M. Camara

A geographical approach to identify sleeping sickness risk factors in a mangrove ecosystem

Objectives  To provide a better understanding of sleeping sickness transmission and spread in mangrove areas to optimize its control.

Trapping tsetse flies on water

Riverine tsetse flies such as Glossina palpalis gambiensis and G. tachinoides are the vectors of human and animal trypanosomoses in West Africa. Despite intimate links between tsetse and water, to our knowledge there has never been any attempt to design trapping devices that would catch tsetse on water. In mangrove (Guinea) one challenging issue is the tide, because height above the ground for a trap is a key factor affecting tsetse catches. The trap was mounted on the remains of an old wooden dugout, and attached with rope to nearby branches, thereby allowing it to rise and fall with the tide. Catches showed a very high density of 93.9 flies/”water-trap”/day, which was significantly higher (p < 0.05) than all the catches from other habitats where the classical trap had been used. In savannah, on the Comoe river of South Burkina Faso, the biconical trap was mounted on a small wooden raft anchored to a stone, and catches were compared with the classical biconical trap put on the shores. G. p. gambiensis and G. tachinoides densities were not significantly different from those from the classical biconical one. The adaptations described here have allowed to efficiently catch tsetse on the water, which to our knowledge is reported here for the first time. This represents a great progress and opens new opportunities to undertake studies on the vectors of trypanosomoses in mangrove areas of Guinea, which are currently the areas showing the highest prevalences of sleeping sickness in West Africa. It also has huge potential for tsetse control using insecticide impregnated traps in savannah areas where traps become less efficient in rainy season. The Guinean National control programme has already expressed its willingness to use such modified traps in its control campaigns in Guinea, as has the national PATTEC programme in Burkina Faso during rainy season.

Ebola outbreak brings to light an unforeseen impact of tsetse control on sleeping sickness transmission in Guinea.

In addition to the thousands of deaths due the unprecedented ebola outbreak that stroke West Africa (2014-2016), national health systems in affected countries were deeply challenged impacting a number of diseases control programs. Here we describe the case of Human African Trypanosomiasis (HAT), a deadly neglected tropical disease due to a trypanosome transmitted by tsetse flies for which no vaccine nor chemoprophylaxis exists. Data are presented for the disease focus of Boffa in Guinea where a pilot elimination project combining medical screening and vector control was launched in 2012. During ebola, HAT active screening activities were postponed and passive surveillance also was progressively impaired. However, tsetse control using small insecticide impregnated targets could be maintained. The over two years disruption of screening activities led to a dramatic increase of HAT prevalence, from 0.7% in 2013 (21/2885) to 2% (69/3448) in 2016, reaching epidemic levels (>5%) in some villages. In deep contrast, control levels reached in 2013 (0.1%; 7/6564) were maintained in areas covered with impregnated targets as no cases were found in 2016 (0/799). In Boffa, ebola has thus incidentally provided a unique framework to assess the impact of current HAT control strategies. A first lesson is that the “screen and treat” strategy is fragile as rapid bursts of the disease may occur in case of disruption. A second lesson is that vector control reducing human-tsetse contacts, even implemented alone, is effective in providing a good level of protection against infection. This advocates for a greater attention being paid to the combination of tsetse control together with medical activities in aiming to reach the HAT elimination objective in Africa.

Impact of the Ebola outbreak on Trypanosoma brucei gambiense infection medical activities in coastal Guinea, 2014-2015 : a retrospective analysis from the Guinean national Human African Trypanosomiasis control program

Background The 2014–2015 Ebola outbreak massively hit Guinea. The coastal districts of Boffa, Dubreka and Forecariah, three major foci of Human African Trypanosomiasis (HAT), were particularly affected. We aimed to assess the impact of this epidemic on sleeping sickness screening and caring activities. Methodology/Principal findings We used preexisting data from the Guinean sleeping sickness control program, collected between 2012 and 2015. We described monthly: the number of persons (i) screened actively; (ii) or passively; (iii) treated for HAT; (iv) attending post-treatment follow-up visits. We compared clinical data, treatment characteristics and Disability Adjusted Life-Years (DALYs) before (February 2012 to December 2013) and during (January 2014 to October 2015) the Ebola outbreak period according to available data. Whereas 32,221 persons were actively screened from February 2012 to December 2013, before the official declaration of the first Ebola case in Guinea, no active screening campaigns could be performed during the Ebola outbreak. Following the reinforcement and extension of HAT passive surveillance system early in 2014, the number of persons tested passively by month increased from 7 to 286 between April and September 2014 and then abruptly decreased to 180 until January 2015 and to none after March 2015. 213 patients initiated HAT treatment, 154 (72%) before Ebola and 59 (28%) during the Ebola outbreak. Those initiating HAT therapy during Ebola outbreak were recruited through passive screening and diagnosed at a later stage 2 of the disease (96% vs. 55% before Ebola, p<0.0001). The proportion of patients attending the 3 months and 6 months post-treatment follow-up visits decreased from 44% to 10% (p <0.0001) and from 16% to 3% (p = 0.017) respectively. The DALYs generated before the Ebola outbreak were estimated to 48.7 (46.7–51.5) and increased up to 168.7 (162.7–174.7), 284.9 (277.1–292.8) and 466.3 (455.7–477.0) during Ebola assuming case fatality rates of 2%, 5% and 10% respectively among under-reported HAT cases. Conclusions/Significance The 2014–2015 Ebola outbreak deeply impacted HAT screening activities in Guinea. Active screening campaigns were stopped. Passive screening dramatically decreased during the Ebola period, but trends could not be compared with pre-Ebola period (data not available). Few patients were diagnosed with more advanced HAT during the Ebola period and retention rates in follow-up were lowered. The drop in newly diagnosed HAT cases during Ebola epidemic is unlikely due to a fall in HAT incidence. Even if we were unable to demonstrate it directly, it is much more probably the consequence of hampered screening activities and of the fear of the population on subsequent confirmation and linkage to care. Reinforced program monitoring, alternative control strategies and sustainable financial and human resources allocation are mandatory during post Ebola period to reduce HAT burden in Guinea.

Écologie de Glossina palpalis gambiensis VANDERPLANK, 1949 (Diptera : Glossinidae) en zone de mangrove de Guinée : influence des marées sur les densités capturées

The mangrove area on the Guinea littoral constitutes a favourable habitat for transmission of Trypanosoma brucei gambiens, the parasite causing sleeping sickness also called Human African Trypanosmosis (HAT), due the simultaneous presence of the vector (tsetse flies) and the human hosts. In order to assess the influence of the sea tides on the densities of Glossina palpalis gambiensis (Gpg), major vector of HAT in the mangrove, entomological surveys were performed using two transects, according to tides coefficient (great and small) and tide daily fluctuations (high and low). On each transect, 12 biconical traps were deployed through the mangrove to the continent. In total, up to 612 Gpg were caught, giving a density of 2.13 flies/trap/day (f/t/d). Highest captures were recorded during small tides and more tsetse were caught during the dry season than in the wet season. There were significant differences between captures when considering the different biotopes, and highest tsetse densities were recorded at the junction of the river and the channel of the mangrove (6.17±5.24); and in the channels of mangrove (3.50±3.76), during high tides of small coefficients. The results of this study may be used to improve vector control methods.

Écologie de Glossina palpalis gambiensis VANDERPLANK, 1949 (Diptera : Glossinidae) en zone de mangrove de Guinée : influence des marées sur les densités capturées@@@Ecology of Glossina palpalis VANDERPLANK, 1949 (Diptera: Glossinidae) in mangrove area of Guinea: influence of tides on tsetse densities

The mangrove area on the Guinea littoral constitutes a favourable habitat for transmission of Trypanosoma brucei gambiens, the parasite causing sleeping sickness also called Human African Trypanosmosis (HAT), due the simultaneous presence of the vector (tsetse flies) and the human hosts. In order to assess the influence of the sea tides on the densities of Glossina palpalis gambiensis (Gpg), major vector of HAT in the mangrove, entomological surveys were performed using two transects, according to tides coefficient (great and small) and tide daily fluctuations (high and low). On each transect, 12 biconical traps were deployed through the mangrove to the continent. In total, up to 612 Gpg were caught, giving a density of 2.13 flies/trap/day (f/t/d). Highest captures were recorded during small tides and more tsetse were caught during the dry season than in the wet season. There were significant differences between captures when considering the different biotopes, and highest tsetse densities were recorded at the junction of the river and the channel of the mangrove (6.17±5.24); and in the channels of mangrove (3.50±3.76), during high tides of small coefficients. The results of this study may be used to improve vector control methods.

[Ecology of Glossina palpalis VANDERPLANK, 1949 (Diptera: Glossinidae) in mangrove area of Guinea: influence of tides on tsetse densities].

The mangrove area on the Guinea littoral constitutes a favourable habitat for transmission of Trypanosoma brucei gambiens, the parasite causing sleeping sickness also called Human African Trypanosmosis (HAT), due the simultaneous presence of the vector (tsetse flies) and the human hosts. In order to assess the influence of the sea tides on the densities of Glossina palpalis gambiensis (Gpg), major vector of HAT in the mangrove, entomological surveys were performed using two transects, according to tides coefficient (great and small) and tide daily fluctuations (high and low). On each transect, 12 biconical traps were deployed through the mangrove to the continent. In total, up to 612 Gpg were caught, giving a density of 2.13 flies/trap/day (f/t/d). Highest captures were recorded during small tides and more tsetse were caught during the dry season than in the wet season. There were significant differences between captures when considering the different biotopes, and highest tsetse densities were recorded at the junction of the river and the channel of the mangrove (6.17±5.24); and in the channels of mangrove (3.50±3.76), during high tides of small coefficients. The results of this study may be used to improve vector control methods.