The mechanisms behind vaccine-induced strain replacement in the pneumococcus remain poorly understood. There is emerging evidence that distinct pneumococcal lineages can co-colonise for significant time periods, and that novel recombinants can readily emerge during natural colonisation. Despite this, patterns of post-vaccine replacement are indicative of competition between specific lineages. Here, we develop a multiscale transmission model to investigate explicitly how within host dynamics shape observed ecological patterns, both pre- and post-vaccination. Our model framework explores competition between and within strains defined by distinct antigenic, metabolic and resistance profiles. We allow for strains to freely co-colonise and recombine within hosts, and consider how each of these types may contribute to a strain's overall fitness. Our results suggest that antigenic and resistance profiles are key drivers of post-vaccine success.
Copyright: © 2023 Mulberry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.