title: Beyond Tsetse--Implications for Research and Control of Human African Trypanosomiasis Epidemics.
abstract: Epidemics of both forms of human African trypanosomiasis (HAT) are confined to spatially stable foci in Sub-Saharan Africa while tsetse distribution is widespread. Infection rates of Trypanosoma brucei gambiense in tsetse are extremely low and cannot account for the catastrophic epidemics of Gambian HAT (gHAT) seen over the past century. Here we examine the origins of gHAT epidemics and evidence implicating human genetics in HAT epidemiology. We discuss the role of stress causing breakdown of heritable tolerance in silent disease carriers generating gHAT outbreaks and see how peculiarities in the epidemiologies of gHAT and Rhodesian HAT (rHAT) impact on strategies for disease control.
authors.affiliation: Centre for Infectious Diseases, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK. Electronic address: Sue.Welburn@ed.ac.uk.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Welburn
authors.affiliation: Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: David H
authors.initials: DH
authors.lastname: Molyneux
authors.affiliation: Centre for Infectious Diseases, Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Maudlin
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D012106:Research / Q000639:trends; D014353:Trypanosomiasis, African / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D014370:Tsetse Flies / Q000469:parasitology*
keywords: HAT; epidemics; epigenetics; famine; sleeping sickness; tsetse