Validation of parasite transmission models: The example of onchocerciasis

Most parasites have complex life cycles; and mathematical models can help in targeting interventions and predicting disease-control efforts. For actual applications, quantification and validation of models is a key issue. We illustrate the process of validation by presenting a (re)analysis of fly-feeding experiments carried out by the Onchocerciasis (river blindness) Control Programme (OCP/WHO) in West Africa, with the objective to validate ONCHOSIM, an onchocerciasis transmission model. In these experiments flies were fed on human patients and dissected to count the number of microfilariae they had ingested. To assess microfilarial skin densities, skin snips (biopsies) were taken and examined. Originally, the resulting curve was interpreted as showing saturation and considered the main regulating (density-dependent) mechanism of onchocerciasis transmission in the model. Taking into account measurement errors in the skin microfilarial density of human subjects (on whom the flies were fed) we now conclude that the relationship is essentially linear. This prompts us to requantify ONCHOSIM. Possible alternative density-dependent mechanisms are discussed.