Epidemiological and clinical consequences of within-host evolution

Many viruses and bacteria are known to evolve rapidly over the course of an infection. However, epidemiological studies generally assume that within-host evolution is an instantaneous process. We argue that the dynamics of within-host evolution has implications at the within-host and at the between-host levels. We first show that epidemiologists should consider within-host evolution, notably because it affects the genotype of the pathogen that is transmitted. We then present studies that investigate evolution at the within-host level and examine the extent to which these studies can help to understand infection traits involved in the epidemiology (e.g. transmission rate, virulence, recovery rate). Finally, we discuss how new techniques for data acquisition can open new perspectives for empirical and theoretical research.