eradication.
Main Results:
- Imperfect compliance with diagnostic testing significantly impacts selection for avoidance and disease control.
- An intermediate level of testing frequency can paradoxically select for the highest degree of diagnostic test avoidance.
- Key thresholds were identified that predict whether a testing regime favors avoidance or extinction.
Conclusions:
- The evolution of diagnostic test avoidance is a critical factor in designing effective testing strategies.
- Careful consideration of testing frequency and compliance is necessary to prevent selection for avoidance.
- Findings have implications for managing various infectious diseases, including malaria, chlamydia, and COVID-19.
