Assessing the effect of prevalence on the predictive performance of species distribution models using simulated data

Aim The proportion of sampled sites where a species is present is known as prevalence. Empirical studies have shown that prevalence can affect the predictive performance of species distribution models. This paper uses simulated species data to examine how prevalence and the form of species environmental dependence affect the assessment of the predictive performance of models. Methods Simulated species data were based on various functions of simulated environmental data with differing degrees of spatial correlation. Seven model performance measures – sensitivity, specificity, class‐average (CA), overall prediction success, kappa (κ), normalized mutual information (NMI) and area under the receiver operating characteristic curve (AUC) – were applied to species models fitted by three regression methods. The response of the performance measures to prevalence was then assessed. Three probability threshold selection methods used to convert fitted logistic model values to presence or absence were also assessed. Results The study shows that the extent to which prevalence affects model performance depends on the modelling technique and its degree of success in capturing dominant environmental determinants. It also depends on the statistic used to measure model performance and the probability threshold method. The response based on κ generally preferred models with medium prevalence. All performance measures were least affected by prevalence when the probability threshold was chosen to maximize predictive performance or was based directly on prevalence. In these cases, the responses based on AUC, CA and NMI generally preferred models with small or large prevalence. Main conclusions The effect of prevalence on the predictive performance of species distribution models has a methodological basis. Relevant factors include the success of the fitted distribution model in capturing the dominant environmental determinant, the model performance measure and the probability threshold selection method. The fixed probability threshold method yields a marked response of model performance to prevalence and is therefore not recommended. The study explains previous empirical results obtained with real data.     

The microdistribution of the trichomycete Smittium culisetae in the hindgut of the black fly host Simulium vittatum

We examined the distribution of hyphae of the trichomycete fungus Smittium culisetae (Harpellales: Legeriomycetaceae) in the hindgut of a larval black fly (Simulium vittatum, cytospecies IS-7) by analyzing its prevalence and relative abundance. Hyphal prevalence was highest in the posterior colon (93.1%) and rectum (86.3%), with low prevalence (12.0%) in the anterior colon. Relative abundance of hyphae was highest in the posterior colon, followed by the rectum; relative abundance of hyphae in the anterior colon was lower. Hyphae of S. culisetae were not observed in the pylorus. We used a novel method of quantifying the relative abundance of S. culisetae in the host hindgut. The hindgut was observed with an ocular grid, and abundance was expressed as the ratio of grids occupied by hyphae to the number of grids occupied by hindgut.     

金黄色葡萄球菌的检测方法优化及其在舟山市水产品加工厂中的污染状况调查

金黄色葡萄球菌(Staphylococcus aureus)是引起食物中毒的重要致病菌。为简化金黄色葡萄球菌复杂的检测方法,并了解舟山市水产品中该致病菌的污染状况,通过比较已公开的3套针对耐热核酸酶编码基因的PCR鉴定体系,根据特异性和灵敏性实验筛选了1套最优的针对金黄色葡萄球菌的PCR鉴定体系。基于这一体系和国家规定的标准方法,对舟山市水产品加工厂各个环节采集的120份样品中金黄色葡萄球菌的污染状况进行了调查。结果显示,120份样品中金黄色葡萄球菌的检出率为8.3%,PCR检测方法与国标法检出阳性率比较无显著差异,而且集中在原料和环境这两个环节检出金黄色葡萄球菌,在半成品和成品中却未检测到。由此,可以认为舟山市水产品加工厂的原料和环境中存在着一定的安全隐患,而成品相对较为安全。     

Real-time PCR Demonstrates High Prevalence of Schistosoma japonicum in the Philippines: Implications for Surveillance and Control

Background

The Philippines has a population of approximately 103 million people, of which 6.7 million live in schistosomiasis-endemic areas with 1.8 million people being at risk of infection with Schistosoma japonicum. Although the country-wide prevalence of schistosomiasis japonica in the Philippines is relatively low, the prevalence of schistosomiasis can be high, approaching 65% in some endemic areas. Of the currently available microscopy-based diagnostic techniques for detecting schistosome infections in the Philippines and elsewhere, most exhibit varying diagnostic performances, with the Kato-Katz (KK) method having particularly poor sensitivity for detecting low intensity infections. This suggests that the actual prevalence of schistosomiasis japonica may be much higher than previous reports have indicated.

Methodology/Principal Findings

Six barangay (villages) were selected to determine the prevalence of S. japonicum in humans in the municipality of Palapag, Northern Samar. Fecal samples were collected from 560 humans and examined by the KK method and a validated real-time PCR (qPCR) assay. A high S. japonicum prevalence (90.2%) was revealed using qPCR whereas the KK method indicated a lower prevalence (22.9%). The geometric mean eggs per gram (GMEPG) determined by the qPCR was 36.5 and 11.5 by the KK. These results, particularly those obtained by the qPCR, indicate that the prevalence of schistosomiasis in this region of the Philippines is much higher than historically reported.

Conclusions/Significance

Despite being more expensive, qPCR can complement the KK procedure, particularly for surveillance and monitoring of areas where extensive schistosomiasis control has led to low prevalence and intensity infections and where schistosomiasis elimination is on the horizon, as for example in southern China.     

Monitoring the obesity epidemic in France: the Obepi surveys 1997-2006

The objective of the study was to describe the prevalences of obesity in French adults over a 9-year period. Mailed questionnaire surveys, in 1997, 2000, 2003, and 2006, sampled 20,000 representative French households by the method of quotas. Weight, height, and waist circumference were reported by all members of the selected households > or = 18-years. Obesity was defined according to the WHO criteria, BMI > 30 kg/m2. The prevalence of adult obesity increased progressively from 8.6% (95% confidence interval: 8.2-8.8) in 1997 to 13.1% (12.7-13.5) in 2006. The increase affected all ages, socioeconomic strata, and regions. Although the prevalence of obesity increased in parallel in men and women from 1997 to 2003, the rate of increase was lower in men between 2003 and 2006. These surveys showed a sharp increase in the prevalence of obesity in France in recent years contrasting with a stable prevalence in the 1980s. The results of the first Obepi surveys prompted the French government to implement a Nutrition and Health National Plan in 2001. Regular monitoring of obesity prevalence in France and neighboring countries is needed to compare future trends.     

Prevalence Study of Yaws in the Democratic Republic of Congo Using the Lot Quality Assurance Sampling Method

Background

Until the 1970s the prevalence of non-venereal trepanomatosis, including yaws, was greatly reduced after worldwide mass treatment. In 2005, cases were again reported in the Democratic Republic of the Congo. We carried out a survey to estimate the village-level prevalence of yaws in the region of Equator in the north of the country in order to define appropriate strategies to effectively treat the affected population.

Methodology/Principal Findings

We designed a community-based survey using the Lot Quality Assurance Sampling method to classify the prevalence of active yaws in 14 groups of villages (lots). The classification into high, moderate, or low yaws prevalence corresponded to World Health Organization prevalence thresholds for identifying appropriate operational treatment strategies. Active yaws cases were defined by suggestive clinical signs and positive rapid plasma reagin and Treponema pallidum hemagglutination serological tests. The overall prevalence in the study area was 4.7% (95% confidence interval: 3.4–6.0). Two of 14 lots had high prevalence (>10%), three moderate prevalence (5–10%) and nine low prevalence (<5%.).

Conclusions/Significance

Although yaws is no longer a World Health Organization priority disease, the presence of yaws in a region where it was supposed to be eradicated demonstrates the importance of continued surveillance and control efforts. Yaws should remain a public health priority in countries where previously it was known to be endemic. The integration of sensitive surveillance systems together with free access to effective treatment is recommended. As a consequence of our study results, more than 16,000 people received free treatment against yaws.     

Detection of human papillomavirus types by the polymerase chain reaction and the differentiation between high-risk and low-risk cervical lesions

By means of a consensus polymerase chain reaction (PCR) method, the prevalence of HPV types was determined in cervical biopsies from 137 women referred to the gynecological outpatient clinic for colposcopy because of an abnormal cervical smear. The prevalence of HPV was 80.3%. There was a statistically highly significant rise in the prevalence of the oncogenic HPV types (16, 18, 31, 33) with increasing severity of cervical intraepithelial neoplasia (CIN I to III), indicating a role for these HPV types in the pathogenesis of cervical cancer. The prevalence of other HPV types decreased significantly with the severity of the lesion, suggesting that these HPV types play a less significant role in this process. These data indicate that HPV typing with PCR may be a valuable tool for distinguishing between highrisk and low-risk cervical lesions. Furthermore, our results suggest that the detection of HPV types by consensus PCR in the cervix of patients with an abnormal smear but without histologically detectable CIN is a useful tool for predicting which of these patiens will eventually develop CIN. Finally, a relatively low percentage (3%) of HPV double infections is reported in this study.     

Detection of human papillomavirus types by the polymerase chain reaction and the differentiation between high-risk and low-risk cervical lesions.

By means of a consensus polymerase chain reaction (PCR) method, the prevalence of HPV types was determined in cervical biopsies from 137 women referred to the gynecological outpatient clinic for colposcopy because of an abnormal cervical smear. The prevalence of HPV was 80.3%. There was a statistically highly significant rise in the prevalence of the oncogenic HPV types (16, 18, 31, 33) with increasing severity of cervical intraepithelial neoplasia (CIN I to III), indicating a role for these HPV types in the pathogenesis of cervical cancer. The prevalence of other HPV types decreased significantly with the severity of the lesion, suggesting that these HPV types play a less significant role in this process. These data indicate that HPV typing with PCR may be a valuable tool for distinguishing between high-risk and low-risk cervical lesions. Furthermore, our results suggest that the detection of HPV types by consensus PCR in the cervix of patients with an abnormal smear but without histologically detectable CIN is a useful tool for predicting which of these patients will eventually develop CIN. Finally, a relatively low percentage (3%) of HPV double infections is reported in this study.     

Evaluation of two coproscopic techniques for the diagnosis of schistosomiasis in a low-transmission area in the state of Minas Gerais, Brazil

This population study, which evaluated two parasitological methods for the diagnosis of schistosomiasis mansoni, was performed in a low-transmission area in Pedra Preta, Montes Claros, Minas Gerais, Brazil. A total of 201 inhabitants of the rural area participated in this research. Four stool samples were obtained from all participants and analysed using the Kato-Katz method (18 slides) and a commercial test, the TF-Test?, which was performed quantitatively. The data were analysed to determine prevalence, the sensitivity of the diagnostic methods, the worm burden and the definition of the "gold standard", which was obtained by totalling the results of all samples examined using the Kato-Katz technique and the TF-Test?. The results showed that the prevalence obtained from the examination of one Kato-Katz slide (the methodology adopted by the Brazilian control programme) was 8% compared to 35.8% from the "gold standard", which was a 4.5-fold difference. This result indicates that the prevalence of schistosomiasis in so-called low-transmission areas is significantly underestimated.     

Pathogenicity of the protozoan parasite Marteilioides chungmuensis in the Pacific oyster Crassostrea gigas

Marteilioides chungmuensis is an ovarian parasite that causes nodule-like structures to appear on the gonads of female Pacific oysters, Crassostrea gigas. It is known that the prevalence of infection increases in summer and decreases from autumn to spring. To investigate the decrease in prevalence of infection and pathogenicity of the parasite, a biopsy method was developed to detect infected oysters, which were then monitored to calculate the mortality rate. Mortality of infected oysters was recorded monthly and changes in reproductive development observed histologically. Compared with control groups, a significant difference in mortality was observed in infected oysters in September and October. Histological observations showed that infected oysters produced oocytes continuously, even in autumn when healthy oysters were reproductively inactive. This prolonged spawning activity of infected oysters resulted in nutritional wasting and mortality. From December onwards, however, almost all infected oysters survived, though the infection persisted. Infection intensity decreased gradually from December. Histological observations revealed that, in winter, infected oysters released infected and uninfected oocytes through the genital canal. The gonad subsequently degenerated and was replaced with connective tissue, as in normal, healthy spent oysters. The results revealed that prevalence of infection decreased from September to May. It is hypothesised that the decline in prevalence within the epizootic area in autumn occurred because infected oysters died and that the winter decrease was due to recovery from infection.     

Using the Prevalence of Individual Species of Intestinal Nematode Worms to Estimate the Combined Prevalence of Any Species

Objectives

To assess if a probabilistic model could be used to estimate the combined prevalence of infection with any species of intestinal nematode worm when only the separate prevalence of each species is reported, and to estimate the extent to which simply taking the highest individual species prevalence underestimates the combined prevalence.

Methods

Data were extracted from community surveys that reported both the proportion infected with individual species and the combined proportion infected, for a minimum sample of 100 individuals. The predicted combined proportion infected was calculated based on the assumption that the probability of infection with one species was independent of infection with another species, so the probability of combined infections was multiplicative.

Findings

Thirty-three reports describing 63 data sets from surveys conducted in 20 countries were identified. A strong correlation was found between the observed and predicted combined proportion infected (r = 0.996, P<0.001). When the observed and predicted values were plotted against each other, a small correction of the predicted combined prevalence by dividing by a factor of 1.06 achieved a near perfect correlation between the two sets of values. The difference between the single highest species prevalence and the observed combined prevalence was on average 7% or smaller at a prevalence of ≤40%, but at prevalences of 40–80%, the difference was about 12%.

Conclusions

A simple probabilistic model of combined infection with a small correction factor is proposed as a novel method to estimate the number of individuals that would benefit from mass deworming when data are reported only for separate species.     

Anti‐helminth‐induced changes in the prevalence of entodiniomorphid ciliates in semi‐captive chimpanzees

Ciliates are some of the most abundant gut fauna in wild chimpanzees. However, their presence in captive populations is usually low presumably due to anti‐helmintic prophylaxis or feeding on low fibre diet. We studied a semi‐captive colony of chimpanzees at the Sweetwaters Sanctuary in Kenya subject to routine prophylactic dose of albendazole to clear chimpanzees of parasitic helminths. Fresh faecal samples from known individuals were collected before and subsequently after prophylaxis. The samples were fixed in 10% formalin and examined by the sedimentation method. Troglodytella abrassarti had 42.5% prevalence whereas other ciliates had 65% prevalence. The prevalence of the T. abrassarti and other ciliates significantly declined immediately after prophylaxis and then rose slowly thereafter. Our results suggest that ciliates are susceptible to anti‐helmintic prophylaxis and that treatment may eliminate ciliates or inhibit their proliferation within the host subsequently lowering their prevalence in the population. Variation in prevalence was not influenced by the age of the host. However, a steady recovery of ciliate prevalence was lower for male compared to female hosts. Our results imply that the intervals between prophylactic regimes could be prolonged differently for males and females to increase the prevalence of ciliates in captive populations.     

Endemic cretinism in a traditional society in Mali: from the collectivity to the individual

The prevalence of endemic cretinism was measured in a village belonging to the Bwa ethnic group in Mali liable to iodine deficiency and suffering from endemic goitre. In this village according to mental and motor handicaps found in cretinism, we used two psychometric tests: the Raven's Progressive Matrice (PM 47) and a "peg test". Using the fiduciary inference method on the two tests associated with a clinical and qualitative approach, we obtained a prevalence of myxedematous cretinism close to 1.2%.     

Prevalence of pathogenic Yersinia enterocolitica strains in pigs in the United States

Yersinia enterocolitica is considered an important food-borne pathogen impacting the pork production and processing industry in the United States. Since this bacterium is a commensal of swine, the primary goal of this study was to determine the prevalence of pathogenic Y. enterocolitica in pigs in the United States using feces as the sample source. A total of 2,793 fecal samples were tested for its presence in swine. Fecal samples were collected from late finisher pigs from 77 production sites in the 15 eastern and midwestern pork-producing states over a period of 27 weeks (6 September 2000 to 20 March 2001). The prevalence of ail-positive Y. enterocolitica was determined in samples using both a fluorogenic 5' nuclease PCR assay and a culture method. The mean prevalence was 13.10% (366 of 2,793 fecal samples tested) when both PCR- and culture-positive results were combined. Forty-one of 77 premises (53.25%) contained at least one fecal sample positive for the ail sequence. The PCR assay indicated a contamination rate of 12.35% (345/2,793) compared to 4.08% (114/2,793) by the culture method. Of the 345 PCR-positive samples, 252 were culture negative, while of the 114 culture-positive samples, 21 were PCR negative. Among 77 premises, the PCR assay revealed a significantly (P < 0.05) higher percentage (46.75%, n = 36 sites) of samples positive for the pathogen (ail sequence) than the culture method (22.08%, n = 17 sites). Thus, higher sensitivity, with respect to number of samples and sites identified as positive for the PCR method compared with the culture method for detecting pathogenic Y. enterocolitica, was demonstrated in this study. The results support the hypothesis that swine are a reservoir for Y. enterocolitica strains potentially pathogenic for humans.     

Interpopulation variation in the prevalence and intensity of parasitic mite infection in the land snail Arianta arbustorum

Abstract. The parasitic mite Riccardoella limacum sucks blood in the lung of its host, the land snail Arianta arbustorum . The infection of various host populations was examined in Switzerland. In a lowland snail population, prevalence of infection did not vary among seasons. However, intensity of mite infection in dissected individuals of A. arbustorum was high in autumn, but low in winter and spring when ≤100 mite eggs were found attached to the lung epithelium. A novel, non-invasive parasite screening method was used to estimate the number of mites on living host snails. An analysis of repeatability revealed that 92.9% of the snails were correctly classified as infected or non-infected with this non-invasive method. Prevalence of mite infection was examined in 997 adults of A. arbustorum from 11 natural populations distributed over an altitudinal gradient ranging 335–2360 m. No infected snails were found in 7 populations, while in the remaining 4 populations the prevalence of mite infection ranged 45.8–77.8%. Intensity of infection also differed among the 4 host populations. No geographic pattern in prevalence of infection was found. However, parasitic mites did not occur in snail populations situated at elevations of 1290 m or higher. A possible explanation for this finding could be that the host's hibernation period may be too long at high elevations for mites and their eggs to survive. At low elevations, other factors may affect the presence of R. limacum in the lung of A. arbustorum .     

The serologic screening for celiac disease in the general population (blood donors) and in some high-risk groups of adults (patients with autoimmune diseases,osteoporosis and infertility) in the Czech republic

The prevalence of celiac disease (CD) was determined in healthy blood donors and in high-risk groups of adults (a total of 1835 adults—randomly selected 1312 healthy blood donors, 102 patients with primary osteoporosis, 58 patients with autoimmune diseases and 365 infertile women). It was calculated on the basis of a two-step serologic screening method—in the first step IgA and IgG antigliadin antibodies (AGA) and IgA anti-γ-glutamyltransferase (‘transglutaminase’) antibodies (ATG) were estimated, in the second step sera positive for IgA AGA and/or IgA ATG were examined for antiendomysial IgA (AEA) antibodies. Immunoenzymic assay (ELISA) was used for determining of AGA and ATG antibodies; immunoflurescence method, performed on human umbilical cord tissue, was used for assaying of AEA antibodies. Total serum IgA level in only IgG AGA positive subjects was measured by routine turbidimetric method. 0.45% of healthy blood donors, 0.98% of osteoporotic patients, 2.7% of patients suffering from autoimmune disease and 1.13% of women with infertility considered as immunologically mediated were found to be positive in both steps of serologic screening (AGA and/or ATG and antiendomysium positive). The presumed high prevalence of seropositivity for CD in apparently healthy Czech adult population was confirmed. In the high-risk groups, the prevalence of seropositivity for CD was approximately 2–4 times higher than in healthy blood donors. The real prevalence of CD in the tested groups, however, can be estimated after performing small intestinal biopsy in the seropositive patients.     

Use of hidden Markov capture–recapture models to estimate abundance in the presence of uncertainty: Application to the estimation of prevalence of hybrids in animal populations

Estimating the relative abundance (prevalence) of different population segments is a key step in addressing fundamental research questions in ecology, evolution, and conservation. The raw percentage of individuals in the sample (naive prevalence) is generally used for this purpose, but it is likely to be subject to two main sources of bias. First, the detectability of individuals is ignored; second, classification errors may occur due to some inherent limits of the diagnostic methods. We developed a hidden Markov (also known as multievent) capture–recapture model to estimate prevalence in free‐ranging populations accounting for imperfect detectability and uncertainty in individual's classification. We carried out a simulation study to compare naive and model‐based estimates of prevalence and assess the performance of our model under different sampling scenarios. We then illustrate our method with a real‐world case study of estimating the prevalence of wolf (Canis lupus) and dog (Canis lupus familiaris) hybrids in a wolf population in northern Italy. We showed that the prevalence of hybrids could be estimated while accounting for both detectability and classification uncertainty. Model‐based prevalence consistently had better performance than naive prevalence in the presence of differential detectability and assignment probability and was unbiased for sampling scenarios with high detectability. We also showed that ignoring detectability and uncertainty in the wolf case study would lead to underestimating the prevalence of hybrids. Our results underline the importance of a model‐based approach to obtain unbiased estimates of prevalence of different population segments. Our model can be adapted to any taxa, and it can be used to estimate absolute abundance and prevalence in a variety of cases involving imperfect detection and uncertainty in classification of individuals (e.g., sex ratio, proportion of breeders, and prevalence of infected individuals).     

Estimating the Sizes of Populations at High Risk for HIV: A Comparison Study

Objectives

Behavioral interventions are effective strategies for HIV/AIDS prevention and control. However, implementation of such strategies relies heavily on the accurate estimation of the high-risk population size. The multiplier method and generalized network scale-up method were recommended to estimate the population size of those at high risk for HIV by UNAIDS/WHO in 2003 and 2010, respectively. This study aims to assess and compare the two methods for estimating the size of populations at high risk for HIV, and to provide practical guidelines and suggestions for implementing the two methods.

Methods

Studies of the multiplier method used to estimate the population prevalence of men who have sex with men in China published between July 1, 2003 and July 1, 2013 were reviewed. The generalized network scale-up method was applied to estimate the population prevalence of men who have sex with men in the urban district of Taiyuan, China.

Results

The median of studies using the multiplier method to estimate the population prevalence of men who have sex with men in China was 4–8 times lower than the national level estimate. Meanwhile, the estimate of the generalized network scale-up method fell within the range of national level estimate.

Conclusions

When high-quality existing data are not readily available, the multiplier method frequently yields underestimated results. We thus suggest that the generalized network scale-up method is preferred when sampling frames for the general population and accurate demographic information are available.     

Identifying regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis

Objective

To provide regional estimates of the prevalence of maternal haemorrhage and explore the effect of methodological differences between studies on any observed regional variation.

Methods

We conducted a systematic review of the prevalence of maternal haemorrhage, defined as blood loss greater than or equal to 1) 500 ml or 2) 1000 ml in the antepartum, intrapartum or postpartum period. We obtained regional estimates of the prevalence of maternal and severe maternal haemorrhage by conducting meta-analyses and used meta-regression to explore potential sources of between-study heterogeneity.

Findings

No studies reported the prevalence of antepartum haemorrhage (APH) according to our definitions. The prevalence of postpartum haemorrhage (PPH) (blood loss ≥500 ml) ranged from 7.2% in Oceania to 25.7% in Africa. The prevalence of severe PPH (blood loss ≥1000 ml) was highest in Africa at 5.1% and lowest in Asia at 1.9%. There was strong evidence of between-study heterogeneity in the prevalence of PPH and severe PPH in most regions. Meta-regression analyses suggested that region and method of measurement of blood loss influenced prevalence estimates for both PPH and severe PPH. The regional patterns changed after adjusting for the other predictors of PPH indicating that, compared with European women, Asian women have a lower prevalence of PPH.

Conclusions

We found evidence that Asian women have a very low prevalence of PPH compared with women in Europe. However, more reliable estimates will only be obtained with the standardisation of the measurement of PPH so that the data from different regions are comparable.     

Birth and population prevalence of Duchenne muscular dystrophy in the Netherlands

Summary Mutations causing Duchenne muscular dystrophy (DMD) have a short survival. Therefore, birth and population prevalence are maintained by new mutations. The present inventory was made to estimate the birth and population prevalence rates of DMD in the Netherlands. Seven methods of case identification were used. Data on 496 definite, probable or possible DMD patients born since 1961, or alive on January 1, 1983, were obtained. Several methods gave an estimated ascertainment of more than 95%. The prevalence rate at birth of DMD was estimated at 23.7×10^–5 (14215) male live births (MLB) yearly. The prevalence rate in the male population on January 1, 1983 was 5.4×10^–5 (118496). About 1% of the males in this study may have autosomal recessive Duchenne-like muscular dystrophy. Until now there has been no convincing evidence for geographic differences in DMD prevalence at birth. A list of frequency studies of Duchenne muscular dystrophy is included. The DMD mutation rate calculated by the indirect method is 7.9×10^–5 genes per generation. However, this may well be an over-estimate, as this method does not account for germline mosaicism. Using a modified sex ratio method the proportion of sporadic DMD among all cases was estimated to be 0.106 (range 0–0.332). High frequency of germline mosaicism in DMD is a likely cause for the apparent lack of sporadic cases as found in previous studies, if mutation rates in male and female gametes are equal. Therefore, methods for estimating the proportion of new mutants in DMD should take germline mosaicism into account. The modified sex ratio method allows incorporation of data on germline mosaicism if available.