As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes coronavirus disease 2019 (COVID-19), began to spread globally, it became apparent that the virus, unlike the closely related SARS-CoV in the 2003 outbreak, could not be contained by symptom-based screening alone. Asymptomatic and clinically mild infections were uncommon during the 2003 SARS-CoV outbreak, and there were no reported instances of transmission from persons before the onset of symptoms.¹ SARS-CoV-2 spread faster than SARS-CoV, and accumulating evidence showed that SARS-CoV-2, unlike SARS-CoV, is transmitted from persons without symptoms. However, measures to reduce transmission from individuals who do not have COVID-19 symptoms have become controversial and politicized and have likely had negative effects on the economy and many societal activities. Optimal control of COVID-19 depends on directing resources and health messaging to mitigation efforts that are most likely to prevent transmission. The relative importance of mitigation measures that prevent transmission from persons without symptoms has been disputed. Determining the proportion of SARS-CoV-2 transmission that occurs from persons without symptoms is foundational to prioritizing control practices and policies.

Spatial disease ecology is emerging as a new field that requires the integration of complementary approaches to address how the distribution and movements of hosts and parasites may condition the dynamics of their interactions. In this context, migration, the seasonal movement of animals to different zones of their distribution, is assumed to play a key role in the broad scale circulation of parasites and pathogens. Nevertheless, migration is not the only type of host movement that can influence the spatial ecology, evolution, and epidemiology of infectious diseases. Dispersal, the movement of individuals between the location where they were born or bred to a location where they breed, has attracted attention as another important type of movement for the spatial dynamics of infectious diseases. Host dispersal has notably been identified as a key factor for the evolution of host–parasite interactions as it implies gene flow among local host populations and thus can alter patterns of coevolution with infectious agents across spatial scales. However, not all movements between host populations lead to dispersal per se. One type of host movement that has been neglected, but that may also play a role in parasite spread is prospecting, i.e., movements targeted at selecting and securing new habitat for future breeding. Prospecting movements, which have been studied in detail in certain social species, could result in the dispersal of infectious agents among different host populations without necessarily involving host dispersal. In this article, we outline how these various types of host movements might influence the circulation of infectious disease agents and discuss methodological approaches that could be used to assess their importance. We specifically focus on examples from work on colonial seabirds, ticks, and tick-borne infectious agents. These are convenient biological models because they are strongly spatially structured and involve relatively simple communities of interacting species. Overall, this review emphasizes that explicit consideration of the behavioral and population ecology of hosts and parasites is required to disentangle the relative roles of different types of movement for the spread of infectious diseases.

We report key epidemiologic parameter estimates for coronavirus disease identified in peer-reviewed publications, preprint articles, and online reports. Range estimates for incubation period were 1.8–6.9 days, serial interval 4.0–7.5 days, and doubling time 2.3–7.4 days. The effective reproductive number varied widely, with reductions attributable to interventions. Case burden and infection fatality ratios increased with patient age. Implementation of combined interventions could reduce cases and delay epidemic peak up to 1 month. These parameters for transmission, disease severity, and intervention effectiveness are critical for guiding policy decisions. Estimates will likely change as new information becomes available.

Data from the WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) 2022 revision were analyzed to assess the status of routine immunization in the WHO African Region disrupted by the COVID-19 pandemic. In 2022, coverage for the first and third doses of the diphtheria–tetanus–pertussis-containing vaccine (DTP1 and DTP3, respectively) and the first dose of the measles-containing vaccine (MCV1) in the region was estimated at 80%, 72% and 69%, respectively (all below the 2019 level). Only 13 of the 47 countries (28%) achieved the global target coverage of 90% or above with DTP3 in 2022. From 2019 to 2022, 28.7 million zero-dose children were recorded (19.0% of the target population). Ten countries in the region accounted for 80.3% of all zero-dose children, including the four most populated countries. Reported administrative coverage greater than WUENIC-reported coverage was found in 19 countries, highlighting routine immunization data quality issues. The WHO African Region has not yet recovered from COVID-19 disruptions to routine immunization. It is critical for governments to ensure that processes are in place to prioritize investments for restoring immunization services, catching up on the vaccination of zero-dose and under-vaccinated children and improving data quality.

When colonization and gene flow depend on host-mediated dispersal, a key factor affecting vector dispersal potential is the time spent on the host for the blood meal, a characteristic that can vary strongly among life history stages. Using a 2-patch vector-pathogen population model and seabird ticks as biological examples, we explore how vector colonization rates and the spread of infectious agents may be shaped by life stage-dependent dispersal. We contrast hard (Ixodidae) and soft (Argasidae) tick systems, which differ strongly in blood- feeding traits. We find that vector life history characteristics (i.e. length of blood meal) and demographic constraints (Allee effects) condition the colonization potential of ticks; hard ticks, which take a single, long blood meal per life stage, should have much higher colonization rates than soft ticks, which take repeated short meals. Moreover, this dispersal potential has direct consequences for the spread of vector-borne infectious agents, in particular when transmission is transovarial. These results have clear implications for predicting the dynamics of vector and disease spread in the context of large-scale environmental change. The findings highlight the need to include life-stage dispersal in models that aim to predict species and disease distributions, and provide testable predictions related to the population genetic structure of vectors and pathogens along expansion fronts.

Virulence is generally defined as the reduction in host fitness following infection by a parasite (see Box 1 for glossary) [1]. In general, parasite exploitation of host resources may reduce host survival (mortality virulence), decrease host fecundity (sterility virulence), or even have sub-lethal effects that disturb the way individuals interact within a community (morbidity) [2,3]. In fact, the virulence of many parasites involves a combination of these various effects (Box 2). In practice, however, virulence is most often defined as disease-induced mortality [1, 4–6]. This is especially true in the theoretical literature, where the evolution of sterility virulence, morbidity, and mixed strategies of host exploitation have received relatively little attention. While the focus on mortality effects has allowed for easy comparison between models and, thus, rapid advancement of the field, we ask whether these theoretical simplifications have led us to inadvertently minimize the evolutionary importance of host sterilization and secondary virulence effects. As explicit theoretical work on morbidity is currently lacking (but see [7]), our aim in this Opinion piece is to discuss what is understood about sterility virulence evolution, its adaptive potential, and the implications for parasites that utilize a combination of host survival and reproductive resources.