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The broad spectrum of pathogens under the umbrella of NTDs lead to a range of negative health outcomes, from malnutrition and anaemia to organ failure, blindness and carcinogenesis. For some NTDs, the most severe clinical manifestations develop over many years of chronic or repeated infection. For these diseases, the association between infection and risk of long-term pathology is generally complex, and the impact of multiple interacting factors, such as age, co-morbidities and host immune response, is often poorly quantified. Mathematical modelling has been used for many years to gain insights into the complex processes underlying the transmission dynamics of infectious diseases; however, long-term morbidities associated with chronic or cumulative exposure are generally not incorporated into dynamic models for NTDs. Here we consider the complexities and challenges for determining the relationship between cumulative pathogen exposure and morbidity at the individual and population levels, drawing on case studies for trachoma, schistosomiasis and foodborne trematodiasis. We explore potential frameworks for explicitly incorporating long-term morbidity into NTD transmission models, and consider the insights such frameworks may bring in terms of policy-relevant projections for the elimination era.<\/jats:p>\n                  <jats:p>This article is part of the theme issue \u2018Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs\u2019.<\/jats:p>","DOI":"10.1098\/rstb.2022.0279","type":"journal-article","created":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T19:05:40Z","timestamp":1692558340000},"update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Modelling morbidity for neglected tropical diseases: the long and winding road from cumulative exposure to long-term pathology"],"prefix":"10.1098","volume":"378","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3189-7047","authenticated-orcid":true,"given":"Anna","family":"Borlase","sequence":"first","affiliation":[{"name":"Department of Biology 1 , ,"},{"name":"University of Oxford 1 , ,"},{"name":"Oxford OX1 3SZ, UK 1 , ,"},{"name":"Big Data Institute, Li Ka Shing Centre for Health Information and Discovery 2 , ,"},{"name":"University of Oxford 2 , ,"},{"name":"Oxford OX3 7LF, UK 2 , ,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4699-5931","authenticated-orcid":false,"given":"Joaquin M.","family":"Prada","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences 3 , ,"},{"name":"University of Surrey 3 , ,"},{"name":"Guildford GU2 7XH, UK 3 , ,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2934-1063","authenticated-orcid":true,"given":"Thomas","family":"Crellen","sequence":"additional","affiliation":[{"name":"Big Data Institute, Li Ka Shing Centre for Health Information and Discovery 2 , ,"},{"name":"University of Oxford 2 , ,"},{"name":"Oxford OX3 7LF, UK 2 , ,"},{"name":"School of Biodiversity, One Health & Veterinary Medicine, Graham Kerr Building 4 , ,"},{"name":"University of Glasgow 4 , ,"},{"name":"Glasgow G12 8QQ, UK 4 , ,"},{"name":"Wellcome Centre for Integrative Parasitology, Sir Graeme Davies Building 5 , ,"},{"name":"University of Glasgow 5 , ,"},{"name":"Glasgow G12 8TA, UK 5 , ,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"175","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"2026010106395048700_RSTB20220279C1","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.1016\/S0140-6736(09)60233-6","article-title":"Rescuing the bottom billion through control of neglected tropical diseases","volume":"373","author":"Hotez","year":"2009","journal-title":"Lancet"},{"key":"2026010106395048700_RSTB20220279C2","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.trstmh.2008.02.024","article-title":"Combating the \u2018other diseases\u2019 of MDG 6: changing the paradigm to achieve equity and poverty reduction?","volume":"102","author":"Molyneux","year":"2008","journal-title":"Trans. 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