Volume 98, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Infectious diseases often present as coinfections that may affect each other in positive or negative ways. Understanding the relationship between two coinfecting pathogens is thus important to understand the risk of infection and burden of disease caused by each pathogen. Although coinfections with and are very common outside Africa, it is yet unclear whether infections by the two parasite species are positively associated or if infection by one parasite suppresses the other. In this study, we use bivariate Poisson lognormal models (BPLM) to estimate covariate-adjusted associations between the incidence of infections (as measured by the force of blood-stage infections, FOI) and clinical episodes caused by both and in a cohort of Papua New Guinean children. A BPLM permits estimation of either positive or negative correlation, unlike most other multivariate Poisson models. Our results demonstrated a moderately positive association between and infection rates, arguing against the hypothesis that infections protect against infections. Our findings also suggest that the BPLM is only useful for counts with suitably large means and overdispersion.


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Supplemental Figure

  • Received : 30 Jun 2017
  • Accepted : 14 Oct 2017

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