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Abstract
Malaria is an important cause of global morbidity and mortality. The fact that some
people are bitten more often than others has a large effect on the relationship between
risk factors and prevalence of vector-borne diseases. Here we develop a mathematical
framework that allows us to estimate the heterogeneity of infection rates from the
relationship between rates of infectious bites and community prevalence. We apply
this framework to a large, published data set that combines malaria measurements from
more than 90 communities. We find strong evidence that heterogeneous biting or heterogeneous
susceptibility to infection are important and pervasive factors determining the prevalence
of infection: 20% of people receive 80% of all infections. We also find that individual
infections last about six months on average, per infectious bite, and children who
clear infections are not immune to new infections. The results have important implications
for public health interventions: the success of malaria control will depend heavily
on whether efforts are targeted at those who are most at risk of infection.