Wellcome Centre for Molecular Parasitology, College of Medical, Veterinary and Life Sciences, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, United Kingdom.
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS Biol. 2019 Jan 11;17(1):e3000105. doi: 10.1371/journal.pbio.3000105. eCollection 2019 Jan.
Human African trypanosomiasis (HAT), or African sleeping sickness, is a fatal disease found throughout sub-Saharan Africa. The disease is close to elimination in many areas, although it was similarly close to elimination once before and subsequently reemerged, despite seemingly low rates of transmission. Determining how these foci persisted and overcame an apparent transmission paradox is key to finally eliminating HAT. By assessing clinical, laboratory, and mathematical data, we propose that asymptomatic infections contribute to transmission through the presence of an overlooked reservoir of skin-dwelling parasites. Our assessment suggests that a combination of asymptomatic and parasitaemic cases is sufficient to maintain transmission at foci without animal reservoirs, and we argue that the current policy not to treat asymptomatic HAT should be reconsidered.
人体感染非洲锥虫病（HAT），又称非洲昏睡病，是一种在撒哈拉以南非洲流行的致命疾病。尽管该疾病的传播率看似较低，但在许多地区，该病已接近消除，尽管它曾一度接近消除，但后来又再次出现。确定这些焦点是如何持续存在并克服明显的传播悖论的，是最终消除 HAT 的关键。通过评估临床、实验室和数学数据，我们提出无症状感染通过存在被忽视的皮肤寄生虫库而有助于传播。我们的评估表明，无症状和带寄生虫感染病例的组合足以在没有动物宿主的情况下维持传播，我们认为不应再考虑当前不治疗无症状 HAT 的政策。
