Interactions of multiple strain pathogen diseases in the presence of coinfection, cross immunity, and arbitrary strain diversity

A model for coinfection in multiple strain infectious diseases is developed to incorporate coinfection statuses, immune and infection history, and cross immunity. It is solved for the symmetric interior equilibrium through the use of a ladder operator formalism inspired by quantum mechanical methods. We find that coinfection can fundamentally affects transmission dynamics with important epidemiologic and evolutionary consequences. It can significantly shift the distribution of age at infection for highly antigenically diverse pathogens so that in small host populations, an evolutionary strategy maximizing individual strain transmissibility might be less optimal than one which maximizes the total prevalence of all strains in the system. Alternatively, mechanisms which inhibit coinfection and thus increase total infection prevalence may be evolutionarily advantageous.