A Spatio-temporal Model of African Animal Trypanosomosis Risk

[b]Background[/b]African animal trypanosomosis (AAT) is a major constraint to sustainable development of cattle farming in sub-Saharan Africa. The habitat of the tsetse fly vector is increasingly fragmented owing to demographic pressure and shifts in climate, which leads to heterogeneous risk of cyclical transmission both in space and time. In Burkina Faso and Ghana, the most important vectors are riverine species, namely Glossina palpalis gambiensis and G. tachinoides, which are more resilient to human-induced changes than the savannah and forest species. Although many authors studied the distribution of AAT risk both in space and time, spatio-temporal models allowing predictions of it are lacking.[b]Methodology/Principal Findings[/b]We used datasets generated by various projects, including two baseline surveys conducted in Burkina Faso and Ghana within PATTEC (Pan African Tsetse and Trypanosomosis Eradication Campaign) national initiatives. We computed the entomological inoculation rate (EIR) or tsetse challenge using a range of environmental data. The tsetse apparent density and their infection rate were separately estimated and subsequently combined to derive the EIR using a "one layer-one model" approach. The estimated EIR was then projected into suitable habitat. This risk index was finally validated against data on bovine trypanosomosis. It allowed a good prediction of the parasitological status (r(2) = 67%), showed a positive correlation but less predictive power with serological status (r(2) = 22%) aggregated at the village level but was not related to the illness status (r(2) = 2%).[b]Conclusions/Significance[/b]The presented spatio-temporal model provides a fine-scale picture of the dynamics of AAT risk in sub-humid areas of West Africa. The estimated EIR was high in the proximity of rivers during the dry season and more widespread during the rainy season. The present analysis is a first step in a broader framework for an efficient risk management of climate-sensitive vector-borne diseases

Diversite Phlebotomienne Dans Trois Villages De La Commune De Bouake (Côte D’ivoire) Durant La Periode De Mars A Juin 2019

La leishmaniose cutanée est une parasitose due à des protozoaires du genre Leishmania et répandue dans le monde. Une enquête médicale réalisée dans trois villages de la ville de Bouaké, autour de cas suspects de leishmaniose cutanée, a permis de confirmer la présence de cette pathologie dans ces villages. Dans le cadre de l’identification des acteurs du cycle épidémiologique de la leishmaniose cutanée, une étude entomologique a été conduite dans ces villages afin d’identifier les phlébotomes potentiels vecteurs de leishmanies. Les pièges huileux et les pièges lumineux CDC, ont été posés entre mars et juin 2019, suivant une méthode de rotation entre les sites de piégeage. Ils ont été posés entre 17h et 18h et relevés le lendemain matin entre 7h et 8h. La diversité spécifique des espèces identifiées a été déterminée à partir des indices écologiques d’équitabilité et de Hill. Ces pièges ont permis la capture de 135 phlébotomes, dont 78 ont été morphologiquement identifiés. Le genre Sergentomyia constituait 91% de nos récoltes contre 9% pour le genre Phlebotomus. Ph. bergeroti, Ph. rodhaini et Ph. sergenti étaient les espèces du genre Phlebotomus, capturées dans ces sites. Des travaux approfondis portant sur l’identification du parasite à la fois chez les phlébotomes et chez l’homme doivent être effectués, afin d’identifier les phlébotomes incriminés dans la transmission des leishmanies à Bouaké. Cutaneous leishmaniasis is a parasitosis caused by protozoa of the genus Leishmania and is widespread worldwide. A medical survey carried out in three villages of the city of Bouaké, around suspected cases of cutaneous leishmaniasis, confirmed the presence of this pathology in these villages. As part of the identification of the actors of the epidemiological cycle of cutaneous leishmaniasis, an entomological study was conducted in these villages in order to identify potential phlebotomus vectors of leishmaniasis. Oil traps and CDC light traps were set between March and June 2019, following a rotation method between trapping sites. They were set between 5:00 pm and 6:00 pm and were collected the next morning between 7:00 am and 8:00 am. The specific diversity of the identified species was determined from the ecological indices of equitability and Hill's ecological indices. These traps allowed the capture of 135 sandfish, 78 of which were morphologically identified. The genus Sergentomyia constituted 91% of our harvests against 9% for the genus Phlebotomus. Ph. bergeroti, Ph. rodhaini and Ph. sergenti were the species of the genus Phlebotomus caught at these sites. Further work on the identification of the parasite in both sandflies and humans should be carried out in order to identify the sandflies incriminated in the transmission of leishmania in Bouaké

Use of vector control to protect people from sleeping sickness in the focus of Bonon (Côte d’Ivoire)

Background Gambian human African trypanosomiasis (gHAT) is a neglected tropical disease caused by Trypanosoma brucei gambiense transmitted by tsetse flies (Glossina). In Côte d’Ivoire, Bonon is the most important focus of gHAT, with 325 cases diagnosed from 2000 to 2015 and efforts against gHAT have relied largely on mass screening and treatment of human cases. We assessed whether the addition of tsetse control by deploying Tiny Targets offers benefit to sole reliance on the screen-and-treat strategy. Methodology and principal findings In 2015, we performed a census of the human population of the Bonon focus, followed by an exhaustive entomological survey at 278 sites. After a public sensitization campaign, ~2000 Tiny Targets were deployed across an area of 130 km2 in February of 2016, deployment was repeated annually in the same month of 2017 and 2018. The intervention’s impact on tsetse was evaluated using a network of 30 traps which were operated for 48 hours at three-month intervals from March 2016 to December 2018. A second comprehensive entomological survey was performed in December 2018 with traps deployed at 274 of the sites used in 2015. Sub-samples of tsetse were dissected and examined microscopically for presence of trypanosomes. The census recorded 26,697 inhabitants residing in 331 settlements. Prior to the deployment of targets, the mean catch of tsetse from the 30 monitoring traps was 12.75 tsetse/trap (5.047–32.203, 95%CI), i.e. 6.4 tsetse/trap/day. Following the deployment of Tiny Targets, mean catches ranged between 0.06 (0.016–0.260, 95%CI) and 0.55 (0.166–1.794, 95%CI) tsetse/trap, i.e. 0.03–0.28 tsetse/trap/day. During the final extensive survey performed in December 2018, 52 tsetse were caught compared to 1,909 in 2015, with 11.6% (5/43) and 23.1% (101/437) infected with Trypanosoma respectively. Conclusions The annual deployment of Tiny Targets in the gHAT focus of Bonon reduced the density of Glossina palpalis palpalis by >95%. Tiny Targets offer a powerful addition to current strategies towards eliminating gHAT from Côte d’Ivoire

Tsetse fly ecology and risk of transmission of African trypanosomes related to a protected forest area at a military base in the city of Abidjan, Côte d’Ivoire

African trypanosomoses, whose pathogens are transmitted by tsetse flies, are a threat to animal and human health. Tsetse flies observed at the military base of the French Forces in Côte d’Ivoire (FFCI base) were probably involved in the infection and death of military working dogs. Entomological and parasitological surveys were carried out during the rainy and dry seasons using “Vavoua” traps to identify tsetse fly species, their distribution, favorable biotopes and food sources, as well as the trypanosomes they harbor. A total of 1185 Glossina palpalis palpalis tsetse flies were caught, corresponding to a high average apparent density of 2.26 tsetse/trap/day. The results showed a heterogeneous distribution of tsetse at the FFCI base, linked to more or less favorable biotopes. No significant variation in tsetse densities was observed according to the season. The overall trypanosomes infection rate according to microscopic observation was 13.5%. Polymerase chain reaction (PCR) analyses confirmed the presence of Trypanosoma vivax and T. congolense forest type, responsible for African animal trypanosomosis. Our findings suggest that there is a risk of introduction and transmission of T. brucei gambiense, responsible for human African trypanosomiasis, on the study site. This risk of transmission of African trypanosomes concerns not only the FFCI base, but also inhabited peripheral areas. Our study confirmed the need for vector control adapted to the eco-epidemiological context of the FFCI base

Multicentric assessment of the efficacy and tolerability of dihydroartemisinin-piperaquine compared to artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in sub-Saharan Africa

<p>Abstract</p> <p>Background</p> <p>The choice of appropriate artemisinin-based combination therapy depends on several factors (cost, efficacy, safety, reinfection rate and simplicity of administration). To assess whether the combination dihydroartemisinin-piperaquine (DP) could be an alternative to artemether-lumefantrine (AL), the efficacy and the tolerability of the two products for the treatment of uncomplicated falciparum malaria in sub-Saharan Africa have been compared.</p> <p>Methods</p> <p>A multicentric open randomized controlled clinical trial of three-day treatment of DP against AL for the treatment of two parallel groups of patients aged two years and above and suffering from uncomplicated falciparum malaria was carried out in Cameroon, Côte d'Ivoire and Senegal. Within each group, patients were randomly assigned supervised treatment. DP was given once a day for three days and AL twice a day for three days. Follow-up visits were performed on day 1 to 4 and on day 7, 14, 21, 28 to evaluate clinical and parasitological results. The primary endpoint was the recovery rate by day 28.</p> <p>Results</p> <p>Of 384 patients enrolled, 197 were assigned DP and 187 AL. The recovery rates adjusted by genotyping, 99.5% in the DP group and 98.9% in the AL group, were not statistically different (p = 0.538). No Early Therapeutic Failure (ETF) was observed. At day 28, two patients in the DP group and five in AL group had recurrent parasitaemia with <it>Plasmodium falciparum</it>. In the DP group, after PCR genotyping, one of the two recurrences was classified as a new infection and the other as recrudescence. In AL group, two recurrences were classified after correction by PCR as recrudescence. All cases of recrudescence were classified as Late Parasitological Failure (LPF). In each group, a rapid recovery from fever and parasitaemia was noticed. More than 90% of patients did no longer present fever or parasitaemia 48 hours after treatment. Both drugs were well tolerated. Indeed, no serious adverse events were reported during the follow-up period. Most of the adverse events which developed were moderate and did not result in the treatment being stopped in either treatment group.</p> <p>Conclusions</p> <p>Dihydroartemisinin-piperaquine was as effective and well-tolerated as artemether-lumefantrine in the treatment of uncomplicated falciparum malaria. In addition, dihydroartemisinin-piperaquine, a single daily dose, could be an advantage over artemether-lumefantrine in Africa because of better treatment observance.</p

Diagnostic clinique et traitement de la trypanosomiase humaine africaine dans le contexte d'élimination

La trypanosomiase humaine africaine (THA) est une maladie séculaire, successivement négligée et oubliée qui a réussi à traverser le temps, depuis le début du XXe siècle jusqu'à nos jours. Elle est responsable de plusieurs millions de morts impactant négativement la vie sociale et économique des populations rurales d'Afrique subsaharienne. Si les principales manifestations cliniques n'ont pas varié depuis sa découverte, la recherche d'un traitement plus efficace, plus spécifique et moins toxique s'est poursuivie très timidement. Depuis la découverte du premier médicament, l'Atoxyl®, il y a plus de 120 ans, plusieurs autres molécules ont été adaptées au traitement de la THA. Cependant, aucune nouvelle molécule spécifique de la THA n'a été développée. Les recherches ont porté plutôt sur de nouveaux protocoles ou la combinaison de molécules déjà existantes et prévues pour le traitement d'autres maladies. Récemment toutefois, le traitement de première intention du deuxième stade de la THA à Trypanosoma brucei gambiense est passé du mélarsoprol, dérivé arsenical très toxique, à la combinaison thérapeutique de nifurtimox et d'éflornithine (NECT), puis au fexinidazole, avec en perspective, un traitement oral à dose unique à base d'acoziborole. Pour la seconde fois après le contrôle de l'endémie des années 1960, les efforts de lutte ont permis d'atteindre le plus bas nombre de nouveaux cas déclarés de THA en 2018, au point que l'OMS, ainsi que plusieurs autres initiatives (Campagne panafricaine d'éradication de la mouche tsé-tsé et de la trypanosomiase, Déclaration de Londres sur les maladies tropicales négligées, Objectifs de développement durable, etc.), visent son élimination comme problème de santé publique en 2020 et l'arrêt de la transmission en 2030. Ce contexte de faible incidence fait perdre toute rentabilité aux prospections médicales à la Jamot et appelle à un changement de stratégie. Il faut désormais privilégier la surveillance passive en intégrant le dépistage et le traitement de la THA dans les centres de santé périphériques. Cela nécessite, pour ce personnel non averti, un rappel de la symptomatologie clinique, essentielle à la suspicion de THA, et une information sur l'actualité thérapeutiqu

Clinical Study Efficacy and Safety of Artesunate-Amodiaquine versus Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium falciparum Malaria in Sentinel Sites across Côte d&apos;Ivoire

Two years after the introduction of free Artesunate-Amodiaquine (ASAQ) and Artemether-Lumefantrine (AL) for the treatment of uncomplicated malaria in public health facilities in Côte d&apos;Ivoire, we carried out this study to compare their efficacy and tolerability in three surveillance sites. It was a multicentre open randomised clinical trial of 3-day ASAQ treatment against AL for the treatment of 2 parallel groups of patients aged 2 years and above. The endpoints were (1) Adequate Clinical and Parasitological Response (ACPR) at day 28 and (2) the clinical and biological tolerability. Of the 300 patients who were enrolled 289, with 143 (49.5%) and 146 (50.5%) in the ASAQ and AL groups, respectively, correctly followed the WHO 2003 protocol we used. The PCR-corrected ACPR was 99.3% for each group. More than 94% of patients no longer showed signs of fever, 48 hours after treatment. Approximately 78% of the people in the ASAQ group had a parasite clearance time of 48 hours or less compared to 81% in the AL group ( = 0.496). Both drugs were found to be well tolerated by the patients. This study demonstrates the effectiveness and tolerability of ASAQ and AL supporting their continuous use for the treatment of uncomplicated P. falciparum malaria infection in Côte d&apos;Ivoire

Efficacy and Safety of Artesunate-Amodiaquine versus Artemether-Lumefantrine in the Treatment of Uncomplicated Plasmodium falciparum Malaria in Sentinel Sites across Côte d’Ivoire

Two years after the introduction of free Artesunate-Amodiaquine (ASAQ) and Artemether-Lumefantrine (AL) for the treatment of uncomplicated malaria in public health facilities in Côte d’Ivoire, we carried out this study to compare their efficacy and tolerability in three surveillance sites. It was a multicentre open randomised clinical trial of 3-day ASAQ treatment against AL for the treatment of 2 parallel groups of patients aged 2 years and above. The endpoints were (1) Adequate Clinical and Parasitological Response (ACPR) at day 28 and (2) the clinical and biological tolerability. Of the 300 patients who were enrolled 289, with 143 (49.5%) and 146 (50.5%) in the ASAQ and AL groups, respectively, correctly followed the WHO 2003 protocol we used. The PCR-corrected ACPR was 99.3% for each group. More than 94% of patients no longer showed signs of fever, 48 hours after treatment. Approximately 78% of the people in the ASAQ group had a parasite clearance time of 48 hours or less compared to 81% in the AL group (p=0.496). Both drugs were found to be well tolerated by the patients. This study demonstrates the effectiveness and tolerability of ASAQ and AL supporting their continuous use for the treatment of uncomplicated P. falciparum malaria infection in Côte d’Ivoire