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Screening Strategies for a Sustainable Endpoint for Gambiense Sleeping Sickness.
J Infect Dis. 2020 06 11; 221(Suppl 5):S539-S545.JI

Abstract

BACKGROUND

Gambiense human African trypanosomiasis ([gHAT] sleeping sickness) is a vector-borne disease that is typically fatal without treatment. Intensified, mainly medical-based, interventions in endemic areas have reduced the occurrence of gHAT to historically low levels. However, persistent regions, primarily in the Democratic Republic of Congo (DRC), remain a challenge to achieving the World Health Organization's goal of global elimination of transmission (EOT).

METHODS

We used stochastic models of gHAT transmission fitted to DRC case data and explored patterns of regional reporting and extinction. The time to EOT at a health zone scale (~100 000 people) and how an absence of reported cases informs about EOT was quantified.

RESULTS

Regional epidemiology and level of active screening (AS) both influenced the predicted time to EOT. Different AS cessation criteria had similar expected infection dynamics, and recrudescence of infection was unlikely. However, whether EOT has been achieved when AS ends is critically dependent on the stopping criteria. Two or three consecutive years of no detected cases provided greater confidence of EOT compared with a single year (~66%-75% and ~82%-84% probability of EOT, respectively, compared with 31%-51%).

CONCLUSIONS

Multiple years of AS without case detections is a valuable measure to assess the likelihood that the EOT target has been met locally.

Links

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Authors+Show Affiliations

Castaño MS
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. University of Basel, Basel, Switzerland.
Aliee M
Mathematics Institute, University of Warwick, Coventry, United Kingdom. Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, United Kingdom.
Mwamba Miaka E
Programme National de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, the Democratic Republic of the Congo.
Keeling MJ
Mathematics Institute, University of Warwick, Coventry, United Kingdom. Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, United Kingdom. School of Life Science, University of Warwick, Coventry, United Kingdom.
Chitnis N
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. University of Basel, Basel, Switzerland.
Rock KS
Mathematics Institute, University of Warwick, Coventry, United Kingdom. Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, United Kingdom.

MeSH

Democratic Republic of the CongoDisease EradicationHumansModels, BiologicalStochastic ProcessesTrypanosoma brucei gambienseTrypanosomiasis, African

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31876949

Citation

Castaño, M Soledad, et al. "Screening Strategies for a Sustainable Endpoint for Gambiense Sleeping Sickness." The Journal of Infectious Diseases, vol. 221, no. Suppl 5, 2020, pp. S539-S545.
Castaño MS, Aliee M, Mwamba Miaka E, et al. Screening Strategies for a Sustainable Endpoint for Gambiense Sleeping Sickness. J Infect Dis. 2020;221(Suppl 5):S539-S545.
Castaño, M. S., Aliee, M., Mwamba Miaka, E., Keeling, M. J., Chitnis, N., & Rock, K. S. (2020). Screening Strategies for a Sustainable Endpoint for Gambiense Sleeping Sickness. The Journal of Infectious Diseases, 221(Suppl 5), S539-S545. https://doi.org/10.1093/infdis/jiz588
Castaño MS, et al. Screening Strategies for a Sustainable Endpoint for Gambiense Sleeping Sickness. J Infect Dis. 2020 06 11;221(Suppl 5):S539-S545. PubMed PMID: 31876949.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening Strategies for a Sustainable Endpoint for Gambiense Sleeping Sickness. AU - Castaño,M Soledad, AU - Aliee,Maryam, AU - Mwamba Miaka,Erick, AU - Keeling,Matt J, AU - Chitnis,Nakul, AU - Rock,Kat S, PY - 2019/12/27/pubmed PY - 2021/2/17/medline PY - 2019/12/27/entrez KW - Democratic Republic of the Congo KW - elimination of transmission KW - gambiense human African trypanosomiasis KW - mathematical modeling KW - sleeping sickness SP - S539 EP - S545 JF - The Journal of infectious diseases JO - J Infect Dis VL - 221 IS - Suppl 5 N2 - BACKGROUND: Gambiense human African trypanosomiasis ([gHAT] sleeping sickness) is a vector-borne disease that is typically fatal without treatment. Intensified, mainly medical-based, interventions in endemic areas have reduced the occurrence of gHAT to historically low levels. However, persistent regions, primarily in the Democratic Republic of Congo (DRC), remain a challenge to achieving the World Health Organization's goal of global elimination of transmission (EOT). METHODS: We used stochastic models of gHAT transmission fitted to DRC case data and explored patterns of regional reporting and extinction. The time to EOT at a health zone scale (~100 000 people) and how an absence of reported cases informs about EOT was quantified. RESULTS: Regional epidemiology and level of active screening (AS) both influenced the predicted time to EOT. Different AS cessation criteria had similar expected infection dynamics, and recrudescence of infection was unlikely. However, whether EOT has been achieved when AS ends is critically dependent on the stopping criteria. Two or three consecutive years of no detected cases provided greater confidence of EOT compared with a single year (~66%-75% and ~82%-84% probability of EOT, respectively, compared with 31%-51%). CONCLUSIONS: Multiple years of AS without case detections is a valuable measure to assess the likelihood that the EOT target has been met locally. SN - 1537-6613 UR - https://www.unboundmedicine.com/medline/citation/31876949/Screening_Strategies_for_a_Sustainable_Endpoint_for_Gambiense_Sleeping_Sickness_ DB - PRIME DP - Unbound Medicine ER -