title: Environmental transmission of Mycobacterium ulcerans drives dynamics of Buruli ulcer in endemic regions of Cameroon.
abstract: Buruli Ulcer is a devastating skin disease caused by the pathogen Mycobacterium ulcerans. Emergence and distribution of Buruli ulcer cases is clearly linked to aquatic ecosystems, but the specific route of transmission of M. ulcerans to humans remains unclear. Relying on the most detailed field data in space and time on M. ulcerans and Buruli ulcer available today, we assess the relative contribution of two potential transmission routes--environmental and water bug transmission--to the dynamics of Buruli ulcer in two endemic regions of Cameroon. The temporal dynamics of Buruli ulcer incidence are explained by estimating rates of different routes of transmission in mathematical models. Independently, we also estimate statistical models of the different transmission pathways on the spatial distribution of Buruli ulcer. The results of these two independent approaches are corroborative and suggest that environmental transmission pathways explain the temporal and spatial patterns of Buruli ulcer in our endemic areas better than the water bug transmission.
authors.affiliation: UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France.|Ecole des Hautes Etudes en Santé Publique, Rennes, France.
authors.forename: Andrés
authors.initials: A
authors.lastname: Garchitorena
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Calistus N
authors.initials: CN
authors.lastname: Ngonghala
authors.affiliation: Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun.|UMR 912 - SESSTIM - INSERM/IRD/Aix-Marseille Université Faculté de Médecine, Marseille, France.
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Texier
authors.affiliation: Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun.|Unité d'Epidémiologie de Maladies Emergentes, Institut Pasteur, Paris, France.
authors.forename: Jordi
authors.initials: J
authors.lastname: Landier
authors.affiliation: Laboratoire de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun.
authors.forename: Sara
authors.initials: S
authors.lastname: Eyangoh
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.|Department of Earth System Science, Stanford University, Stanford, CA 94305, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Bonds
authors.affiliation: UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France.|Ecole des Hautes Etudes en Santé Publique, Rennes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Guégan
authors.affiliation: UMMISCO, UMI IRD-UPMC 209, Bondy, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Roche
mesh_terms: D054312:Buruli Ulcer / Q000382:microbiology / Q000635:transmission*; D002163:Cameroon; D004777:Environment; D006801:Humans; D019911:Mycobacterium ulcerans / Q000472:pathogenicity*