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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
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Summary
This summary is machine-generated.

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.

Keywords:
diagnostic test escapedisease surveillanceevolutionpublic health

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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.