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Co-infecting parasites and pathogens remain a leading challenge for globalpublic health due to their consequences for individual-level infection risk anddisease progression. However, a clear understanding of the population-levelconsequences of co-infection is lacking. Here, we constructed a model thatincludes three individual-level effects of co-infection: mortality, fecundity,and transmission. We used the model to investigate how these individual-levelconsequences of co-infection scale up to produce population-level infectionpatterns. To parameterize this model, we conducted a four-year cohort study inAfrican buffalo to estimate the individual-level effects of co-infection withtwo bacterial pathogens, bovine tuberculosis (BTB) and brucellosis, across arange of demographic and environmental contexts. At the individual-level, ourempirical results identified BTB as a risk factor for acquiring brucellosis,but we found no association between brucellosis and the risk of acquiring BTB.Both infections were associated with reductions in survival and neitherinfection was associated with reductions in fecundity. Results of the modelreproduce co-infection patterns in the data and predict opposite impacts ofco-infection at individual and population scales: whereas BTB facilitatedbrucellosis infection at the individual-level, our model predicts the presenceof brucellosis to have a strong negative impact on BTB at the population-level.In modeled populations where brucellosis is present, the endemic prevalence andbasic reproduction number (Ro) of BTB were lower than in populations withoutbrucellosis. Therefore, these results provide a data-driven example ofcompetition between co-infecting pathogens that occurs when one pathogenfacilitates secondary infections at the individual level.

Interactions between chronic diseases: asymmetric outcomes of co-infection at individual and population scales