Big city, small world: Density, contact rates, and transmission of dengue across Pakistan.

Moritz U. G. Kraemer; T. Alex Perkins; Derek A.T. Cummings; Rubeena Zakar; Simon I. Hay; David L. Smith; Robert C. Reiner

We revealed significant differences in mixing components between urban and rural settings 289 and found that a population-weighted urban accessibility metric was able to absorb differences 290 in mixing between these settings indicating that this specific covariate accounts for aspects 291 influencing mixing. Mixing is presumably influenced directly by human behavior and has been 292 shown to be highly unpredictable, largely dependent on the local context and the spatial and 293 temporal scale (Yang et al. 2014) . In this study however we could show that the density-294 dependent covariate selected was able to capture the influence of these key encounters on a 295 district level. Once differences in mixing were accounted for, estimated R0 values indicated 296 considerably larger differences between transmission potential in Lahore versus all other 297 districts. Synchronizing more accurate geo-referenced data would allow to assess the 298 importance of spatial scale on the relationship between "mixing parameters" and urban The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/018481 doi: bioRxiv preprint in rainfall, temperature, vegetation coverage or mosquito abundance will help guide 312 surveillance and control efforts targeted mostly towards the ecological aspects of mosquito 313 dispersal (Johansson 2015). Once infection occurs much debate has been focused around 314 optimizing intervention strategies to reduce disease incidence, which is largely determined by 315