Environmental mutations in the Campo focus challenge elimination of sleeping sickness transmission in Cameroon

Sleeping sickness is still prevalent in Campo, southern Cameroon, despite the efforts of World Health Organization and the National Control Programme in screening and treating cases. Reducing disease incidence still further may need the control of tsetse vectors. We update entomological and parasitological parameters necessary to guide tsetse control in Campo. Tsetse flies were trapped, their apparent densities were evaluated as the number of flies captured per trap per day and mapped using GIS tools. Polymerase chain reaction based methods were used to identify their trypanosome infection rates. Glossina palpalis palpalis was the dominant vector species representing 93.42% and 92.85% of flies captured respectively during the heavy and light dry seasons. This species presented high densities, that is, 3.87, 95% CI [3.84–3.91], and 2.51, 95% CI [2.49–2.53] flies/trap/day in the two seasons. Moreover, 16.79% (of 1054) and 20.23% (of 1132 flies) were found infected with at least 1 trypanosome species for the 2 seasons respectively, Trypanosoma congolense being the most prevalent species, and Trypanosoma. brucei gambiense identified in 4 samples. Tsetse flies are abundant in Campo and present high trypanosome infection rates. The detection of tsetse infected with human trypanosomes near the newly created palm grove show workers' exposition. Tsetse densities maps built will guide vector control with ‘Tiny Targets’

Actigraphy in Human African Trypanosomiasis as a Tool for Objective Clinical Evaluation and Monitoring: A Pilot Study

The clinical picture of the parasitic disease human African trypanosomiasis (HAT, also called sleeping sickness) is dominated by sleep alterations. We here used actigraphy to evaluate patients affected by the Gambiense form of HAT. Actigraphy is based on the use of battery-run, wrist-worn devices similar to watches, widely used in middle-high income countries for ambulatory monitoring of sleep disturbances. This pilot study was motivated by the fact that the use of polysomnography, which is the gold standard technology for the evaluation of sleep disorders and has greatly contributed to the objective identification of signs of disease in HAT, faces tangible challenges in resource-limited countries where the disease is endemic. We here show that actigraphy provides objective data on the severity of sleep-wake disturbances that characterize HAT. This technique, which does not disturb the patient's routine activities and can be applied at home, could therefore represent an interesting, non-invasive tool for objective HAT clinical assessment and long-term monitoring under field conditions. The use of this method could provide an adjunct marker of HAT severity and for treatment follow-up, or be evaluated in combination with other disease biomarkers in body fluids that are currently under investigation in many laboratories

Impact of a small-scale tsetse fly control operation with deltamethrin impregnated “Tiny Targets” on tsetse density and trypanosomes’ circulation in the Campo sleeping sickness focus of South Cameroon

Background: Significant progress has been made towards African sleeping sickness elimination in the last decade. Indeed, the World Health Organization (WHO) global goal of eliminating the chronic form of the disease as a public health problem was achieved in 2020 (i.e., < 2,000 new cases per year). Vector control has played an important role in achieving this goal. In this study, we evaluated the impact of the insecticide impregnated Tiny Targets on tsetse fly densities and their infection rates with Trypanosoma spp in the Campo sleeping sickness focus of South Cameroon. Methods: The study site was divided into two areas: (i) the south-west experimental area, which included vector control, and (ii) the eastern part as the non-intervention area. After compiling the baseline entomological data (tsetse densities and trypanosome infection rates), around 2000 Tiny Targets were deployed in the South-West area and replaced every six months for two years. Post-intervention surveys were conducted every six months to determine tsetse densities and levels of trypanosome infections with PCR-based methods. Results: Following the intervention, tsetse mean catches decreased by 61% after six months, and up to 73% after twelve months (pre-intervention: 2.48 flies/trap/day, 95%CI [1.92–3.14]; 12-months post-intervention: 0.66 tsetse/trap/day, 95%CI [0.42–0.94]). This decrease was not sustained after 18 months, and the mean catch doubled compared to that after 12 months. After 24 months, the mean catches still increased by 17% (18 months: 1.45 tsetse/trap/day, 95%CI [1.07–1.90] and 24 months: 1.71 tsetse/trap/day, 95%CI [1.27–2.24]). In the non-intervention area, a variation in tsetse catches was observed during the two years, with a general increase from 2.43 [0.73–5.77] to 3.64 [1.47–7.70] tsetse/trap/day. In addition, trypanosome infection rates dropped by 75% in both areas (P-value < 0.001) from 21.20% to 5.06% and from 13.14% to 3.45% in intervention and control areas respectively. Conclusion: Tiny targets have proven useful in reducing tsetse population densities and trypanosome infection rates, providing evidence for the integration of this tool in current strategies towards trypanosomiasis elimination in Campo. The non-sustained decrease of tsetse densities after one year may indicate reinvasions from neighbouring breeding sites or that the intervention area was not large enough. Our results show the need to scale up by accessing difficult breeding sites and extend the tiny targets to the whole transborder focus

Trypanosome infection rates before and during the target intervention in the control area.

Trypanosome infection rates before and during the target intervention in the control area.</p

Summary of the number of flies captured in non-intervention area.

Summary of the number of flies captured in non-intervention area.</p

Patterns of trypanosome infection rates in <i>Glossina palpalis palpalis</i> in intervention and non-intervention areas.

Patterns of trypanosome infection rates in Glossina palpalis palpalis in intervention and non-intervention areas.</p

Boxplot of <i>Glossina palpalis palpalis</i> apparent densities per trap during the vector control operation.

Boxplot of Glossina palpalis palpalis apparent densities per trap during the vector control operation.</p

Study area—Campo, South Cameroun.

Figure designed using the ESRI satellite base map (https://www.arcgis.com/home/webmap/viewer.html?url= = https://server.arcgisonline.com/arcgis/rest/services/World_Imagery/MapServer&source=sd).</p

Location and distribution of tiny targets in the intervention area.

Figure designed using the ESRI satellite base map (https://www.arcgis.com/home/webmap/viewer.html?url = https://server.arcgisonline.com/arcgis/rest/services/World_Imagery/MapServer&source=sd).</p

<i>Trypanosoma</i> sp. infection rates before and during the vector control in the intervention area.

Trypanosoma sp. infection rates before and during the vector control in the intervention area.</p