title: Epidemiology of sleeping sickness in Boffa (Guinea): where are the trypanosomes?
abstract: Human African Trypanosomiasis (HAT) in West Africa is a lethal, neglected disease caused by Trypanosoma brucei gambiense transmitted by the tsetse Glossina palpalis gambiensis. Although the littoral part of Guinea with its typical mangrove habitat is the most prevalent area in West Africa, very few data are available on the epidemiology of the disease in such biotopes. As part of a HAT elimination project in Guinea, we carried a cross-sectional study of the distribution and abundance of people, livestock, tsetse and trypanosomes in the focus of Boffa. An exhaustive census of the human population was done, together with spatial mapping of the area. Entomological data were collected, a human medical survey was organized together with a survey in domestic animals. In total, 45 HAT cases were detected out of 14445 people who attended the survey, these latter representing 50.9% of the total population. Potential additional carriers of T. b. gambiense were also identified by the trypanolysis test (14 human subjects and two domestic animals). No trypanosome pathogenic to animals were found, neither in the 874 tsetse dissected nor in the 300 domestic animals sampled. High densities of tsetse were found in places frequented by humans, such as pirogue jetties, narrow mangrove channels and watering points. The prevalence of T. b. gambiense in humans, combined to low attendance of the population at risk to medical surveys, and to an additional proportion of human and animal carriers of T. b. gambiense who are not treated, highlights the limits of strategies targeting HAT patients only. In order to stop T. b. gambiense transmission, vector control should be added to the current strategy of case detection and treatment. Such an integrated strategy will combine medical surveillance to find and treat cases, and vector control activities to protect people from the infective bites of tsetse.
authors.affiliation: Programme National de Lutte contre la THA, Ministère de la Santé, Conakry, Guinée.
authors.forename: Moise Saa
authors.initials: MS
authors.lastname: Kagbadouno
authors.forename: Mamadou
authors.initials: M
authors.lastname: Camara
authors.forename: Jeremi
authors.initials: J
authors.lastname: Rouamba
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Rayaisse
authors.forename: Ibrahima Sory
authors.initials: IS
authors.lastname: Traoré
authors.forename: Oumou
authors.initials: O
authors.lastname: Camara
authors.forename: Mory Fassou
authors.initials: MF
authors.lastname: Onikoyamou
authors.forename: Fabrice
authors.initials: F
authors.lastname: Courtin
authors.forename: Sophie
authors.initials: S
authors.lastname: Ravel
authors.forename: Thierry
authors.initials: T
authors.lastname: de Meeûs
authors.forename: Bruno
authors.initials: B
authors.lastname: Bucheton
authors.forename: Vincent
authors.initials: V
authors.lastname: Jamonneau
authors.forename: Philippe
authors.initials: P
authors.lastname: Solano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D019352:Censuses; D002648:Child; D002675:Child, Preschool; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D058751:Livestock / Q000254:growth & development; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000453:epidemiology / Q000469:parasitology; D011156:Population Density; D015995:Prevalence; D014347:Trypanosoma brucei gambiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000453:epidemiology* / Q000469:parasitology; D014370:Tsetse Flies / Q000254:growth & development; D055815:Young Adult