Enhanced metagenomics-enabled transmission inference with TRACS

Coexisting strains of the same species within the human microbiota pose a substantial challenge to inferring the host-to-host transmission of both pathogenic and commensal microbes. Here, we present TRACS, a highly accurate algorithm for estimating genetic distances between strains at the level of individual SNPs, which is robust to intra-species diversity within the host. Analysis of well-characterised Faecal Microbiota Transplantation datasets, along with extensive simulations, demonstrates that TRACS substantially outperforms existing strain aware transmission inference methods. We use TRACS to infer transmission networks in patients colonised with multiple strains, including SARS-CoV-2 amplicon sequencing data from UK hospitals, deep population sequencing data of Streptococcus pneumoniae and single-cell genome sequencing data from malaria patients infected with Plasmodium falciparum . Applying TRACS to gut metagenomic samples from a large cohort of 176 mothers and 1,288 infants born in UK hospitals revealed species-specific transmission rates between mothers and their infants. Notably, TRACS identified increased persistence of Bifidobacterium breve in infants, a finding missed by previous analyses due to the presence of multiple strains.