Control Of African Trypanosomiasis Research Articles

Does a One Health approach to human African trypanosomiasis control hasten elimination? A stochastic compartmental modeling approach

Background. In response to large strides in the control of human African trypanosomiasis (HAT), in the early 2000s the WHO set targets for elimination of both the gambiense (gHAT) and rhodesiense (rHAT) forms as a public health (EPHP) problem by 2020, and elimination of gHAT transmisson (EOT) by 2030. While global EPHP targets have been met, and EOT appears within reach, current control strategies may fail to achieve gHAT EOT in the presence of animal reservoirs, the role of which is currently uncertain. Furthermore, rHAT is not targeted for EOT due to the known importance of animal reservoirs for this form. Methods. To evaluate the utility of a One Health approach to gHAT and rHAT EOT, we built and parameterized a compartmental stochastic model, using the Institute for Disease Modeling's Compartmental Modeling Software, to six HAT epidemics: the national rHAT epidemics in Uganda and Malawi, the national gHAT epidemics in Uganda and South Sudan, and two separate gHAT epidemics in Democratic Republic of Congo distinguished by dominant vector species. In rHAT foci the reservoir animal sub-model was stratified on four species groups, while in gHAT foci domestic swine were assumed to be the only competent reservoir. The modeled time horizon was 2005-2045, with calibration performed using HAT surveillance data and Optuna. Interventions included insecticide and trypanocide treatment of domestic animal reservoirs at varying coverage levels. Results. Validation against HAT surveillance data indicates favorable performance overall, with the possible exception of DRC. EOT was not observed in any modeled scenarios for rHAT, however insecticide treatment consistently performed better than trypanocide treatment in terms of rHAT control. EOT was not observed for gHAT at 0% coverage of domestic reservoirs with trypanocides or insecticides, but was observed by 2030 in all test scenarios; again, insecticides demonstrated superior performance to trypanocides. ConclusionsEOT likely cannot be achieved for rHAT without control of wildlife reservoirs, however insecticide treatment of domestic animals holds promise for improved control. In the presence of domestic animal reservoirs, gHAT EOT may not be achieved under current control strategies.

Knowledge, Attitude, and Practice of Livestock Owners and Livestock Assistants towards African Trypanosomiasis Control in The Gambia.

Background In Africa, it has been estimated that 50 million cattle and 70 million sheep and goats are at risk of animal African trypanosomiasis, and three million cattle die annually. Methods This study was conducted in all the regions of The Gambia except Kombo Saint Mary Island (Banjul). Structured questionnaires were administered to 440 randomly selected livestock owners and 23 livestock assistants, and 7 focus group discussions were held for both livestock owners and livestock assistants. The data were analyzed mainly using descriptive statistics and content analysis methods. Results A total of 94.5% and 75% of livestock owners reported having seen tsetse and horse flies, respectively, while 100% of livestock assistants reported having seen tsetse flies. Forty-seven percent of the livestock owners indicated a positive attitude toward control measures, while 42% of them had no idea how to control tsetse flies. On the other hand, 57% of livestock assistants believe that tsetse and horse flies are the main reasons why AAT is still in their community. There was a statistically significant difference between all the respondents' characteristics and the practices done by livestock owners to prevent AAT vectors from biting their animals. Conclusion This study shows that trypanosomiasis is still a major problem for livestock health and production in The Gambia, and it requires disease and vector control.

Policy and Linkages in the Application of a One Health System for Reporting and Controlling African Trypanosomiasis and Other Zoonotic Diseases in Zambia.

The capacity to detect, control and manage emerging and re-emerging zoonotic diseases in Africa has been limited by a lack of utilisation of available reporting structures and policies to support programmes at national and local levels. This study explored the impact of the Zambian government policies on animal and human disease reporting and management and on One Health opportunities. An in-depth review and analysis of strengths, weaknesses, opportunities, and threats in the existing policies and reporting structures in the departments responsible for Veterinary Services, Health, and Wildlife, was conducted. According to our findings, sub-optimal implementation of existing policies related to the control of zoonotic diseases was impacting disease reporting, and reporting structures play an important role in effective and sustainable reporting of zoonotic diseases. Further, the study explored capacities and strategies in trypanosomiasis control as a case study that could prompt effective adoption of a One Health approach, and as such, the study suggests measures that could help to assess the performance of a One Health system in the control of African trypanosomiasis and other zoonotic diseases.

Spatial analysis of G.f.fuscipes abundance in Uganda using Poisson and Zero-Inflated Poisson regression models.

BackgroundTsetse flies are the major vectors of human trypanosomiasis of the form Trypanosoma brucei rhodesiense and T.b.gambiense. They are widely spread across the sub-Saharan Africa and rendering a lot of challenges to both human and animal health. This stresses effective agricultural production and productivity in Africa. Delimiting the extent and magnitude of tsetse coverage has been a challenge over decades due to limited resources and unsatisfactory technology. In a bid to overcome these limitations, this study attempted to explore modelling skills that can be applied to spatially estimate tsetse abundance in the country using limited tsetse data and a set of remote-sensed environmental variables.MethodologyEntomological data for the period 2008–2018 as used in the model were obtained from various sources and systematically assembled using a structured protocol. Data harmonisation for the purposes of responsiveness and matching was carried out. The key tool for tsetse trapping was itemized as pyramidal trap in many instances and biconical trap in others. Based on the spatially explicit assembled data, we ran two regression models; standard Poisson and Zero-Inflated Poisson (ZIP), to explore the associations between tsetse abundance in Uganda and several environmental and climatic covariates. The covariate data were constituted largely by satellite sensor data in form of meteorological and vegetation surrogates in association with elevation and land cover data. We finally used the Zero-Inflated Poisson (ZIP) regression model to predict tsetse abundance due to its superiority over the standard Poisson after model fitting and testing using the Vuong Non-Nested statistic.ResultsA total of 1,187 tsetse sampling points were identified and considered as representative for the country. The model results indicated the significance and level of responsiveness of each covariate in influencing tsetse abundance across the study area. Woodland vegetation, elevation, temperature, rainfall, and dry season normalised difference vegetation index (NDVI) were important in determining tsetse abundance and spatial distribution at varied scales. The resultant prediction map shows scaled tsetse abundance with estimated fitted numbers ranging from 0 to 59 flies per trap per day (FTD). Tsetse abundance was found to be largest at low elevations, in areas of high vegetative activity, in game parks, forests and shrubs during the dry season. There was very limited responsiveness of selected predictors to tsetse abundance during the wet season, matching the known fact that tsetse disperse most significantly during wet season.ConclusionsA methodology was advanced to enable compilation of entomological data for 10 years, which supported the generation of tsetse abundance maps for Uganda through modelling. Our findings indicate the spatial distribution of the G. f. fuscipes as; low 0–5 FTD (48%), medium 5.1–35 FTD (18%) and high 35.1–60 FTD (34%) grounded on seasonality. This approach, amidst entomological data shortages due to limited resources and absence of expertise, can be adopted to enable mapping of the vector to provide better decision support towards designing and implementing targeted tsetse and tsetse-transmitted African trypanosomiasis control strategies.

In vitro effects and mechanisms of action of Bidens pilosa in Trypanosoma brucei

Background and aimAfrican trypanosomiasis poses serious health and economic concerns to humans and livestock in several sub-Saharan African countries. The aim of the present study was to identify the antitrypanosomal compounds from B. pilosa (whole plant) through a bioactivity-guided isolation and investigate the in vitro effects and mechanisms of action against Trypanosoma brucei (T. brucei). Experimental procedureCrude extracts and fractions were prepared from air-dried pulverized plant material of B. pilosa using the modified Kupchan method of solvent partitioning. The antitrypanosomal activities of the fractions were determined through cell viability analysis. Effects of fractions on cell death and cell cycle of T. brucei were determined using flow cytometry, while fluorescence microscopy was used to investigate alterations in cell morphology and distribution. Results and conclusionThe solvent partitioning dichloromethane (BPFD) and methanol (BPFM) fractions of B. pilosa exhibited significant activities against T. brucei with respective half-maximal inhibitory concentrations (IC50s) of 3.29 μg/ml and 5.86 μg/ml and resulted in the formation of clumpy subpopulation of T. brucei cells. Butyl (compound 1) and propyl (compound 2) esters of tryptophan were identified as the major antitrypanosomal compounds of B. pilosa. Compounds 1 and 2 exhibited significant antitrypanosomal effects with respective IC50 values of 0.66 and 1.46 μg/ml. At the IC50 values, both compounds significantly inhibited the cell cycle of T. brucei at the G0-G1 phase while causing an increase in G2-M phase. The results suggest that tryptophan esters may possess useful chemotherapeutic properties for the control of African trypanosomiasis.

African Trypanosomiasis Dynamics: Modelling the Effects of Treatment, Education, and Vector Trapping

African trypanosomiasis is a vector-borne disease that is mainly transmitted by infected tsetse flies. A deterministic model of tsetse fly vector, human, and cattle hosts is formulated and analyzed to gain insights into the disease dynamics. The roles of public health education, treatment, and tsetse fly traps are studied. The effective reproduction number, a threshold used to determine whether the disease persists or dies out in the population, is determined. The sensitivity analysis of the model parameters is performed to determine their relationship with the effective reproduction number. The results show that the tsetse fly biting rate is the most sensitive parameter to the effective reproduction number. Furthermore, the model’s numerical simulation shows that a combination of all three interventions has the most significant impact on the control of African trypanosomiasis. Thus, we recommend that these control measures be put concurrently in endemic areas for effective control of the disease transmission.

Insights into the Control and Management of Human and Bovine African Trypanosomiasis in Zambia between 2009 and 2019-A Review.

Tsetse transmitted trypanosomiasis is a fatal disease commonly known as Nagana in cattle and sleeping sickness in humans. The disease threatens food security and has severe economic impact in Africa including most parts of Zambia. The level of effectiveness of commonly used African trypanosomiasis control methods has been reported in several studies. However, there have been no review studies on African trypanosomiasis control and management conducted in the context of One Health. This paper therefore seeks to fill this knowledge gap. A review of studies that have been conducted on African trypanosomiasis in Zambia between 2009 and 2019, with a focus on the control and management of trypanosomiasis was conducted. A total of 2238 articles were screened, with application of the search engines PubMed, PubMed Central and One Search. Out of these articles, 18 matched the required criteria and constituted the basis for the paper. An in-depth analysis of the 18 articles was conducted to identify knowledge gaps and evidence for best practices. Findings from this review provide stakeholders and health workers with a basis for prioritisation of African trypanosomiasis as an important neglected disease in Zambia and for formulation of One Health strategies for better control and/or management of the disease.

Blood meal sources and bacterial microbiome diversity in wild-caught tsetse flies

Tsetse flies are the vectors of African trypanosomiasis affecting 36 sub-Saharan countries. Both wild and domestic animals play a crucial role in maintaining the disease-causing parasites (trypanosomes). Thus, the identification of animal reservoirs of trypanosomes is vital for the effective control of African trypanosomiasis. Additionally, the biotic and abiotic factors that drive gut microbiome diversity in tsetse flies are primarily unresolved, especially under natural, field conditions. In this study, we present a comprehensive DNA metabarcoding approach for individual tsetse fly analysis in the identification of mammalian blood meal sources and fly bacterial microbiome composition. We analyzed samples from two endemic foci, Kafue, Zambia collected in June 2017, and Hurungwe, Zimbabwe sampled in April 2014 (pilot study) and detected DNA of various mammals including humans, wild animals, domestic animals and small mammals (rat and bat). The bacterial diversity was relatively similar in flies with different mammalian species DNA, trypanosome infected and uninfected flies, and female and male flies. This study is the first report on bat DNA detection in wild tsetse flies. This study reveals that small mammals such as bats and rats are among the opportunistic blood meal sources for tsetse flies in the wild, and the implication on tsetse biology and ecology needs to be studied.

Integration of Human African Trypanosomiasis Control Activities into Primary Healthcare Services: A Scoping Review.

.Human African trypanosomiasis (HAT) also known as sleeping sickness is targeted for elimination as a public health problem by 2020 and elimination of infection by 2030. Although the number of reported cases is decreasing globally, integration of HAT control activities into primary healthcare services is endorsed to expand surveillance and control. However, this integration process faces several challenges in the field. This literature review analyzes what is known about integrated HAT control to guide the integration process in an era of HAT elimination. We carried out a scoping review by searching PubMed and Google Scholar data bases as well as gray literature documents resulting in 25 documents included for analysis. The main reasons in favor to integrate HAT control were related to coverage, cost, quality of service, or sustainability. There were three categories of factors influencing the integration process: 1) the clinical evolution of HAT, 2) the organization of health services, and 3) the diagnostic and therapeutic tools. There is a consensus that both active and passive approaches to HAT case detection and surveillance need to be combined, in a context-sensitive way. However, apart from some documentation about the constraints faced by local health services, there is little evidence on how this synergy is best achieved.

A mathematical model for evaluating the role of trypanocide treatment of cattle in the epidemiology and control of Trypanosoma brucei rhodesiense and T. b. gambiense sleeping sickness in Uganda

BackgroundHuman and animal African trypanosomiases impose a large economic and health burden in their endemic regions. Large strides have been made in the control of human African trypanosomiasis (HAT), yet these efforts have largely focused on the non-zoonotic form of the disease. Using a mathematical model with a 10 year time horizon, we demonstrate the role of the cattle treatment with trypanocides in the epidemiology of zoonotic and non-zoonotic HAT in Uganda, and its potential implications on elimination and eradication of the disease. Methodology/principal findingsWe created two compartmental, deterministic models, each comprised of three sub-models: humans, the tsetse fly vector (Glossina fuscipes fuscipes), and cattle. We applied these models to two HAT foci in Uganda: the gambiense (chronic, non-zoonotic) form in the Northern Region, and the rhodesiense (acute, zoonotic) form in the Eastern Region. Parameters were derived from prior literature or assumed. In both foci we assumed G. fuscipes fuscipes expresses zoophilic biting behavior.With trypanocide treatment of cattle administered every 3 months, treatment in stage I (representing engagement in active or passive surveillance) had a larger impact on HAT burden than cattle treatment coverage. However increasing cattle treatment coverage allowed for further reduction in prevalence in both foci. Using these model parameters, our estimated R0 suggests humans cannot alone sustain the HAT epidemic in Uganda. Conclusions/significanceEven in the absence of zoonotic transmission, loss of a preferred tsetse host species can affect HAT risk. Thus One Health strategies which integrate HAT and animal African trypanosomiasis control may improve the timeliness and sustainability of gHAT and rHAT elimination and eradication in Uganda. Furthermore, such strategies reduce the burden of a high-morbidity livestock disease of economic importance.

Integration of Human African Trypanosomiasis Control Activities into Primary Health Services in the Democratic Republic of the Congo: A Qualitative Study of Stakeholder Perceptions.

.Human African trypanosomiasis is close to elimination in several countries in sub-Saharan Africa. The diagnosis and treatment is currently rapidly being integrated into first-line health services. We aimed to document the perspective of stakeholders on this integration process. We conducted 12 focus groups with communities in three health zones of the Democratic Republic of the Congo and held 32 interviews with health-care providers, managers, policy makers, and public health experts. The topic guide focused on enabling and blocking factors related to the integrated diagnosis and treatment approach. The data were analyzed with NVivo (QSR International, Melbourne, Australia) using a thematic analysis process. The results showed that the community mostly welcomed integrated care for diagnosis and treatment of sleeping sickness, as they value the proximity of first-line health services, but feared possible financial barriers. Health-care professionals thought integration contributed to the elimination goal but identified several implementation challenges, such as the lack of skills, equipment, motivation and financial resources in these basic health services. Patients often use multiple therapeutic itineraries that do not necessarily lead them to health centers where screening is available. Financial barriers are important, as health care is not free in first-line health centers, in contrast to the population screening campaigns. Communities and providers signal several challenges regarding the integration process. To succeed, the required training of health professionals, as well as staff deployment and remuneration policy and the financial barriers in the primary care system need to be addressed, to ensure coverage for those most in need.

Integrated cost-benefit analysis of tsetse control and herd productivity to inform control programs for animal African trypanosomiasis

BackgroundAnimal African trypanosomiasis (AAT) and its tsetse vector are responsible for annual losses estimated in billions of US dollars ($). Recent years have seen the implementation of a series of multinational interventions. However, actors of AAT control face complex resource allocation decisions due to the geographical range of AAT, diversity of ecological and livestock systems, and range of control methods available.MethodsThe study presented here integrates an existing tsetse abundance model with a bio-economic herd model that captures local production characteristics as well as heterogeneities in AAT incidence and breed. These models were used to predict the impact of tsetse elimination on the net value of cattle production in the districts of Mambwe, in Zambia, and Faro et Déo in Cameroon. The net value of cattle production under the current situation was used as a baseline, and compared with alternative publicly funded control programmes. In Zambia, the current baseline is AAT control implemented privately by cattle owners (Scenario Z0). In Cameroon, the baseline (Scenario C0) is a small-scale publicly funded tsetse control programme and privately funded control at farm level. The model was run for 10 years, using a discount rate of 5%.ResultsCompared to Scenario C0, benefit-cost ratios (BCR) of 4.5 (4.4–4.7) for Scenario C1 (tsetse suppression using insecticide treatment of cattle (ITC) and traps + maintenance with ITC barrier), and 3.8 (3.6–4.0) for Scenario C2 (tsetse suppression using ITC and traps + maintenance with barrier of targets), were estimated in Cameroon. For Zambia, the benefit-cost ratio calculated for Scenarios Z1 (targets, ITC barrier), Z2 (targets, barrier traps), Z3 (aerial spraying, ITC barrier), and Z4 (aerial spraying, barrier traps) were 2.3 (1.8 - 2.7), 2.0 (1.6-2.4), 2.8 (2.3–3.3) and 2.5 (2.0–2.9), respectively. Sensitivity analysis showed that the profitability of the projects is relatively resistant to variations in the costs of the interventions and their technical efficiency.ConclusionsIt is envisioned that the methodologies presented here will be useful for the evaluation and design of existing and future control programmes, ensuring they have tangible benefits in the communities they are targeting.

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.

BackgroundThe 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 findingsWe 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/SignificanceThe 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.

Strategies for Trypanosoma brucei gambiense elimination.

Strategies for Trypanosoma brucei gambiense elimination.

Novel trypanocide from an extract of Pleurotus sajor-caju against Trypanosoma congolense

Context: Control of African trypanosomiasis relies on chemotherapy, but the development of resistance and the problem of drug residues require research for alternatives. Triterpenes and phenolics, the major constituents of Pleurotus sajor-caju (Fr.) Singer (Pleurotaceae), are reported to be effective against trypanosomiasis.Objective: Trypanocidal effect of whole Pleurotus sajor-caju aqueous extract was investigated in vivo against Trypanosoma congolense.Materials and methods: Mice (25–32 g) were divided into seven groups of six animals. Mice in groups A–F received 2.5 × 104 trypanosomes, while group G was uninfected. Extracts (100–250 mg/kg) were administered intraperitoneally for 5 days to groups A–D while diminazine aceturate (group E) and normal saline (group F) served as positive and negative controls, respectively. Parasitemia, survival time, body weight and haematological parameters were monitored for 60 days post-treatment.Results: Parasitemia decreased significantly (p < 0.01) post-treatment with 200 and 250 mg/kg of the extract and became undetectable by day 16 and 12 post-infection, respectively; the ED50 was 221.5 mg/kg. The packed cell volume (PCV) and the weight of mice treated with 250 mg/kg extract were 46.20 ± 2.6% and 32.05 ± 3.63 g, respectively, which is higher than the group treated with diminazine aceturate. The mean survival time of animals in groups D and E was >60 days, while that of group F was <4 days. Differential leucocyte count on day 68 post-infection in groups C, D and E were not significantly different.Conclusion: Pleurotus sajor-caju therefore could be a potential source of new trypanocidal drugs.

Cost analysis of options for management of African Animal Trypanosomiasis using interventions targeted at cattle in Tororo District; south-eastern Uganda

BackgroundTsetse-transmitted African trypanosomes cause both nagana (African animal Trypanosomiasis-AAT) and sleeping sickness (human African Trypanosomiasis - HAT) across Sub-Saharan Africa. Vector control and chemotherapy are the contemporary methods of tsetse and trypanosomiasis control in this region. In most African countries, including Uganda, veterinary services have been decentralised and privatised. As a result, livestock keepers meet the costs of most of these services. To be sustainable, AAT control programs need to tailor tsetse control to the inelastic budgets of resource-poor small scale farmers. To guide the process of tsetse and AAT control toolkit selection, that now, more than ever before, needs to optimise resources, the costs of different tsetse and trypanosomiasis control options need to be determined.MethodsA detailed costing of the restricted application protocol (RAP) for African trypanosomiasis control in Tororo District was undertaken between June 2012 and December 2013. A full cost calculation approach was used; including all overheads, delivery costs, depreciation and netting out transfer payments to calculate the economic (societal) cost of the intervention. Calculations were undertaken in Microsoft Excel™ without incorporating probabilistic elements.ResultsThe cost of delivering RAP to the project was US$ 6.89 per animal per year while that of 4 doses of a curative trypanocide per animal per year was US$ 5.69. However, effective tsetse control does not require the application of RAP to all animals. Protecting cattle from trypanosome infections by spraying 25 %, 50 % or 75 % of all cattle in a village costs US$ 1.72, 3.45 and 5.17 per animal per year respectively. Alternatively, a year of a single dose of curative or prophylactic trypanocide treatment plus 50 % RAP would cost US$ 4.87 and US$ 5.23 per animal per year. Pyrethroid insecticides and trypanocides cost 22.4 and 39.1 % of the cost of RAP and chemotherapy respectively.ConclusionsCost analyses of low cost tsetse control options should include full delivery costs since they constitute 77.6 % of all project costs. The relatively low cost of RAP for AAT control and its collateral impact on tick control make it an attractive option for livestock management by smallholder livestock keepers.

Neglected zoonotic diseases: It's now time for action urges WHO.

Sir, Zoonoses refer to those diseases that are naturally transmitted from vertebrate animals to humans and vice versa.[1] In fact, zoonotic disease accounts for almost two-third of the infectious agents that can affect humans by causing more than 200 diseases.[2] Neglected zoonotic diseases (NZDs) are a subset of the neglected tropical diseases and are so called because they primarily affect the poor and marginalized populations living in close proximity with domestic or wild animals in resource-constrained settings (poor health and sanitary conditions) across the globe.[1,2] Further, these NZDs such as anthrax, brucellosis, leptospirosis, rabies, echinococcosis, taeniasis/cysticercosis, food-borne Trematodiases, human African trypanosomiasis, leishmaniasis, and schistosomiasis impose a double burden on the quality of life of people not only by compromising their health, but even by compromising the life of the livestock on whom they heavily depend for their survival.[1,2] However, the findings of a recently released report have suggested that most of the NZDs can be contained through the use of existing knowledge and tools.[3] Acknowledging the enormous impact of NZDs on human population, in the year 2008, a global One Health concept was formulated to promote an interdisciplinary and multisectoral approach to deal with those diseases that precipitates when humans and animals share a common environment.[2] However, the success of One Health approach is dependent on the strategic planning, multilevel integration of existing interventions, and involvement of stakeholders at both policy maker and community levels.[1,2,3] Furthermore, some of the nations across African (such as African Trypanosomiasis control in Uganda), Latin America and Asian region (such as Brucellosis control in Mongolia) have successfully implemented One Health approach to contain specific prevalent NZDs.[3,4,5] In order to successfully contain NZDs, a project by the name Advocacy for neglected zoonotic diseases (ADVANZ) was initiated in the African region not only to persuade the policy makers about the public health importance of the NZD, but also to empower the concerned stakeholders, and to share the experience of nations from the African region with international partners.[3,6] In addition, other measures, such as quarantine, test and slaughter, environmental hygiene, mass immunization, vector control, reservoir control, and early diagnosis with prompt treatment, have also been recommended.[1,2,3] However, a wide range of challenges, such as poor political commitment, lack of financial support, deficiency in the public health system, civil rights, lack of resources, lack of coordination between international and national agencies, and weaker surveillance mechanism, have also been identified that are halting the progress of the nations.[3,4,6] In addition, the WHO, Food and Agriculture Organization, and World Organization for Animal Health have joined their hands and pledged to reduce the magnitude of NZDs.[1] Subsequently, more emphasis was given to overcome the global impact of NZDs (viz. rabies, cysticercosis, echinococcosis, and leishmaniasis) at the World Health Assembly meet in 2013.[2,3] In fact, a comprehensive policy framework (with well-defined roles of different stakeholders like decision makers, veterinary specialist, community, etc.) has also been developed by the WHO to involve the concerned sectors and thus collectively speed up the elimination of different NZDs.[1,3] It is very essential to understand that for the control of NZDs, there is an indispensable need for a multisectoral (viz. policy making, veterinary science, food safety, and agriculture) approach, empowerment of the leaders and engagement of the local community.[3,5] However, the primary step is to systematically assess the local and regional burden of the NZDs so that cost-effective strategies can be planned and implemented.[3,4] In addition, interventions such as formulating guidelines for the surveillance, prevention, control and treatment of specific diseases; establishing mechanisms for facilitating the exchange of information across relevant sectors and programs in nations; strengthening of the public health care delivery system/surveillance; increasing financial allocation or adopting innovative funding mechanisms to strengthen the prevention and control activities; consolidating the achieved gains and maintaining momentum for control and elimination of NZDs; creating awareness among members of community regarding the do's and don’ts for specific NZDs; and facilitating applied research activities, also deserves a crucial place in containment of the zoonotic diseases.[1,3,4,5,6] To conclude, even though neglected zoonotic disease continues to be a major cause of poor health among rural populations worldwide, nevertheless they attract least priority in most of the nations. Thus, it is high time that the international community must rise up to this challenge and take complete responsibility for the control and elimination of the NZDs. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Collateral benefits of restricted insecticide application for control of African trypanosomiasis on Theileria parva in cattle: a randomized controlled trial.

BackgroundTick and tsetse-borne diseases (TTBDs) constrain livestock production in tropical and subtropical regions of the world. Of this community of endemic diseases, East coast fever (T.parva) is the most important tick-borne disease (TBD) accounting for 70% of all losses due to TBDS in this region where control efforts target either tsetse or TBDs and seldom both. In those instances where simultaneous pyrethroid insecticide TTBD control is implemented, collateral benefits of tsetse control on TBD control have not been quantified. In the interest of guiding future TTBD control efforts, the effect of restricting pyrethroid insecticides to the legs, belly and ears (RAP) of cattle for tsetse and trypanosomiasis control on T.parva prevalence in crop-livestock production systems in Tororo district, south-eastern Uganda was determined.MethodsWe randomly allocated 16 villages to diminazene diaceturate (DA) and 3 graded RAP (25%, 50% and 75% of village herd sprayed respectively) treatment regimens. All cattle were ear-tagged, treated with diminazene diaceturate (DA) and those in regimens 2-4 received monthly graded RAP. Blood samples taken fourteen days post DA treatment and once three monthly were analysed by molecular techniques for T.parva.ResultsIn total, 8,975 samples from 3,084 animals were analysed. Prevalence of T.parva varied between 1-3% in different treatment regimens. RAP regimens were associated with slightly lower average risk of infection compared to DA. However, the confidence interval was broad and the result was not statistically significant. There was no evidence of a dose response relationship between graded RAP and T.parva prevalence. These findings are discussed herein with regard to endemic stability development to different TBDs.ConclusionsWe found only a slight effect of RAP on T.parva infection. Since sample size determination was based on trypanosomes incidence, the study was underpowered given the low T.parva prevalence. While the findings need to be confirmed in future studies, the observed slight reduction in the risk of infection with T.parva might not compromise endemic stability.

Designing Sleeping Sickness Control

Control of African trypanosomiasis caused by the protozoan parasite Trypanosoma brucei is an important issue in medicine, veterinary medicine, and agricultural economy. Because vaccine development is unlikely, development of safer and more effective chemotherapeutics is critical. The biosynthetic pathway of glycosylphosphatidylinositol (GPI), which acts as membrane anchors of coat proteins, variant surface glycoproteins, and transferrin receptors, is a validated target of drug development. An article in this issue reports the first chemically synthesized inhibitor of the third mannosyltransferase from the GPI pathway, stimulating further investigation toward practical and useful compounds.

Response from Savioli and Colleagues from the Department of Neglected Tropical Diseases, World Health Organization

Response from Savioli and Colleagues from the Department of Neglected Tropical Diseases, World Health Organization