Since the identification and imprisonment of “Typhoid Mary”, a woman who infected at least 47 people with typhoid in the early 1900s, epidemiologists have recognized that “superspreading” hosts play a key role in disease epidemics. Such variability in transmission also exists among species within a community and among habitat patches across a landscape, underscoring the need for an integrative framework for studying transmission heterogeneity, or the differences among hosts or locations in their contribution to pathogen spread. Here, we synthesize literature on human, plant, and animal diseases to evaluate the relative influence of host, pathogen, and environmental factors in producing highly infectious individuals, species, and landscapes. We show that host and spatial heterogeneity are closely linked and that quantitatively assessing the contribution of infectious individuals, species, or environmental patches to overall transmission can aid management strategies. We conclude by posing hypotheses regarding how pathogen natural history influences transmission variability and highlight emerging frontiers in this area of study.

The effect of global climate change on infectious disease remains hotly debated because multiple extrinsic and intrinsic drivers interact to influence transmission dynamics in nonlinear ways. The dominant drivers of widespread pathogens, like West Nile virus, can be challenging to identify due to regional variability in vector and host ecology, with past studies producing disparate findings. Here, we used analyses at national and state scales to examine a suite of climatic and intrinsic drivers of continental-scale West Nile virus epidemics, including an empirically derived mechanistic relationship between temperature and transmission potential that accounts for spatial variability in vectors. We found that drought was the primary climatic driver of increased West Nile virus epidemics, rather than within-season or winter temperatures, or precipitation independently. Local-scale data from one region suggested drought increased epidemics via changes in mosquito infection prevalence rather than mosquito abundance. In addition, human acquired immunity following regional epidemics limited subsequent transmission in many states. We show that over the next 30 years, increased drought severity from climate change could triple West Nile virus cases, but only in regions with low human immunity. These results illustrate how changes in drought severity can alter the transmission dynamics of vector-borne diseases.